good.

Think of the poor CEOs

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Medicare pays over 100k to hospitals per resident just for literally having them there, not even accounting for the work they do. A third year resident physician at Montefiore makes 77k. So yeah, the hospital can afford to increase their pay and benefits, to say nothing of working conditions.

The only reason hospitals get away with this is the ACGME (accredits physician residency) has made it so doctors are (1) matched into a program and then (2) absolutely cannot leave the program if they want to become licensed. It's absolutely insane. I bet your employer would pay you less and treat you like shit too if your options were to work there or go find a totally new career after 8+ years of education and hundreds of thousands in student loans.

My dad was an administrator at Montefiore back in the old, old days, long before administrators got the mega salaries they get nowadays. He was an old-school socialist - started a bunch of free clinics across the Bronx and organized the first hospital at Rikers. He was instrumental in helping 1199 start at Montefiore (late 1950s).

He ended up getting fired because the board wanted to move to the sort of semi for-profit/HMO model in vogue the past few decades.

He would be happy to see this. Indeed, he'd probably have let them use his office to organize on the down low.

I'm a chip off the old block, so --> ❤️

Good! About time! Some programs like treated their residents better due to nicer program directors but others like IM and FM were notorious for overworking their residents.

Great! I hope ALL the residents in every hospital unionize!

I can’t wait for the people of New York to unionize. It would be amazing to see every New Yorker skip out on paying rent for a few years. For the utility work to give it to the people for cheap and charge the corporations more. Where every New York goes, so does the country.

I wish them the greatest success

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What? Lol I want to see the people of New York unionize at every level. It would literally change the world.

After seeing how much the nurses got this a no brainer

UNITED WE BARGAIN! hell yeah

Wtf, how is that legal? Sounds like there’s potential for a suit there

Perhaps I misunderstood, considering your handle.

Some time ago there was a law written that the ACGME is exempt from anti-trust laws and most residents who want to fight back are either too fatigued or don’t want to risk loosing their spot due to retaliation. Hard to fight back when you just got off your 26 hours shift with rounds in 6 hours

That is insanity and I can’t believe I’m just learning about this now.

Regarding your other point, individually it is quite hard but collective action and bargaining is quite impactful. Look at the recent example of the nurses strike.

I hope this changes some time soon

the most recent generation of residents is finally pushing back at this, monti case in point, but the work is far from over. it wont be until all residents are compensated properly for their work and aren’t forced to have multiple 24hr shifts a week. it literally is a risk to patient care and Libby Zion is a very tragic example. now you aren’t considered a “team player” if you accurately report your hours and don’t cap them at 80 a week

They're not even primarily fighting for pay. They want to be less overworked.

Additionally a big problem with that sentiment is...

Many hospitals claim that residents actually don't provide any value. It's part of the reason the resident system was created in the first place to subsidize them.

There's a chance they just say it's not worth it to have trainees and just hire full doctors only.

Roughly half of all companies only hire experienced candidates and make entry level workers someone else's problem

Good, they should.

Lol lmao at the idea that hospitals are going to replace their thousand plus residents, who are doing 60-90 hours of work every week, with attendings who won't work that much and will cost 3-10 times as much. Just lol. And imagine taking hospitals at face value that residents don't provide value. That is, on its face, a stupid claim.

You couldn’t be more wrong. Residents run these hospitals

Sometimes I like to mess around in the Texas subreddit with this account lol

People like your father are inspirations to me. I have loved learning about some of the activists from the 50s and 60s that were pushing to uplift their communities. The push for community building, unionization, and uplifting the working class that was present in the US during the late 1800s and early/mid-1900s ran deep -- but has largely been ignored as a part of US history. Speeches by Fred Hampton and other leaders during the 50s/60s still bring me hope of what our cities can become.

“Where every New York goes, so does the country.”

This is so hilariously out of touch. New York is behind on most things besides maybe public transport and even that costs the state/city way too much. New York is a great example of how public sector unions without a strong government actor to tame them can ruin a city.

good - the work conditions for residents are absolutely fucking abysmal and boggle the mind in terms of safety for both practitioners and patients, ~16 hour shifts for ~$70k your first year.

