www.savethematch.org ...

chef · Oct 23, 2003

launched 10/21/03

is nrmp feeling the heat?

lawyers rule!

Whisker Barrel Cortex · Oct 23, 2003

The residency system without the match will be chaotic and not in medical students best interest in my opinion. Imagine if you started getting approached and pressured into signing late in your third year. Some program offers you a spot and says you've got 3 weeks to respond. This is before you have seen any other programs. You could easily end up at a program that you will be miserable at. Offers will end up coming earlier and earlier. Maybe salaries will inch up slightly, but probably not enough to affect peoples decisions on where they will train. Not many will go to podunk community over a well known program just because they pay 55K vs 40K.

Just my opinion. I think to abandon the match will be a bad idea.

trauma_junky · Oct 23, 2003

Ok, this may not be the place to ask, but what the hell.

What is the difference between a community and regular residency program?

Winged Scapula · Oct 24, 2003

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?

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...

Amy · Oct 24, 2003

Just to be fair, here's the plaintiffs' website. It's best to see the argument from both sides...

http://www.residentcase.com/

trauma_junky · Oct 24, 2003

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...

Is there an advantage to one over the other?

edmadison · Oct 24, 2003

I've said this before and I'll keep saying it. What makes everyone think the lawsuit will make salaries go up. I think many will go down. Want a covetted ortho or derm slot -- many people would do it for free!

Be carefull what you ask for.

Ed

DR · Oct 25, 2003

Yeah, I'm not so sure the change would lead to a better way. Look what happened with HMO's...they tried to fix a system and it created a world of problems. I think if you talk to some FMG's, many of whom have gotten their spots the old way (until recently), you might see how the old system can be a bit scary. There's no way to shop around the old way, you just have to decide whether you want to accept their offer, within a very short period of time without seeing other programs. I also agree that salaries might not go up all that much. Supply and demand are major determinants, and the fact that there are very few derm spots compared with IM spots, etc. drives the competitive nature of the specialty for example. At the med school I graduated from, they had a large derm department and had lots of research going on, and it was very cutting edge...but they lacked a residency program. When students interested in derm asked why they had no program, they replied that the institution receives great pressures from medical organizations, mostly derm orgs, to NOT have a program. Interesting. I think when a system that was conceived over time, with thought and patience, suddenly is forced to quickly and hastily change, things are rushed and not usually very wll thought out. There is a danger of a different methodology that may be fraught with glitches, if it is conceived under the time and pressure climate of a lawsuit.

chef · Oct 25, 2003

eliminating the match.. what kidna timeframe r we talkin about here if the case is won by plaintiffs? 3-4 yrs? or more like 10-15 yrs?

Idiopathic · Oct 25, 2003

Medicare pays for residents right? Is there some sort of control they would have over pay scales?

drusso · Oct 27, 2003

Law school graduates go onto secure entry-level positions that involve on the job training without the function a match system. Ever see starting salaries at top law firms for first-year associates? They're way more than intern salaries at Hopkins, Harvard, or Mayo.

The first-year law associates must fiercely compete with eachother in order to work horrendous hours, get delegated the legal "scutwork" of the firm, and endure harsh working conditions all without the benefit of even signing up to take the bar!

So, why are they making almost three times as much as their first year medical colleagues at top medical institutions? Could it be that lawyers actually write the law?

gasman2003 · Oct 29, 2003

If top programs want to stay "top programs" they will pay competitive salaries or lose their candidates to other programs. Just like the law firm analogy...the top firms pay the best starting salaries...

Plus, salaries could never drop below minimum wage, which if you add things up, a lot of us aren't that far from...

I don't know what exactly will come of this lawsuit but I think it will ultimately benefit residents. There may be some bumps along the way though.

chef · Oct 30, 2003

changes r coming folks...

