Macleans article on residents' salary

[MarathonRunner]

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

 

I was talking to one of my dietitian friends today, and she confirmed, that every single Registered Dietitian has to complete a Dietitians of Canada accredited program. She did say that some schools (UBC, McGill) have integrated internships, as part of their undergraduate program (ie. you start doing the internship the summer between third and fourth year of university, and complete it after graduation). Other schools, like all the accredited programs in Ontario, don't offer integrated internships, so they have to do an internship after graduation, or as part of a Masters degree. She also said that some schools have an option - where getting into the integrated internship is competitive, so not all students in the dietetics program will get in after third year, and will have to apply to do a post-grad internship.

 

So yeah, there are several routes, but all of them, according to my friend and the Dietitians of Canada website, require three things: 1. a Dietitians of Canada accredited undergraduate program (just a "nutrition" degree isn't good enough), 2. an internship, either integrated, post-graduate, or as part of a Masters program, and 3. passing the dietetics registration exam for the province you plan to practice in.

 

I think the chart on the Dietitians of Canada site is not exactly clear, because even the post-degree internship route requires a Dietitians of Canada accredited undergrad program, although it doesn't say that explicitly. But it clearly states so here: http://www.dietitians.ca/Career/Education.aspx

 

There are three steps to becoming a professionally qualified dietitian in Canada.

 

1. Education: Accredited Undergraduate Programs

2. Internships and Practicum Programs

3. Registration to Practice

 

There are two educational steps to becoming a registered dietitian - you must meet both academic and practical experience requirements.

 

Education

 

The first step is to earn a Bachelor’s degree in food and nutrition from a university program that has been accredited by Dietitians of Canada (DC).

 

Your choice of undergraduate program will determine what route you take in order to become registered to practice.

 

Path A - Fully Integrated

Path B - Partially Integrated

Path C - Not Integrated

-Post Degree Internship

-Combined Masters Practicum Programs

[itimebomb2]

Any economists out there? Unless that are some serious coercive forces involved, where there are not - market forces define a price. Since people are still hoarding to try to get into medical school to earn this so-called "slave wage" - there must be enough fringe benefits (and by fringe I mean securely becoming a millionaire for the rest of your life, and being one of the most respected members of society) - to justify the price.

 

Just like any career - the job market in medicine is dictated by natural forces of competition. Hell, if anything, the physicians have the greater coercive power in the relationship. They could work residents way harder before the number and quality of medical applicants and physicians even started to show minor signs of detriment.

 

The only argument I MIGHT accept in this case is that residents are being coerced by more powerful attending physicians into receiving lower pay and greater work... but even that is a stretch, since they're along the same path.

[apache]

qualitative economics is a constructivist, highly politicized discipline that exists to push agendas and conveniently gives numerical value to and simplifies subtle, esoteric sociological variables to fit into a linear regression model and claim objectivity. it's the most bogus discipline in university, period. there's no further proof of this than the flagrant fear mongering that crushed uranium stocks last week as volumes soared to 6 times normal and values dropped 50 percent, now that libya is in the news and insistutional investors picked the carcasses up the stocks are only down about 20 percent, not a bad 60 percent gain in 2 weeks, it's too bad you didn't see cnn talking about china, russia, and india's ardent support of their continuation of their nuclear programs: we just hear from switzerland, which composes .25 percent of demand... if that's not flagrant market manipulation an coercion then i don't know what is... talk about a free market, but no one really lied, they just left stuff out

 

you know, if not for sociology and psychology, people might take some of these qualitative economists seriously!

 

the coercive forces are extremely subtle to begin with: the propaganda you are initially fed, that you'll be saving lives out of the good of your heart, that the bureaucracy, hypocrisy, and other short-commings of the medical system don't exist. the lack of exposure you are able to get to the medical profession as an undergrad. when these factors are coupled with a constant advertising brigade that systemically convinces people that their self worth is tied to their net worth, to their "rank" in society the undergrad is as hooked as the crack addict that gets their first hit.

