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  • #61
    Originally posted by CordMcNally View Post

    I would be curious to see if there's any animosity between residents with these. Depending on the class size, having one or two pregnant residents not taking overnight call, etc. could potentially breed some resentment.
    I do believe their training timing is paused - so that time needs to be completed.

    As an attending back in 2014, covered three consecutive maternities in 5 doc clinic. Yes, it's more work. Still wouldn't have it any other way. We all benefit from better leave policy long term. Everyone plays their part.

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    • #62
      everyone pro resident union also pro forgiveness of resident student loan debt?

      bc that is presented front and center as a position of the committee of interns and residents who represents the resident union

      https://www.cirseiu.org/ scroll down just a little bit

      personally, no. I think there are other people in greater need where such funds could be spent

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      • #63
        Originally posted by STATscans View Post
        I will say it. I think this is a terrible idea.

        Residents are supposed to be working long hard hours. It is a rite of passage. You aren’t a full fledge(sic) physician yet. In time you will
        It might be a terrible idea, but this rationale is nonsensical.

        Working long hours doesn't make you a better resident - it makes you tired. In fact, there have been prior studies that have shown sleep deprivation hinders performance.

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        • #64
          Originally posted by jacoavlu View Post
          everyone pro resident union also pro forgiveness of resident student loan debt?

          bc that is presented front and center as a position of the committee of interns and residents who represents the resident union

          https://www.cirseiu.org/ scroll down just a little bit

          personally, no. I think there are other people in greater need where such funds could be spent
          While I agree that forgiving student loans for doctors (who will be in the top 1-5% of income earners in the US) is kinda dumb, unions have other perks. We were part of CIR during training, and they did help us to get salary increases during negotiations, along with some decent benefits.

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          • #65
            Originally posted by HikingDO View Post

            Honestly though, and as a family medical doc like me, you know that a decent amount of family med residency is a waste of time. After delivering dozens of babies in residency, how many have you delivered in practice? How many vents have you run? How many central lines have you placed? My point is that we can eliminate hours in residency without eliminating relevant training. Is residency about training, or is it about hazing and giving the hospital and attendings cheap labor and coverage? Just because we wasted time with near useless rotations in residency doesn’t mean current trainees should keep making the same mistake.
            I delivered babies for 3 years. But my call group thinned out too much and it was too much of a burden being on call everyday. I continued to do the newborn nursery until last year. If i could I would still be doing inpatient medicine. I enjoyed it but is is not practical where I am.

            I know a few people from residency who became hospitalists. And a few who do full spectrum. But you are right that the cast majority of us just do outpatient work.

            Don't you feel that by taking care of the sicker inpatient cases it made you a better outpatient doc though?

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            • #66
              Originally posted by xraygoggles View Post

              While I agree that forgiving student loans for doctors (who will be in the top 1-5% of income earners in the US) is kinda dumb, unions have other perks. We were part of CIR during training, and they did help us to get salary increases during negotiations, along with some decent benefits.
              yes, all conversations are nuanced

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              • #67
                Originally posted by StarTrekDoc View Post

                I do believe their training timing is paused - so that time needs to be completed.

                As an attending back in 2014, covered three consecutive maternities in 5 doc clinic. Yes, it's more work. Still wouldn't have it any other way. We all benefit from better leave policy long term. Everyone plays their part.
                I know that their training time has to be completed for parental leave but that doesn't answer how the other residents feel when those shifts still need to be filled and those patients still needs to be seen. It also doesn't answer the question about the overnight calls and 24+ hour shifts. I'm assuming those don't get made up.

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                • #68
                  Sleep is important for learning. Sleep is important for good patient care.
                  I am pro-sleep.
                  I am also pro student and resident.
                  I frankly worry about them.
                  I think the debt burden alone for school currently is frightening.

                  Unions?

                  As I said before, complicated.

                  I have a friend (electrician in Boston area). He loves his union. He is 66. He says they made his working situation safer and provided good benefits and pay.

                  I fish with him and have zero reason to disagree.

                  He is a good friend.

                  He is a biased blue-doggy Democrat and we don't fully agree politically.