FOR IMMEDIATE RELEASE-October 28, 2003
Kim Becker, Director of Public Relations
Phone: (703) 620-6600, ext. 207
Email: prel@www.amsa.org
Web: www.amsa.org

NATIONAL RESIDENT MATCHING PROGRAM AGREES TO MEDICAL STUDENTS' PROPOSAL

Reston, VA - Yesterday, the National Resident Matching Program (NRMP) agreed
to a proposal set forth by the American Medical Student Association (AMSA),
the nation's largest, independent medical student organization, to increase
student choice and negotiating ability in the system widely known as "The
Match." Among the many changes, the NRMP incorporated a new requirement,
which had been strongly recommended by AMSA and under consideration by the
NRMP, to require residency programs to disclose, prior to the ranking
deadlines, the actual contracts applicants will be expected to sign after
matching with the programs. The new rule will take effect for applicants
participating in the 2005 Match.

"Without contract disclosure, students were unable to make a fully informed
decision about their choice of residency program," said Lauren Oshman, M.D.,
M.P.H., National President of AMSA. "Now students will be better equipped to
compare actual salaries, working conditions, and work-related benefits and
will have increased ability to negotiate for higher pay, better hours, or
more comprehensive benefits."

In response to an anti-trust lawsuit that was filed against the NRMP, six
other medical organizations and 29 teaching hospitals, AMSA-who is not a
party in the lawsuit- calls for improvements to the current system or
alternative models that would provide more choice and increased negotiating
abilities for applicants.

Matt Oster, the member of the NRMP Board of Directors nominated by AMSA and
a fourth year medical student at the University of Pennsylvania, presented
the changes to the Board.

The NRMP also agreed to link its website to the Accreditation Council for
Graduate Medical Education to better inform applicants about the
accreditation status of residency programs; instructed staff to present a
proposal for a comprehensive annual evaluation of the Match in order to stay
aligned with the changing needs of graduate medical education and
contemporary medical students; and convene committees to review the
composition of the NRMP Board of Directors and to evaluate the system for
helping unmatched applicants to obtain residency positions.

"Even though AMSA is not a participant in the lawsuit, we will continue
advocating for the rights, well-being and improved working conditions for
physicians-in-training," said Oshman. "This is the power of student activism
at its very best-this marks a positive step towards meeting students' needs
and protecting the future of medical education. The end result will be
better trained physicians and better quality of care for our patients."

GeddyLee · Oct 30, 2003

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.

drusso · Oct 30, 2003

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.

Fine. Don't pay me as much as my law colleague (who I probably had a better GPA than in undergrad), I'll settle for being paid as much as a nurse.

Other junior professionals (lawyers, architects, etc) must negotiate their wages and salaries in the real world. Their first jobs are considered "entry level" or "training experiences." Why should physicians have it differently? I'm a fully licensed PGY-2 resident. I have a medicare UPIN number. My institutions bills for my services *EXACTLY* like it bills for its attendings...

Why do you underestimate what our services are worth? If I get a poor end of the year review then I should get paid less. If I get a good end year review, do well on the in-service exams, etc then I should get paid more. Isn't this the way the world works?

orthoguy · Oct 30, 2003

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.

drusso · Oct 30, 2003

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.

Orthoguy,

You are afraid of competition and want to be ****holded by the medical establishment in the name of "training." That's pathetic. Removing the anticompetitive nature of the match would benefit all applicants (MD and DO alike). I have no problem with a centralized application system, but I do have problems with a system that treats all applicants as equals when in fact we are not. I'd open up the DO match to MD's (if they can demonstrate proficient OMM skill). My USMLE score was probably better than yours and if programs want me they should compete for me.

Talk to me about "molding" when it's 3AM and you're on your 15th admission (after being q3 for three months) and you've got a patient crashing on the floor and the ICU is "full" and you're managing a patient in DKA in triage because there are no monitored beds available and the nurse (who makes almost twice as much as you) is on her smoking break etc, etc, etc. Lawyer do in fact make life and death decisions--though not in the same way as doctors. You should not be so narrow minded.

Commerical pilots (and pilot trainees) are responsible for hundreds of lives at a single time and the federal government appropriately limits their schedules because the FFA has read the studies and understands the implications of sleep deprivation on human functional performance. Why are you protecting the system? What kind of panzy are you? If you believe that some VP of Nursing or hospital administrator is going to back you up when the **** hits the fan you are painfully unaware of the reality of hospital politics...

