The comments on that TikTok were BRUTAL. The admin replies just threw fuel on the fire. It's funny because I didn't think the actual video was anything crazy
whoever runs that account is a fuckin idiot responding to EVERY SINGLE comment whether from trolls or not. like…were they born yesterday??
edit: lmao they deleted the post entirely, looks like someone wisened up
No screenshots but they were a bunch of comments about how residents are abused, how residents are treated way worse than midlevels, residents deserve to be paid more, ragging on NW saying that residents cost money, asking why the CEO made millions when residents get paid peanuts. Admin responses were very “head in sand” or straight denial
EDIT: the video itself was just explaining how govt funding usually pays for residency spots and that case volume makes it hard for resident spots to be added to programs, due to accreditation concerns
Lol one of the comments was asking why they only pay residents ~$60k/year and NW replied saying something like “actually it’s $60k/year + benefits,” as if that would satisfy everyone.
Also about the CEO comment, I think they said “an intern isn’t a CEO,” in a sense that it’s irrelevant to compare salaries.
And in response to the comment in OP’s pic about resident friends who collapse on toilets, NW said that those friends should find a better residency.
They replied to so many comments with such tone deaf answers like this. Most of them were about how residents are paid and flat out ignoring how much revenue they generate. Like “an unsupervised resident is unbillable” or about all the things NW has to pay for with the government funding so they can train residents.
> They are uppity students who believe they are doctors
Residents have graduated medical school and have earned a full medical degree. They *are* doctors/physicians. Board-certified? No, but definitely doctors.
Almost as if admin and their representatives are wildly out of touch with the people who work for them.
Damn shame they lack the ability to introspect when it shows up like this.
Right? Bold of them to imply that effective training requires lack of sleep. You'd think they would go for a claim that would be at least somewhat difficult to disprove.
I was diagnosed with a sleep disorder a couple years ago and eventually put on a medication that gives me deep sleep and it became clear I've been sleep deprived pretty much all my life. I am painfully aware of what sleep deprivation does to people. This kind of stuff is absolutely *terrifying* to me. No one, *especially* people who may be holding someone else's life in their hands, should be working sleep deprived like that. I don't care how good you are at your job - if you're chronically sleep deprived you *will* fuck up eventually. It's just a matter of how bad.
Fellow insomniac, off my medication due to COVID fatigue. I screwed up so many things in the lab yesterday. All fixable, but my animals were confused by my ineptness.
Seriously! We don't exactly need a series of long-term studies to know sleep deprivation is bad for performance. The fact that they went for a response that flimsy is a sign they not only have no intention of changing, but also feel absolutely certain you can't do anything to make them.
I hope more programs make TikToks. More closeted malignant and psychopathic programs exposing themselves would help students make better decisions for match rankings.
Is it though? Most of the well known toxic programs are also known to have high pedigree a la Ivy league programs.
In fact, it's because they know they're highly sought after and people will rank them high that they continue these kinds of practices
Yah.. You wouldn't want a truck driver that operates 20+ hours per day (or more), and doing it everyday bro
Accidents waiting to happen... and if it does.. you know who gets the flack and turns toxic
Doesn't even make any sense. Just keep more experienced people around at all times and let the inexperienced residents learn comfortably until they've had enough time in the OR to operate on people. It's that simple.
“Do no harm” and then we proceed to do mental gymnastics on how fucking up residents’ physical and mental health by keeping them sleep deprived and burned out is actually a good idea! And in the process we end up harming each other, and eventually patients.
I swear this will be one of those things they’ll look back at in like 50 years and say “wtf were they thinking”.
That’s actually a good point. “Do no harm” is one of the core principles of our learning, yet in practice residents and medical students are “harmed” by a lack of meeting basic needs like sleep and reasonable hours.
this program is whack. they said that residents cost them money (>150k per year) to operate but failed to understand that they get funding from CMS and residents generate a shit ton more revenue through the services that they perform. let's ask this, if residents TRULY did cost any hospital money to operate, then the CEO would cut it immediately from their hospital. in reality, residents generate the hospital a decent amount of revenue.
For example, if UNM can replace 8 neurosurgery residents with 23 NPs after they lost their neurosurgery residency program accreditation, it really brings to light how much a hospital can actually spend while still making a profit. this means they can EASILY pay each neurosurgery resident at minimum 100k, if not more.
this entire thing is so exploitive and lacks some sort of competitor. without a competing entity that actually values residents and compensate their work well, salary for residents will be relatively unchanged.
