Resident Physicians Might Not Be Underpaid After All. Here’s Why

Are residents actually underpaid? Here's what the numbers say.

Sep 12, 2016 - Guest Author


This article is contributed by Dr. Griffin Myers, Doximity Fellow, board certified physician and entrepreneur

Residency is hard. Really hard. In fact, I completely underestimated how hard it would be. My sweet wife loves to remind me that she didn’t think I’d be able to finish it for the first 2 years. And, honestly, I thought the same.

Because it’s hard, it’s common for residents to complain about it together. We all did. We sat around the resident lounge and commiserated by complaining together. We built great friendships, learned medicine, and cared for a great group of folks together. We also all agreed we were underpaid. Now that I’m a few years out of that formative experience, I want to revisit this touchy topic. Are residents actually underpaid?

The Truth Behind Residency Pay

Last week I met a resident at a local training program here in Chicago who told me, “I’m a highly educated doctor, and I make less than minimum wage!” I had heard that before, but could it possibly be true? Here’s what the numbers say.

The national minimum wage is currently $7.25 per hour. The highest state minimum wage isn’t from a state at all; it comes to us from the District of Columbia at $11.50. There are higher minimum wages in some cities, but they’re almost definitionally exceptions. If you want to see the minimum wage in your state, you can find state data here.

Those are hourly wages, but, remember, residents aren’t paid by the hour. They’re paid a salary. In fact, they’re paid via a very specific process within Medicare regulations. Salaries are based on seniority, specialty, and location/cost of living. Thankfully, we have really good data on this. In fact, the American Association of Medical Colleges publishes a report every year with exact numbers. Here’s a quick breakdown: last year, the average first-year salary (i.e. lowest year) was $51,586. The middle half of all residents had a salary between $49,396 and $53,273. (Not a lot of variation.) For the same year, the Social Security Administration reports the average salary nationally for everyone was $46,481. So, major point here: residents made a full 10% more than the average American.

I know the next part of the argument, though: “Residents work so many more hours that their wages must be below minimum wage.”

Let’s look at that. A few years back the Accreditation Council for Graduate Medical Education, the group that accredits residency programs, put a new 80-hour work week rule in place. It’s pretty simple: residents can’t work more than 80 hours per week, or the program gets in trouble. (For neurosurgery residents it’s 88.) Here are two things important to note: (1) Nearly every resident you ever talk with will tell you that they break the rule. (2) Very few programs have ever been shut down for violating this rule.

Trust me, when you’re doing a residency, it feels like you’re breaking the rule. In fact, if you’re reading this during your residency, you might be thinking right now: “I know I’m over the limit!” In truth, statistically, you probably aren’t. Remember, it’s not one week over 80 that counts; it’s an average over a period of time. You can come up with occasional weeks that push past 80, sure. But, overall, you likely aren’t averaging over 80 hours.

For argument’s sake, let’s say residents work that full 80 hours every week for an entire year. With an average salary of $51,586 divided by 80 hours per week for 48 weeks (4 weeks vacation being standard in residencies), the hourly wage becomes $13.43.

I’ll admit, as a physician that feels low. If you compare that to the long list of hourly wages published by the Bureau of Labor Statistics, that puts residents just above “Driver/Sales Workers” at $13.41 and just below “Grounds Maintenance Workers” at $13.50. There are obviously differences in education and skill level, but, another major point: that is absolutely not below minimum wage.

But is that the whole story? Not at all. In fact, if you look up “physicians” on that same list, you’ll find the average hourly wage to be $97.33. That’s right: finish your residency, and you get a whopping 624% raise. That logic leads you to believe that up to $89.30 per hour of a resident’s compensation comes in the form of training and education. It’s not green money, but it’s real. And pretty soon it becomes green money, assuming you finish the residency program.

Important Factors in the Compensation Equation

Residency makes for a long, long runway to higher compensation ahead. But you don’t do a residency for the money; you do it for the training and the future value of that training. In other words, it’s an investment today to make more money tomorrow. Feels weird not to include that in the compensation equation.

