Isn’t that the norm throughout residency and fellowship programs nationwide. Is it right, nope. Has to been normalized; yes.

I believe you are correct that it is norm and agree that it isn't right. So they are taking steps to change that.

Time to change the norm

Is there overtime pay involved?

Nope. Their hourly adjusted wages are quite often well below minimum wage.

William Stewart Halsted developed a novel residency training program at Johns Hopkins Hospital that, with some modifications, became the model for surgical and medical residency training in North America.

Halsted was a known cocaine addict.

They tried it. They did huge studies on it. It ended in way worse patient care and more deaths. Handoffs are the biggest risk to a patient and unfortunately these long shifts resulted in better care

My wife works for a penn affiliate. It’s been pretty awful in my opinion so far.

Residents and many fellows participate in a process called the “match”. You interview for positions, put in your preferences and on a certain day the computer spits out where you will work. This means there are no opportunities to meaningfully compare or negotiate salary or benefits. And once you’re matched your choice is to either take the job or significantly derail your career after you’ve already spent 8 years studying (undergrads + med school).

The 80 hour cap itself is relatively new; 20 years ago there were few if any guardrails.

Citation?

Hearing stories from friends and family members in residencies around the country really opened my eyes to how brutal these programs are. If people knew how sleep deprived, overworked, and exhausted some of these people are on shift, they probably wouldn’t want them treating people.

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The thing the article leaves out is how much money the hospitals save by having these workers because the cost of residency is payed for out of Medicare. UPenn covers a small percentage of what it costs to pay residents while getting 80 hours/week of free doctor labor.

u/ferrusmannusbannus imagination, 2023, Reddit.com

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Not at all. Ever.

Thank you for clarifying.

80 hour long weeks are nonsense already, but with that kind of pay it’s straight up absurd.

If you're referring to the iCOMPARE study, that is patently false. There were no differences in mortality, readmission or other patient safety indicators. Interns reported more dissatisfaction with flexible hour programs (i.e., not long shifts) while program directors felt the opposite. https://www.nejm.org/doi/full/10.1056/nejmoa1810642 https://www.nejm.org/doi/full/10.1056/NEJMoa1800965

There was similarly no difference in patient outcomes for surgical residents. https://www.nejm.org/doi/full/10.1056/NEJMoa1515724

Additionally, it is not the long shifts that are the problem. Almost everyone who does this job knows what they're signing up for at this point since your last 2 years of medical school is spent spending thousands of hours around residents. What people I've talked to have a problem with is being undervalued and abused by the healthcare systems on top of these expectations.

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Ok that made me laugh out loud. No, of course not! And I did the math once on my residency salary (years ago) and we only made about $12/hr

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Resident: "You want me to do what?"

Halsted: "WORK!"

Resident: "For 80+ hours every single week?"

Halsted: "OOO BABY YEAH, LET'S DO SOME MEDICINE!"

New England Journal of Medicine

https://www.nejm.org/doi/full/10.1056/NEJMoa1900669

Northwestern University

https://news.northwestern.edu/stories/2016/02/longer-shifts-surgical-residents-safe

Jama Study on Handover Mortality

https://jamanetwork.com/journals/jama/fullarticle/2589342

Canadian Medical Association

https://www.sciencedaily.com/releases/2015/02/150209122838.htm

New England Journal of Medicine

https://www.nejm.org/doi/full/10.1056/NEJMoa1900669

Northwestern University

https://news.northwestern.edu/stories/2016/02/longer-shifts-surgical-residents-safe

Jama Study on Handover Mortality https://jamanetwork.com/journals/jama/fullarticle/2589342

Canadian Medical Association

https://www.sciencedaily.com/releases/2015/02/150209122838.htm

Incorrect. The national average annual salary of US doctors is $183,500

Yeah lemme roll up this 100 and snort that fat rail of...medicine

And yet they keep building shiny new buildings. Its almost as if they are profiting off the sick and dying.

I’m talking about the findings of the FIRST study with surgical residents our of Northwestern as well as findings in Canadian ICU residents.

https://news.northwestern.edu/stories/2016/02/longer-shifts-surgical-residents-safe

https://www.sciencedaily.com/releases/2015/02/150209122838.htm

That is patently untrue lmao. There are some surgical specialists (cardiac, neurosurgery, plastics) who make 700+, but not many. 300-450k is more in range for general surgery, and these are people who have been through 5 years of grueling residency and usually have $250-500k in student loan debt to pay off. Surgery is not as sweet a deal as it seems to the general public, in fact it's widely regarded in medicine as a specialty for insane people.