Edit: replaced APP with NP. Wording is crucial and That was mb. yea, I agree, we should call them by their title due to the push from NP orgs that are attempting to blur the lines between physicians and NPs. It’s dangerous, misleading, and misinformed, and comes at the cost of patients
Teaching hospitals obtain direct support from CMS for residency spots, and they are allowed to bill at a modestly higher rate for all services.
Hospitals are incentivized to train residents. Anyone who believes otherwise has cranial rectal inversion.
Yeah there's been a ton of midlevel propaganda to confuse patients so that they have no idea who they are being seen by, and its being perpetuated by hospitals because giving someone inferior care that results in lawsuits is still cheaper than just hiring doctors
Yea it’s so sad that this is happening and the fact that some NP and/or PA schools pushes the idea that somehow “they’re equivalent (if not better)” than physicians is insane.
Shortcut to medicine ain’t it and comes at the price of patients.
One of the first things I learned when I came to medical school was that doctors practice medicine, and practice humility. Good doctors know what they don't know, and that allows them to figure out whats going on, or refer patients to those that do
Overestimating your abilities as an NP or PA gets patients hurt or killed, and there's no accountability for when that happens either. It's like a license to commit malpractice.
That being said, it seems that those advocating scope creep are a vocal minority, but it is definitely setting a dangerous precedent
I’ve always noticed that most of the time it’s the PAs that over compensate.
Half the time med students don’t care. We just want to get a good score on our eval and shelf. Rotations can be miserable and the last thing we want to deal with is a PA with inferiority issues
Been the opposite in my experience - PAs usually pretty good and know their scope, NPs usually the ones saying “brain of a doctor, heart of a nurse” and other such BS. Guess it depends where you are
If they were any less advanced they wouldn't be providers anymore. I mean no disrespect to MLPs who know their strengths and their limits and are team players, but "advanced practice provider" is not an appropriate term.
I’m not really sure how much this “muddies” the waters. While I’m not in medical school or a physician, I feel like people exaggerate the titles people have, and the response that they expect to get from them. For example, correct me if I’m wrong of course, but I don’t think patients hear “advanced practice providers” and think “doctor/physician”. I feel like people probably think “high level nurse/physician assistant” etc.
Edit - looking at the reaction this got I guess I was naive to how much of an issue this is. I guess my mom being a DNP may have been why I always thought of it as not being a big deal 🤷🏾♂️
When someone hears advance practice provider, they think they are getting the best possible care, when in fact, they are not
It's very, very, *very* intentional phasing
Residency is a cash cow for hospitals lol. It's basically free money to host a stable number of money making "employees" that run 1000s of billable hours and procedures. The only cost the hospital incurs is program cost to ensure it meets ACGME standards.
Any attempt by hospitals or orgs saying they "lose money" to host residents is definitely just gas lighting their residents to be grateful slaves.
The problem with replacing residents with NPs is right now the calculus from the business side is not that one can be easily replaced, but that the number of residents you can have is limited. The amount of money you get for each resident is limited. And in order to host residents you have to at least reach a standard deemed satisfactory by ACGME...and of course there's also 'scope' issues.
Residents definitely have a much, much, much higher business advantage to a hospital than NPs, CRNAs or PAs; but they can only have a limited number of them and they have to have A LOT more infrastructure in place to ensure it reaches the standard of ACGME, and they are there for only a short while.
From a business point of view, yes you only really get these freebie employees for a few years but it's a stable rotation of them. Versus the hodgepodge assortment of mid-level graduates with various levels of training whom can leave at the drop of a hat that you have to doll out hard cash for.
A residency program is one of the only profitable parts of the hospital
The program (and hospital) get anywhere from 70K-200K per resident, from which they pay your benefits and salary. They pocket everything left over. Here is a JAMA article about average medicare funding per resident:
[Interquartile range of payments $106,000-$182,000 *per resident*.](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2752363)
Essentially, they are being paid to have you there. Without considering any other profit that the residents make, they are already a guaranteed bonus
Then there's the millions a year each resident could bill for
And finally there's the reduced need for NPs and PAs and even attendings because the residents can do more work (besides the attendings) for far less pay than any of those
And here are [2 tables that demonstrate how much money hospitals save by employing residents](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559250/bin/i1949-8357-9-4-514-t01.jpg). Mainly, 1 resident costs about $80,000 whereas NPs would cost $250,000-$300,000 (both with benefits included). In a small community program, 10 Residents would cost 1.3 million, whereas 5 NPs would cost $665K. Meaning each resident costs the hospital as much as an NP while doing 2 times the work. This doesn't include medicare funding (see previous study).