I know this might be tough for a resident to read after another grueling day, but taking care of patients is an incredible honor. That skill and daily privilege is worth something. In fact, I think it’s worth a lot. Can you pay the rent with that honor? No, but if you discount it entirely or say it’s not worth anything, well, you may need less help with economics and more help from a career advisor.

Dr. Griffin Myers is a board certified emergency physician, entrepreneur, and nationally recognized thought leader in healthcare innovation and value-based care. His writings do not substitute for professional medical advice, diagnosis, or treatment. No patient relationship is created by your use of this content. You can follow him on Twitter @griffinrmyers and find this and other media at his website: www.griffinmyers.com.

Training Trends and Residency Navigator updates

A fresh look at student selections and trainee trajectories in the 2016-2017 Residency Navigator

Sep 06, 2016 - Erin Gray


In just a few short weeks, fourth year medical students will enter arguably the most important period in their careers -- the residency application process. This can be an overwhelming and expensive process, fraught with dozens of factors to consider. In an average year, each medical student applies to 36 programs, travels to 12.3 interviews, and pays as much as $7,000 on travel and fees. All told, this process piles on another $100 million in medical student debt per year.

To help medical students in their quest to find the right residency program, Doximity is pleased to release the 2016-2017 Residency Navigator, a comprehensive guide to over 4,000 residency programs across 27 specialties. Along with objective data, program pages include 260,000 nominations, ratings and reviews from 52,000 U.S. physicians, giving medical students an insider look of what resident life is like at that program. Residency Navigator is built around personalized search filters, allowing students to customize their searches based on the factors most important to them, including geography, practice setting, clinical reputation, and alumni “outcomes” measurements of board certification, subspecialization and research output.

What are medical students searching?

We analyzed students’ searches over the past year and discovered a few trends.

Specialty searches

Orthopedic surgery was by far the most disproportionately explored specialty (relative to the total number of applicants in 2015*). Perhaps this is an indication that orthopedic surgery applicants are conducting more thorough research because of the specialty’s competitive nature. We asked orthopedic surgeon and sports medicine specialist Jerome Enad, MD to explain the specialty’s appeal:

“Orthopedics provides an enjoyable and stimulating specialty to medical students. Most of us can see ourselves in the role of an orthopedic patient - shoulder sprain, knee injury, low back pain, etc. Thus it is professionally rewarding to use our training and expert knowledge to diagnose and treat these common conditions. The specialty of Orthopedics allows us to provide both non-surgical and surgical treatment options to help our patients. Therefore we act as advisors as well as technicians. It can be mentally challenging to find the right treatment option, but our results are usually definite and satisfying.”

Otolaryngology beat out urology by a nose for the second most searched specialty (sorry, we couldn’t resist).

Location searches

One of the most-used search features of Residency Navigator is to discover programs by geography. Med students seem to have set their sights on major coastal states.

  • Northeast
  • New York
  • California
  • Illinois
  • Texas
  • Florida

Residents who train together, stay together... right?

Residency is an intense time in a physician’s life, so the bonds between co-residents are often strong. In fact, 60% of co-authors who trained together first did so in residency. So when residency wraps and it’s time to plant roots, it can be a shock when their colleagues move away.

With this in mind, we examined which states are lucky enough to keep the residents who trained in those states 2-12 years post-residency. It turns out, there’s big love for the Big Sky Country, whereas physicians trained in D.C. perhaps “Don’t Connect” enough to stick around longer.

States with the highest post-residency physician retention rate

  • Montana (77%)
  • California (75%)
  • Texas (63%)
  • Oklahoma (59&)
  • Florida (58%)

States with the lowest post-residency physician retention rate

  • Connecticut (34%)
  • New Hampshire (32%)
  • Delaware (29%)
  • Rhode Island (29%)
  • D.C. (20%)

Which specialties plant their roots in residency vs. cut and run?

Child neurologists, family physicians and pediatricians are among the top five specialists that stayed in-state post-training. Perhaps their bonds with families in the community grow deep while in residency, making it harder to relocate, or perhaps these specialties are most supportive of starting one’s own family.

