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launched 10/21/03
is nrmp feeling the heat?
lawyers rule!
is nrmp feeling the heat?
lawyers rule!
Originally posted by trauma_junky
Ok, this may not be the place to ask, but what the hell.
What is the difference between a community and regular residency program?
Originally posted by Kimberli Cox
Community programs are "regular" residency programs. The distinction is usually between a Community and a University program. The latter are affiliated with a University (hence the name) whereas the former are not; they are generally run by private hospital corporations.
On that note, moving to General Residency Issues...
Originally posted by GeddyLee
Lawyers make more than residents because residents work for hospitals that are typically financially in the "red" and are paid for by the government. Law firms on the other hand make money hand over fist and can afford to pay more. Doing away with the match won't change this.
Ah...AMSA is up to their fine work again. Looking at the contract before you sign it will certainly mean all the difference in the world. Hey...isn't AMSA a major proponent for free medical care and universal access to medicine? I'm sure doubling every resident in the nation's salary will go a long way toward getting prescription drug coverage. Don't they also make it fairly obvious through their continuous rantings about the need for universal health care that physicians should be willing to take pay cuts? What do these people really want? a system that costs more and delivers less? These people are way out in left field on every issue. They are extremist in their views, and I find it disgusting.
Regardless of what AMSA says, or what anyone tells you, you do not want the match to be dissolved. This would create major havoc for fourth year students trying to jockey for a spot. You can imagine the kinds of negiotiations that might occurr....this applicant is better, but this one will work for 10K less per year...etc, etc, etc
Programs with financial troubles can choose poorer applicants, because, hey....they're desparate, they'll work for less.
What's wrong with the match? Maybe I'm missing something, but it seems legitimate to me. After all, you aren't required to rank a program that interviews you...and the outcome is that everyone gets the best applicant or program that they could. It probably saves hundreds of hours of leg work and phone calls.
Now that AMSA is involved, I'm really against doing away with the match. AMSA is the hoakiest bunch of flag wavers I've ever seen. Their magazine "new physician" is totally biased and never delivers any useful, truthful information to its members. Too bad they don't use all that might to fight for things that can be changed.
Seriously, do you really think being able to read the program's contract before you rank them is going to give you any real information? I've already read one...it's a joke. Just goes to show what an organization with thousands of medical students' support and lots of money can accomplish.....absolutely nothing.
Originally posted by orthoguy
I hate to do this, ohhhhh but I have to.
Residency is not about selling your wares to the highest bidder so that you can "bill as an attending." Its avowed purpose is to continue your training and mold a medical student teeming with information and no real skills into a physician. The law analogy simply does not hold true because lawyers are not expected to make life or death decisions for their clients. Lawyers are not expected to wake up at 3am when their patient having an MI. It is apples and oranges people.
It appears that some of you will not be content until we have restricted all work hours, turned the matching process into free market capitalism at its worst (hey I submit to you that my DO thread that has offended so many people holds more true than ever on this thread/abolish the match and let residencies bid over the best applicants/see what is left for the DO) and abolished our medical system.
As a resident you should consider yourself an apprentice refining your craft. If you continue to try to bargain like a businessman/lawyer don't be surprised when people start comparing our once noble profession to them.
Originally posted by orthoguy
1) Eliminating the match allows competitive specialties and competitive residencies to pit residents against one another giving contracts to those who underbid the rest. Want to do Optho at New York Eye and Ear, well 400 other candidates are AOA with a 250 on their boards as well. How does the hospital decide, well who will work the most for the least pay. Everyone wants to graduate with the NYE&E name, they are in the position of power, not the residents. The match levels the playing field.
2) What an intelligent thing it is to compare our system of resident salary to that of other countries especially when they for the most part exist in a socialized system. Perhaps you would like to eliminate the wonderful reimbursements you get as an attending gasman and convert to a socialized system so that you can make a couple of extra bucks during residency. Further, in Canada some residencies require that the resident PAY to train. Keep this in mind when you are constructing your utopia as well.
