Macleans article on residents' salary

[MarathonRunner]

Interesting article about the differences in pay between the various provinces:

http://oncampus.macleans.ca/education/2011/03/09/medical-residents-in-alberta-the-highest-paid-in-canada/

 

I tend to think that people will choose a program based on specialty and location before salary, but salary probably isn't too far behind.

[ubcredfox]

What's particularly funny about this article, is that at a recent meeting of Staff Physicians and Residents discussing working hour legislation i.e. our wonderful work hours, capped at 90 hours per week in Nova Scotia and such luxuries as "only" 26 hours on call in a row, there was talk from some of the Surgical staff that since now resident's were working "so little" they might as well get paid less. Now that's foward thinking!

 

Even the US has us licked in terms of work hour legislation. Now that's funny.

[kaymcee]

So what if your counterpart one province over makes ten thousand more than you?! The problem is that the topic of how much an attending physician can reasonably expect to make is such a strangely taboo topic. If medical students knew that a family physician can very, very easily pocket $150,000 for their first year of practice, we might not care so much about $40,000 vs $50,000 for an R1 salary. Specialists can do double, triple or more for the more lucrative ones. Even rural family physicians who work their face off can bill $750,000. A community cardiologist showed us his T4: $394,000 gross earnings.

 

Physicians are very handsomely paid once they're certified. People panic about a $200,000 line of credit, but they shouldn't.

 

Medical students should know average billings for specialties, not because it will help them decide on a career, but because it will help them relax about their financial future.

[Smurfette]

Having just gone through the match, I can't think of anybody I know that ranked their residency programs based on how much residents make. The quality of the program, family, lifestyle, opportunities for staff positions/fellowships post-residency, and where people ultimately wanted to end up were the primary considerations.

 

It's interesting that you bring up the "taboo", kaymcee. I feel like I have no idea how much staff physicians actually make in the different specialties. And this is after I've made my career choices, lol.

[A-Stark]

What's particularly funny about this article, is that at a recent meeting of Staff Physicians and Residents discussing working hour legislation i.e. our wonderful work hours, capped at 90 hours per week in Nova Scotia and such luxuries as "only" 26 hours on call in a row, there was talk from some of the Surgical staff that since now resident's were working "so little" they might as well get paid less. Now that's foward thinking!

 

Even the US has us licked in terms of work hour legislation. Now that's funny.

 

On behalf of all Dal clerks, though, I'd like to thank PARI-MP for their attainment of the 9am post-call day which we have been granted as well. But this attitude extends even to things like peds - at a journal club in Saint John, one staff went off about the post-call day in particular.

 

I don't know about anyone else, but sleep is good.

[NLengr]

So what if your counterpart one province over makes ten thousand more than you?!

 

The problem is it's not like anyone in residency is well compensated. At least for the first few years. If you are trying to start a family (like many residents), that pay jump from $45,000 to $55,000 is worth A LOT.

 

It's all well and good that you are gonna make lots of cash later on. Unfortunately, later on fertility is gonna drop. Waiting to have kids is a gamble for many residents. Having some extra cash on hand would make life easier during the kids first few years.

[gradguy]

Medical students should know average billings for specialties, not because it will help them decide on a career, but because it will help them relax about their financial future.

 

Excellent point kaymcee! I've received many emails recently about an OMA survey about physician income, hours worked, and overheard costs. I really hope they release the results of the study to the public, or at least to the general membership of the OMA.

[kaymcee]

The problem is it's not like anyone in residency is well compensated. At least for the first few years. If you are trying to start a family (like many residents), that pay jump from $45,000 to $55,000 is worth A LOT.

 

That is precisely what your $200,000 line of credit is for. Not to trivialize any financial hardship, but $45,000 (pretty much tax-free) is a solid amount of money for a family with a newborn, especially when supplemented with more line of credit debt.

[entkeener]

That is precisely what your $200,000 line of credit is for. Not to trivialize any financial hardship, but $45,000 (pretty much tax-free) is a solid amount of money for a family with a newborn, especially when supplemented with more line of credit debt.