Absolutely laughable how divorced from reality this is.

Also, future earning potential is not an excuse for working conditions that are unsafe for residents (and their patients).

It's probably a tiny bit more than that (I would estimate low 200s), which is good money, but people often forget the INSANE amounts of debt we take on for med school. I'm finishing up my third year and 200k in the hole, and I'm one of the lucky ones because I don't have undergrad debt. Some of my classmates are on track to hit $500k in debt by graduation :(

Yep, my dad said he basically lived at the hospital when he did his residency back in the 70s. Talking 120hr weeks

Yikes.

How much are you making now?

Thats why its called a residency lol. You are expected to live there.

Lol this is coming from Mr. Rittenhouse. I graduate this year with 300k+ in debt (only from med school). Will get paid ~60k working 80+ hours and most of that will go to my loans. I'm just hoping the match algorithm allows me to stay in my $750 a month apartment that floods with a hole in the ceiling that I felt lucky to have for med school given my financial situation. Yes, as an attending I'll finally get paid a good wage nowhere near 700k (200k if I'm lucky) and most of that money will be going to those loans for a while.

And at penn it’s even lower. Hospitalists at penn start at the mid $140s. After 10+ years post residency they can expect to be in the $200s.

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It’s like socialism for the admin sector of health care, both at hospitals like Penn but also insurance companies, pharma, etc. I don’t have the figures to hand but the size of the admin sector at most medical centers has grown tremendously compared to clinicians of any level.

Oh I know. My partner is a DO and I've heard plenty about the hospital administrators and the... ahem... vital work they do for the hospital.

In this country we always have money for two things: bombs, and paying administrators to spend all day in meetings, justifying the need for their own positions.

This is every university hospital across the country….

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There is certainly hard-work and debt that is put into it but most doctors in the US are part of the top 1% in terms of wealth. They are compensated very well. Medicine pays much more in the US than comparable European countries.

would you want your gallbladder removed by a resident who has been working 80 hours straight and not able to request time off?

Well someone has to make enough money to have 2 yachts /s

God, the level of disrespect that the ivory towers get away with >:(

Don't forget the 300k debt lol

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> New England Journal of Medicine > https://www.nejm.org/doi/full/10.1056/NEJMoa1900669

This study says: "Longer Shifts for Surgical Residents are Safe for Patients"

It does not say: "[Making residents work less hours for more money] ended in way worse patient care and more deaths. "

> Northwestern University > https://news.northwestern.edu/stories/2016/02/longer-shifts-surgical-residents-safe

This study says: "resident physicians who were randomly assigned to schedules that eliminated extended shifts made more serious errors than resident physicians assigned to schedules with extended shifts, although the effect varied by site." However, it adds a big caveat: "The number of ICU patients cared for by each resident physician was higher during schedules that eliminated extended shifts." Additionally, the shorter shifts could still be 16 hours, and there was no data about total hours worked in a week, just about the length of a single shift.

It does not say: "[Making residents work less hours per week or for more money] ended in way worse patient care and more deaths. "

> Jama Study on Handover Mortality > https://jamanetwork.com/journals/jama/fullarticle/2589342

This study says: "End-of-rotation transitions may introduce risk in internal medicine inpatient care."

It does not say: "[Making residents work less hours per week or for more money] ended in way worse patient care and more deaths. "

> Canadian Medical Association > https://www.sciencedaily.com/releases/2015/02/150209122838.htm

This study says: "Shorter duty hours for medical residents, although marginally better for residents themselves, may result in worse patient care, according to a randomized trial assessing resident duty hour schedules in the intensive care unit."

This is the closest to your argument, but again, it looks at the length of individual shifts, not total hours worked in a week or month, which may have more of an impact.

Until we see a few studies showing that sustained 40 hour workweeks with 8 hour work days are inferior in patient outcome, I think these are all just bullshit.

And even then, the issue is wellbeing of the residents. It's not all about the patients. My workplace does better if I work 100 hours a week; I do not.

go volunteer and do it for free then if you're such a hero

Making $1M is pretty much unheard of unless you’re a neurosurgeon working insane hours. Your friend is definitely an anomaly. Paradoxically you get paid less in more desirable urban areas with higher COLs as a physician. So it’s true that if you’re fine with living in an area that has a physician shortage you can make really good money in a low COL area. I find a lot of meaning in my work and overall don’t regret my decision but these days if you’re going into medicine for the money, you’re gonna have a bad time.