On the other hand, surgeons are more eager to ship their scalpels across state lines. This could be due to limited available positions for specialized surgeons in some regions.

State-loyal specialties

  • Child neurology (61% of physicians trained in-state, stayed in-state)
  • Family Medicine (59%)
  • Psychiatry (58%)
  • Pediatrics (56%)
  • Oral & Maxillofacial Surgery (55.7%)

Specialties that say sayonara

  • Thoracic Surgery (72% of physician trainees leave state)
  • Colon & Rectal Surgery (70%)
  • Plastic Surgery (67%)
  • Vascular Surgery (66%)
  • Ophthalmology (65%)

Happiness

Satisfaction with one’s residency experience derives from a number of variables, including but not limited to culture and people, training environment and geography. We asked current and recent alumni across the country for an “overall rating: willingness to recommend this program to others.” For this analysis, physicians who rated their programs at least 4 out of 5 stars on this gestalt satisfaction metric were considered to be “happy.”

By Geography

Like last year, residents who trained in Oregon, Vermont, Minnesota and North Carolina were among the most satisfied with their programs. Residents in Idaho, however, would be the most likely to recommend their training programs. Apparently Idaho is a pretty “apeeling” place to train. How do you like them potatoes?

Happiest States

  • Idaho (100%)
  • Vermont (98.3%)
  • Oregon (97.7%)
  • Minnesota & North Carolina (96.2%)
  • Utah (95.7%)

Unhappiest States

  • Oklahoma (84.6%)
  • Nebraska (83.7%)
  • Mississippi (82.8%)
  • Nevada (77.8%)
  • South Dakota (76.2%)

For some states, overall satisfaction varied between those who had trained as specialists versus in primary care. For example, specialists who trained in West Virginia were unanimously satisfied with their programs (100%, at the time of this publication), but primary care physicians were much less satisfied, placing the state in the bottom five on the satisfaction scale (84%).

By Gender

As we saw last year, female residents tend to be somewhat less satisfied than male residents (M = 93%, F = 90%), and the gender gap widens in some historically male-dominated specialties. Orthopedic surgery, for example, has the largest satisfaction divide (82 percent for women vs. 96 percent for men ; p<0.01), followed by surgery (85 percent vs. 92 percent; p< 0.01) and anesthesiology (88 percent and 93 percent; p<0.01). However, female Physical Medicine & Rehabilitation residents are more satisfied than male residents (94 percent vs. 92 percent).


Gender Balance*

Historically, medicine has been a male dominated industry, however in recent years there has been a growing number of females entering the field. According to the AAMC, 47 percent of current medical students and 46 percent of residents are women.

The gender divide, by state

  • Who runs Delaware? Girls. (Or rather female residents.) Delaware has the largest number of female residents -- there are 14% more female residents than male. Other female dominant states include: Idaho and Oregon.
  • Where does M.D. stand for “Male Dominant”? Mississippi. For every female resident, there are almost 2 male residents. A significant imbalance also exists in Oklahoma and Minnesota.

Most gender balanced states

  1. South Dakota
  2. Washington, D.C.
  3. Rhode Island
  4. Maine
  5. North Dakota

* Based on Doximity profiles of current and recent program alumni


Doctors know best

We’d like to thank our Doximity members for sharing their training experiences to help the next generation of physicians find the right program fit. It’s an inspirational example of what the world’s largest body of physicians can achieve together.

Visit Residency Navigator: https://residency.doximity.com/

Choosing a Medical Residency Program

Aug 31, 2016 - Guest Author


This post comes from Dr. Joyce Park, current resident at NYU Medical Center. You may view the original article on Dr. Park's blog, TeawithMD.


It’s August and that means a) the summer is passing by way too quickly and b) it’s getting to that time of residency program applications again! For my friends out there who are in medicine, I know what you’re going through, and I’ve put together a bunch of #PathtoMD posts to help you out along the way, from how to pick your interview outfit to rocking your residency interviews. But before you get too deep in the interview process, first things first: you have to choose which residency programs you want to apply to. It can be hard to figure out which programs to apply to, which is why I wanted to write a post about some of the factors that came into play when I was deciding between programs to apply to and to rank.