 

the medical discipline furthers denies the self worth of students who are not willing to work inhumane hours, we're called lazy, we're verbally abused... if you're not firmly inoculated with experiences that strongly lead to an opposite view, or don't have the strength of mind to resist this social pressure this can break you, destroy your sense of self worth, and cause ostracization from your classmates, residents and attendings. you may be legally protected but there is an underlying malice, very much like that committed by young women in secondary school. i can easily make an argument for coercive propaganda and psychological abuse and how this leads to a slave wage. there is nothing to be gained from working such obscene hours, not only is it a detriment to yourself but a detriment to patient care.

 

next we move into the predatory lending of banks to medical students and the immense amount of debt most medical students take on in their training, you have to realize that this experience is a gradual one and you are slowly entrapped, it's not something people decide to jump into overnight (if i were to start 1st year undergrad next year i would avoid medicine like the plague)... i'm sure people don't plan on having kids when they're in 2nd year undergrad, but it happens in residency, and well you have to pay for that kid, just like those poor people in the ghetto have to deal drugs to pay for groceries.... when you owe 200,000 and are in an im residency there are undoubtably coercive financial, sociological, and psychological forces to work for a literal slave wage, economics just can't quantify them into a numerical variable, but 5 minutes of mental masturbation can come up with quite a few that if i were to ask residents about, would most definitely be verified

 

on the topic of the free market, canada's largest psychiatry program, with over 150 residents, at the u of t, has their own association... for 1 specialty, and at only 1 university... and one of their goals is to protect resident well-being, so it seems like not everyone is for this idea of selling their soul to medicine:

 

http://prat.utpsychiatry.ca/

 

btw... doctors aren't the most respected members of society anymore

 

on an aside, a much more profitable route is to do an fm residency, get the llb and go to the states and sue for malpractice... i think that's succexxy, a big **** you to the whole medical slave mongers... plus you'll be filthy (filthy, filthy) rich, and probably will be getting some respect since you're helping victims of sloppy physicians

 

 

Any economists out there? Unless that are some serious coercive forces involved, where there are not - market forces define a price. Since people are still hoarding to try to get into medical school to earn this so-called "slave wage" - there must be enough fringe benefits (and by fringe I mean securely becoming a millionaire for the rest of your life, and being one of the most respected members of society) - to justify the price.

 

Just like any career - the job market in medicine is dictated by natural forces of competition. Hell, if anything, the physicians have the greater coercive power in the relationship. They could work residents way harder before the number and quality of medical applicants and physicians even started to show minor signs of detriment.

 

The only argument I MIGHT accept in this case is that residents are being coerced by more powerful attending physicians into receiving lower pay and greater work... but even that is a stretch, since they're along the same path.

[cheech10]

Predatory lending? I guess you could see it as that, but the truth is med students get a large loan with generous repayment terms at below market interest rates. Anyone else would kill for that kind of loan.

 

It's the students and residents that are at fault for their spending: don't live like an attending until you are an attending. A classmate of mine bought a big screen plasma tv, new leather couches, and a new mercedes in his first year of med school! No surprise that his debt became unmanageable, especially combined with vacation after vacation. Half the posts in the LOC threads are asking where one can get a loan that is not limited by year (50K per year vs 200K up front), newsflash: that provision is to protect you from blowing all your money at once.