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Hmmm...if only there were some model where people didn't make mountains of money off the sick and dying. Has any country thought of that? Probably not.

lol just throwing your one anectode out as a hard fact. Reddit's fucking hilarious. Ortho is literally one of like 3 highest paid specialties maybe your brother should have mentioned that

The ones that do are falling apart and most opt for private healthcare regardless

40 hour work weeks will never work for residencies unless you are going to double the length of them which no one wants. You have an absolutely insane amount to learn.

$120,000

Temple needs this as well, if not more. The residents are overworked in a much higher acuity and higher volume area of the city. Their pay is comparably better than Penn, but any ability to negotiate is a positive for the worker. With the successful nurses strike and the graduate student protest, it's the right momentum

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Not bad.

Should be more, no?

80 hours? No thank you. I barely survive mentally doing half that.

Bro what? Just not true.

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https://www.wsj.com/articles/nhs-uk-national-health-service-strike-costs-11675693883

https://www.theguardian.com/society/2023/jan/08/sick-man-of-europe-why-the-crisis-ridden-nhs-is-falling-apart

https://globalnews.ca/news/9458260/health-care-private-options-majority-canadians-support-poll/

sure bud

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And they probably deserve it. Those residents are run ragged. Damn shame

The whole residency system needs an overhaul. I don't want care providers making medical interventions when they're sleep-deprived.

Even the NHS staff of 1.2M is made up of 50% clinical staff and 50% admin/support…

Doctors are characters, only group of people I’ve worked with who strictly insist on being referred to as “Dr Doe, not John” by other adults/co-workers.

Actual journalism and facts getting downvoted. Classic redditors in their little bubble

Big Four accounting firm’s do the same thing to associates. They should unionize as well.

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Give me 5 minutes and I'll post just as many articles saying the opposite. It's the Internet, it's easy to find confirmation bias.

Edit: only took me three minutes. It's wild, almost like different news sources are getting paid by different people to promote different agendas.

https://www.healthcare-now.org/blog/new-poll-shows-canadians-overwhelmingly-support-public-health-care/

https://www.washingtonpost.com/world/2019/06/04/brits-are-fiercely-protective-their-health-care-system-trump-suggested-he-wants-it-included-trade-talks/

https://www.cnbc.com/2019/05/17/france-versus-the-united-states-how-the-two-nations-health-care-systems-compare.html

I used links to real articles! According to you that means you have to believe me and support universal health care now or you're just a reddit nephew.

I’ve never worked with an MD that insisted on that, and I’ve worked closely with a lot of them for over a decade. I don’t work in a hospital setting though, so maybe that is why.

80 hours /week is on the light side for residency in general. 100 hours/week averaged over a month is the cap, so you could realistically have a 4 week schedule of 120 hours, 120 hours, 80 hours, 80 hours while making ~$50-60k/year depending on specialty and location

What's the average US vs. European med school grad's debt?

That's why US doctors get paid more. They're starting from a huge negative

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Fellowship comes after residency. You're comparing someone fresh out of residency training to an attending that just finished optional fellowship training

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patients want that too!

Me looking at the ivory tower salaries and trying to escape the toxic academic rat race asap

I read that in Robert Evans' voice.

/r/BehindTheBastards

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Removed, be civil

Removed, be civil

While you're at it, maybe look into why they have huge numbers of "temporary" employees with no benefits at all. And how they actively avoid letting anyone claim they caught anything at work so they can avoid paying them for time off. They are NOT the good guy.

It’s more than 2x in the US compared to the UL and Germany. Debt from school accounts for some but not all the difference. This has been explored extensively and it is widely accepted that in the US physician salaries, on average, are profligate.

I’m unclear about the down votes. These wages are publicly available in US labor reports and you can see that they are in the top 1% (even among some of the lower paid specialist). This is just a fact. Now, if you think they are too high, too low, or just right— that can be debated.

$120,000 an hour is pretty good

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Duty hour restrictions officially limit it to 80/week averaged over 4 weeks (https://en.m.wikipedia.org/wiki/Medical_resident_work_hours#Towards_an_80-hour_work_week) but many programs, including several at Penn, go over this.

Not if you get paid an hour a year.