Location, Location, Location

When I talk to my colleagues about their experiences choosing between residency programs, many expressed that location of the program was one of their top deciding factors. This was particularly true for my colleagues who are married, have children, or have other familial obligations or ties to a certain area. Let’s be completely frank here, when you’re looking at residency programs in a similar tier, the training you will get at each one is more or less equally strong. The little differences between each residency program, as mentioned in the rest of this post, can sway you one way or another, but if the training is equivalent, location can make a big difference and sometimes be the ultimate deciding factor.

Mentorship

I think the further I got in my career, the more I grew to fully appreciated the importance of a good mentor, someone who will take you under his or her wing and be your role model in your professional life. I touched on this topic before in my post about how to match into dermatology (or other competitive specialties), but I can’t stress this enough. A mentor can inspire you to go into a certain specialty, explore a certain area of research, decide to subspecialize, set up your practice a certain way, and more. If you have a certain faculty members that you really admire at a certain program, whether it is their research area or their career path, consider exploring those relationships further in residency.

Research

Some individuals know that they want to devote their lives to academic medicine and scientific or clinical research. Others want to be able to do research to explore and/or get into a competitive subspecialty. Whatever your reason, if a certain medical center is particularly strong in your research interest, that is a good reason to take a closer look at that residency program. The Doximity residency navigator compiled top ten programs in each field filtered by research output, so if that is something that interests you, take a look here (scroll to the bottom for ranking by research output). To find a research advisor in your particular field, pay attention to the authors and the institutions putting out major landmark trials and publications in your area of interest. This will also be something you can talk about at interviews.

Track Record

Medicine as a whole is becoming more and more subspecialized, so the track record of alumni from different programs after graduating is another thing to consider. For example, if you are applying in dermatology and know that you want to be a Mohs surgeon right off the bat, you want to try to train at a program with a strong Mohs department, a Mohs surgeon who can mentor you, and with a good history of sending past trainees onto Mohs fellowships. If no one from that program has ever gone into the subspecialty you are considering, your path may be a bit harder (though definitely not impossible).

Subspecialties

This goes along with the track record point above. If you know you want to end up in cardiology, it would help to go to an internal medicine program with a strong cardiology department. During residency you can get to know the cardiologists, do research with them, and improve your chances of staying on for further training. Even if you don’t want to stay at that institution for fellowship, working with respected physicians in their subspecialties can only help you when it comes to applications, because they can help you write letters of recommendation, vouch for you, etc.

Extras

I used this as a catch all for the miscellaneous factors left. There are a lot of things that go into this category, such as work-life balance, happiness of the residents you meet, elective time and opportunities, global health opportunities, salaries (because that changes depending on what region of the US your program is in!), culture and fit of the program, etc. There’s also a lot of personal preferences, which only you will know.

Reputation

I put this one last because I think reputation is very subjective. I included reputation as one of the fields because if someone has no idea which are the highly regarded programs in a field, this is one place to start looking. I remember when I switched into applying for dermatology (you can read the brutally honest saga here), I didn’t really know much about which programs were considered to deliver the best training. I remember googling “top derm programs” and coming across Dr. Wu’s article from Cutis published in 2014. Reading through the top NIH funded programs and the top regarded dermatology programs gave me some inkling as to which programs seemed to be research powerhouses and which had a reputation of excellent resident training. Now, just as a demonstration of how subjective rankings are, NYU Dermatology ranked 17th in Dr. Wu’s methodology, whereas it has ranked either 1st or 3rd for the last two years according to Doximity’s residency navigator. Where does NYU Derm actually fall? It doesn’t matter because at the end of the day, I know that NYU delivers excellent clinical training in the field of dermatology and no ranking will change that. So what I’m saying is that the reputation of a residency program according to the Doximity navigator is just one piece of a much larger picture to consider when evaluating different programs.

What factors played into your decision about medical residency programs? Would love to hear!


Joyce Park is a dermatology resident in New York City and health and beauty blogger at TeawithMD. Originally from California, she completed undergraduate and medical school at Stanford, and has a background in medical journalism at NBC News. She is passionate about educating the public about skincare topics and raising awareness of skin cancer.