 

Anyway, lets examine resident salaries for a sec: 45 K for a first year, but add disability insurance, extended health benefits, etc, and its 48K effectively. Then add 8.7% since there are 6 weeks vacation (4 weeks + Christmas/New Years + 1 week "academic") instead of the mandated 2 weeks for employees. Now at 52 K. Now add 10K since there's no tuition (and there definitely is teaching: none of us could pass the royal college exams on July 1 of PGY-1, and if one is not happy with their program's teaching, well, we were free to choose any program we wished). So we're now at 62 K starting salary. Add a yearly increase of ~8% based on the salary chart (well above the 3% inflation target of the BoC, and even higher than the 1-2% salary inflation in the greater population). Factor in the essentially 100% job security and the future income growth once finished residency, and you have a job that fares better, on average, than any one else after 6-8 years of post-secondary schooling (grad degrees not counted, as they are not strictly necessary for admission). Sure some lawyers/financiers/others make more immediately out of school, but the VAST majority do not. And don't forget, off-service PGY-1s are much less useful at shouldering the workload on rotations, especially speciallized rotations that they didn't see during med school. Finally, in regards to the long hours, it's a salaried position, no one in any salaried field gets overtime for the long hours, and many junior employees in other fields are expected to work long hours as well (eg lawyers in the many years before they make partner, and who have no guarantee of ever reaching that threshold). Plus, you will be very thankful once you start moonlighting/locuming that you are used to the long hours.

[itimebomb2]

Everyone has such great suggestions about how to get rich in other fields... why not just do that then? Clearly you've chosen medicine because if the vast array of privleges that are afforded us - and just about everyone in society would agree that you made the right decision (with exception to the very greedy ones).

 

None of the examples you stated, Muse, are examples of overt oppressive/coersive forces. If they can be reasons not to go into medicine, they are more easily be explained by poor miscalculations by premeds/med students than by actual lapses in the system.

 

Again appealing to simple common sense - the fact that nobody really feels sorry for doctors - including most reasonable doctors themselves (again, we must exclude the greediest of the greey) - is simple proof that they are fairly remunerated.

[itimebomb2]

Want more proof of the intangible benefits of medicine?

 

How many of you would give up medicine even if you didn't earn a cent in residency?

 

Hell, even if a couple of the old farts with families give up because they simply can't handle it (assuming the banks don't just raise their lending) -- there are thousands of equally, if not more qualified premeds waiting to graciously take their place.

[Satsuma]

Hell, even if a couple of the old farts with families give up because they simply can't handle it (assuming the banks don't just raise their lending) -- there are thousands of equally, if not more qualified premeds waiting to graciously take their place.

 

There are alot of people who would be willing to do alot of things, for little renumeration. Just because there are people willing to accept abuses, doesn`t mean it would be fair. And certainly doesn`t mean that a group as a whole needs to accept certain treatment, just because others would.

[Guest copacetic]

i mostly agree except for the notion that salaried postions dont get overtime. alot do.

[cheech10]

There are alot of people who would be willing to do alot of things, for little renumeration. Just because there are people willing to accept abuses, doesn`t mean it would be fair. And certainly doesn`t mean that a group as a whole needs to accept certain treatment, just because others would.

 

How is it not fair? Residency conditions are essentially the same as they have been for the past 10 years (better in fact, with home after handover, etc), so it's not like the working conditions are a surprise to anyone that has done their homework. Any individual that doesn't like it, doesn't have to do it, but will then miss out on the benefits. The fact that so many people go through residency and many more apply but fail to get into med school, suggests that the benefits of going through residency (ie. getting your independent practice licence) outweighs the poor working conditions.

[itimebomb2]

There are alot of people who would be willing to do alot of things, for little renumeration. Just because there are people willing to accept abuses, doesn`t mean it would be fair. And certainly doesn`t mean that a group as a whole needs to accept certain treatment, just because others would.

 

Sure, in a perfect world we would all drive Benz's and live in mansions... but in my limited wisdom it would appear that in this world, the one willing to do the most for the least is the one who gets the job... Just because we were lucky enough to get locked into this privileged position (where due to technicalities, no one can really replace us at this point) doesn't mean we deserve idealistic treatment.

