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Donavan Pham MD

Are Residents in Canada Overworked and Underpaid?

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First time posting here!

My name is Donavan, I'm a first year resident and I recently started a YouTube channel about residency and medicine! I made a video talking about how much Canadian residents' are paid, and estimated the amount of weekly hours typically worked (which vary a lot depending on the specialty). There are no deep secrets here, but one thing that I learned being a resident is that the extra money on-call does add quite a bit to the total.  I wanted to stay objective - in no way am I personally complaining or bragging - but I did include my thoughts at the end of the video. 

Would love to hear if you have any thoughts, questions or feedback!

 

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Thank you for this!

Regarding the $65k for 48 weeks of work, does that money get taxed? Or is it tax-free because you're considered a trainee?

Also, is there tuition for residency, and if so how much is it? (sorry if that's a dumb question!)

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1 minute ago, brady23 said:

Thank you for this!

Regarding the $65k for 48 weeks of work, does that money get taxed? Or is it tax-free because you're considered a trainee?

Also, is there tuition for residency, and if so how much is it? (sorry if that's a dumb question!)

No tuition for residency, the money does get taxed. 

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Considering how much money we stand to make once we're through to the other side, how much we get paid as residents is irrelevant. We also have the option of going into more debt if your salary isn't enough for your lifestyle. Everything we do up until we make consultant money serves to get us there and if it takes a lot without pay, so be it. It's all more than worth it once you're there. As long as you have the means to support yourself (ie LOCs) up until you make real money, you should be happy.

You could argue that you don't want to have to dip into your LOCs. I would argue that having that pressure to live with a smaller income isn't necessarily a bad thing, because most spend what they make, if not more. There's such a thing as 'living like a resident' when consultants talk about strategies to save.

Also, say we do get a significant raise. That won't come without consequences. There's one big pot that we all draw from. That raise will catch up to all of us sooner or later.

I say look at the big picture and consider what you'd be making 10 to 20 years down the line. Be happy that you're in a position that tens, if not hundreds of thousands of people would kill to be in, which is getting harder and harder to attain by the year.

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1 hour ago, W0lfgang said:

Considering how much money we stand to make once we're through to the other side, how much we get paid as residents is irrelevant. We also have the option of going into more debt if your salary isn't enough for your lifestyle. Everything we do up until we make consultant money serves to get us there and if it takes a lot without pay, so be it. It's all more than worth it once you're there. As long as you have the means to support yourself (ie LOCsup until you make real money, you should be happy. 

You could argue that you don't want to have to dip into your LOCs. I would argue that having that pressure to live with a smaller income isn't necessarily a bad thing, because most spend what they make, if not more. There's such a thing as 'living like a resident' when consultants talk about strategies to save. 

Also, say we do get a significant raise. That won't come without consequences. There's one big pot that we all draw from. That raise will catch up to all of us sooner or later. 

I say look at the big picture and consider what you'd be making 10 to 20 years down the line. Be happy that you're in a position that tens, if not hundreds of thousands of people would kill to be in, which is getting harder and harder to attain by the year. 

I respectfully disagree. This seemingly popular belief of "resident pay is low because staff pay is high" or vice versa is a non sequitur. The pay staff physicians receive is representative of their skill and their contributions to society, and is fairly deserved. It does not retroactively render residency pay irrelevant, since staff pay is payment for work done as staff, not as residents.

We have a professional degree which, as you said, is getting harder and harder to attain by the year, and work experience/set of skills that are really quite exclusive, in a field which is essential and relevant to people's lives in a constructive way. If we need to put ourselves further into debt to make ends meet after all that (and clearly, with all this credentials inflation you mentioned, many of our cohorts are now filled with non-trads with families and even more degrees), we are underpaid, period. You cannot justify this with a fair pay that comes only after years, no matter how high it is. I agree it's good to learn good financial habits. It's better if we can learn it while actually being able to save anything meaningful.