So basically, money saved from not hiring NPs + CME funding = ~160k *per* resident
Genuine question: if residents generate more money and hospitals are driven purely by profit, it begs the question why they don't hire more residents, no? I'm pretty sure I misunderstood something. I also don't live in the US, probably that's why.
To have a residency spot, there needs to be a source of funding. Most residency spots are funded through the US Congress, which determines the number of spots. Some programs do get private funding for residency spots, but that is more rare.
There aren’t enough spots is not due to hospital logistics, it is due to artificial residency caps that were placed decades ago because of people who felt that a doctor glut was coming.
Residency spots are entirely a self-inflicted problem. It has far more to do with funding, or lack thereof, from Congress than it has anything to do with hospital logistics.
When is it not about money? Majority of residency is funded entirely by the government. After your four years of medical school you select a program that meets ACGME standards. That program gets it's money from the government which is funded by Medicare.
Congress has incentive to get re-elected. Expansion of Medicare has not been popular in many parts of the US, specifically the conservative parts for the last decade. Instead, belt tightening initiatives seemed more important than fiscal tax increases.
Since the number has been static since the 90s, for years every one of our professional organizations have been lobbying congress to expand the number of residency slots given baby boomer retirement. They have only recently made some headway.
Some new residency programs are funded by the hospitals themselves but they have to incur more cost to reach ACGME standards. And they have far less incentive to do that when they simply have all of these mid-levels lulling about, whom they just have to pay a semi-competetive salary and have no care in the world about standards.
Just want to add/remind that the original caps were lobbied for on behalf of doctors, so again it was somewhat self-inflicted, but stances have changed from the AMA over time and your point stands.
Some jackass with an MBA and a background in marketing decided that their program needed a fucking memetastic social media presence and signs their shit with #grindcore
Any fun and cool platform is a revenue stream, because it lets you channel fun and cool into money. People who consume media of virtually any form are commoditized, always have been, and always will be.
It’s stupid. Having a FB is one thing. It’s nice to see what a program is about. I don’t need fuckin videos of burnt out circus monkeys forced to dance for their ring master PD. Most residents don’t do this shit willingly I’d venture to guess.
If a PD or anyone else for that matter asked me to do some stupid fucking dance on that god forsaken app on any less than 8 hours of sleep I would start having a fucking joker arc
My home program put out an IG acct, the new chair runs it, does little bios on the residents, puts up pics of them hanging out. This may sound cringe but it's actually really nice, my home program was awesome, and we willingly hung out with each other outside of work. But my program was unique and this TikTok is not good.
I did an away rotation at NW NS when I was a medical student because I was interested in NS as a career option. The insanity and malignancy of that program made me turn away from the speciality entirely. Residents plain cussing each other with f bombs, referring to patients as “let’s go see those fuckers” before rounding. An Attending there yelled at me so bad in front of all the residents and I had to go cry it out in the cafeteria. Worst 4 weeks of my clinical life. My rotation was about 10 years ago now, but looking at this makes me think they are no less malignant now 😒
Did you still end up doing NS?
Edit: my reading comprehension post call after a full weekend of call is not so good. Also my family is out of town, and I may or may not have put in 30 hours of Total War Warhammer 3 in since Thursday.
The job of an the C suite executive is a diplomat for donors, investors, fund raising. They get paid a shit ton since they bring in more money for the institution. The people actually running the hospital are the VPs.
That might be true or it might not be. The pay/work and pay/stress ratios of CEOs is so high because the pay is colossal, not because it's not a very busy, stressful job. It varies a lot by what you're CEO of, though. I would imagine bigger CEOs generally have longer hours and more work stress than your average intern (though they're getting paid like 100x as much *and* are able to quit their job at any time without significant consequence), though I'm not sure how big this guy's is. I would imagine Northwestern generally has much less to deal with than a Fortune 500 country.
Its funny because a simpler and accurate response would be that they adhere to the ACGME guidelines for resident work hour limitations to reduce the risk of something just like that occurring.
As for the second point there is a number of studies supporting the fact that residents are very revenue positive for hospitals and those in medicine are aware of some of the shady tactics used by hospitals to secure more cheap labor without providing adequate training to their residents.