Moreover, I don't think you live in the real world. The hospitals make money off of housestaff as cheap labor. When you're an upper level resident and it's *your* license on the line, *your* medicare number being billed and service utilization monitored, *your* legal responsiblity, then you'll sing a different tune. When you're forced to practice "real medicine" without a net you'll see what I'm talking about. Do you think the hospitals will back up residents? Ha! Residents are disposable. Why, because the way the match is structured if a hospital needs to "get rid" of a resident, they know they've got dozens more where that one came from...

Medicine is a "business" (I also have a MPH in medical economics) a noble business perhaps, but a business all the same. Medicine suffers because it does not institute best business practices. Ever work in a VA or a county hospital? Dude, you're killing me! Ever hear the phrase, "No money, no mission?" Your "noble profession" and two dollars will get you on the No. 5 train.

As for your ridiculous MD vs DO thread. Give me a break. It's the year 2003. You obviously don't have a clue what you're talking about when it comes to osteopathic medicine---I've got four words for you "it's a social movement." Apparently, Albert Einstein does a poor job of teaching its medical students and housestaff professionalism...

Osteopathic Medicine: A Reformation in Progress

gasman2003 · Oct 30, 2003

orthoguy is an illegal user. He/she is posting under "orthoguy" but the account is registered to someone else. He/she admits this in the other thread.

I agree with Dr. Russo in that the system as it is set-up now isn't working. Residents are grossly underpaid. They call us employees when it benefits the hospital/government (why are we paying FICA on our income huh?) and students when it doesn't (i.e. limiting work hours, competition for salaries).

Other industries have had similar lawsuits in the past regarding fixed salaries and anti-trust suits and the courts have decided in favor of the student/apprentices every time. It is just a matter of time for the court to decide, and when they do the current system will be overhauled.

I personally think what needs to be done is to keep the Match system the way it is but to make the salary in-line with other professions and adjusted by region. No one with our education should be working the hours we do for $35,000/year. It is ridiculous. Other countries pay their residents much better $50,000-60,000+ (with more vacation), hell even the military pays their residents more than the civilian system here in the US.

As an anesthesiology resident we have our own medicare billing numbers and the hospital bills us out at $80/15 minutes. Why I am making like 8 bucks and hour and struggling to manage my debt and rent. The nurses and OR techs are making more money than me, and it isn't a greed factor, it is a "how can I survive" factor.

orthoguy · Oct 30, 2003

Ho Hum ,what medical school did teach me was a little common sense. You all want to end the match so that there will be this magical transformation of residencies where all of us work 9-5 mon-fri and get paid 65k/year to do it. Hey how wonderful it must be to live in this alternate universe created in your minds, but the reality of this simply does not bear out.

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) 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,

GeddyLee · Oct 30, 2003

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.

drusso · Oct 30, 2003

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.

Click to expand...

Hogwash. There could still be a centralized application system, but the candidates could be given substantially more choice and decision-making power. Programs would have to think more carefully about who they want and what they are willing to pay to get them there. They will have to decide if they want "work horses" who just work 100+ week or if they want to groom well rounded physicians who will have broad-based skills necessary to be future leaders. There will always be an impetus for programs to attract the "best and brightest" however they so choose to define it. Some highly competitive applicants will have multiple offers from highly competitive institutions. There could be an "offer day" where programs offer spots to their top choices, a "vetting period" where applicants consider their choices, and a "decision day" where applicants must register their final decisions.

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.

Click to expand...

Oh, boy you're really on the run if you're calling match reform and resident training reform the harbinger of socialized medicine. Two completely separate issues. Effective financing of health care is a hugely complex issue that has nothing to do with how hospitals profit from dangerous resident working conditions. Come on now...think straight.

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.

Click to expand...

First, I think we are anything but the laziest generation of doctors. The average medical school matriculants brings to medical school far more academic achievement and knowledge than those 30 years ago did. This generation of physicians is far and away more accomplished than any other generation in the history of medicine. The average medical school matriculant deeply understands and applies everyday a sophisticated biomolecular and technological knowledge base that medical students 30 years ago couldn't even fathom. These are the good 'ol days. Those were the bad 'ol days. Even better things lie ahead of us.