A Letter from Surgeon General Dr. Vivek Murthy

Aug 25, 2016 - Guest Author


In a letter sent to U.S. clinicians by mail and via Doximity, Surgeon General Dr. Vivek Murthy launches a clinician-led movement to turn the tide on the nation's opioid crisis.

Read Dr. Vivek Murthy's letter (August 25, 2016)

To learn more about the campaign, take the pledge or explore additional resources for clinicians and patients, visit www.TurnTheTideRx.org

Download the Turn The Tide Pocket Guide, adapted from the CDC Opioid Prescribing Guideline

The Evolving War on Cancer

Aug 18, 2016 - Guest Author


By Dr. Joseph Murray

Since the passage of the National Cancer Act in 1971, overall cancer death rates in the United States for both men and women have declined. Strides have been made over the last 45 years since the beginning of this purported War on Cancer, with particular attention paid to the underlying biology of cancer. Today, the war on cancer has an expanding front, due to knowledge gained from cancer genetics and host interactions. Mutation-specific inhibitors and immunotherapies represent promising and precise targeted therapies in the oncological armamentarium derived from this knowledge.

Independent of our exciting advances in these burgeoning areas of cancer research, declines in cancer mortality can be attributed to a significant decrease in preventable deaths. The decrease in lung cancer deaths, a principle driver of age-adjusted cancer mortality, mirrors decreased rates of tobacco use in the United States. Although informed by carcinogen studies of cigarette smoke, primary prevention through public health advocacy remains a most effective method for decreasing lung cancer mortality. Similarly, the decrease in breast cancer mortality has been attributed to increased mammographic screening, even with the recent controversies in determining recommendations for age at first screening.

However, prevention has been aided by therapeutic advances in reducing cancer mortality. Significant strides in combinatorial therapy, for example surgical, radiological, and hormone-targeted therapy in breast cancer, have dramatically contributed to survival. Bolstered by the Human Genome Project and our ever-expanding trove of “‘omic” – genomic, epigenomic, transcriptomic, proteomic, and metabolomic – data, cancer has never been a more described entity. With the informatic integration of this and clinical data, a more complete understanding of the landscape of cancer continues.

This is the first wave of the War on Cancer. Even with the research gains and notable declines in cancer, malignancy is poised to overtake cardiovascular disease as the most common cause of death in the United States.

Hence, a second wave of the War on Cancer has begun: still targeted, but also personalized and precise.

Perturbations in gene expression in cancer, through mutation or otherwise, have yielded innumerable targets of small molecule, biological, and cellular therapies. In subsets of lung cancer, kinase inhibitors to mutation-specific EGFR and ALK mutations have yielded modest success. In breast cancers, even where targeted therapy to those tumors overexpressing HER2 has failed, new antibodies carrying a potent cytotoxin have improved survival. Other antibody immunotherapies that block the inhibitory effects cancer cells exert on immune responses continue to demonstrate success in melanoma and now other solid malignancies. Cellular therapies using engineered “killer” T cells derived from and infused into patients are demonstrating efficacy in treatment-resistant hematological malignancies, with hopes for efficacy in solid cancers. Looking beyond these advances, cancer-targeted gene expression and direct genetic editing represent the next wave of the War on Cancer.

There is no guarantee that these exciting personalized and precise therapies will yield the magnitude of benefits attained by cancer prevention and combinatorial therapy. Cancer will only become more prevalent as our healthcare system better manages other chronic disease. Whether we “shoot the moon" or not on cancer, it deserves the research and policy attention it garnered in 1971 and, now, in 2016.


Doximity is proud to be a supporting association for The Economist's War on Cancer Forum 2016. On September 28, 2016, over 200 thought leaders from all corners of the healthcare industry will meet in Boston to discuss innovative approaches to combating this deadly disease.

In partnership with The Economist, Doximity is offering 15% off the current registration fee to anyone interested in attending the event. To register, go to https://waroncancer2016.eventbrite.com/?discount=DOXIMITY15 and enter DOXIMITY15.

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