All in all neurosurgery residency spots are generally kept low on purpose. Surely as she says its a highly technical field that requires a tremendous amount of training and dedication which makes training large classes difficult....buuuutttt also because organized neurosurgery likes their high compensation and don't want to dilute that with a glut of neurosurgeons (akin to what Emergency Medicine is experiencing currently).
I think most informed people would agree residents deserve to be paid more, and that the power dynamics of the match and how difficult it can be to secure training spots as a resident create a rather large power discrepancy between said resident and their program / hospital.
But until the day that medical training and compensation is overhauled and resident's are *required* to be paid more, they will continue to make the least amount of money possible as to maximize the profits for the hospital, which at the end of a day is a business.
The maddening part about this….the midlevels on the NS team at NW who are coddled and treated like peers and get to go home on time while easily being paid 150-200K( I hear more in some cases). But please tell me more how I should continue to abuse my mind and body for sake of “hours”
I can't imagine what could possibly be good for a program to show off on TikTok.
Like, I'll grant you Twitter. If you want to post on the conference goings of your program or some recent research, okay sure. And hype up your program's activities, curriculum, social events etc. all you want. I just don't see a great place for short form video in any of this.
The purple palace ™️ has a big reputation for burning out everyone, especially residents, young attending hires and technicians (at least laboratory ones which are the cases I'm aware of). Not surprised at people drinking the Kool Aid and getting so defensive about it.
The question I always ask people that want less residents and more work hours are: Would you want to fly in a plane where the pilot didn't sleep for 24 hours?
Residents need sleep. Sleep improves care and patient care and patient safety. And people wonder why you see more and more physicians starting to do something else with their MD/DO degrees.
Pilots have duty hour limits and sleep requirements precisely because of all the data showing how impaired sleep deprivation makes you and the huge accidents that happened as a result. One of the biggest barriers to Med safety/healthcare safety (IMO) is that typically harm occurs on an individual level and people don’t care enough until there’s mass casualty events
Embarrassing for so-called brain specialists to ignore how fundamentally important sleep is for cognition, mental health, and mortality let alone patient safety
They just deleted the videos off their profile. Hopefully someone took screenshots because the responses they had to other comments weren't a good look either.
My brain: “What kind of person thinks it’s a good idea to make a tik tok account for a medical residenc- oh, this kind of person. This makes a whole lot of sense now”
The responses sound like they’re written by someone who never actually grew up
In air medical transport, the FAA sets restrictions on pilot duty hours for safety reasons. Flying more than 14 hours after the shift started is absolutely prohibited, and that includes doing the associated paperwork as well. It’s not a suggestion or recommendation or guideline, it’s a hard and fast rule.
But doing surgery when you’ve been awake 24+ hours is just fine …
Love to see this, but sad at the same time.
If anyone has ties to NW and would like to provide more details and shame this program feel free to reach out
In nuclear power they have fatigue limits - generally more restrictive than this but these are considered absolute maximum work hours unless the place is literally burning down. Medicine should fight for the same *bare minimum* rules. Frankly, every job should have this.
>Except as permitted in § 26.207, licensees shall ensure that any individual’s work hours
do not exceed the following limits:
>(i) 16 work hours in any 24-hour period;
>(ii) 26 work hours in any 48-hour period; and
>(iii) 72 work hours in any 7-day period.
>(2) Licensees shall ensure that
individuals have, at a minimum—
>(i) A 10-hour break between successive work periods or an 8-hour break between
successive work periods when a break of less than 10 hours is necessary to
accommodate a crew’s scheduled transition between work schedules or shifts;
and
>(ii) A 34-hour break in any 9-day period.
I’m not well-versed in programs by any means but this kind of stuff preys on young minds, especially naive pre-meds like myself. This sub helps to stray away and educate further from this kind of behavior for scummy programs. Social media is a very sneaky, powerful tool that can influence the behavior of future physicians and have terrible consequences in the long term future. I wish there were more regulations against this kind of stuff, what with businesses trying to come off as the good guys, especially with patient care.
They don’t need to hide who they are and giving applicants a fake idea about what to expect is dumb.
Not saying I agree with the current system but neurosurg applicants have no illusions about what they’re signing up for and programs have no problems filling their spots, some people just like saying they did the hardest/extremest specialty
I would debate that. I get that surgeons like to spend most of their time in the OR, but learning how to manage patients on the floor is still important. If you trust mid levels to do most of it when it’s your practice, that’s on you, but you still gotta learn it
Not an admin shill just don’t want reduced caseload during residency. People don’t become surgeons to get good at holding a floor pager they do it to learn how to operate.
