Residencies: doctors have it figured out - page 4

by Amistad

8,589 Unique Views | 77 Comments

After chatting with a fourth year med student today at clinical, it occurred to me how vastly different the physician career-path is from our own. Fourth year medical students are undergoing the process of being matched to a... Read More


  1. 2
    Quote from applewhitern
    Not all doctors work their residencies for "dirt cheap wages." The resident doctors at my university teaching hospital are paid more than I make now, plus they only work 4 days per week. They have generous amounts of time off, and they can work in emergency rooms for extra money if they want to.
    They are definitely in the minority. Most residents work about 80 hours a week (it used to be more, but laws now prevent that due to patient safety issues) - I believe the national average has the typical resident making about $12-15/hour, when you consider how many hours they work.
    anotherone and llg like this.
  2. 4
    Quote from nursel56
    On any given day on this forum you'll find nurses "eating their young" to be a hot topic. The pecking order in a typical 3 or 4 year residency structure would have those people beside themselves. Interns know they have to earn their respect as they plug through the hell of their first year. I don't think nursing has accepted the same, and is more focussed on being treated almost as equal to their elders in the nursing world from day one.
    GREAT post! I totally agree with this, especially.
    anotherone, chare, nursel56, and 1 other like this.
  3. 0
    Quote from klone
    One of the main differences is there are federal (?) regulations on how many new docs are made each year, in order to ensure that there are enough residency spots for all of them.

    No such regulations exist for new nurses or nursing schools. As a result, you see lots of for-profit and fly-by-night "schools" churning out new grad nurses by the thousands, and not enough new grad programs or residencies to accommodate them all.
    There are no fed regulations regarding number of med schools' graduates. There are money Medicare pays for training of the residents. There is only that much of the money, and there are accreditations' rules. If hospital has "X" beds and does "Y" surgeries every year, it can only have certain number of residents. Hospital has to have "X" number of high-risk L&D cases every year in order to train obstetricians, etc. But these rules are pretty flexible and "outside rotations" are not prohibited, so that's usually not a problem.

    Actually, Medicare pays for more residency positions then number of all Americn grads every year. That's why so-called "foreign medical graduates" can get into residency training. At the same time, Medicare (and anybody else, as a matter of fact) doesn't care if newly graduated and licensed doctors can find jobs or not. Right now there is a dead glut of pathologists but pathology residencies continue to churn out grads just like before because they got the money to spend on doing just this. As I mentioned, it is not impossible but extremely difficult for a doctor to change specialty after he/she was initially "matched", and specialties in medicine are prone for the same "fashions" and "waves" of popularuity as everything else.

    Of course, getting $200000 every year for training of one resident who is paid $50000 over the same time, the hospital sure could hire one more resident for the same money. But, you see, it will decrease what attendings can legally pocket for their indespensible "teaching functions". They suffer so much inconviniences calling those friends of them, aka drug reps, to come and tell their residents about those new miracles from the pharmacy and feed them stale pretzels, or mouthing their old war stories by hours while rounding... it would be unacceptable to deny them some miserable financial gratification!
  4. 0
    BTW, doctors as a community vehemently deny the very fact of existence of violence in residency programs.

    In nursing, I cannot imagine situation where a preceptor would have absolute power over a new grad nurse, limited only for things like gang rape, and where the new nurse would knowingly forfeit his/her legal rights in order to remain in training and not to kill chances of being a nurse in the future. But that's how it looks like in some residency programs. If you take a textbook for doctors, chances are you'll find a list of "experts" or "referrees" in there, many of whom will be listed as "residents". These people were "honored" to do a job of writing down whole chapters for the author without any pay, any royalties from the money which came from selling the book and such, all that done in their sparce free time. It is so specified in legal paperwork they have to sign to be so "honored". For some of them, the "honor" would be an opportunity (not a guarantee!) to get a reference letter from the author. For some, it would be a single option to just stay where they are. And the opportunity to become such sort of intellectual slave is considered to be a hallmark of a good, benigh residency program. The worse ones can be only compared to a cross between gestapo, ghetto and Moscow in 1937.
  5. 1
    Quote from BostonFNP
    Nursing needs more education not less.
    *** Maybe if nurses were not graduating so well educated, but useless at the bedside, there would be more interest in hiring new grads.
    morte likes this.
  6. 1
    Nurse "residency" programs are the exception and not the rule and I have found they are "offered" by the larger academic type facilities almost exclusively.
    *** Yes I understand that. However a few health systems use a universal nurse residency program for all new nurses wether the grad working in the big flagship hospital or one of the smaller feeder hospitals in the system.

    They don't offer new grads positions because they are too cheap to train them. They staff poorly on purpose and complain about a nursing shortage that doesn't exist.
    *** Yes well said and 100% correct. However it is my observation that new grads are graduating from nursing school helpless at the bedside and not having learned simple and basic nursing tasks and skills. Rather than the well trained new nurse concentrating on learning time managment, advanced skills and critical thinking when she is first hired, she must be trained in fundamental nurse tasks and skills by her employer. This dramaticaly increases the cost of training new grads.