                  But I agree that the "man" (office people) can try to screw over the worker bees and I imagine putting in electrical wiring in Boston could be pretty dangerous.

                  I also have seen bad effects of unions in medicine.

                  I worked at a hospital (not to be named) doing cardiac anesthesia and the nurses were NOT unionized. They were awesome! worked really hard to get the cases done. They (and everyone else) could only go home when the work was done, and everyone worked really hard together to get it all finished.

                  Since it was set up so we could only get home if everything was done and everyone wanted to go home we pushed hard to get the cases done. (safely of course, fast room turnovers, good teamwork).

                  I worked at another hospital (not to be named) where the nurses were unionized and they worked shifts. They would move like snails. I asked my boss: "hey, can we do anything to incentivize the nurses to speed up........pay them for fast set ups or quick room turnovers etc." I was told by my boss: "the union will not allow this".

                  This sounded odd so I asked the nurses and they confirmed. I forget the actual logic but they did not want to have some nurses treated differently from the others or some such stuff.

                  The older nurses liked moving slow and did not want to be pushed.

                  The less they did the less they had to do prior to shift change. Slow was rewarded so slow it was.

                  Like a lot of things I see both sides. I am a clinical worker bee (when doing anesthesia). I have seen the "management = Office people" be stingy with the PPE during covid, and be incompetent and/or sinister when it comes to paying people for clinical work. (mostly incompetent, I think)

                  Also, the nurses in TN (after a certain high profile criminal trial) probably don't have a lot of love for the hospital and the administration who basically threw the RN under the bus (can you say scapegoat?) following a tragic medical error.

                  I guess (like many things) I don't have the answer and I don't know what this will do but I would proceed with caution.

                  If nothing else, there might be unintended consequences........labeled as lazy trouble makers or difficulty getting a job (small world).

                  I don't know if those things are "fair". I do not think residents should be tortured and I think we ALL should try to get enough sleep (safer, healthier, better).

                  I also don't know where the line is. It is likely a gray area. Yes, we need to treat them with respect and kindness and help them learn. Yes they are stressed.

                  Residency needs to be challenging but not abusive.

                  Unsure if unions are the answer or just something that will complicate things.

                  Maybe they will help. Maybe if the staff was a little kinder and more altruistic they would not be needed.

                  Comment


                  • #69
                    Originally posted by jacoavlu View Post
                    everyone pro resident union also pro forgiveness of resident student loan debt?

                    bc that is presented front and center as a position of the committee of interns and residents who represents the resident union

                    https://www.cirseiu.org/ scroll down just a little bit

                    personally, no. I think there are other people in greater need where such funds could be spent
                    I don't favor forgiving these loans without addressing the cost of tuition. This will not fix the root cause.

                    In fact, it might (will?) make it worse as the schools have no incentive to control costs or lower tuition (gov guaranteed loan payment) and the students are not as worried about borrowing if they think (or are told) it will be forgiven.

                    Cost of all education needs to drop. Schools need to cut the fat and lower (or at least not increase) the cost of tuition.

                    Now the tax payer is on the hook for all the loans if the student fails to pay or if it is forgiven.

                    The schools just keep increasing rates, and collecting funds.

                    Comment


                    • #70
                      Originally posted by Tangler View Post

                      I don't favor forgiving these loans without addressing the cost of tuition. This will not fix the root cause.

                      In fact, it might (will?) make it worse as the schools have no incentive to control costs or lower tuition (gov guaranteed loan payment) and the students are not as worried about borrowing if they think (or are told) it will be forgiven.

                      Cost of all education needs to drop. Schools need to cut the fat and lower (or at least not increase) the cost of tuition.

                      Now the tax payer is on the hook for all the loans if the student fails to pay or if it is forgiven.

                      The schools just keep increasing rates, and collecting funds.
                      Everyone should consider that some amount of the outstanding 2T student debt is going to be forgiven regardless of what we do. Anyone in PSLF, or even the 20/25 yr PAYE/REPAYE plans is not going to pay off their loans in their entirety. And the less you make the more will be forgiven.