[Satsuma]

How is it not fair? Residency conditions are essentially the same as they have been for the past 10 years (better in fact, with home after handover, etc), so it's not like the working conditions are a surprise to anyone that has done their homework. Any individual that doesn't like it, doesn't have to do it, but will then miss out on the benefits. The fact that so many people go through residency and many more apply but fail to get into med school, suggests that the benefits of going through residency (ie. getting your independent practice licence) outweighs the poor working conditions.

 

There are many benefits with being a physician - hopefully the top on this list is having a career that you find rewarding. But that doesn't justify the poor working conditions. Though people may tolerate it for the end results. Does that mean that as residents and as potential consumers of healthcare, we shouldn`t advocate for change?

 

Sure, home after handover is an improvement - but that still means working more than 24hrs straight. Most people in this country would consider that an unreasonably long workday. Most patients are shocked when they find out that their doctor who is caring for them is sleep deprived. And with reason, I wouldn't want a sleep deprived doc taking care of me.

 

In Australia residents did a study. They had residents wearing badges, colour coded, and representing the hours the resident had been working. So...say 2 hrs, 12 hrs, 24 hrs etc.(I don`t recall what the exact breakdown was) Pts were asked whether they wanted that doc taking care of them and what do you think the outcome was? It's a no brainer.

 

Working conditions may not be a surprise, but that doesn`t mean residents need to just accept them, and not try and improve things. If residents before us just accepted things, we would`t have home after handover now. And we can certainly advocate for change to improve things for those to follow - now it seems not everyone will be appreciative.

 

And if physicians are leaders and role models in healthcare, shouldn`t we be trying to lead healthy lives? How is it that we can counsel pts to sleep more, eat better, exercise more etc, when most of us have a hard time living up to our own recommendations.

[coastalslacker]

Sure, in a perfect world we would all drive Benz's and live in mansions... but in my limited wisdom it would appear that in this world, the one willing to do the most for the least is the one who gets the job... Just because we were lucky enough to get locked into this privileged position (where due to technicalities, no one can really replace us at this point) doesn't mean we deserve idealistic treatment.

 

I find it interesting sometimes to look back on posts I've made in the past. My perspective and views are often quite different. My guess is that your perspective will be different once you've gone through clerkship and are in the midst of your residency. Maybe not, time will tell. I apologize for the sententious tone of this. Cheers.

[Mourning Cloak]

Apropos of this thread . . . .

 

Apparently CNN will be airing Pinkerson's excellent documentary of the Triangle shirtwaist factory fire on March 26, 2011. This fire was a pivotal event in the evolution of NA occupational health & safety legislation.

 

If you are lucky enough to receive a TV channel airing this - watch it!

[itimebomb2]

Agreed on the patient front - the tiredness is certainly a concern that needs to be addressed - but I thought we were talking about the "slave labour" as it pertains the remuneration, specifically. Working fewer hours in the interest of improving patient care would likely be matched by a concurrent decrease in wages.

 

Alternatively, it is probably possible to rework the call system so that hours are distributed in a way that doesnt require individuals to be up all night after a full day's work. Depends on the service, I suppose.

 

The most important thing in medicine - the patient - is being ignored in these arguments. The fact of the matter is that exhausted residents and doctors provide dangerous care, and patients suffer as a result. The culture of medicine accepts this substandard provision of care as a necessary evil, instead of trying to change the system so that patients are given better care by physicians who are not mentally and physically exhausted. This is unacceptable.

[NLengr]

Agreed on the patient front - the tiredness is certainly a concern that needs to be addressed - but I thought we were talking about the "slave labour" as it pertains the remuneration, specifically. Working fewer hours in the interest of improving patient care would likely be matched by a concurrent decrease in wages.

 

Alternatively, it is probably possible to rework the call system so that hours are distributed in a way that doesnt require individuals to be up all night after a full day's work. Depends on the service, I suppose.

 

If you took the number of hours and over halved them to a 40 hour week you would still work more than the avg. govt. worker at 37.5/wk.