Next, you evoke the 'ol slippery slope argument. If we regulate resident work hours we will have to regulate attending work hours. Again, two completely separate issues. No one *makes* attendings work. They can walk away from their employment situation any time they wish. Residents cannot walk away. We depend upon the institutions that employ us for certification that will eventually allow us to be independent. Residents labor under the burden significant educational debt. If they do not complete the program, then they have few ways of ever getting out from under this debt. This is called indentured servitude. You may think such and arrangement is okay, but history shows us that it is morally bankrupt. One could argue that the entire graduate medical education system could be revamped along the lines of a competency-based training curriculum. Instead of a general surgery residency being 5 years long it could be 300 choles, 250 hernia repairs, etc. I'm not saying I support this, I am only saying that there exists many possible solutions. An alternate solution might be to completely subsidize all medical education so graduates owe nothing when they finish. Then, if you don't like the working conditions you can walk away from it and wait tables and be none the worse off except for the years invested in pursuing your degree.

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.

Click to expand...

So "special?" Please. Who are you kidding? You want to *REALLY* be special and take care of sick people--become a nurse. You want a calling? Become a social worker or a priest. Or better yet become an elementary school teacher. If you aspire to be a physician so you can be "some one special" you are hopelessly more pathetic than I could have ever imagined!

Who says that being a doctor means having to be defined by a professional role ipso facto? Sure, it define *part* of who I am, but I am also a guy who enjoys hiking, fitness, theatre, fine wine, cooking, lively debate, travelling, intellectual challenge, managing organizational change, research, politics, population studies, motivating others, etc. I'm someone's son, brother, lover, and neighbor. I'm a child of God. When I leave the hospital I am not "Dr. Russo." I am Dave. I do not introduce myself socially as "Dr. Russo." I do not have it on my credit cards. That's not to say that I believe that being a physician doesn't have a moral or societal obligation--it does. I only suggest that all professions (lawyers, nurses, social workers, psychologists, public health practitioners, college professors, intellectuals in general) have moral, social, and civic obligations and responsiblities. You remind me of the naive medical school applicant who says that they want to be a doctor so that they can "help" people. Garbage men help people and the hours are better...

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,

Click to expand...

Stop being a sanctimonious (and curiously anonymous) DO-bashing butthole. Stop trying to defend a system that is broken. Stop romanticizing a system that is inefficient, wasteful, unfair, and often dangerous. Stop thinking that the Golden Age was circa 1960. Read about medical errors, population-based health care, medical economics, the cognitive science of medical decision making, and osteopathic medicine. Then think about it.

Oh, and in the future, try to refrain from stealing someone else's identity and consider having the balls to actually sign your name to what you believe in. When I first started reading your posts I thought that you were just another uninformed, reactionary idiot. However, with just a little goading you've demonstrated yourself to be a dispicable, cowardly bigot.

To be one's self, and unafraid whether right or wrong, is more admirable than the easy cowardice of surrender to anonymity.

Irving Wallace

gasman2003 · Oct 30, 2003

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.

orthoguy · Oct 30, 2003

LOL, I will just start by saying the 2 things in life that least concern me are finding out more about osteopathic medicine and getting my own screen-name. Further, the previous sanctimonious garbage combined with the addition of an Irving Wallace quote is almost too much to bear (I nearly fell off my chair in laughter reading it)

That being said, drusso counter-proposal as to what to do when he does away with the matching process is as dumb as it reads. "1st we will have an offer day, then a counter-offer day, then we will have the verification of the mutual agreement to propose an offer day and finally we will have a decision day where we all decide whether or not we are undecided" He acknowledges that this system leaves your average candidate at the mercy of the hospital but does not address directly how to deal with it. Further, he is aware that the possibility of individuals working more for less money exists but also leaves this to the residency program to work out. He has no real substance to his argument only that "We will get more money and more bargaining power"

He does not dispute that in other non-US systems that do not have the match the problems that I mentioned have come to fruition. As I said, look to Canada to see how some residents PAY for their training.

There is not a giant leap between socialized health-care and resident salary. Perhaps you are not aware where your paycheck truly comes from. The hospital receives FEDERAL SUBSIDIES to train you. In other words, the government pays the hospitals to train us. Where are you expecting this extra money for MANDATORY training to come from then when most US hospitals continue to function in the red? Perhaps you will explain to me how we do this without increasing the amount of money that John Q Public must pay out of his/her check. You really have to think before you type.