I do agree with the limited supply idea as far as it applies to within medicine. Healthcare system is overburdened, residents are cheap labour and will unfortunately likely continue to be. If a raise at resident level means a cut at staff level, I'm sure most residents would opt to endure the status quo. That being said, there should always be an effort to draw the resources from outside so that staff physicians are not hurt by resident raises. I could not care less about what happens to the pay in other industries. To stay still in a zero-sum game means your cut of the pie is eventually taken from you, as all current staff physicians must know so painfully well from their terrible negotiations with the government. I hope that the residency associations across the country realize this as our situation is essentially just a micro version of theirs.

Definitely look at the staff pay down the line. Counting your blessings is a great way to stay sane. But I will not be told that what I am getting is fair when it isn't.

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6 hours ago, W0lfgang said:

Considering how much money we stand to make once we're through to the other side, how much we get paid as residents is irrelevant. We also have the option of going into more debt if your salary isn't enough for your lifestyle. Everything we do up until we make consultant money serves to get us there and if it takes a lot without pay, so be it. It's all more than worth it once you're there. As long as you have the means to support yourself (ie LOCs) up until you make real money, you should be happy.

You could argue that you don't want to have to dip into your LOCs. I would argue that having that pressure to live with a smaller income isn't necessarily a bad thing, because most spend what they make, if not more. There's such a thing as 'living like a resident' when consultants talk about strategies to save.

Also, say we do get a significant raise. That won't come without consequences. There's one big pot that we all draw from. That raise will catch up to all of us sooner or later.

I say look at the big picture and consider what you'd be making 10 to 20 years down the line. Be happy that you're in a position that tens, if not hundreds of thousands of people would kill to be in, which is getting harder and harder to attain by the year.

Things are unfortunately changing for the worse and a correction has to be made sooner or later. I agree that 50k post-tax is enough to live on but students these days are graduating with more and more debt and training appears to get longer and longer as the job market worsens. There are lots of fellows out there in Canada that aren't used as anything but cheap labour to help the staff's bottom line. Nevermind that a lot of practices hire newly minted, fellowship trained physicians as "junior staff" where they are paid less for more work.

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57 minutes ago, hero147 said:

I agree that 50k post-tax is enough to live on

It's only enough to live on if you are single.  Try making that as the sole bread winner with a spouse and two kids.  The debt I built up in medical school and residency is so crippling I fear it will be with me the majority of my life given my family situation.  I am already engaging in quite aggressive (though honest) billing just so I can keep up with my payments, which is somewhere I never thought I would be when I walked into my first day of medical school full of idealism.  I would gladly have traded less tuition and more residency pay for less income as staff.

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Just now, distressedpremed said:

We in Alberta still pay tuition - it's about $950 a year. 

same at Ottawa so at least some places in Ontario charge it as well - it used to actually be a good thing ha. SInce I was a student on the old rules, I was able to claim fully time status for tax purposes (but not for osap purposes strangely). So I paid I think it was 800 a year and got back more than that in tax savings. Plus since I was a student I got all kinds of various student discounts as well. 

One of the problems with all the math about this is that you really are a student as a resident. I worked on average base of 9.5 hours a day (excluding call) as a radiology resident. It is by most job standards a lot and call was on top of that. Yet of that 2.5 hours a day was spent on straight up teaching formally  in case rounds/lecture. Another at least one to two hours was spent on reviewing cases or learning something new during the day in other ways - more teaching. There was also one to two other days a month on some retreat, guest lecturer, or testing etc which was more academic stuff. In my last year there was less daily teaching needed but I got a lot more time given to me to study, and was often sent home if it was slow. I also had a few months of pure research time during the training which was academic to say the least.  This is not to say there wasn't a ton of work but rather I don't think it isn't fair to also ignore that time either. I don't think many other residencies are dissimilar either. Other fields we may be comparing too don't have that sort of academic stuff factored in. They are already past the training part ha for the most part. 

That all being said I would say:

1) You do work a ton of hours, and at strange times. 

2) The pay in absolute terms is not bad (as a 5th year I was topping out at 80K a year). The salary scale by the way is in the contracts which for each province is online. 

3) However expensive cities, family obligations, and a high debit load with rising interest rates all but a major squeeze on some residents. If you have more expensive tastes as well I have  seen that really grind some residents into the ground to the point where we had to arrange for some emergency financing just to get through.  