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Who should unionize?

https://i.imgur.com/pK9HOgx.gif

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I believe the official cap is now 80 hrs/week averaged over a month. At least that’s what every program I’ve interviewed at has said this application cycle. But in reality you work till the job is done. Hell, even as a medical student I easily averaged over 80 hrs/week over some surgical rotations and even when we all went home the residents were going home to spend a few more hours finishing their notes and chart reviewing for the next day. You’re also heavily disincentivized to report going over duty hours because if your program is repeatedly reported for duty hour violations they’re placed on probation and may eventually be discredited, leaving you hundreds of thousands of dollars in debt with no guarantee of completing your residency at another program. If you compare hours to salary most residents, especially in the surgical specialties, make a good bit less than minimum wage.

You're being downvoted because Reddit can't reconcile a concept of the the victimized proletariat also being part of the oppressive 1%.

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Good, residents should unionize. This is not a problem unique to Penn. Nationally, residents (and fellows) are over worked and underpaid for the services they provide (not to mention their salary largely coming from Medicare and not the hospital itself). To give you a sense of things, senior residents and fellows often moon-light (pick up extra shifts), where they're paid the actual market rate for the work and it's usually about 5x the salary the hospital pays them. Large health systems (literally every one in the area) would not be able to function without their resident/fellow workforce.

The mystery bureaucrats and board members living in Penn Valley with long driveways will never let that happen

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FIRST PATIENT OF THE DAY IS ME. TIME TO ADMINISTER TOPICAL ANESTHETIC TO MY SINUSES AND REPEAT AS NECESSARY UNTIL HEART ATTACK OCCURS.

Eh, I don't think the match is the issue. I think it would be worse for residents on a more open market system.

The issue is they've got you over the barrel. You've got hundreds of thousands of debt on one end and need residency to get to the actual income on the other. And there are more people who want those spots than positions to fill.

You can't counter that imbalance with a one-on-one negotiation. You need a union - and even then.

This is a really embarrassing way to realize that doctor lied to you Lmao

One time my partner took her mom to the ER after a syncope. She got triaged in, they did an ECG, drew some labs, got a line going and gave her some fluids. After a while, the resident ER doc comes in. He's young, mid-20s, and looks like a train hit him. Just absolutely exhausted, no real rest for days, total warmed-over shit. He looks at my partner and says, "Yeah, so, it turns out your mom is just dehydrated. She needs to drink more urine."

"What?"

"Your mom's dehydrated. She needs to drink more urine."

"My mom needs to 'drink more urine'?"

The resident paused, stared into space for a moment, sat down on a chair in the room and silently put his face in his hands and then his head between his knees. He stayed like that for a minute, then just stood up and left the room.

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Work hour restrictions for US resident physicians is 80 hours/week averaged over four weeks not 100. Also a 24+6 hour continuous work limit.

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Wealth and income are not synonyms.

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The article about Canada is for the option for folks to pay for private healthcare if they want to. It does not say anything about the public healthcare system in Canada failing.

Regarding the first two articles, the NHS is struggling just like the private American healthcare system is struggling. We’re barely a year out from a global pandemic.

The US pays more per capita for healthcare than any developed country in the world. And it’s not even close. A few links doesn’t change anything.

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Oh don't worry. He's one unexpected deductable away from wholeheartedly endorsing free public healthcare.

Keep in mind that residents don’t make much at all. Less than nurses in lots of cases

I find that in hospital/work settings, it's professional to do that. Refer to them as DR, same as you would in school with Dr or Professor. But outside of work, at functions or happy hours, the person would be a real dick if they still made you call them Dr when you're not on the clock

That's the best resident story I've heard thanks for sharing.

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>Large health systems (literally every one in the area) would not be able to function without their resident/fellow workforce.

This is the issue. The system can't function without those people hours the residents put in. It's not like they're sitting there picking their noses.

If you take that away, the whole system is in shambles. Some departments of hospitals had this happen when covid would spread amongst those residents. Now imagine that happening not just to departments, but to entire hospitals? It can't happen. The issue as far as I can tell is that more residents are needed to spread out those hours.

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Did it work?

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Honestly (I work in healthcare finance in a large health system) the issue isn't lack of funds or staffing but ridiculous misappropriation of funds and staff.

A decent example is Hospitals everywhere regularly burn through admin staff (patient schedulers, coordinators, etc) refusing to give them a livable wage, so they leave. In the departments I have worked for it's uncommon to find someone in these roles who has been there for more than 3 years. These people are the backbone of hospitals (just like residents and fellows) They ask for a raise and get told no, so they leave. This seems like a random side note but the MDs in these departments are earning 10-15x the salary, a salary they earn 100% because of the efforts of the admin staff. When the a MDs admin leaves, their productivity dives, they have to work extra hours to meet quota and they become miserable. But... When budget season comes around the MDs gladly take their 5% raise and 10% bonus without a word about the admin folks that hold them up. Do the math, 5% of a 10x salary is half the admin salary... That's just the raise for inflation!