As an aside, to your comment that we as a group know more about biochemistry etc etc, while this is true, this is also not our doing. It is the advances of the generations of physicians before us that has left us with this vast knowledge to build upon or did we sequence the human genome while we were 1st years in the anatomy labs.

I am not going to address the personal attacks (so this pretty much precludes anything the intellectual giant gasman has to say), but I will say that this is about what is best for patients and doctors. Doing away with the matching system, in spite of the nonsensical romantic musings of the above ignorant individuals, will not benefit residents.

And I still say that resident work-hour restrictions are bad for patients and physicians training. How can you justify a patient being admitted by one person, signed off to another night float doctor on a board and then having the patient passed off yet again to the admitting doctor the next day. The patient is not served by having a doctor who had received a 2 min sign-out take care of him/her. It is VALUABLE for the physician on his call day to admit a patient and take care of him/her for the 1st 24 hours. Most acute medical issues will occur in that time and that is when the physician will learn best how to deal with said medical complications.

drusso · Oct 30, 2003

Ortho,

First, it's too bad you don't appreciate Irving Wallace: Since you obviously don't get the allusion to blind faith in corrupt systems you should read his book The Man. Second, it's embarrassingly anti-intellectual that you still cling to fatuous beliefs about osteopathic physicians. Third, I am well aware of how residents are paid and your contention that revamping resident training will lead to socialized medicine remains internally inconsistent despite your saying otherwise.

If you think handing off patients will lead to increased medical errors, you should see what sleep deprivations does:

Effect of sleep deprivation on the performance of simulated laparoscopic surgical skill.

Eastridge BJ, Hamilton EC, O'Keefe GE, Rege RV, Valentine RJ, Jones DJ, Tesfay S, Thal ER.

Southwestern Center for Minimally Invasive Surgery and the Division of Burns, Trauma, and Surgical Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9158, USA. [email protected]

BACKGROUND: Resident work hours may impact patient care. We hypothesized that "call-associated" acute sleep deprivation has no effect on technical dexterity as measured on a minimally invasive surgery trainer, virtual reality (MIST VR) surgical simulator. METHODS: Thirty-five surgical residents were prospectively evaluated pre-call (rested), on-call (rested), and post-call (acutely sleep deprived). Participants completed questionnaires regarding sleep hours and level of fatigue. Technical skill was assessed using the MIST VR. Speed, errors, and economy of motion were automatically recorded by the MIST VR computer simulator. Data were analyzed by paired Student t test and analysis of variance. RESULTS: Estimated hours of sleep and subjective indicators of fatigue were different between rested and sleep-deprived residents. The number of errors and time to complete all tasks increased at the post-call assessment. CONCLUSIONS: Resident work schedules lead to sleep deprivation and fatigue. Call-associated sleep deprivation and fatigue are associated with increased technical errors in the performance of simulated laparoscopic surgical skills.

The point being that just enforcing an 80 work week rule is not enough. The whole system needs to be revamped. The Europeans have understood this for decades and have not only cut resident hours to 50 per week, but have redesigned the entire process of care delivery in teaching hospitals so that the quality of care has actually increased:

International Journal for Quality in Health Care

Moreover, over 1/3 of what residents actually do during a day has nothing to do with patient care or of any meaningful educational value.

Understanding residents' work: moving beyond counting hours to assessing educational value.

Boex JR, Leahy PJ.

Office of Health Services Organization and Research, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio 44272, USA. [email protected]

PURPOSE: To begin to understand how residents' work affects their own educations and the hospitals in which most of their training takes place, the authors undertook a systematic review of the literature analyzing residents' activities. This review sought to analyze resident physicians' activities to assess the educational value of residents' work. METHOD: The published literature was searched in 2001 using the Medline and Science Citation Index databases, and the unpublished literature was searched using bibliographies and key informants. One hundred six studies were rated for methodological rigor using the Cochrane Collaboration protocol, as modified by Bland et al. for nonclinical trials. Only those studies undertaken following the Bell Commission's report in 1987 and whose methodological rigor score fell at or above the median for all studies rated were included in the data synthesis. Results data from 16 studies that included over 1,000 residents in six different specialties, were combined under the definitions of types of residents' activities: marginal, patient care, teaching and learning, and other. RESULTS: This preliminary analysis found that residents devoted approximately 36% of their effort to direct patient care necessary to achieve specialty-specific learning objectives, 15% to the residency program's organized teaching activities, and potentially as much as 35% to delivering patient care of marginal or no educational value. An additional 16% of residents' waking time on duty was spent in other, unspecified activities. CONCLUSION: It is possible and potentially valuable to consider not only the number of hours worked by residents, but the educational content of their work when considering residency work and hour reforms