4) Yup you will make much more as staff but that isn't as much comfort as you might think if you are drowning (see 3) for 5-7 long years (residency + fellowships). Plus those fellowships often pay LESS than residency - the power of a union in action ha. That is kicking you when you are down :)

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If you actually compare us to the UK, we are definitely overworked and underpaid, but in their system, staff make a lot less than they do here. 

If you compare us to the US we actually are similar. Our pay is after conversion, lower, but we get more weeks of vacation, typically in the US, residents get 3 weeks and some residencies only give 2 weeks. 

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11 hours ago, medisforme said:

It's only enough to live on if you are single.  Try making that as the sole bread winner with a spouse and two kids.  The debt I built up in medical school and residency is so crippling I fear it will be with me the majority of my life given my family situation.  I am already engaging in quite aggressive (though honest) billing just so I can keep up with my payments, which is somewhere I never thought I would be when I walked into my first day of medical school full of idealism.  I would gladly have traded less tuition and more residency pay for less income as staff. 

Just curious given your signature, do you think you would have been better off financially continuing on with nursing as a career instead?

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11 minutes ago, 1D7 said:

Just curious given your signature, do you think you would have been better off financially continuing on with nursing as a career instead?

I try not to think about that because there is no going back now.  However, with the opportunities in nursing for career advancement and the associated pay I have little doubt I would be so much further ahead at present in terms of RRSP, education funds etc... 

I did not go into medicine for the money, but had I know more about the relatively poor pay that family physicians receive relative to their medical training and hours (the amount of unpaid work family docs engage in during the day caught me off guard), I think I would have thought a little more about it before committing.  

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Relative to the amount of school needed for the job, the type of work being done, and the number of hours worked, absolutely Resident’s are underpaid. So are clerks - I remember the nightmare it was to think that in clerkship I was actually paying someone thousands of dollars to allow me work 90 hr weeks.... 

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14 hours ago, hero147 said:

Things are unfortunately changing for the worse and a correction has to be made sooner or later. I agree that 50k post-tax is enough to live on but students these days are graduating with more and more debt and training appears to get longer and longer as the job market worsens. There are lots of fellows out there in Canada that aren't used as anything but cheap labour to help the staff's bottom line. Nevermind that a lot of practices hire newly minted, fellowship trained physicians as "junior staff" where they are paid less for more work.

I agree. After knowing that nurse practitioners make around 120 k in Ontario, with no calls and all retirement benefits (hospital's employee), with staff physician's supervision. Their training requires 2 year master degree, which is far less rigorous than medical residents.  I really beg to question if 4000 post-tax is enough for a resident with family members, and with non-traditional background.

A lot of primary care physicians' hours and time are not compensated, for following up on labs+ test results, calling patients, etc. If you work with a lot of underserved population, a lot of GPs that I know won't charge patients for ohip-billable services: fax over refills, filling out disability insurance forms, vaccination forms for schools, sick notes, physical exams for driving, etc...

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55 minutes ago, ZBL said:

Relative to the amount of school needed for the job, the type of work being done, and the number of hours worked, absolutely Resident’s are underpaid. So are clerks - I remember the nightmare it was to think that in clerkship I was actually paying someone thousands of dollars to allow me work 90 hr weeks.... 

Haha..starting to feel that now with 1:4 call on IM.

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On 9/15/2018 at 1:57 PM, Donavan Pham MD said:

Might depend on the school, but because we are still considered students of the university, there is a small tuition/administration fee, which was less than 1000$ for the year if I remember correctly

True, I think that you do pay around 700-1000 depend on your university.

Also, during residency, you need to save money for LMCC 2 (2700), CFPC exam (3000) or FRCPC exam ( > 5000). If you happen to do residency in Toronto or Vancouver, and choose not to live with a roommate, it's very difficult to save money even if you live frugally. All the money that I saved all straight went into LMCC 2. A lot of my colleagues are still using their LOC to supplement for travelling, dining out, and car insurance, etc. 

