Lawsuit article

anybody know how to join the class? I'd love to be a part of any group that can dismantle the match. I think it is a horrible process.

Yeah I read it. I think they have a very legitimate antitrust claim but I don't know if any judge is going to make a drastic ruling on this one. The fact remains that people can't afford the quality of healthcare that they recieve in the US. What I mean is that the actual price of the services they recieve are artifically depressed secondary to us residents getting overworked and underpaid. To pay us what we are worth on the open market would bankrupt the system (or close alot of residency programs).

I understand your point about the possibility of dismantling institutions. However, I doubt these institutions can find nurses or PA's to do the same work at the same pay. Consider the following:
Results of the 2001 AAPA Physician Assistant Census Survey indicate that the mean total income from primary employers for PAs who are not self-employed and who work at least 32 hours per week for their primary employer is $71,046 (standard deviation $18,364); the median is $67,743. The comparable mean for PAs who have been in clinical practice for less than one year is $59,839 (standard deviation $11,963); the median is $58,578.

That's for 32-40 hours. How much for 100 hours? Obviously residents will probably never make $100,000, but I do think better compensation and less hours could be achieved if the match was eliminated.

I read the article and thought...wouldn't it be nice if... Then the dream ended and I woke up!!!
I think the real issue is enforcement of the limitation on weekly resident work hours and the duration of each shift. I know that as a 4th year med student post call on ortho, by 4:30pm I could care less about $$$$ and just want sleep.
Although the fixed salaries DO appear to be in violation of antitrust legislation, some compromise could certainly be made between the institutions and the residents. It's a scam the way the residency programs in the big/popular areas that attract the 25-30 y/o graduates & pay their residents so little because they know they have location going for them. On the other hand, programs (such as the infamous Toledo, MCO) pays big bucks to get you to a small midwestern city, with less "big city" trauma experience, low cost of living etc.
:evilgrin: :evilgrin:

This lawsuit is trouble.

I can't help but think that it might improve the lives of some, but ultimately shut the door on many others. The NRMP has vastly simplified the matching process and allowed applicants like myself to apply to a crap load of programs and increase his/her chances of applying at a good program. Imagine having to submit separate applications, LOR's, personal statements, etc. to individual programs. I think the process is fine like it is.

Higher compensation for residents would result in an increase in the cost of medical care (meaning more people will go without), a decrease in the number of residents in programs (meaning more work for those who are left) and ultimately a decrease in the number of people getting into medical school.

Secondly, we do provide an incredible service to medical institutions. But one fact remains: In a sense, we're still students learning a trade. Patients don't come to see us, they come to see the attendings who teach us. There are many ATTENDINGS out there who don't make $100,000/yr. I sure in h$%& don't think I deserve the same compensation as them. We're doing the hospital a huge service, but the hospitals are providing us with a structured environment where we can tool around with actual patients and learn how to be doctors. We've come a long way since residents lived at the freakin' hospital and barely made enough money to feed themselves (where the term 'residency' comes from). I'm gonna get paid almost 200,000 dollars to learn my trade over the next five years, so I can get out here and pull down a minimum of $300K/yr in practice. I don't think my life is all that bad.

I agree with bone_jock 100%. More money during residency would be nice, but it will all end up on the shoulders of those who can't afford health care in the first place.

If you really want to make a difference in the financial situation of young doctorss, go after the med schools that leave most of us 6 figures in debt when we finish. If a class action suit arises attempting to recover somce tuition dollars, I am ready to hop on board.

Ortho 2003,
If you decide to charge after the med schools let me know if you need a wingman! I owe so much money that at our loan exit interview I was given the option to surrender a limb instead of cash. I would agree that this is the root of the problem and (as Bone Jock said) not the salaries we will earn.

Let's roll.
:roll smile:

Interesting article which raises some valid points. I would like to post this article to the front page to see what kind of responses we can generate from staff/fellows/residents that may not visit the OSRR Forum.

Could the 8 members who posted comments please send me a PM letting me know whether you would be willing to post your comments on the front page of the Orthogate site as well if this article was posted.

Boy, I vehemently disagree with most of the comments here. I guess the bottom line is whether one believes in free market economics or not (the comments here have a very socialist feel to them). Doctors provide a service to their clients (patients) in exchange for things. Some physicians work for money, some for the intellectual challenge, some for the rewarding feeling they get from helping people. Most do it for the combination of these things. I think the sweeping generalizations above that "it would bankrupt the system" and "programs would close their doors" are complete BS. Residents are extremely profitable employees for their hospitals. They allow a vastly larger number of patients to be seen than could be done by the tiny board certified staffs of hospitals but they still bill for the visits. Furthermore, when changes in laws come about such as the one proposed by this lawsuit, free markets adjust extremely quickly to sort out the situation. If residents suddenly cost hospitals 60k/yr instead of 35 or so they do now, how do any of you know what would happen? You don't. We can make some guesses, some inferences maybe, but nobody really knows how the medical economy will react to that. I have my own opinions about what will happen, but it would be pointless to voice them here because the truth is nobody really knows. The important thing to think about with this suit is its moral/legal merit. Whether or not you are on board with the complainants has nothing to do with how you think the medical economy will react to higher salaries. What you should think about is whether or not the AAMC is breaking the antitrust laws that have been in place for decades to protect employees. It alleges that young physicians are being singled out as a group and treated in a manner that is patently illegal for any other group of employees. It poses the question "why should we be treated differently than everyone else?" I for one don't believe that just because I'm learning while working means that I should be paid less than I'm worth. Every employee learns while he is working. IT employees work towards certifications on certain types of software that will boost their income, young attorneys learn from more experienced partners and grow their income potential progressively, etc etc. Just because we are working toward board certification and the greatly increased income that attends such, doesn't imply that laws against setting salaries don't apply to our industry. The hospital makes money off its residents, so why shouldn't they share in those profits? Or at the very least why shouldn't we dismantle a system that allows all residencies to work in concert to keep salaries low?