Finally, given your personality it becoming increasingly clear to me why you fear marketplace competition, system reform, and remain anonymous in your posting...if I were a program director and was able to goad this kind of response out you, your application would go straight to the bottom of the stack!

orthoguy · Oct 30, 2003

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.

orthoguy · Oct 30, 2003

Further, I was trained as a medical student in the hospital that houses the man whose name has become synonymous with work-hour restriction, Dr. Bell, whom I have personally worked with. The law-suit that led to NY's work hour restrictions was centered on inadequate resident supervision, not the work hours. 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.

You really should look these things up rather than performing your 10 min Medline search for "sleep deprivation and residency"

drusso · Oct 31, 2003

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.

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?

orthoguy · Oct 31, 2003

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?

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.

drusso · Oct 31, 2003

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.

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.

You have not justified why being anti-DO is useful nor have you justified why the current is system should remain the same. Moreover, you have explicitly stated that you will continue to be anti-intellectual and a coward by not learning more about osteopathic medicine and properly registering on SDN. Strangley, you have no interest in actually owning your own ideas even as misguided as they be. And, to add insult to injury, you mocked Irving Wallace who was only an outstanding author, but also an accomplished playwright and journalist.

The lesson you need to internalize is that bad ideas flow from bad character. Yes, I will attack your character because I and others (Gasman2003, Chef, and numerous others who have sent me private messages and emails) find your ideas disgusting and inappropriate for a professional forum---being an osteopathic bigot is disgusting. Being an Uncle Tom for a currupt and broken system is disgusting. And, being a philistine and luddite is just a waste of (presumably) a decent college education.

orthoguy · Oct 31, 2003

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.

.

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.

drusso · Oct 31, 2003

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.

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...

OrthoFixation · Oct 31, 2003

***I am not Orthoguy nor the true poster under that name***

It is crazy not to see the whole picture before you decide (i.e. can't review the contract prior to matching). That is just wrong.

I am glad the 80 hour rule is in place. If truck drivers need sleep and can kill people via sleep deprivation, doc's trump that 3 fold.

Free market competition for residency spots? I think it might be a good thing but should not restrict your choices. So a system and rules are obviously needed. I don't have the answers, but the ability to support my family is required, especially since I will work 80 hours a week and have little time for moonlighting to prop up my income. That is, assuming my institution will even allow it.

I'm not looking to get wealthy during residency, but a reasonable salary would be nice, like say $60K.

Engineers, accountants, lawyers, etc. all have to be trained for the real world after graduatioin. That is part of hiring a new grad. Everyone knows that. I see no difference for medicine. For that matter, hiring a new employee requires training regardless of background. If a new hire can substantially contribute in the first six months, that is unusual and great.

This is all a business matter and the training institutions currently have the upper hand. It kind of reminds me of fraternities and hazing. Few wanted to cut it out, saying it was a rite of passage. They said "If I had to go through this crap, why shouldn't you?"

orthoguy · Oct 31, 2003

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...

Debating with you drusso is like trying to convince a blind man to enjoy the new colors you have painted your wall. 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.

want$it$bad · Oct 31, 2003

Originally posted by drusso
Because you don't believe that DO's can compete against you? Why? Because you're a bigot?
[/B]

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.

Su4n2 · Oct 31, 2003

if DO's have inferior thinking capabilities, how do they match into rads, NS, derm,ortho, path, anes at allopathic institutions? obviously, the PD's of those programs don't think they are inferior. and if they are beating out allo candidates fot the job, who is inferor"?

also, i am curious why u think the education is subpar? are u even in med school? if so, lets compare our curriculum and see if mine is subpar. last year my school matched people to harvard, yale, cleveland clinic, sinai, etc. do u think you know better than the PD's of those programs about the merits of our education?

just curious....

drusso · Oct 31, 2003

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.