 

If you then halved the salary accordingly you'd be making 25-26k per year in the HIGHEST paid provinces. If you assume you are working 240 days/year (365 days - (4 wks vacation + no weekends), you make a grand total of:

 

$13 bucks and change per hour.

 

The people in our hospital Tim Horton's make significantly more than this. Hell, the people at the private Tim Horton's make over $10 an hour.

 

That's downright shocking.

 

By the way, if you work it out to 80 hours per week at 52k a year it's roughly the same hourly wage, except now you get the added benefit of losing more to taxes.

[apache]

if i didn't have any debt i would, or would only do a fm residency

 

i can't wait until you get into residency, like satsuma said, i think your views will change, it's easy to say when you sit there in class for 15 hours a week... wait until you've been up for 30 hours straight, lol

 

Want more proof of the intangible benefits of medicine?

 

How many of you would give up medicine even if you didn't earn a cent in residency?

 

Hell, even if a couple of the old farts with families give up because they simply can't handle it (assuming the banks don't just raise their lending) -- there are thousands of equally, if not more qualified premeds waiting to graciously take their place.

[A-Stark]

Any economists out there? Unless that are some serious coercive forces involved, where there are not - market forces define a price. Since people are still hoarding to try to get into medical school to earn this so-called "slave wage" - there must be enough fringe benefits (and by fringe I mean securely becoming a millionaire for the rest of your life, and being one of the most respected members of society) - to justify the price.

 

Right, certainly all premeds have a good understanding of residency and where their career path will lie. And I've little doubt that market forces play a crucial role in determining Royal College training requirements, CaRMS processes, and collective bargaining via provincial residency associations.

 

Just like any career - the job market in medicine is dictated by natural forces of competition. Hell, if anything, the physicians have the greater coercive power in the relationship. They could work residents way harder before the number and quality of medical applicants and physicians even started to show minor signs of detriment.

 

I'd say that the improvements in hours and remuneration for residents can be attributed to shifts in the culture of medical training and the effectiveness of the aforementioned residency associations. The job market is dictated by demographics, billing rules, and - when it comes to hospital-based specialties - often government/district funding.

 

The only argument I MIGHT accept in this case is that residents are being coerced by more powerful attending physicians into receiving lower pay and greater work... but even that is a stretch, since they're along the same path.

 

There is certainly a culture of arguably excessive work and hours which can be seen still in some specialties at some centres (e.g. neurosurgery anywhere). Maybe when you actually get to clerkship you'll understand that there absolutely IS something of a "coercive" structure to work. Teams operate on hierarchies. If the senior always must know what's going on, the juniors and clerks will actually be doing the paperwork. And if your senior asks you to, say, pull a central line and put pressure on a patient's neck or groin for 20 minutes, you do not have an option to decline. Saying you'll "get to it later" is probably a bad idea too. Similarly with discharge write-ups/dictations, writing transfer orders, or, of course, going to see a patient in emerg.

 

I do NOT in general have any problem with doing so-called "scut" or paperwork or, well, generally doing various "patient care" tasks. But you're fooling yourself if you think that this is some situation of "market forces" or "free choice". That's just nonsense.

[NLengr]

If we reduced the hours to ~40-50/wk, residents should still be paid 45k-52k same if they want close to parity with other young professionals.

 

It's only fair to pay physicians the same as the lower paid of the young engineers, accountants, pharmacists, lawyers etc.

 

If that was the case, I'd be happier with the pay.

[apache]

i guess sometimes people like to see things in black and white, it's easier that way, you don't have to dig that deep or think that hard.

 

you can tell that to the 5 women in surgery talk i attended, 4 of whom went into tear filled diatribes about how horrible their life was, one of whom had to take a year off of stress leave, and all of whom complained of psychological abuse... that's not "overtly" coercive, because ****, we can't measure it, guess that means it doesn't exist

 

 

None of the examples you stated, Muse, are examples of overt oppressive/coersive forces. If they can be reasons not to go into medicine, they are more easily be explained by poor miscalculations by premeds/med students than by actual lapses in the system.