3) An and as for the "well pilots are regulated argument" I think you need to realize how dangerous it is to allow the federal government to establish restrictions o resident work hours. Though we come from the laziest generation of doctors, (this system has trained doctors for 40 years) we still must realize that restrictions will not end with just residents. No one regulates attending work-hours and ultimately this is where the brunt of the decision making falls. How long before the government realizes that there are PLENTY of attendings working more than 80 hours/week and puts a cap on their hours too. Then your lovely resident work-hour restrictions has impeded upon your ability to maintain a living.
4) Remember, our profession is not Law or the Airline industry, stop trying to turn it into those and ruin what makes becoming a physician so special. As a physician it is not our job to take care of our sick and dying patient?s for a strictly limited # of hours/week. We become physicians because it defines who we are both in and out of the hospital, as we care for sick people whenever they need it.
Stop living with the blinders on during residency and making decisions as if the 3+ years you spend in residency are they manner in which you will spend the rest of your life. You 2 really need to get a clue and stop thinking you can turn residency into some high paying, few hour working cash cow,
Originally posted by orthoguy
No one is disputing the effects of sleep deprivation. However I assume you did not read the rest of my post or that, since you are in PM&R, you truly do not appreciate what it takes to develop a competent internal medicine physician or surgeon.
Originally posted by drusso
Dude, you dug yourself into this hole. There is nothing you can say to erase the facts that:
1) *YOU* established your anti-intellectual credentials (and thereby lost all related credibility) by DO-bashing.
2) *YOU* established your reactionary point of view by arguing in favor of a broken system and not suggesting any meaningful reforms of your own.
3) *YOU* cling to being ****holded and fearful of marketplace competition.
And I did read the of your post and if you were intelligent enough to read the links I sent you, you would see the my response is that medical errors will not go up and training will not be adversely affected if the *PROCESS* of care is changed. Do you understand what "process of care" means?
Originally posted by orthoguy
I do believe anyone reading this will see that you actually have nothing to say on this issue and have reduced yourself to attacking my character rather than the merits of my argument.
Originally posted by drusso
Wrong. I've offered an alternative proposal to the match; I've suggested that graduate medical education be competency based instead of time-based; I've argued how changing the PROCESS of care in academic settings would accomodate more efficient resident working conditions; and, I've tried to persuade you that injecting more marketplace dynamics into the residency interview and selection process would promote better competition and encourage programs to increase their quality and wages to attract the high caliber candidates. You have brushed all these arguments aside only to continue to argue that DO's are inferior to MD's.
.
Originally posted by orthoguy
Um, read above, I have never bashed DO's on this thread, nor was it important to my argument. You seem to believe that competition is universally beneficial for applicants whereas I have told you it is not and given you examples as to why it would be not. Get over the DO thing from another thread and deal with what I ACTUALLY said here.
Originally posted by drusso
You actually wrote:
It appears that some of you will not be content until we have restricted all work hours, turned the matching process into free market capitalism at its worst (hey I submit to you that my DO thread that has offended so many people holds more true than ever on this thread. Abolish the match and let residencies bid over the best applicants and see what is left for the DO) and abolished our medical system.
So, there you have it. You believe that if the match is abolished (which I've never proposed) that DO's wouldn't get good offers. Why? Because you don't believe that DO's can compete against you? Why? Because you're a bigot?
You also have no interest in trying to dissuade yourself of these beliefs because you've never asked for clarifying information about the educational and training experiences of osteopathic physicians. Moreover, you admitted that you have no interest in actually actively *LEARNING* about the topic. Hmm. What other things in life have you given up learning about?