Every provider should be in support of paying everyone else more, we all are on the same team and need each other. Too many MDs and MBAs (nearly all hospital leadership are MD or MBA) say they want to fix things but don't actually put the ink to paper.

I could give 50 more examples of gross waste, from materials to art for the lobbies, but it just deviates from the point- hospitals can afford to pay these residents and fellows, it wouldn't break the system, it would just require the hospital to pay the people who are actually doing the work for their hours.

The argument is that in a few years the residents and fellows will get their big pay checks but at whose expense ... The patients!

Agreed - that was my point but you summarized it well!

I wanted to let others know that residents can’t just “pick up” and find another job like any other employee. There is a huge power imbalance between hospitals and the trainee doctors who work there. There are also essentially no market forces to dictate better conditions since medical students do not directly choose their residency program.

Exactly. The US med system may crush anyone who doesn't keep 500k+ ready for emergencies. Just don't have a crisis!

>Oh, and also publicly hang anyone who thinks...

This type of rhetoric is unacceptable regardless of ideology and if repeated will result in a ban.

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I do work with them closely though. I work in drug dev tho, not in a practice setting.

Yes, in this case it is both. It is a hard grueling job (especially the training)— i’m in a family of doctors— but for most they end up very well paid.

Every worker deserves the opportunity to be represented by a union

There are Penn residents that still do this.

I've worked with a few in practice and clinical who did still prefer "Dr" even at the casinos for work parties. Some of them can be pompous (even while taking off their wedding bands to drunkenly flirt with whoever they can)

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The 80 hours is in hospital time. If you’re lucky they’ll let you finish charting at home.

I see your "being in a family of doctors" and raise you "being a doctor in a family of poor people". My income is way higher than my family aggregate growing up. My wealth is negative: I'm still hundreds of thousands in debt, despite living like I'm still in section 8.

Also it’s more than 80 hours/week.

It’s bc of their non-profit status. They definitely make a profit but they have to put it back into the hospital hence the 500 million dollar+ buildings everywhere (ahem chop)

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I’m sorry to hear that. Not sure how long you have been a doc. Have you read white cost investor?

Just in my 4th year now. Definitely have looked at whitecoatinvestor and have been aggressively (most would say too aggressively) implementing financial best practices for awhile now. Still, despite having had a full ride to undergrad, worked since I was 16, and having had a side gig in med school, the debt is enormous. PSLF and REPAYE should get me through, but quite a few of my colleagues are in worse shape, and other career paths would have had much higher ROI. Workers everywhere are getting a raw deal, docs included. Capital defeats labor by a landslide.

Brought to you by Raytheon

I endorse this. I’m not a doctor (NP), but I work for a surgeon and see 100% of his post-ops. We absolutely could not do our jobs without the admin support staff. Surgical schedulers work miracles! The front desk is the face of the health system. I could go on and on. They need to be paid more and treated better. (Patients also need to be accountable for how they treat them, but that’s another story.)

Knew some scientists in Philly who were *always* having coke zero and pulling 9-12 hours days 6-7 times a week most of the time.

I'll never know whether or not that was spiked, but I have my suspicions.

Remember when the AMA fought against Nurse Practitioners having increased responsibilities in care providing settings?

Look at the trains - we said things would break if we allowed workers to strike to pursue things like better staffing ratios and safer working conditions. The strike was prevented/broken and East Palestine is paying for the greed of the railroads.

It seems like these hospitals *will* break as a matter of when, not if. The number of Alzheimer's, Parkinson's, and other neurodegen. disease patients is going to increase significantly as boomers and millenials age.

The for-profit hospitals' dilemma during the pandemic (a short-term shock of many patients everywhere at the same time) could not be resolved by clever management of travel nurses. Just-in-time deliberately removes as much slack as possible to turn it into profit, patients and care providers be damned.

We can pull the band-aid off sooner or we can deal with infection and sepsis later, but the bill for these profits that most of us don't see will come due.

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What a dumb take.

Go get treatment in a 100 plus year old building that's falling apart and with poorly retrofitted updates that frequently break then.

New infrastructure for better healthcare outcomes is a good thing.

I wish them luck with that, Penn is famously anti union and has a strong and effective management structure at keeping them out or otherwise knee capping them.

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Dated a girl that worked for the big four as an international tax accountant. It was much worse than dating a resident, her hours were double the most overworked medicine resident at times.