 

[Der Kaiser]

Nobody is so rational as to be able to predict the future no matter how much information they might have. Students considering medicine will not truly understand the difficulty of residency without actually doing it. They cannot be considered rational actors responding to market forces, because they are not rational and they do not have perfect foresight. Not to mention that by the time a med student gets to residency he/she has already invested 6-8 years into medicine. They may not think the payoff is very good, but they do not want to lose the value they have already accrued (in terms of future earnings). Anyway, I guess I am saying it is not as simple as rational actors responding to market forces.

[apache]

a perfect synopsis of the long paragraph i wrote way back, but short sweet and concise, perfect post!

 

Nobody is so rational as to be able to predict the future no matter how much information they might have. Students considering medicine will not truly understand the difficulty of residency without actually doing it. They cannot be considered rational actors responding to market forces, because they are not rational and they do not have perfect foresight. Not to mention that by the time a med student gets to residency he/she has already invested 6-8 years into medicine. They may not think the payoff is very good, but they do not want to lose the value they have already accrued (in terms of future earnings). Anyway, I guess I am saying it is not as simple as rational actors responding to market forces.

[Ian Wong]

Nobody is so rational as to be able to predict the future no matter how much information they might have. Students considering medicine will not truly understand the difficulty of residency without actually doing it. They cannot be considered rational actors responding to market forces, because they are not rational and they do not have perfect foresight. Not to mention that by the time a med student gets to residency he/she has already invested 6-8 years into medicine. They may not think the payoff is very good, but they do not want to lose the value they have already accrued (in terms of future earnings). Anyway, I guess I am saying it is not as simple as rational actors responding to market forces.

 

I don't think it's possible to realize exactly how much medicine demands of you until you are living it, particularly residency. Residency is a whole other level of commitment beyond medical school. It's an incredible stressor, between the sleep deprivation and gravity of the decisions you make on a daily basis.

 

I don't think the average med student has any idea of just how draining residency can be until they've lived it during clerkship, let alone someone who is premed.

 

Ian

[itimebomb2]

if i didn't have any debt i would, or would only do a fm residency

 

i can't wait until you get into residency, like satsuma said, i think your views will change, it's easy to say when you sit there in class for 15 hours a week... wait until you've been up for 30 hours straight, lol

 

True - my views will change when I hit clerkship. They will change again when I hit residency, I'm sure. All our views will change when we've been practicing attendings for 20 years. How many attendings do you know who would say now that all their work in residency (and the crappy pay attributed to it) wasn't well worth it in the long run?

 

Pointless calculations of the hourly wage of a resident do not take into account the long term benefits of medicine. How do you emunerate the value of a highly respectable, extremely portable, and recession proof job? That's priceless!!

 

Anyways we're going around in circles now. As long as we're bemoaning unfair slave wages, we might as well talk about grad students and the thankless and grueling crap they have to go through for a miniscule wage and an outside shot at a respectable job.

[itimebomb2]

i guess sometimes people like to see things in black and white, it's easier that way, you don't have to dig that deep or think that hard.

 

you can tell that to the 5 women in surgery talk i attended, 4 of whom went into tear filled diatribes about how horrible their life was, one of whom had to take a year off of stress leave, and all of whom complained of psychological abuse... that's not "overtly" coercive, because ****, we can't measure it, guess that means it doesn't exist

 

What definition of coersion are you using here? Just because their life sucks doesn't mean they were being coerced. First of all, no one coerved them to go into surgery where "abuse" is well-known and commonplace. Secondly - yes, some working environments suck - but thats probably just as true of the garbage disposal industry as it is in medicine. Some people are jerks - but that has nothing to do with the remuneration........

[coastalslacker]

you should stop.