Macleans article on residents' salary

[apache]

and this is why some of the best medical students are no longer going into the "trenches" of medicine, i always have fun asking non-medical people what they think the most competitive medical specialties are, they're always floored when i tell them dermatology etc... "the skin doctor! seriously?" is always the surprised response i get, they always think it's neurosurgery or some silly business like that.

 

the new generation is starting to take notice, and the people who go into these time intensive professions really love them, they're being taken advantage of much like pilots after all the airlines nearly went bankrupt. unfortunately, a lot of medical students are beginning to see through this coercive system and are going into lifestyle friendly specialties leaving a gap in the rest. here's an interesting article i remember reading a while back:

 

http://www.nytimes.com/2008/03/19/fashion/19beauty.html

 

It's really no surprise in the medical profession to have people talking straight out of their anuses. Residents will do it. Staff will do it. You'll continue to do it - we all do. It's part of what being a doctor is all about.

 

Here's the rebuttal: in those aforementioned professions, the intern equivalents are not doing the following: working > 24 hour shifts; being on-call outside of their homes sometimes for weekends straight; getting paid less than minimum wage; exposing themselves to infectious pathogens and sharp objects; saving AND endangering people's lives on an immediate and delayed basis. It's unjust. To say that it is "paying dues" is to deny both residents AND patients justice.

 

Women who are beaten by their husbands often do not stand up for themselves because they are told they are "whining". Was Rosa Parks whining? Was Martin Luther King Jr. whining? Was Semmelweiss whining? Seeing an obvious problem and speaking up against it, no matter how indoctrinated this problem is within the culture, is not whining.

 

Is there any wonder why the competitive specialties are highly paid, high lifestyle fields? What student would want to sacrifice their time for people so ungrateful and antagonistic? If the public does not want highly paid doctors, they can also forget about attracting highly intelligent dedicated people to medicine.

[apache]

you're exactly right! that's why i personally am staying miles away from anything that has me working any significant hours a week in residency even if it means skipping out on something i might find cool in exchange for something that might be slightly less cool but doesn't take away my life! life's more fun than medicine, at least for me, ciao! btw, i'm not the only one who feels that way, check out the article on my previous post, i know it's in the us but i see it happening here as well.

 

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

[coastalslacker]

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

 

Yes, our R1s go home on a regular basis. Not all the time, but from when I've been on service with them, probably more often than not. The big issue it creates is coverage. Having said that, I don't think our attendings should be booking clinics they would not be able to finish on their own. Many of them book extremely busy clinics, and then offer little to no teaching throughout the course of them. We're just there to help them churn through the patients, which I think is inappropriate. The ones I have the most respect for consciously don't book more patients than they would be able to handle on their own.

[mavrik13]

Very interesting to read the views expressed here - while I'm still a young'un (starting meds next year), it was interesting to read how a resident's salary varies by province. I doubt it would influence my future career path much, but if I were between two programs as my first choice (with no other differences between them), it would be foolish not to account for the difference in pay.

 

WRT the salary among residents debate (which seems to have taken over from the original topic) - would you be willing to sacrifice salary later on (i.e. hypothetically, have your take-home income reduced from 300k to 250k/year) for in increased salary during residency (50k to 80k starting)? Of course it isn't that simple, but in principle it could work (and it would be foolish to think that the money to increase residents' salaries wouldn't be taken from somewhere else relevant to physicians).

 

One point that is often overlooked in debates about physicians' salaries (from the POV of someone entering medicine, not the general public) is that in Canada, we have the second highest medical salaries in the world (and no one else, other than the states, is even close). Does anyone have a POV from outside of Canada/the states (or know how much a resident in the UK makes?)

[MarathonRunner]

All of what you say is true, but there ARE other health care professionals who have to do internships and don't get paid a single cent!