 

Is this Jack Layton or Olivia Chow writing? Maybe in Cuba $45,000 would go far, but in Canada we do pay taxes (certainly as an R1 I do), plus I have to pay my PAIRO dues, CMPA dues, text books, licensing exams (LMCC x 2, Principles of Surgery, etc...). I am a single male and live pretty modestly on my salary, I cannot imagine having to stretch that kind of money plus work down a large (as you suggest $200K) line of credit.

 

I'm not complaining about what I make. I recognize that I'm part employee and part student as a resident- my program certainly gives me as much if not more than I give them in return at this point in residency.

 

Please consider that surgical residents work on average 80-100 hours a week. If we worked 9-5 jobs we'd be getting significant overtime pay (pay and a half for those hours) and bonuses for working on statutory holidays. When you work it out in that context we make less than minimum wage in PGY-1 in Ontario (and way less than that in the lower-paying provinces)... I hope that puts things into some perspective for you.

[itimebomb2]

WTF man! Since when does having to put yourself into significant debt because of a literal slave wage job a just occurrence?

 

I swear that this residency slavery keeps happening because the general public is resentful of doctors making more money later on. I once spoke to a nurse about the slave wage pay residents receive and she replied with the most smug expression of schadenfreude. Perhaps it was jealousy on her part (a failed premed, perhaps) but good pay later still doesn't justify slavery now.

 

Um... actually it does... in pretty much every profession, you have to pay your dues as an intern before you get to be the boss... accounting, law, consulting, finance, etc...etc... Everyone pays their dues -and they all get paid crap while they do. Sure some PWC interns might make a little more than a medical intern (not a lot more) - but the medical intern has a way more secure future.

 

Assuming that you should get paid for every hour of your work is just plain naive. You get paid 50K for a year of work -- but don't forget your getting bloody TRAINED by doctors who have to take time out of their day to TEACH you and GIVE you lessons that you need to be a doctor. Do you pay them? NO. Stop whining.

[Lactic Folly]

To be fair to both sides:

Residents have dual status as students and employees. If there were no residents, other staff such as clinical associates (GPs) or nurse practitioners would have to be hired at a significantly greater cost to maintain the same patient load. That being said, residency salaries are not out of the range of a normal person's income, with more hours but also more job security.

http://www40.statcan.ca/l01/cst01/labor01b-eng.htm

[Ian Wong]

It's interesting that you bring up the "taboo", kaymcee. I feel like I have no idea how much staff physicians actually make in the different specialties. And this is after I've made my career choices, lol.

 

Like the rest of you, specialty incomes weren't something discussed in med school. In residency, you tend to hear about incomes for your specialty, since there are always senior and graduating residents you can talk to regarding their job offers (or lack thereof, gulp). You don't tend to get a good sense of what other specialties are making unless you have resident friends in those fields to ask.

 

Being on the other side of the fence as an attending, I can understand a little as to why staff people may be less willing to discuss their incomes. The more altruistic line is that money shouldn't decide a specialty choice. While that is theoretically correct, the reality is that there's a pretty wide range of incomes and lifestyles within medicine, and you need to choose a field that fits your interests and balances that against lifestyle and money. To ignore the money factor completely is naive, in my opinion.

 

A more practical line is that physicians are relatively private and guarded about their personal life. The VAST majority of the general public thinks physicians are overpaid for what they do. Releasing your income into the public eye is never going to help you; it can only hurt you. The government already wants to cut physician salaries, and making the public angry about what you make only exacerbates that. Every year, as the BC and Ontario physician billing data is released, you get articles in the papers wondering why physicians make so much money.

 

I realize that med students are not the general public, but I think that's a big part of why you need to shadow physicians and talk to residents in every field. The residents in particular are often more willing to give you the inside scoop on a specialty.

 

Ian

[apache]

i agree, especially since most residents are 25-35, the best time of their lives and they're working 100 hours a week! many people in the medical path become habituated to putting things off until later, always delaying gratification, they don't realize that their lives aren't normal, they're only normal with respect to the perverse perception of normality students have been indoctrinated into believing over 8+ years.