    A simple orientation to new grads isn't an unfair expectation and if they are so afraid to train them and loose them I do think it is reasonable to have them sign a contract that put a time limit on how long they must stay top "pay for" the education
    *** I agree but a simple orientation isn't going to be enough for new grads going into specialiety units. Any new grad should be able to function on a med-surg floor with a few week orientation. They can't though cause nursing schools are letting them down.
    morte likes this.
  7. 0
    In the US, there is (and has been for some time) a shortage of physicians. While in the past, there may have been some localized shortages of nurses, in most parts of the US, there is now a significant oversupply. Virtually every medical school graduate passing the USMLE finds a position as a doctor in short order and it is extremely rare for a licensed new graduate physician to not find a job in practice. In contrast, growing numbers of nursing school graduates passing the NCLEX struggle to find work of any sort and it would not be surprising to find that large numbers new grad RN's never work in health care.

    The US presently ranks 53rd globally in the number of physicians per capita, with fewer doctors relative to population than nearly all industrialized countries and even some third world countries (Physicians (Per 10,000 Population) - GlobalHealthFacts.org). The situation is quite different for nurses with the US is in the top tier - 15th on a per capita basis (Nurses and Midwives (Per 10,000 Population) - GlobalHealthFacts.org).
  8. 1
    Quote from chuckster
    In the US, there is (and has been for some time) a shortage of physicians. While in the past, there may have been some localized shortages of nurses, in most parts of the US, there is now a significant oversupply. Virtually every medical school graduate passing the USMLE finds a position as a doctor in short order and it is extremely rare for a licensed new graduate physician to not find a job in practice. In contrast, growing numbers of nursing school graduates passing the NCLEX struggle to find work of any sort and it would not be surprising to find that large numbers new grad RN's never work in health care.

    The US presently ranks 53rd globally in the number of physicians per capita, with fewer doctors relative to population than nearly all industrialized countries and even some third world countries (Physicians (Per 10,000 Population) - GlobalHealthFacts.org). The situation is quite different for nurses with the US is in the top tier - 15th on a per capita basis (Nurses and Midwives (Per 10,000 Population) - GlobalHealthFacts.org).
    That's all correct - except that the physicians' shortage is located into primary care domain, and that structure of the US medical care is unique. Nowhere in the developed world a doctor may be economically forced to choose specialty because necessity to pay back educational loans or inability to pay insane malpractice insurance rates. Nowhere in the developed world nurses and mid-level providers do so much of medical care. Drawing blood for routine labs, taking ECGs, teaching, complicated dressing changes, line and ostomy care, drugs titration were all parts of doctors' job just some 30 years ago and still are in many countries, not even speaking about "routine" prescribing, monitoring, labs control, etc., done more and more by mid-levels, just like feeding, ambulating and toileting were all parts of nursing care same 30 years ago. Now my classmates balk on taking vital signs and feeding because it is "CNA's job".

    If the system continues to grow the way it goes now, CNAs, MAs and other assisting personnel will be the most numerous healthcare "providers" while nurses doing meds, assessments and all other "medical" and educational care and mid-levels picking up 85% of the rest "routine" doctors' work. The question is what doctors are going to do after that happens. But that's their fault, not nurses'.
    chuckster likes this.
  9. 2
    Quote from PMFB-RN
    ***
    *** Yes well said and 100% correct. However it is my observation that new grads are graduating from nursing school helpless at the bedside and not having learned simple and basic nursing tasks and skills. Rather than the well trained new nurse concentrating on learning time managment, advanced skills and critical thinking when she is first hired, she must be trained in fundamental nurse tasks and skills by her employer. This dramaticaly increases the cost of training new grads.



    *** .
    Double the number of clinical hours required. Make it mandatory for the program to keep accreditation to give students hospital-based clinical hours. Make externship/internship mandatory. Limit paper writing to 1/course for BSN programs and 2/semester for ADN and LPN. Make online courses available for core, leadership and such. Course papers shouldn't account for more than 20% of total score of every course. Every course must have clinical component (and if they cannot put anything clinical in "core curriculum", they probably can discard the whole thing as unnecessary). Make programs unable to offer optional courses like "death and dying" or "family nursing" without half time spent in clinical site.

    And, for God's sake, stop using labs! Students have their own bodies to practice on, and nobody will die because of couple of pokes. We do it anyway whether professors allow it or not.
    LadyFree28 and PMFB-RN like this.
  10. 2
    Quote from nursel56
    I think part of the problem is that medical schools limit the numbers and nursing schools are constantly trying to flood the market with as many nurses as they can.

    Are new nurses willing to work for dirt cheap wages and be on call for lengthy periods of time and submit to the hierarchical nature of medical residencies? It doesn't seem so.
    This is so true with regard to flooding the market. The BON's need to start capping the numbers including local and international nurses. You've got too many schools, too many eligible candidates for licensure and the result is a disaster.

    At least until there truly is a shortage years down the road, it would be wise to halt things, and most of those schools that have been cropping up in recent years should probably close anyway. Many of the newer programs are inadequate.
    morte and nursel56 like this.


Top