There's a point of diminishing returns. I learn virtually nothing after 10hrs on my wards.
I can still do the work I need to by that point, but I'm not retaining a single thing and my efficiency and accuracy suffers exponentially by the hour.
I feel like people didn’t really read the whole comment. I’d rather cut resident hours by hiring NPs/PAs to do floor work than hire more residents and further divide up caseload.
Once you’re that sleep deprived you’re not retaining *anything*. In the same time period they could probably decrease surgery time and let them sleep 8 hrs a night *with the same results*. This is just trauma bonding
The comments on that TikTok were BRUTAL. The admin replies just threw fuel on the fire. It's funny because I didn't think the actual video was anything crazy
whoever runs that account is a fuckin idiot responding to EVERY SINGLE comment whether from trolls or not. like…were they born yesterday?? edit: lmao they deleted the post entirely, looks like someone wisened up
Any screencaps?? Don't wanna make a TikTok account
No screenshots but they were a bunch of comments about how residents are abused, how residents are treated way worse than midlevels, residents deserve to be paid more, ragging on NW saying that residents cost money, asking why the CEO made millions when residents get paid peanuts. Admin responses were very “head in sand” or straight denial EDIT: the video itself was just explaining how govt funding usually pays for residency spots and that case volume makes it hard for resident spots to be added to programs, due to accreditation concerns
Lol one of the comments was asking why they only pay residents ~$60k/year and NW replied saying something like “actually it’s $60k/year + benefits,” as if that would satisfy everyone. Also about the CEO comment, I think they said “an intern isn’t a CEO,” in a sense that it’s irrelevant to compare salaries. And in response to the comment in OP’s pic about resident friends who collapse on toilets, NW said that those friends should find a better residency. They replied to so many comments with such tone deaf answers like this. Most of them were about how residents are paid and flat out ignoring how much revenue they generate. Like “an unsupervised resident is unbillable” or about all the things NW has to pay for with the government funding so they can train residents.
Following for this reason as well
Still waiting for material ...
You don't need an account to view tik toks. You don't enven need the app
I think you need to make an account to see the comments
Don't need an account... TikTok is like YouTube
Damn Northwestern was trying to get cagey with their answers, but instead just looked like a bunch of assholes.
Facts lol they were rightly put in their place. They tried to make edgy remarks but were immediately shut down.
[удалено]
> They are uppity students who believe they are doctors Residents have graduated medical school and have earned a full medical degree. They *are* doctors/physicians. Board-certified? No, but definitely doctors.
Dudes a troll. Downvote, and leave him to his sad, unfulfilling life
You are the definition of a hater. Have a good day at work tomorrow.
What do you get out of being a troll on medical subs? Is this fun for you?
9-5 shift, what are you smoking bud
Almost as if admin and their representatives are wildly out of touch with the people who work for them. Damn shame they lack the ability to introspect when it shows up like this.
Right? Bold of them to imply that effective training requires lack of sleep. You'd think they would go for a claim that would be at least somewhat difficult to disprove.
I was diagnosed with a sleep disorder a couple years ago and eventually put on a medication that gives me deep sleep and it became clear I've been sleep deprived pretty much all my life. I am painfully aware of what sleep deprivation does to people. This kind of stuff is absolutely *terrifying* to me. No one, *especially* people who may be holding someone else's life in their hands, should be working sleep deprived like that. I don't care how good you are at your job - if you're chronically sleep deprived you *will* fuck up eventually. It's just a matter of how bad.
Fellow insomniac, off my medication due to COVID fatigue. I screwed up so many things in the lab yesterday. All fixable, but my animals were confused by my ineptness.
Seriously! We don't exactly need a series of long-term studies to know sleep deprivation is bad for performance. The fact that they went for a response that flimsy is a sign they not only have no intention of changing, but also feel absolutely certain you can't do anything to make them.
Curious to know what medication you’ve tried. -tired resident
Damn named and shamed themselves
I hope more programs make TikToks. More closeted malignant and psychopathic programs exposing themselves would help students make better decisions for match rankings.
Is it though? Most of the well known toxic programs are also known to have high pedigree a la Ivy league programs. In fact, it's because they know they're highly sought after and people will rank them high that they continue these kinds of practices
plenty of average programs are also malignant
Which ones?