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

orthoguy · Oct 31, 2003

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

Please address the aformentiontioned questions about where the extra $$$ in your flawed view of the system will come from and what will happen with middle of the road candidates rather than stating others opnions.

WatchingWaiting · Oct 31, 2003

Re: Please address the aformentiontioned questions about where the extra $$$ in your flawed view of the system will come from

Medicare pays out over $100K per resident to hospital. Hospital pays resident $38K for his first year, while resident is spending a good chunk of his time doing non-educational activities so that hospital can avoid forking over money to hire another nurse or social worker. The term for the resident is a tool. Why you think being a tool is an honor and condemn medical students who have enough brainpower and self-respect to not particularly look forward to being tools is rather mind-numbing.

The money to give residents a decent salary could easily come from a very slight increase in hospital efficiency or very slightly decreased attending salaries. There's ~100,000 residents in circulation right now-- giving every single one of them a 20K per year raise would cost the healthcare system, which currently costs around $700B a year, about $2B a year. Or, you could slice the salaries of the million or so existing physicians $2K per year via a very slight reduction in compensation. I won't argue that $2B is nothing, but it would be a very small change in the cost of providing healthcare, and allow a huge increase in the quality of resident's lives.

Why is spending some of the best years of your life (mid 20s to early 30s) full-time in a hospital with subsistence salary such a wonderful thing?

OrthoFixation · Nov 1, 2003

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.

Your elitist and stereotypical viewpoint is sickening. Your analogy stinks. Let me guess, you're a pre-med or a allo MS-1/2? People in the real world, that actually interface with doc's of varied training backgrounds do not share your slanted opinion.

edinOH · Nov 1, 2003

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.

trauma_junky · Nov 1, 2003

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.

I recommend everyone avoid this troll. What kind of reasoning it this?

trauma_junky · Nov 1, 2003

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.

I agree, but this is starting to sound like a union, if that is what it takes, so be it.

orthoguy · Nov 1, 2003

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.

EdinOh, thank you so much for posting this. You are one of the few reasonable people on this board who understands that the "matchless utopia" does not create the most favorable environment for residents. I was beginning to believe that I was the only one on this board who believed so.

ckent · Nov 1, 2003

I really hope that they don't do away with the match. Besides the beforementioned adverse effect of being pressured to sign with one program before you have heard about your status at another program, I don't see why anybody thinks that doing away with the match will result in better salary/benefits/work hours for residents. Many IM fellowships do not participate in match programs, yet, programs have no problem filling with internists who could be getting paid >100,000 in private practice who agree to join the fellowship to get paid 40,000. If anything, doing away with the match will result in worse salary and benefits for all residents. 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. The only effect that it may have is that you may see community programs starting to offer much higher salaries then the academic programs in order to encourage high caliber students to join their program over university programs.

gasman2003 · Nov 1, 2003

Whether some of you like it or not there is going to be a change to either the core aspects of the Match process and especially likely to see changes in the current system of compensation. If you are in any doubts of this, have an unbiased attorney review the lawsuit...I did.

It is illegal to refer to us as employees for the purposes of taxation, and call us students when it comes to salary, benefits, etc. They can tax us like everyone else, yet they conspire to fix our salaries from region to region. They can't have us both ways. If we are strictly students, stop treating us as employees. This is where the courts will intervene to protect our rights to due process.

I don't know exactly what the changes will be. Perhaps the Match will be found constitutional, but the compensation issues won't, or vice versa.

Maybe the salaries will be the same but hospitals will be allowed to offer additional funds in addition to the salaries in order to lure more candidates. I don't have all the answers but brace yourselves for change. Similar court precedents are in favor of the residents and NOT the NRMP.

Hendooneh · Nov 1, 2003

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.

There is a reason why Harvard and Hopkins are Harvard and Hopkins and more than the institution itself, it is the quality of people that go there. Would they have problems filling these spots if you were say required to pay to go there? no of course they wouldn't, tons of people would pay to go to harvard, would those people be of the same quality as the ones they're getting now? no way!