 

I have friends who are Registered Dietitians, for example, and they have to do a full year's internship with no pay. None whatsoever. Now, they don't have the extremely long hours that medical residents have, but neither do they work 9-5 when on a hospital rotation - they can often put in very long days - I've been told they've had 12-14 hour shifts when on a clinical/hospital rotation (the community rotation that is part of their internship has much more "regular" hours).

 

Dietetic interns also don't have the same responsibility for people's lives as medical residents might, but they can certainly greatly influence someone's health and well-being. And while doing their hospital rotations, they certainly have the potential to be exposed to as many pathogens as any other health care provider in a hospital.

 

And they don't get paid at all. Their labour is completely free during their internship year. Heck, some universities that have "integrated internships" (where the dietetics students start doing some of their rotations in the summer between third and fourth year), require the students to pay tuition while on their internship! So not only are they not getting paid for their work, they are having to pay TO work. (I guess for these intergrated programs, that summer between third and fourth year is more like clerkship, I suppose).

 

Granted, medical residents do work longer hours, in general, and have more than one year of post-graduate training, but at least they do yet paid, even if it is a pitiful salary. Dietetic interns often don't get paid at all.

 

It's really no surprise in the medical profession to have people talking straight out of their anuses. Residents will do it. Staff will do it. You'll continue to do it - we all do. It's part of what being a doctor is all about.

 

Here's the rebuttal: in those aforementioned professions, the intern equivalents are not doing the following: working > 24 hour shifts; being on-call outside of their homes sometimes for weekends straight; getting paid less than minimum wage; exposing themselves to infectious pathogens and sharp objects; saving AND endangering people's lives on an immediate and delayed basis. It's unjust. To say that it is "paying dues" is to deny both residents AND patients justice.

The job security is still no excuse for this kind of system.

 

The reason it continues to exist is not "learning" or "being trained well". It's so staff don't have to do it. Residents put up with the abuse of themselves and of patients because in a mere half-decade or less they will become staff and have residents of their own to abuse. This is why doctors are terrible negotiators - because the nature of the system they accept relies on abuse and antagonism. To stand together would be to abandon this draconian mess. To say that we are doing this to somehow "pay" for teaching is absurd. Most of what I'm learning in residency is self-taught, with bits and pieces of instruction from the occasional attending physician. The majority of residents would likely agree. Furthermore, to agree with coastalslacker, these staff signed up for an academic job and should be expected to teach. However, the argument that we still signed up for residency and should be expected to be slaves is moot because slavery is unjust no matter the context.

 

Women who are beaten by their husbands often do not stand up for themselves because they are told they are "whining". Was Rosa Parks whining? Was Martin Luther King Jr. whining? Was Semmelweiss whining? Seeing an obvious problem and speaking up against it, no matter how indoctrinated this problem is within the culture, is not whining.

 

And to Ian Wong; you are correct in the assertion that hoi polloi think that that doctors are overpaid. The people we are trying to help think that we do not justify our price. Stadiums and olympics do, but health care leaders do not. Is there any wonder why the competitive specialties are highly paid, high lifestyle fields? What student would want to sacrifice their time for people so ungrateful and antagonistic? If the public does not want highly paid doctors, they can also forget about attracting highly intelligent dedicated people to medicine.

[ploughboy]

I once spoke to a nurse about the slave wage pay residents receive and she replied with the most smug expression of schadenfreude.

 

And then she went on break, didn't she? I'm totally in the wrong line of work.

[ploughboy]

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.

 

Agreed. My income will not exceed what I made as an engineer until I get my frcpc and become a staff physician. Even if for some reason I become a PGY-9, I will still be making less than I made in my previous life. I don't even want to think about the opportunity cost involved.

 

I did have a great deal of responsibility in my previous career, but it wasn't on the individual level of "does this person live or die?" that I have now, and most nights I got to sleep in my own bed.

 

Why am I doing this?

[ploughboy]

Isn't this gen surg at u of t? Man...too much.

