While it does cost hospitals something to employ residents, they typically get paid twice for it: once by us, working for wages far below the revenues we help generate, and a second time by the federal government, which pays an annual lump sum for each resident (averaging $112,000) as well as a bonus on each Medicare bill submitted by a hospital that utilizes resident physicians.
Another way to understand these subsidies is to consider what it would cost hospitals to replace residents with nonphysicians who also treat patients with some autonomy—for example nurse practitioners. They perform many of the same tasks as residents but have less training and work far fewer hours. The savings residents provide to hospitals are vast. Here in Seattle, a recent posting for an emergency room nurse practitioner offered $32 to $48 per hour for a job with treatment responsibilities limited to patients with minor illnesses. Resident physicians working in the same emergency department, sometimes asked to treat far more serious issues—from hemorrhagic shock after a major car accident to cardiac arrest—are paid an hourly rate about a third of that.
For the most part, there is an unspoken consensus among residents that nothing can be done to change this.
My wife is a resident at a hospital, and it’s been a pretty bad experience so far. She comes home upset, or at least unhappy, three days out of four. She works too hard, for too long, too often.
As a result, I spend a lot of time and energy trying to lift her spirits, often to no avail. One thing that’s been on my mind lately is the possibility of the residents at Anna’s hospital forming a union or other collective bargaining unit to ask for better conditions, or at least better compensation. There are a bunch of barriers to that ever happening here: most residents accept that “this is just how residency is,” and attitudes in our state are pretty opposed to unions. On top of that, it’s literally written into their contract that they can’t form a union.
That didn’t stop me from thinking about it a bunch last night and keeping myself awake fantasizing about what might be. There is at least one union for residents, and the National Labor Relations Board ruled earlier this year that residents should be considered employees rather than students in regard to their ability to organize.