For real. Chances are most people’s ‘doctor’ is actually an overworked resident. The system would collapse in under a day if residents stopped working

The residency program is complete bullshit. It's basically slave labor and they do SO MUCH of the actual work for hospitals that have them, while getting paid worse than nurses.

IMO it's the part in medicine most in need of a change. No issue with nurses, but compared to residents they have a pretty sweet thing going. More money, less hours.

That won't happen. Because hospitals that say residents don't provide any value are just fucking lying.

Source: My partner is an attending physician at a teaching hospital. The residents do a lot of if not most of the work. Yes she's there to guide/supervise/sign off, but they're still doing valuable work (AND the hospital is getting paid more than the residents salary just for having them there).

It's a bluff, any hospital that decides to forego residents is stupid and their competition will happily scoop them up.

And honestly.. there should be some legal consequences for just blatantly lying for propaganda purposes like hospitals do all the time. Fraud? False advertising? I don't know, but it's crazy they can just say provably false stuff that pushes their agenda and 95% of the population that isn't really familiar with the issues in depth just takes it at face value.

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It's very clear that they've never met anyone who was ever a medical student, or worked with anything remotely close to the field of medicine.

I'm just telling you why the system exists in the first place.

Hospitals didn't want residents at all.

No I've literally had this exact conversation with an ER doctor.

>And imagine taking hospitals at face value that residents don't provide value. That is, on its face, a stupid claim.

It's the reason why the resident system was created in the first place. Hospitals didn't want to pay fresh doctors anything originally. It was a hastle to have them around at all.

The American Medical Association, created this system so fresh new doctors could get paid something even if they aren't actually adding much value during the time they're learning their trade, because of the time needed to train them and the increased liability.

> Residencies are traditionally hospital-based, and in the middle of the twentieth century, residents would often live (or "reside") in hospital-supplied housing. "Call" (night duty in the hospital) was sometimes as frequent as every second or third night for up to three years. Pay was minimal beyond room, board, and laundry services. It was assumed that most young men and women training as physicians had few obligations outside of medical training at that stage of their careers.

It's why they're called residents. It's necessary for the first few years of work to be extended training because no one wants to send fresh medical school grads directly into patient work by themselves.

But on the other hand, said workers are barely worth anything to the institutions because they need their hands held.

That's not why residency was created, and it's not what the AMA cared about.

Thought experiment: remove all residents from the hospitals. What do you think the result would be? The answer will tell you plenty about your claim that they aren't adding much value.

https://www.ama-assn.org/education/improve-gme/history-residency-and-what-lies-ahead

>remove all residents from the hospitals. What do you think the result would be? The answer will tell you plenty about your claim that they aren't adding much value.

Yes in the short term. We already know that hospitals would rather hire traveling nurses for 3-4x what a hired nurse would cost.

We already know that in plenty of industries where the interns and first and second year workers do lots of work, that's it's mostly used for.training purposes anyway and the work isn't very valuable.

And look. All I did was repeat what hospitals have said and talk about why the system exists in the first place.

I'm telling you there's a chance that this is reality.

Nothing you said was correct lmao.

Doctors can be licensed after completing 1 year of training. They can then leave at any time and practice. Furthermore, program transfers are incredibly common. I had three surgeons transfer into my radiology program.

Attendings are far more efficient than a resident. What takes 2 interns and a senior resident on the floor can be done by a single attending in the same time.

The point is that this is actually NOT reality, despite what hospitals are financially incentivized to claim. Residents provide cheap labor and keep hospitals afloat. The alternative is hiring more PA and NP who are by the nature of the way things are set up demand higher pay, or hiring more attending physicians who get paid even higher than that. Residents’ entire salaries are paid for by the federal government as explained above, providing free labor to hospitals. The vast majority of hospitals are such that in certain units the residents are the only doctors/“providers” there overnight. In what world can it be claimed that this is a net negative for the hospital?