 

Indeed, U of T Gen Sx opted out of "home after handover". On a very recent surgical rotation, as the off-service guy I would go home sometime in the early afternoon of my post-call days. The on-service residents would stay late and operate even if they were post-call, because that's just the way the culture is. It was expected.

[Lactic Folly]

Yes, our R1s go home on a regular basis.

It was more the senior residents that I surmised would encounter barriers to going home early.

I agree with your last statements.

[Lactic Folly]

Isn't this gen surg at u of t? Man...too much.

Well, at least they are open about requesting an exemption instead of just ignoring the policy.

[ploughboy]

Dietetic interns also don't have the same responsibility for people's lives as medical residents might, but they can certainly greatly influence someone's health and well-being.

 

With all due respect to dieticians, when the dietician gets paged at 3AM because Mrs Snickerdoodle is or has (pick one or more):

 

1) not moving the left side of her body

2) not making more than 5 mL/hr of urine per hour

3) not responsive

4) a MAP of 55

5) Hgb that has dropped from 120 to 80 for no apparent reason

6) a heart rate of 180

7) gone completely delerious, has stripped off all her clothes and is making inappropriate advances toward her neighbour

8) fallen out of bed and broken her hip

9) had a seizure

10) has a potassium of 7

12) dead

13) disappeared

14) spiked a temperature of 40

15) called her entire family in for a family meeting at 3AM

14) started to desaturate and become tachypnic

16) bleed from all of her lines

17) swallowed an angiocath including the needle

18) no pulse in her left foot, which is cold and pale

19) breathing twice a minute

20) having chest pain

 

Then we can talk.

 

pb

 

 

(NB: I pulled this list off the top of my head in about a minute, based on my last couple of months at work.)

[Lactic Folly]

Well, #17 might require a change to dietetic orders.

[ploughboy]

Well, #17 might require a change to dietetic orders.

 

 

Dietetics suggests a low angiocath diet. Please cosign if agree.

[ploughboy]

Better sign it now, or you'll get paged Qhour about it.

 

Seriously, the most annoying pages are:

7. the pages for things like elevated troponins and whacked out vital signs that you DON'T get

 

Yet somehow, "MD aware" will still show up in the nursing notes. "Gosh, I must have paged the wrong pager..."

[Lactic Folly]

Dietetics suggests a low angiocath diet. Please cosign if agree.

So what happened to the patient?

[A-Stark]

Nice, even the senior residents?

 

Yup, though arguably part of the benefit for the seniors is having juniors and off-service residents (and clerks!) around to handle the morning paperwork that they "ask" us to do. Might be different on other gen surg services here, but I was on the busiest one, so I expect things hold elsewhere as well.

 

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

 

Ugh. I worked with one neurosurg resident who was from the UofT system, and who decided to "tag along" with me and the off-service R1 to the peds OR. I only realized later that he was post-call and had been up much of the night - which was annoying less for his undermining of the PARI-MP contract than for coming post-call to an OR which didn't have room or need for three assists when he wasn't scheduled to do so. He also would come in for evening cases when not on call. I suppose just general insanity is necessary on a service that's chronically understaffed like neurosurg but still...

[ploughboy]

So what happened to the patient?

 

Scope, retrieval of angiocath and discharge, in accordance with that patient's pre-existing plan of care. He/she has swallowed enough things over the years that every hospital in the city is prepared for his/her arrival.

 

I don't want to think about what a horrific childhood this individual must have gone through in order to make him/her such a primitive borderline. All I know is that every emergency, general surgical, psychiatric and GI resident in this city knows who this person is. Getting paged in the middle of the night about his/her latest ingestion is almost a rite of passage, and is something that dieticians or physiotherapists or pharmacists don't ever have to deal with.

 

Not bitter, just realisitc and contributing something relevant to the thread.

[Jochi1543]

All of what you say is true, but there ARE other health care professionals who have to do internships and don't get paid a single cent!