The other thing that drives me crazy in this rhetoric is the way some people quickly turn it into a victim-based argument and cry that if residents demand to be paid fairly that it is the poor that will suffer. This talk only paints residents who want to be treated fairly as animals that would rather hurt the poor than shoulder their fair share of the burden. That description of young physicians is completely unfair in my opinion. Further, there does not exist to my knowledge any real hard evidence that there is a negative correlation between resident physician compensation and health care utilization by the poor, so the argument is based on nothing factual whatsoever.

I would ask that you guys think about what this lawsuit alleges before you pass judgment based on emotions and gut feelings. I for one will be watching this suit very closely and hope it brings about some much-needed changes in the way the medical world looks at resident physicians.

Okay, somebody needs a hug.

Consider this: There are about 15000 new physicians that start residency each year. Increase each of those residents salaries by JUST 30,000 dollars and that equals a price tag of 450 TRILLION dollars of extra fundage that has to be made up some where. And that's only for the first class of residents. They have to continue to pay those residents as well as new residents that come in year after year. And I suppose the magical healthcare fairy is gonna pull that money out of a place where the sun don't shine. No. To breach that gap hospitals will have to raise the cost of care, which will ultimately get passed on to the consumer. Up goes insurance premiums and up goes the number of people who can't afford health insurance.

If you want to argue about work hours. . . .fine. That involves quality of patient care. Financially, I repeat that our lives are not that bad. This argument sounds like full scholarship Div. I athletes who want to get paid for playing college sports.

The hospitals are doing us a FAVOR. WHAT ABOUT MALPRACTICE INSURANCE? We could increase your salary to 65K/yr and make YOU cover your own behind. If we make mistakes, they fall largely on the shoulders of Staff physicians and the hospitals. Again we get to "practice" on real live people and get paid to learn for the first time in our lives.

What if they just made residency part of our schooling? What about that? They could just do away with resident salaries all together and make it post-post graduate work. In which case you can take out more loans on your way to getting your M.D., Res. degree
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Bone Jock, you continue to completely misunderstand what I am saying here. Apparently you think if you throw out some ridiculously large number and proclaim that it will be passed directly on to poor people it will make me feel guilty for wanting free market economics to be present in medicine. You are mistaken (and wrong for that matter). 15,000 residents time 30000 dollars equals 450 Million dollars. You were close, just off by a few orders of magnitude. Anyway, that is not my point at all.

I do not decry the lot in life that residents have. Sure we work long hours and get paid less than the nurses we give orders to, but we do it because we love it right? In this country we have an economy based on exchanging valuable entities with each other. Resident physicians are compensated for their 80-100 hour work weeks in many ways. We get a salary, we get our health and malpractice insurance paid for, and we get knowledge from the staff that teaches and employs us. It is up to each potential resident to decide if the combination of those things is valuable enough to give the employers his effort for 3-5 years. The lawsuit in question and my agreement with it has zero to do with how bad residents' lives are and even less to do with how hospitals would pay higher salaries. The fact is that it is against the law in the united states for all of the companies in a given industry to band together by sharing information to keep salaries equal and low. That is exactly what the current match system does and the complainants are simply asking that the laws be enforced in our industry like they are in all the others.

For us to speculate on where salaries would go and how the hospitals and their clients (patients) would then pay those salaries is completely pointless. We don't even know if salaries would go up if programs couldn't share this information. Take orthopedics for instance. For years there have been many more applicants that spots in residencies. Don't you think that those unmatched guys would take say, half your salary to have your spot? I know I would, because the knowledge I would gain from my residency is so valuable to me that I would actually pay to get it. Salaries could very easily go down if unregulated, we just won't know until that happens. All I'm trying to say is that if the AAMC got out of the way and just let these programs sell themselves to applicants with all they have to offer (including salary and work hours), that the market economy principles would sort out the salaries, the number of applicants, etc ad nauseum. There will always be a need for new physicians and those physicians need training. That void will be filled one way or another. I just think that the whole thing would work better if it were unfettered from AAMC's current level of regulation.

I gotta run but would love to continue this discussion later. Damn ACLS!

later.

Touche mon amie. You got me on the math thing. Last time I try to calculate something in my head. But that's why I'm in medicine instead of engineering. Any way, I guess we'll just have to agree to disagree. But I too will be carefully watching the results of the suit. Later dude.