So, we'll put it to you: How would *YOU* reform the system? And why do you think your changes will work? And, if you think that they are so good, why haven't they been tried yet? That means that you acutally have to have a theory or philosophy about "how the world really works" and you have to convince other people that your worldview is right and hence your ideas are sound. You just can't say, "DO's suck." You have to have theories and evidence to support your statement that "DO's suck."
Remember, the goal is to come up with a cost efficient, safe, appropriately financed and compensated system to train graduate physicians comprehensively. And if you say, "eliminate DO's and US FMG's from the system." then our little debate is over because you would have proven to have not had a single benefit from your reflections on the subject.
I can't wait to see what you come up with...
Knowing that DO's are inferior with regard to intellectual capabilities and clinical training does not make one a bigot. It's no more intolerable than opining that highschool girls basketball is inferior to the NBA.Originally posted by drusso
Because you don't believe that DO's can compete against you? Why? Because you're a bigot?
[/B]
Originally posted by orthoguy
If you TRULY understood my posts you would see that I believe the current system is the best system, and that the alternative that you are "proposing" would do more harm than good. You do not address where this extra $$ is miraculously going to come from nor what the increased competition will do to middle of the road candidates applying for competitive specialties.
Until you are able to address these points, actually take the time to READ my posts and understand what truly occurs during a residency training perhaps I will just have to ignore you.
But when you realize that you have no counter-points to the issues I have raised feel free to wax poetically about my being a "DO bigot" , perhaps quote some W.B. Yeats. It certainly proves what an intellectual you are and enhances your non-existent proposal.
Originally posted by drusso
Why do you think that the current system is the best system and how do you reconcile this belief with the widespread call for reforms among, not just medical students and residents, but medical education as a whole? Why are you invested in the status quo? Why is clinging to your belief that DO's are inferior comforting?
Education is not the filling of a pail, but the lighting of a fire.
W.B. Yeats
Originally posted by want$it$bad
Knowing that DO's are inferior with regard to intellectual capabilities and clinical training does not make one a bigot. It's no more intolerable than opining that highschool girls basketball is inferior to the NBA.
Originally posted by GeddyLee
drusso,
You should be happy to make the salary of a nurse. Nursing never ends...residency does. You are in training. You need this training so that you can become a qualified doctor. You cannot practice good medicine without completing a residency.
You state that you should be paid attending salaries because you do all the work and the hospital bills for your services and blah blah blah.....why don't we just do away with residency training all together?
Certainly in a perfect world we'd all get paid attending salaries from the moment we graduate, but then the hospitals won't be able to afford us. And alas, the training we need becomes unavailable. Remember, your buddies working for law firms work for people who know how to make money. Hospitals haven't, nor will they ever figure that out.
And yes, it is unfair that the government regulates pilot work hours but not physicians'. But guess what, there just aren't enough of us to limit resident work hours to that degree. So then you must find more docs to cover, and then they all want higher salaries too. There isn't enough money to do it, and you need to be there as much as possible to get your training.
Now this AMSA crap, about giving students the right to negotiate their contract, is pure BS. No one here wants negotiation of resident salaries and contracts. Because I for one would work for free and take call Q2 to land a top residency spot in OPH. And how unfair it would be, when all the AOA USMLE >260 applicants lost out to me, because they all wanted to be paid 100K a year and take call Q15 with a 40 hour/wk work limit.
Some things are worth more than an un-noticeable increase in you monthly pay.
Originally posted by gasman2003
Orthoguy seems to rationalize the situation by saying "hey look out because we don't want attendings hours limited to 80 hours per week".
First, if I am an attending and I am working 80 hours per week averaged over 4 weeks, I would start job-hunting.
Second, I don't want an attending who has been awake more than 30 hours or working more than 80 hours per week averaged over 4 weeks, operating on me any more than a resident!!! These rules were put in place to protect patients and they should apply to attendings as well. If it is unsafe for residents (based on studies), it is unsafe for attendings. You spew this crap about being so idealistic yet when rules are changed to protect patients from overworked residents you balk at the idea. What a hipocracy.