 

I have friends who are Registered Dietitians, for example, and they have to do a full year's internship with no pay. None whatsoever. Now, they don't have the extremely long hours that medical residents have, but neither do they work 9-5 when on a hospital rotation - they can often put in very long days - I've been told they've had 12-14 hour shifts when on a clinical/hospital rotation (the community rotation that is part of their internship has much more "regular" hours).

 

Dietetic interns also don't have the same responsibility for people's lives as medical residents might, but they can certainly greatly influence someone's health and well-being. And while doing their hospital rotations, they certainly have the potential to be exposed to as many pathogens as any other health care provider in a hospital.

 

And they don't get paid at all. Their labour is completely free during their internship year. Heck, some universities that have "integrated internships" (where the dietetics students start doing some of their rotations in the summer between third and fourth year), require the students to pay tuition while on their internship! So not only are they not getting paid for their work, they are having to pay TO work. (I guess for these intergrated programs, that summer between third and fourth year is more like clerkship, I suppose).

 

Granted, medical residents do work longer hours, in general, and have more than one year of post-graduate training, but at least they do yet paid, even if it is a pitiful salary. Dietetic interns often don't get paid at all.

 

Thank you, it's the same in a lot of other professions. On my medic practicum, all my preceptors worked 12 hour shifts, 4 on 4 off, while I worked 24/7 with no pay. My practicum also took forever because I couldn't get the specific calls I needed, so it was an immense financial drain on me as I couldn't work while I was there. So even the prospect of taking home 5 or 6 grand via stipend as a 4th year med student is alluring in comparison.

 

Grad students and post-docs don't get paid a ton, either, even though a lot of them work with minimal supervision and, esp. PhDs and post-docs, often have some advanced skills. I think as trainees, we have it pretty good in terms of finances.

[RyanMaverick]

With all due respect to dieticians, when the dietician gets paged at 3AM because Mrs Snickerdoodle is or has (pick one or more):

 

1) not moving the left side of her body

2) not making more than 5 mL/hr of urine per hour

3) not responsive

4) a MAP of 55

5) Hgb that has dropped from 120 to 80 for no apparent reason

6) a heart rate of 180

7) gone completely delerious, has stripped off all her clothes and is making inappropriate advances toward her neighbour

8) fallen out of bed and broken her hip

9) had a seizure

10) has a potassium of 7

12) dead

13) disappeared

14) spiked a temperature of 40

15) called her entire family in for a family meeting at 3AM

14) started to desaturate and become tachypnic

16) bleed from all of her lines

17) swallowed an angiocath including the needle

18) no pulse in her left foot, which is cold and pale

19) breathing twice a minute

20) having chest pain

 

Then we can talk.

 

pb

 

 

(NB: I pulled this list off the top of my head in about a minute, based on my last couple of months at work.)

 

I feel like #12 shouldn't take up a whole lot of your time...

 

I'm currently a pharmacy resident so I can shed some light onto that field to help add to the debate.

 

We make 50k for a 1 year optional residency. However if you really want to do any meaningful clinical work (such as the pharmacists you see on the wards), you require at least a residency and possibly a PharmD as well. The community pharmacist or dispensary pharmacist doesn't have anywhere near as rewarding of a job with respect to patients. In addition, the residencies generally come with a 1-2 year return to service agreement or else you make about 2k for the year.

 

Pharmacist salaries out of school range from 75 to 100k, and don't have a lot of room for growth around that.

[cheech10]

#12 can take a lot of time. Pronouncing death, filling out a death certificate, dictating a final note, notifying the family MD, calling the family in, informing the family, getting consent for organ/tissue donation, and getting consent for autopsy are all part of the process. It can take an hour or more.

[Satsuma]

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.