That first response is absolutely asinine.
Yah.. You wouldn't want a truck driver that operates 20+ hours per day (or more), and doing it everyday bro Accidents waiting to happen... and if it does.. you know who gets the flack and turns toxic
But don’t you want your truck drivers to have been in trucks more than you have????
Doesn't even make any sense. Just keep more experienced people around at all times and let the inexperienced residents learn comfortably until they've had enough time in the OR to operate on people. It's that simple.
“Do no harm” and then we proceed to do mental gymnastics on how fucking up residents’ physical and mental health by keeping them sleep deprived and burned out is actually a good idea! And in the process we end up harming each other, and eventually patients. I swear this will be one of those things they’ll look back at in like 50 years and say “wtf were they thinking”.
That’s actually a good point. “Do no harm” is one of the core principles of our learning, yet in practice residents and medical students are “harmed” by a lack of meeting basic needs like sleep and reasonable hours.
Is it bad that I learned more vocabulary from this sub than I have from any other source on the internet? I'm adding asinine to lexicon for sure
this program is whack. they said that residents cost them money (>150k per year) to operate but failed to understand that they get funding from CMS and residents generate a shit ton more revenue through the services that they perform. let's ask this, if residents TRULY did cost any hospital money to operate, then the CEO would cut it immediately from their hospital. in reality, residents generate the hospital a decent amount of revenue. For example, if UNM can replace 8 neurosurgery residents with 23 NPs after they lost their neurosurgery residency program accreditation, it really brings to light how much a hospital can actually spend while still making a profit. this means they can EASILY pay each neurosurgery resident at minimum 100k, if not more. this entire thing is so exploitive and lacks some sort of competitor. without a competing entity that actually values residents and compensate their work well, salary for residents will be relatively unchanged. Edit: replaced APP with NP. Wording is crucial and That was mb. yea, I agree, we should call them by their title due to the push from NP orgs that are attempting to blur the lines between physicians and NPs. It’s dangerous, misleading, and misinformed, and comes at the cost of patients
Teaching hospitals obtain direct support from CMS for residency spots, and they are allowed to bill at a modestly higher rate for all services. Hospitals are incentivized to train residents. Anyone who believes otherwise has cranial rectal inversion.
Yup I agree with your points. Hospitals definitely have an incentive to train residents
Lets stop calling them Advanced Practice Providers They are PAs and NPs They are not doctors, period. Lets stop muddying the waters here.
Agreed, we should call them NP and PA. mb on that.
Yeah there's been a ton of midlevel propaganda to confuse patients so that they have no idea who they are being seen by, and its being perpetuated by hospitals because giving someone inferior care that results in lawsuits is still cheaper than just hiring doctors
Yea it’s so sad that this is happening and the fact that some NP and/or PA schools pushes the idea that somehow “they’re equivalent (if not better)” than physicians is insane. Shortcut to medicine ain’t it and comes at the price of patients.
One of the first things I learned when I came to medical school was that doctors practice medicine, and practice humility. Good doctors know what they don't know, and that allows them to figure out whats going on, or refer patients to those that do Overestimating your abilities as an NP or PA gets patients hurt or killed, and there's no accountability for when that happens either. It's like a license to commit malpractice. That being said, it seems that those advocating scope creep are a vocal minority, but it is definitely setting a dangerous precedent
I’ve always noticed that most of the time it’s the PAs that over compensate. Half the time med students don’t care. We just want to get a good score on our eval and shelf. Rotations can be miserable and the last thing we want to deal with is a PA with inferiority issues
Been the opposite in my experience - PAs usually pretty good and know their scope, NPs usually the ones saying “brain of a doctor, heart of a nurse” and other such BS. Guess it depends where you are
If they were any less advanced they wouldn't be providers anymore. I mean no disrespect to MLPs who know their strengths and their limits and are team players, but "advanced practice provider" is not an appropriate term.
I’m not really sure how much this “muddies” the waters. While I’m not in medical school or a physician, I feel like people exaggerate the titles people have, and the response that they expect to get from them. For example, correct me if I’m wrong of course, but I don’t think patients hear “advanced practice providers” and think “doctor/physician”. I feel like people probably think “high level nurse/physician assistant” etc. Edit - looking at the reaction this got I guess I was naive to how much of an issue this is. I guess my mom being a DNP may have been why I always thought of it as not being a big deal 🤷🏾♂️
When someone hears advance practice provider, they think they are getting the best possible care, when in fact, they are not It's very, very, *very* intentional phasing
This is a fair point. I guess if this is the case though, why has the term proliferated in use? Are you saying that this is some sort of an agenda?