People like orthoguy simply fear change because they lack abstract thinking abilities. This is why he/she a) can't figure out how to get their own log-in for this forum b) can't fathom the idea of a system out there which may improve conditions for both hospitals and residents.
Nobody is going to be working for free in a system without the Match. First, if the residents win the lawsuit than we will have protection as employees rather than apprentices/students. This means we can collective bargaining to negotiate higher salaries and establish minimum salaries (some hospitals already have resident unions). Second, what med school grad with 80,000+ debt is going to be able to work for free? It would certainly be the exception rather than the rule.
This same kind of controversy happened before the original Match system was put in place so it is no surprise that there is controversy now. It will all work itself out so people like orthoguy who are in panic mode can just relax.
I agree with Dr. Russo's advice that perhaps Orthoguy's time might be better spent updating his/herself on medical economics, law and medicine, getting his/her own userID, and osteopathic medicine.
Originally posted by edinOH
Fogive me for getting in the middle of your pissing match, but I would like to add my two cents (hardly worth even that really).
For every lawyer making 60k fresh out of law school there are ten more happy to be making 25k. There are no guarantees in the law. Feast or famine for most attorneys for their entire careers. Sure there are those who make millions as partners in big plush firms but the large majority are happy to clear a cool 100k a year after many years of busting their ass.
A friend of mine just graduated law school from a respected state institution. He has yet to find a job, just like many of his classmates. The market is pretty saturated right now. And when he does, he will be lucky to be making 36k. The same I'm making as a resident.
And have you looked at the salaries of architects? Someone mentioned them for comparison. 36k a year to start would be a blessing for most. Engineers make a little more. But the above two examples are all very susceptible to market vagarities. Something very few physicians really have to worry about.
If you do away with the match, residency would either become more like any other job search with take-it-or-leave-it offers, negotiations for salary and benefits etc. This could be very good for some and very bad for others. Or it would become much more like applying to graduate school. Similar to the application process as it stands now with just one minor exception. Tuition.
Some of the more competitive programs could start charging "tuition" for their highly sought after spots. One resident could be paying their 10k a year "tuition" to the program for the privlege of training there while another candidate might be there on "scholarship", receiving a $500/ month "stipend". The rest of course would be made up in even more student loans.
If you truly advocate a "free market system", then be prepared to be affected by free market forces. Some of the other, less compeitive spots would probably offer more money, but not the kind that some think they might see.
How would you like to be the average candidate who was forced to accept a position with a salary of 20k a year, 2 weeks vacation, and partially paid health benefits, working next to the much more competitive candidate who is earning 46k a year, gets 4 weeks vacation, and has full benefits and a company car? Market forces at work again!
The current system, in my opinion, is the best of the possible "win/win" situations for both the resident and the program. The virtues of which we are all familiar with.
And another thing. AMSA is the most clueless organization I have come in contact with in organized medicine.
Originally posted by ckent
Places like Hopkins and Harvard could start offering 20,000 in salary and benefits, and students would still line up at their front door wanting to sign their crappy contracts just to be associated witht heir name.
Originally posted by orthoguy
What was lost in the fray after the commotion the very flawed committee created was that patient care was not effected by sleep deprived residents, rather it was by residents who provided patient care without direct attending input.
And how unfair it would be, when all the AOA USMLE >260 applicants lost out to me, because they all wanted to be paid 100K a year and take call Q15 with a 40 hour/wk work limit.
What happened was that the applicants they got were people that cared a lot about money and not much else so in fact their quality of work force went down because of this!!! Sure they probably had higher board scores and better grades that year but they also all had in common the fact they they choose to go there because of the money not because of education.
Originally posted by Sledge2005
This comment really proves how far removed from reality you and your arguments are. There isn't a single resident in the country that doesn't make any patient care decisions without direct attending input.
I recommend everyone avoid this troll. What kind of reasoning it this?