There will always be competition among hospitals to get the best work force they can. This competition however has different levels. In applying I have been to places were I was treated as if I was the most amazing applicant that they have ever had and other placest where I was flatly told that I would not have a chance to go there and to apply elsewhere and ignored for the most part.

I think there is some truth to your statement as some hospitals in which money is the number one issue, most likely the better community hospitals, will cut pay for applicants. Other community hospitals might increase pay for applicants but I really don't see that happening either. Universities for the most part rely on their reputations to attract people and nominal pay as it stands now makes it possible for people to go there so I don't see a big change there.

In the system as we have it today, any hospital can easily increase their salary scale in order to be ranked higher on applicants lists. In fact one of the hospitals I interviewed at the director told us that they had tried increasing the salaries into the 60's. 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.

Given all this, I personally still don't like the match. I think the system should be centralized. Everyone should receive offers and be able to think about it until a certain day when you can only hold one position at a time. When a new offer comes you have a week to think about it and then you have to pick one of the two. This system works well for medical school admissions and we would do well with it for residency too.

This allows people to really show interest in a program. If that program doesn't really want you they will tell you and you start to form relations with your second choice program. The way things stand currently you can show interest in one program and tell them you really want to go there but if say they really didn't want you for some reason you are plain out of luck. Sending a letter to your second choice program and telling them you will rank them highly does not mean anything to anyone as i understand unless if you tell that program that they are the number one spot on your list.

Mirror Form · Nov 2, 2003

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.

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.

Many of your other arguments are just as ridiculous, but I just realized how pointless it is to argue with someone such as yourself (i.e. someone w/ preconcieved notions based on what you'd like to believe instead of evidence). So, instead of wasting my time typing, I'm just going to go to bed. I recommend everybody else stop wasting their time debating with this troll too.

DigableCat · Nov 2, 2003

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.

I wouldn't feel sorry for those bastards at all....because they were greedy and expected something unreasonable.

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.

But isn't this a trend in all of medicine. People using money as the principle reason in a lot of decision making. The first question on many posters minds isn't "What does X do?". It's "How much does X make?" I hesitate to say that our quality of workforce has decreased. But the quality of reasoning for why people go into medicine has certainly been watered down.

orthoguy · Nov 2, 2003

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.

Hey medical student, did you ever hear the phrase it is better to keep your keep your mouth shut and let people think you are intelligent rather than opening your mouth and proving them wrong?

You have no idea how life works in a hospital if you do not believe that house staff make decisions without attending supervision. (perhaps you have only rotated through small private community hospitals) Spend a night in an ICU or perchance travel to a county ER at 3am or even walk into Columbia's medical floors after 6 pm and see what goes on.

And for your personal records look up the Libby Zion case and its role in forming the Bell commission.

But if you want some Cliff notes here they are below:

"The grand jury report, issued December 1986, did not find cause for a criminal indictment of the physicians, but it did indict the way medical residents were trained at New York Hospital and elsewhere in New York. The report claimed that the "medically deficient care and treatment in this case" which included lack of supervision and overworked residents was "systemic" and posed a grave potential danger to patients. It specifically cited:

lack of exam in ER by an attending physician

admission to medical service under supervision of only an intern and junior medical resident "

" The malpractice trial ended with something of a split verdict: The jury believed the doctors had made mistakes, but it also believed the cocaine allegations. Zion and his wife were awarded $375,000, but no punitive damages were assessed. And while exactly what happened to Libby Zion remains, even after all these years, the subject of dispute, a couple of things are clear.

The only people who saw and treated her that night were two residents: one who was nine months out of medical school and the other who?d been a resident for two years."

GeddyLee · Nov 2, 2003

I recommend everyone avoid this troll. What kind of reasoning it this?

Hey Trauma_junky,

good luck on getting into medical school

Maybe you can explain where my reasoning fails? Otherwise, go back to beating off over which med school you'll be accepted to, and stop posting on the "General Residency Issues" forum like the know-it-all prick that you are.

You are so far removed from this whole issue, the only thing you can contribute are things that you heard from someone else...

www.savethematch.org ...

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