                      Student loan planner does a very interesting podcast talking about this. For some people the cost of grad school might be cheaper than it was 30 years ago if theyre smart and preferentially use retirement accounts to reduce AGI, etc

                      Comment


                      • #71
                        Originally posted by Turf Doc View Post

                        Everyone should consider that some amount of the outstanding 2T student debt is going to be forgiven regardless of what we do. Anyone in PSLF, or even the 20/25 yr PAYE/REPAYE plans is not going to pay off their loans in their entirety. And the less you make the more will be forgiven.

                        Student loan planner does a very interesting podcast talking about this. For some people the cost of grad school might be cheaper than it was 30 years ago if theyre smart and preferentially use retirement accounts to reduce AGI, etc
                        Wasteful.

                        Universities paid with tax dollars.

                        Root cause not addressed.

                        The “cost” of school did not decrease. You are incorrect in your terminology.

                        Foolish and myopic

                        Comment


                        • #72
                          Originally posted by The White Coat Investor View Post

                          Labor acts differently when it also is the owner. For example, I actually care whether my patient comes back to our ED. Why? Because I own the job. I actually appreciate it when the ED is busy. Why? Because I make more money because I own the job. How do the nurses feel? Very differently. They're paid hourly by the hospital.

                          So no, I don't think you're quite right there. The jobs are too melded to be separated out.

                          Bolded is true, but it doesn't change the fact that doctoring is labor. So, I'm not sure what your point is.

                          Furthermore, the difference with nurse compensation and your compensation is that nurses are paid hourly and you are paid based on your productivity. The fact that you are an owner is coincidental.

                          Labor can be incentivized in that way even if they have no ownership stake. For example, I have a bunch of colleagues who are paid on a wRVU basis. They are not owners. They care very much about being busy and having happy patients that that want to see them and tell their friends to do the same. Because the more efficient they are and the more care they can delivery, the higher their compensation will be.

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                          • #73
                            Originally posted by Tangler View Post

                            Wasteful.

                            Universities paid with tax dollars.

                            Root cause not addressed.

                            The “cost” of school did not decrease. You are incorrect in your terminology.

                            Foolish and myopic

                            I’m not saying it’s good policy, it’s just the reality. I’m saying that the cost to the student went down if they’re having enough written off through the rules of REPAYE/PAYE/PSLF. That is correct any way you slice it.

                            Comment


                            • #74
                              Originally posted by Tangler View Post
                              I worked at another hospital (not to be named) where the nurses were unionized and they worked shifts. They would move like snails. I asked my boss: "hey, can we do anything to incentivize the nurses to speed up........pay them for fast set ups or quick room turnovers etc." I was told by my boss: "the union will not allow this".

                              This sounded odd so I asked the nurses and they confirmed. I forget the actual logic but they did not want to have some nurses treated differently from the others or some such stuff.

                              The older nurses liked moving slow and did not want to be pushed.

                              The less they did the less they had to do prior to shift change. Slow was rewarded so slow it was.
                              Exactly. Watch an OR being turned over by union employees and watch a private OR turnover—night and day. And that’s before you time it!

                              Inculcating laziness with financial reward and disincentivizing actual work is ridiculous in any field—but especially medicine—and has sadly predictable results.

                              Some people make, and some people take.

                              It’s simply a mindset, I suppose.

                              Pride in your work is something to be valued and strived for, regardless of what you do.

                              Comment


                              • #75
                                Originally posted by Turf Doc View Post


                                I’m not saying it’s good policy, it’s just the reality. I’m saying that the cost to the student went down if they’re having enough written off through the rules of REPAYE/PAYE/PSLF. That is correct any way you slice it.
                                Sorry, I did not get intend any negative comments to be directed at you, but rather at the concept of loan forgiveness.

                                Politicians trying to buy votes from kids.

                                Wasteful loss of money for those paying taxes.

                                Root cause not addressed.

                                Universities keep raising tuition & know the government (tax payers) will bail them out.

                                Makes students depend on the government for “forgiveness”.

                                Also adds needless layers of red tape and bureaucracy.

                                Another way for the feds to control your life and to fleece the tax payer.
                                Last edited by Tangler; 04-19-2022, 02:47 AM.

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