 

Pharmacists go to school for 5 years, can slack the last 4, and come out making 90-100 k, the debt level is much lower, and the stress is nothing compared to a surgical/im/obsygyn/etc. resident. you can say that the surgeon will make good money when he is 33 (10 years after the pharmacist finishes), but he's still doing a job that is significantly more stressful/trying etc. and has given up prime years of his life!

 

WTF man! Since when does having to put yourself into significant debt because of a literal slave wage job a just occurrence?

 

I swear that this residency slavery keeps happening because the general public is resentful of doctors making more money later on. I once spoke to a nurse about the slave wage pay residents receive and she replied with the most smug expression of schadenfreude. Perhaps it was jealousy on her part (a failed premed, perhaps) but good pay later still doesn't justify slavery now.

[0nsp]

Um... actually it does... in pretty much every profession, you have to pay your dues as an intern before you get to be the boss... accounting, law, consulting, finance, etc...etc... Everyone pays their dues -and they all get paid crap while they do. Sure some PWC interns might make a little more than a medical intern (not a lot more) - but the medical intern has a way more secure future.

 

Assuming that you should get paid for every hour of your work is just plain naive. You get paid 50K for a year of work -- but don't forget your getting bloody TRAINED by doctors who have to take time out of their day to TEACH you and GIVE you lessons that you need to be a doctor. Do you pay them? NO. Stop whining.

 

Definitely written by someone who has never worked a day in his life. By the time you're a resident you will be singing a far different tune. No other profession is as disproportionately underpaid as residents are. And there is no way to justify it. Does the employee call their boss at 3 am for an important decision and get paid MORE than the boss? Only in medicine can a nurse do that, and still double a resident in salary with 1/3 the education. It's preposterous. Yes we are not fully trained doctors yet, but that doesn't mean we aren't important. Between 5 pm to 8 am the lives f 40 ward patients are in my hands and you better make sure that the person you call to save your life at 3 am is being well paid for his trouble.

[coastalslacker]

Definitely written by someone who has never worked a day in his life. By the time you're a resident you will be singing a far different tune. No other profession is as disproportionately underpaid as residents are. And there is no way to justify it. Does the employee call their boss at 3 am for an important decision and get paid MORE than the boss? Only in medicine can a nurse do that, and still double a resident in salary with 1/3 the education. It's preposterous. Yes we are not fully trained doctors yet, but that doesn't mean we aren't important. Between 5 pm to 8 am the lives f 40 ward patients are in my hands and you better make sure that the person you call to save your life at 3 am is being well paid for his trouble.

 

I think it's perhaps unfair to say they've never worked a day in their life. However, I would say the Meds 2013 tag would indicate they don't know WTF they're talking about with respect to medicine.

 

I've had a couple moon-lighting shifts and it is remarkable the change in mind-set when you are actually getting paid appropriately for the level of responsibility that you have. You don't feel like you're getting taken advantage of.

 

I would caution those who reference our attendings altruistically giving up their time to "teach" us. They made a choice to be in a teaching centre and it is therefore part of their job description. If they don't want to teach us, they should go find a job someplace else. For many of them, we provide more to them than they do to us. Similarly, as has already been mentioned, the hospital system relies on residents to function - if they had to employ mid-level providers (NP, PA), their costs would explode.

 

So what do you think about this comment: Busier residents should be paid more. We aren't comparing apples to apples when we're talking about pay during residency - some specialties actually have a more reasonable hourly wage.

[lostintime]

I think the argument that "You picked this path, you gotta suck it up" is really stupid. That's like back in the day when there was no social justice and safety laws and people were being overworked to death and it was "just a fact of life". Just because things are ****ty doesn't mean they're right. I hate the whole argument, "BACK IN THE DAY, this was the way it was, so you better suck it up". Well guess what, it's 2011 and maybe there should be some changes to a system that's not fair.