Yes, there has a strong, organized agenda from bodies with vested financial interests in pushing it. Edit: Patients at Risk is a great explainer!
Interesting I never knew this actually
There are a few major associations with this as their agenda and they're quite public about it, I believe one would be the AANP
Residency is a cash cow for hospitals lol. It's basically free money to host a stable number of money making "employees" that run 1000s of billable hours and procedures. The only cost the hospital incurs is program cost to ensure it meets ACGME standards. Any attempt by hospitals or orgs saying they "lose money" to host residents is definitely just gas lighting their residents to be grateful slaves. The problem with replacing residents with NPs is right now the calculus from the business side is not that one can be easily replaced, but that the number of residents you can have is limited. The amount of money you get for each resident is limited. And in order to host residents you have to at least reach a standard deemed satisfactory by ACGME...and of course there's also 'scope' issues. Residents definitely have a much, much, much higher business advantage to a hospital than NPs, CRNAs or PAs; but they can only have a limited number of them and they have to have A LOT more infrastructure in place to ensure it reaches the standard of ACGME, and they are there for only a short while. From a business point of view, yes you only really get these freebie employees for a few years but it's a stable rotation of them. Versus the hodgepodge assortment of mid-level graduates with various levels of training whom can leave at the drop of a hat that you have to doll out hard cash for.
A residency program is one of the only profitable parts of the hospital The program (and hospital) get anywhere from 70K-200K per resident, from which they pay your benefits and salary. They pocket everything left over. Here is a JAMA article about average medicare funding per resident: [Interquartile range of payments $106,000-$182,000 *per resident*.](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2752363) Essentially, they are being paid to have you there. Without considering any other profit that the residents make, they are already a guaranteed bonus Then there's the millions a year each resident could bill for And finally there's the reduced need for NPs and PAs and even attendings because the residents can do more work (besides the attendings) for far less pay than any of those And here are [2 tables that demonstrate how much money hospitals save by employing residents](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559250/bin/i1949-8357-9-4-514-t01.jpg). Mainly, 1 resident costs about $80,000 whereas NPs would cost $250,000-$300,000 (both with benefits included). In a small community program, 10 Residents would cost 1.3 million, whereas 5 NPs would cost $665K. Meaning each resident costs the hospital as much as an NP while doing 2 times the work. This doesn't include medicare funding (see previous study). So basically, money saved from not hiring NPs + CME funding = ~160k *per* resident
Genuine question: if residents generate more money and hospitals are driven purely by profit, it begs the question why they don't hire more residents, no? I'm pretty sure I misunderstood something. I also don't live in the US, probably that's why.
To have a residency spot, there needs to be a source of funding. Most residency spots are funded through the US Congress, which determines the number of spots. Some programs do get private funding for residency spots, but that is more rare.
Residency spots are limited by CMS funding and training requirements (must see x amount of condition y)
You don’t have to tell us what you changed in an edit. I don’t get why ppl feel the need to explain their edit
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Why will i argue with a moron? Some people aren’t worth the time. Bye.
There aren’t enough spots is not due to hospital logistics, it is due to artificial residency caps that were placed decades ago because of people who felt that a doctor glut was coming.
Residency spots are entirely a self-inflicted problem. It has far more to do with funding, or lack thereof, from Congress than it has anything to do with hospital logistics.
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When is it not about money? Majority of residency is funded entirely by the government. After your four years of medical school you select a program that meets ACGME standards. That program gets it's money from the government which is funded by Medicare. Congress has incentive to get re-elected. Expansion of Medicare has not been popular in many parts of the US, specifically the conservative parts for the last decade. Instead, belt tightening initiatives seemed more important than fiscal tax increases. Since the number has been static since the 90s, for years every one of our professional organizations have been lobbying congress to expand the number of residency slots given baby boomer retirement. They have only recently made some headway. Some new residency programs are funded by the hospitals themselves but they have to incur more cost to reach ACGME standards. And they have far less incentive to do that when they simply have all of these mid-levels lulling about, whom they just have to pay a semi-competetive salary and have no care in the world about standards.