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2 hours ago, ZBL said:

Relative to the amount of school needed for the job, the type of work being done, and the number of hours worked, absolutely Resident’s are underpaid. So are clerks - I remember the nightmare it was to think that in clerkship I was actually paying someone thousands of dollars to allow me work 90 hr weeks.... 

I can appreciate the argument for residents, but under what circumstances do clerks contribute more work than the supervision and teaching that is devoted to them (much of which is provided by residents)??

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46 minutes ago, Lactic Folly said:

I can appreciate the argument for residents, but under what circumstances do clerks contribute more work than the supervision and teaching that is devoted to them (much of which is provided by residents)??

I’m not sure what this has to do with appropriate compensation.  Is your argument that because clerks are receiving teaching (taking away time from the team), that negates any positive work they contribute? 

 

Staff get paid more than senior residents, senior residents more than JRs, JRs more than clerks and with that pay grade comes different administrative and teaching duty. Doesn’t mean the person at the bottom should be paid nothing. And relative to the amount of work you do as a clerk, it’s a bit odd that you are net negative thousands for that - rounding, doing consults, writing notes, dictating etc. Yes you are receiving teaching and learning, but you aren’t (or shouldn’t be) useless. 

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Clerks are students, not employees (unlike residents who have dual status). The work that they do is basically hands-on training, and is supervised by residents and staff, who also see the patient, check the student's work, and are 100% responsible for any errors or omissions. 

It's just an odd concept since I never really expected pay as a clerk - any stipend was a bonus, as there are other professions where students do unpaid practicums as part of their training. Of course, clerks aren't useless, and often they can spend the most time talking to patients which is very valuable. I was just curious what services wouldn't function properly without clerks (except perhaps when extra retractors are needed in the OR). Are there still many services where clerks do solo call without resident backup?

Ref. House of God Law #11.

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8 hours ago, ZBL said:

Relative to the amount of school needed for the job, the type of work being done, and the number of hours worked, absolutely Resident’s are underpaid. So are clerks - I remember the nightmare it was to think that in clerkship I was actually paying someone thousands of dollars to allow me work 90 hr weeks.... 

Clerks should not overrate their importance to the system. They are students - very junior apprentices at most - and are doing all that work to learn how to do the job. Residents work still harder. But they still have a union and post-call days and, well, a salary with paid vacation and sick leave. I didn't think I was particularly underpaid as a resident - even despite the hours at times - but our call stipends sucked and still do because of bad outcomes with prior negotiations. Staff pay is almost inconceivably better, but you're now responsible for everything. And if you end up being up all night on a Friday you still might be on call Saturday, Sunday, Monday... but is 5pm Monday ever awesome! (Those days may or may not be coincidence.)

6 hours ago, Lactic Folly said:

I can appreciate the argument for residents, but under what circumstances do clerks contribute more work than the supervision and teaching that is devoted to them (much of which is provided by residents)??

Indeed. Teaching requires time and you can't - as a resident or staff - simply go by a clerk's assessment without questions or your own assessment. It's helpful to have someone around to write painstakingly detailed notes from time to time but I can't think of many instances where having a med student didn't just slow me down (at least after PGY1). 

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10 hours ago, A-Stark said:

Clerks should not overrate their importance to the system. They are students - very junior apprentices at most - and are doing all that work to learn how to do the job. Residents work still harder. But they still have a union and post-call days and, well, a salary with paid vacation and sick leave. I didn't think I was particularly underpaid as a resident - even despite the hours at times - but our call stipends sucked and still do because of bad outcomes with prior negotiations. Staff pay is almost inconceivably better, but you're now responsible for everything. And if you end up being up all night on a Friday you still might be on call Saturday, Sunday, Monday... but is 5pm Monday ever awesome! (Those days may or may not be coincidence.)

Indeed. Teaching requires time and you can't - as a resident or staff - simply go by a clerk's assessment without questions or your own assessment. It's helpful to have someone around to write painstakingly detailed notes from time to time but I can't think of many instances where having a med student didn't just slow me down (at least after PGY1). 

Clerks slow you down as a staff.

I don't mind having one around occasionally to have someone to talk to but I know they will slow down my day. 

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