[lostintime]

And while lots of other professions have a lot of responsibility, I would like to add that having to deal with dying people who you have to make quick decisions about that could significantly alter their course and prognosis is kinda a lot of responsibility/stress. I think it's safe to say that MOST people who earn $50 000 do not have to deal with that at like 3 a.m. in the morning.

[kaymcee]

This is fun, everyone!

 

entkeener, I can assume by your name that you're a resident in one of the more lucrative, although job-starved, surgical programs. You talk about putting things into perspective, but in 6 more years you will be making a hefty annual salary, more than the vast majority of Canadians could expect to make in a decade. And brooksbane, it's not just "good pay later" it's "exceptional pay later".

 

I'm not sure I buy the "we sacrifice our twenties" line, either. Many of my classmates, myself included, have taken wonderful vacations between semesters, international electives, pre-residency trips, etc. Yes, we work hard, but we also will have a rewarding, stable, lucrative career when it's all through. I don't think I'm delaying gratification whatsoever, and my $165,000 of debt shows that.

 

I am having difficulty understanding how we can all complain so much about money...

[NLengr]

...but $45,000 (pretty much tax-free) is a solid amount of money for a family with a newborn, especially when supplemented with more line of credit debt.

 

Do you have kids? $45,000 is not a solid amount of money to raise a child with, especially in a bigger center, or a boom town. It's probably enough to scrape by, but nothing close to solid. Sure you can dip into credit, but in the end you are paying that back, so it's costing you extra. The whole "just dip into credit" attitude is responsible for a huge portion of the financial problems we are seeing/gonna see in the next few years. It's not too much to ask to pay residents the going rate for first year engineers, which is far far more than $45,000.

 

I can tell you when I worked as a new engineer I was making more than a first year residents and I was working 40 hours a week. When I went home, I stayed home, nobody called me at 5 am. On top of that, the level of responsibility I had was nowhere near what a resident faces.

 

I always find it kinda funny that some people who will be residents in the future are so against providing far wages and working conditions for residents. It's like all those people in the states who work so hard to strip collective bargaining rights and group benefits away from public employees. They complainers don't have them, so instead of asking their employers why they don't, they bend over backwards to screw the other working man.

[entkeener]

This is fun, everyone!

 

entkeener, I can assume by your name that you're a resident in one of the more lucrative, although job-starved, surgical programs. You talk about putting things into perspective, but in 6 more years you will be making a hefty annual salary, more than the vast majority of Canadians could expect to make in a decade. And brooksbane, it's not just "good pay later" it's "exceptional pay later".

 

I'm not sure I buy the "we sacrifice our twenties" line, either. Many of my classmates, myself included, have taken wonderful vacations between semesters, international electives, pre-residency trips, etc. Yes, we work hard, but we also will have a rewarding, stable, lucrative career when it's all through. I don't think I'm delaying gratification whatsoever, and my $165,000 of debt shows that.

 

I am having difficulty understanding how we can all complain so much about money...

 

 

The pay isn't 'exceptional' later- it's appropriate, and in many cases (e.g. pediatrics) grossly low and unacceptable when you consider the years of training and opportunity cost of not pursuing another line of work.

 

Even with tuition rebates an R1 loses about 20% of their paycheck to the government, unemployment insurance, PAIRO, disability insurance, etc... Another 1% goes to CMPA and CPSO fees. LMCC parts 1 and 2 aren't reimbursed, nor are textbooks or principles of surgery exams. There are other work expenses which you probably haven't thought about that you don't get reimbursed for such as hospital parking or gas to get between hospitals if you have to do home call (and even though these can be written off, given our low tax bracket the vast majority of this burden is borne by the resident). For argument's sake let's say the typical R1 in Ontario takes home $40,000 after tax and work-related costs (but in actuality it is much less).

 

Now let's consider the cost of all that money many residents have borrowed to get where they are. In your case that's 165K. Although you do have ACCESS to $200K, I do caution you that unlike OSAP none of it is 'free money.' At the current 'prime' rate of 3% that 165K costs you about 5K per year (before paying down a penny of principle, and don't expect it to stay at 3% for long).