 

Do I pay them? Yeah...when I take care of all the admissions overnight while my attending is sleeping and they get to bill for all those admissions, and what about all their pts I take care of on the floor overnight? When I suture up a pt's lac, drain an abcess, even dx and treat a simple UTI etc. all without my staff ever laying eyes on the pt, that is a bonus for them. They get to bill for a pt they never saw. Or what about all the WSIB forms I fill out - it's not teaching me a thing, but they get to bill for it. So yeah, they are around to teach me things I still need to learn, but it isn`t like as staff, having a resident around to do work and take care of your pts while you sleep doesn`t have its benefits.

[A-Stark]

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.

 

They are not taking "time out of their day" as some sort of favour - they are quite literally paid to be involved in teaching at the postgraduate and often undergraduate level as part of an academic appointment. And considering as a resident (and clerk) you will see patients for staff, dictate for them, and do myriad other tasks related to patient care, I'd say you are more than owed a small amount of instruction, teaching, and mentorship from them.

[Satsuma]

I have friends who are Registered Dietitians, for example, and they have to do a full year's internship with no pay.

 

I may be wrong about this, but when I was speaking with dietician at my hospital, she said there was no formal "schooling" to be an RD. That the program is "on the job" training once you are accepted to it.

 

If this is true then to me it is more accurate to compare this "internship" to clerkship of med school rather than residency. Medical student clerks work and don`t get paid for 2 years. They pay tuition to get to work all those hours.

 

Residents have already put in these 2 years of on the job training before residency.

[MarathonRunner]

I may be wrong about this, but when I was speaking with dietician at my hospital, she said there was no formal "schooling" to be an RD. That the program is "on the job" training once you are accepted to it.

 

If this is true then to me it is more accurate to compare this "internship" to clerkship of med school rather than residency. Medical student clerks work and don`t get paid for 2 years. They pay tuition to get to work all those hours.

 

Residents have already put in these 2 years of on the job training before residency.

 

I have several friends who are dietitians (I contemplated studying dietetics myself for my undergrad, so I know many people in the field) and there definitely is formal training. They have to do a four year Dietitians of Canada accredited undergrad program to start - you can't just study "nutrition" and become a dietitian (a fact that many people interested in the profession don't seem to know - they get into a nutrition program and then find out that they can't become an RD) - you have to go to one of the accredited programs. These programs are structured to include the skills and knowledge that a registered dietitian needs, as opposed to a general nutrition program. They definitely do clinical courses in fourth year.

 

Most of these programs include field placements out in the community, which would be equivalent to clerkship. The internship is analogous to residency, albeit only a year, but they dietetic intern does not get paid. The internship is a post-graduate program, just like residency. My friends said they have to do internship placements in the community, in a clinical setting (normally a hospital), and in a foodservice setting. They have to demonstrate that the have the competencies required of an entry-level dietitian.

 

Now, maybe the dietitian at your hospital completed her schooling years ago? And the fact that you call her a dietician leads me to believe she wasn't trained in a recent Dietitians of Canada accredited program - she would be a Dietitian in that case, not a dietician (it may be a minor quibble, but the job title of Registered Dietitian or Professional Dietitian is protected in all provinces).

 

Anyhow, the "dietician" you spoke with seems to have given you information is completely different from the info I've received from my friends, who are Registered Dietitians. There certainly is formal training required. The requirements to be an RD are: 4 year honours degree in a Dietitians of Canada accredited program, 1 year internship with several different placements required, successful completion of the dietetics registration exam.

 

Now residents obviously have a lot more responsibility, but the point I was trying to make is that there are other health care professionals who have to undergo post-graduate training, and who aren't paid any better than residents (and in some cases aren't paid at all). I do think residents deserve better pay and better hours, and although we've seen some improvement in the hours (ie. home after call) there is obviously still room for improvement, and I hope we see it by the time I get to residency in four years!

[NLengr]

There seems to be two streams. One where you go through a specific Dietician undergrad, the other where you do it as a post graduate thing after a normal degree. At least that's how I read it.

 

http://www.dietitians.ca/Career/Internships-Practicum-Programs/Internship-Routes.aspx