Medical school is education, and in the US it’s astronomically expensive (some people graduate with half a million dollars of debt).

Residency is more like on-the-job training (a hospital still makes money when a resident sees and treats you). It just takes longer to train a physician because there are human lives at stake.

Yes, teaching fellows and others in academia are often taken advantage of and work for free, but that doesn’t mean physicians are evil for getting paid during residency.

>It just takes longer to train a physician because there are human lives at stake.

Airbags?

Our electrical infrastructure?

Our plumbing?

Please, there are plenty of of industries that have lives at stake and we don't have a cartel controlling the supply of people. The issue is that we don't have enough Physician(By design), so they need to operate independently. Any other industry has multiple layers of qualified people checking to make sure things are safe.

I kind of dream of a world where you'd have 1 physician and a physician manager and a physician director all looking at your paperwork. Instead you get 1 total.

I don’t want to trivialize the amount of work that goes into airbags, electrical infrastructure, or plumbing.

However, the human body is much more complicated. Would you trust the life of a loved one who, God forbid, has cancer or needs surgery to a person with a fraction of the education and training physicians receive?

By the way, I’m reminded of a joke: a doctor called a plumber for a faucet leak. The plumber fixed it in 5 minutes and charged $175. The doctor said “how can you charge that much for 5 minutes of work? I spend a whole hour with a patient and charge less!” The plumber said “that’s exactly what I used to say when I was a doctor.”

> Would you trust the life of a loved one who, God forbid, has cancer or needs surgery to a person with a fraction of the education and training physicians receive?

False dichotomy.

Right now the ACGME limits the number of residents. This causes a lower supply, so instead of having 6 surgeons working on you, you have 1-3. Do you only want a few people fresh from residency working on you? Or a bunch of physicians with various experience?

Also, plot twist, we own a medical company. (not physicians, but a different cartel that is paid way less and got a pay cut since 2016) You can treat 7 people per 37 minutes, each paying between $40-$125. Physicians is way worse, you can charge $250 for 5-10 minutes.

(Note that this ignores documentation costs/times, but it should give you an order of magnitude to play with.)

We don't do that blatant 7 people per 37 minutes, its more like 1 person per every 60 minutes, but as the clinic grows we've had 2 people per 60 minutes out of necessity. The hospital/other clinics do this.

I need to do an AMA on owning a medical clinic. My wife, the primary doctor, isnt exactly happy that I bite the hand that feeds. We already lost our chiropractor referrals because I couldn't handle their mysticism and spoke out against it.

> a hospital still makes money when a resident sees and treats you

Hospitals lose money on residencies. That's why there aren't enough and the ones that do exist need to be subsidized by the federal government.

How does this actually work? I have never worked in a medical context and am ignorant of their internals so this is a genuine question.

I _have_ been a patient going to a specialist appointment where the only doctor I saw was a resident, and I don't think I or my insurance were charged any less. So if their work brings in the same amount of revenue for the same services, and if resident often do a lot of hours (I seem to recall several years ago their hours were capped to not be _dangerous_ but are still a lot), and they're paid less during their residency than after it ... why _don't_ hospitals make money off residents? Is there some training going on parallel to seeing/treating patients which is really expensive?

My source is my father who is a physician who chairs a residency. He’s always complaining about the business analysts wanting to cut the program because it’s not making enough. My understanding is that yes there are a lot of highly paid doctors at the residency who are basically just supervising the residents so you end up in a situation where you have just as many full doctors plus the resident costs to treat the same number of people. The residency also does a bunch of non revenue generating stuff like retreats and training every Friday which hurts margins.

Average medical school costs are ~230K.

Residency is not college, residents are practicing physicians that are providing considerable value to society and in many cases they are paid appallingly little for the amount that they work.

Postdocs are paid, and that's basically what a residency is. Or you can think of it as a co-op during a CS degree, which is also paid.

PhD students are paid as well, at least in research departments.

Postdocs/PhDs theoretically are supposed to be paid to advance scientific knowledge.

Physicians are not advancing scientific knowledge.

Also a co-op during a CS degree isnt paid with taxes.

I think I understand where you're coming from, but even ignoring resident salaries the majority of other healthcare spending is already government-funded, and in my ideal world all of it would be, so it's hard for me to be upset about this.

I don't understand your point about scientific knowledge, in my mind keeping people alive is at least equally as important as advancing scientific knowledge.

> Physicians are not advancing scientific knowledge.

Yes, but they are providing a similarly valuable service. And, in fact, almost all medical practice contributes to the development of knowledge as well. Lot's of physicians (even residents) write papers.

Physicians are some of the larger victims of this inflation, no? Also “they” are not doing anything with ACGME in general, that’s an entirely separate issue.