 

So where would that leave you? Take home pay of $35K per year. For one person to live off of in a small city/town-based program? Not that bad. However, you were talking about supporting a family with a child, though while managing your 165K in debts.... still sound good to you? That works out to less than $3000 per month for working 80-100+ hours a week or about 320-400+ hours per month.

[Lactic Folly]

So what do you think about this comment: Busier residents should be paid more. We aren't comparing apples to apples when we're talking about pay during residency - some specialties actually have a more reasonable hourly wage.

 

In provinces that have call stipends in addition to the base resident salary, this is already the case - the more call someone does, the more they get paid. Any more than this and you are venturing on thin ground IMO and setting the stage for inter-specialty conflict.

 

If you pay someone more because they spend more hours in the hospital, are you saying that they are essentially worth more? What about people who take their work home with them? How would you keep track of work hours and how busy someone actually is? What if someone is in-house overnight but has a quiet night and spends several hours in their call room waiting to be paged?

 

I remember speaking to pathologists who had received some criticism about how much they were paid in comparison to their hours.. the response was that they were not being paid for the hours, but rather the impact of their decisions.. will that patient undergo treatment for cancer? have that amputation? if wrong, arms and legs don't grow back.

[coastalslacker]

In provinces that have call stipends in addition to the base resident salary, this is already the case - the more call someone does, the more they get paid. Any more than this and you are venturing on thin ground IMO and setting the stage for inter-specialty conflict.

 

If you pay someone more because they spend more hours in the hospital, are you saying that they are essentially worth more? What about people who take their work home with them? How would you keep track of work hours and how busy someone actually is? What if someone is in-house overnight but has a quiet night and spends several hours in their call room waiting to be paged?

 

I remember speaking to pathologists who had received some criticism about how much they were paid in comparison to their hours.. the response was that they were not being paid for the hours, but rather the impact of their decisions.. will that patient undergo treatment for cancer? have that amputation? if wrong, arms and legs don't grow back.

 

lol, I recognize it is thin ground. I also think it will be a moot point over the next couple years as "home after handover" (home at 8AM post call in Ontario) becomes established and actually filters its way into practice in the busier programs where it is currently ("unofficially") frowned upon. This is a good thing.

 

All that said, I work 11-12 hour days and my buddy in another speciality works 8. Tops. I have other friends who get 14 days off a month. Like every resident, we take our work home with us. We all get paid the same. I'm just sayin'... (and we ALL know who has busy call shifts and who doesn't, at least we do where I work...). I apologize in advance to all my hard-working colleagues for these inflammatory remarks. Just stirrin' the pot.

 

On a completely different note, in response to some other posts, I think the assertion that one of the reasons we accept all of this bull-shizzat is because we have the "certainty" of having a good "stable" job in the end is currently patently false as recent media reports have reinforced. Honestly, lots of smart kids are going to be seriously reconsidering whether they want to get into medicine, which is a shame.

[Lactic Folly]

I also think it will be a moot point over the next couple years as "home after handover" (home at 8AM post call in Ontario) becomes established and actually filters its way into practice in the busier programs where it is currently ("unofficially") frowned upon.

Just curious, have you actually seen this happening? It seems there are some significant barriers.

[A-Stark]

Seems to actually happen in gen surg here, though sometimes the residents seem to stick around until later int he morning for a case or to finish paperwork. Not so much on neurosurg, though they have so few residents that it's hard to judge. My impression is that at somewhere like UofT, the culture is very much *not* in favour of the post-call day, at least in some programs. Anecdotally, it's better accepted at Dal. That doesn't mean that clerks don't end up staying past noon, though this seems to happen on medicine rotations rather than surgery. And to me on peds - my last day was spent post-call doing final presentations all morning and dictating until well into the afternoon. Ugh.

[Lactic Folly]

Seems to actually happen in gen surg here

Nice, even the senior residents?

My impression is that at somewhere like UofT, the culture is very much *not* in favour of the post-call day, at least in some programs.

Yeah, some programs at UofT have requested an exemption from home after handover.