COL vs salaries

[Cumberland]

I had a conversation with some people the other day- gasoline has quadupled in the past five years, natural gas prices have gone up 100% or more, the cost of groceries and supplies have increased with these as well. Health insurance is atrocious for a lot of people. But a resident's salary is about the same as it was a few years ago, or has gone up by only a few thousand. How much longer are we expected to live with out cost of living increases? Why arent salaries changing to reflect current prices? I am a nurse, and have seen the average nurse's salary double since 1997 when I graduated. My starting salary then is what a nurses assistant makes now.

One part of the issue is that the free market is completely taken out of equation in terms of residency. Virtually all medical graduates need to complete a residency. The match system coordinates the selection process -- and in the end the rank list is the only real choice the newly minted doctor makes in the process. S/he isn't presented with multiple offers to choose from on the backend of the process like any other non-medical or post-residency job-seeker. One outcome is that residencies don't compete with one other much at all in the income area. Sure, similar salaries for the same work in areas where the cost of living differs dramatically can and do factor heavily into some people's rank list so in that sense income enters the equation -- but still only on the front-end with the rank list and indirectly.

So, in a sense one could (not sure I would) argue that residencies are colluding to keep their captive labor source costs artificially low.

[spotty_dog]

So, in a sense one could (not sure I would) argue that residencies are colluding to keep their captive labor source costs artificially low.

Interestingly, the house staff at Highland in Oakland has unionized, and has bargained for a significantly higher salary than most residents -- however, it's still not *enough* higher to compensate for the drastically higher cost of living in the Bay area.

Yeah, it would be wild (though not going to happen in any real way) if the market was truly at work. If people had multiple offers (instead of the match). Of course, you'd see some places (for certain areas of medicine) fold. You'd see drastic variations in pay. You'd see some programs attempt to make a name and beef up a particular area overnight -- using pay for leverage (while maybe they'd let some of their programs die on the vine). I think powerful programs' pay structure would fluctuate less dramatically in such an environment than you might expect -- Mayo, Stanford, Hopkins, etc. would be insulated by their prestige / other opportunities that they offer so incoming residents would forgo the pay for a few years to attain such "intangibles".

[Vishenka69]

In some of the hospitals in the city the residents are part of a union and can negotiate a higher salary and other perks. The place where DH did his intern year had this and his salary went up before he even started. The one he's at right now raised salary and gave a book allowance, to discourage residents from bringing in a union. But even with all the raises, 7 years after college DH makes as much as an average college grad.

[houseelf]

Two of the big city programs that DH looked at for fellowship offered a salary for a PGY7 that practically would render our children eligible for subsidized school lunches. I kid you not.

I completely agree with Kevin's market supression analysis. When DH's residency salary is calculated at an hourly basis, it is less than minimum wage. (Caveat: DH's program grants him the "privilege" of training here by offering him approximately $10-15 LESS than many other GS programs). Nonetheless, when DH was eligible to moonlight during his lab years, the residents refused to work for less than $75/hour. The hospitals HAD to pay that amount to attract physician moonlighters to do the same work as residents.

I'm telling you, this whole residency thing is a pyramid scheme, a scam that is nationally endorsed. And, I'm not one tiny bit bitter about it.

Kelly

I think that is it, Tara. Hospitals are still in the mindset that residents are either single and can room in a 2 bed apt with 3 others and split the $1000 rent, or that they are childless/newlyweds whose spouse works ft and will probably bring home $40K a year.

Last year DH got a bump of $3K or so in addition to the PGY increase. Apparently part of the reason for this additional increase was threat of unionization. The resident group says that salaries are lowest here of most west coast programs. COL is lower too but salary still was on the low side. I think a PGY1 is around $40K. When he started the salaries were about a PGY level behind Colorado so his pay stayed the same for two years. The GME office here was very easygoing about letting him start as PGY4 so I have no complaints. It could have been worse.

I agree with Kevin's take on this. Some people might factor salary/benefits into their rank but other factors carry more weight. And there is no salary negotiation like so many other jobs.

I've been meaning to set up a resident salary survey but am not sure how to do it in a way that accounts for PGY level, a good range of salaries, and anonymity.

Some administrations / hospitals / programs may make themselves feel better by thinking of the resident as a single guy or gal, but I don't think that's the predominant reason for the relatively low wages. Certainly a lot of nurses straight out of school at 22 years of age are indeed single. But, with the market at play in that profession, they relocate wherever they want, find a setting that suits them best (academic/community city/rural, etc, etc.) and seal the deal with a competitive signing bonus. Then, top the whole sunday off with a starting salary better than a PGY4 resident at the same institution (and work 40 hours / week and get bonus pay if they choose to pick up additional hours). Oh, then they might just get some friends to split rent with as well.

Please note -- I'm not begrudging nurses their pay, just using them as an example of the market at work.