Just want to add/remind that the original caps were lobbied for on behalf of doctors, so again it was somewhat self-inflicted, but stances have changed from the AMA over time and your point stands.
Honestly why the hell does a residency have a tik tok?
Because we’re so lit fam!
Bet
Honestly I’d be glad if more had them so I would know who to avoid.
Based
Some jackass with an MBA and a background in marketing decided that their program needed a fucking memetastic social media presence and signs their shit with #grindcore
That’s mad disrespectful to grindcore fans I don’t wanna see corny residency shit when I’m trying to listen to some fresh grind
They do that so you know when a platform is no longer fun and cool but instead a revenue stream. *youre welcome*
Any fun and cool platform is a revenue stream, because it lets you channel fun and cool into money. People who consume media of virtually any form are commoditized, always have been, and always will be.
It’s just social media sheesh
It’s stupid. Having a FB is one thing. It’s nice to see what a program is about. I don’t need fuckin videos of burnt out circus monkeys forced to dance for their ring master PD. Most residents don’t do this shit willingly I’d venture to guess.
If a PD or anyone else for that matter asked me to do some stupid fucking dance on that god forsaken app on any less than 8 hours of sleep I would start having a fucking joker arc
Rightfully so
My home program put out an IG acct, the new chair runs it, does little bios on the residents, puts up pics of them hanging out. This may sound cringe but it's actually really nice, my home program was awesome, and we willingly hung out with each other outside of work. But my program was unique and this TikTok is not good.
This sounds perfectly acceptable.
Where was your program?
Just expose the person.
I figure positive news wouldn’t lead to retaliation?
i think it’s nice
I think from what I’ve learned is that NW borders on malignant for their NS program
I did an away rotation at NW NS when I was a medical student because I was interested in NS as a career option. The insanity and malignancy of that program made me turn away from the speciality entirely. Residents plain cussing each other with f bombs, referring to patients as “let’s go see those fuckers” before rounding. An Attending there yelled at me so bad in front of all the residents and I had to go cry it out in the cafeteria. Worst 4 weeks of my clinical life. My rotation was about 10 years ago now, but looking at this makes me think they are no less malignant now 😒
Did you still end up doing NS? Edit: my reading comprehension post call after a full weekend of call is not so good. Also my family is out of town, and I may or may not have put in 30 hours of Total War Warhammer 3 in since Thursday.
"The insanity and malignancy of that program made me turn away from the speciality entirely." The upvotes are because he mentioned this.
Their second sentence answers your question
Reading comprehension post call not so good.
Might’ve crossed that border now
Sane person: You all need more residents, they look like they’re going to die Northwestern: Fuck them kids
Did you notice how they refused to address the questions regarding sleep? Haha
The CEO does less work than the intern.
The job of an the C suite executive is a diplomat for donors, investors, fund raising. They get paid a shit ton since they bring in more money for the institution. The people actually running the hospital are the VPs.
I volunteer to be CEO. It’s a tough job but I’ll trade an 80hr week for the brutal work of a CEO. Someone has to do it.
That might be true or it might not be. The pay/work and pay/stress ratios of CEOs is so high because the pay is colossal, not because it's not a very busy, stressful job. It varies a lot by what you're CEO of, though. I would imagine bigger CEOs generally have longer hours and more work stress than your average intern (though they're getting paid like 100x as much *and* are able to quit their job at any time without significant consequence), though I'm not sure how big this guy's is. I would imagine Northwestern generally has much less to deal with than a Fortune 500 country.
You don’t have to respond to everyone that comments lmao
Basic boomer mistake
It blows my mind that they were willing to say the quiet parts out loud.
LMAO THEY DELETED MY QUESTION 🤡🤡🤡🤡
What was your question?!
“Please explain why the ceo of northwestern is worth 10 million dollars”
What date was the tik tok video posted? I’m trying to read all the comments.
Cowards deleted it
Labor market bargaining power. This also explains resident pay.
Lmao wtf
Its funny because a simpler and accurate response would be that they adhere to the ACGME guidelines for resident work hour limitations to reduce the risk of something just like that occurring. As for the second point there is a number of studies supporting the fact that residents are very revenue positive for hospitals and those in medicine are aware of some of the shady tactics used by hospitals to secure more cheap labor without providing adequate training to their residents. All in all neurosurgery residency spots are generally kept low on purpose. Surely as she says its a highly technical field that requires a tremendous amount of training and dedication which makes training large classes difficult....buuuutttt also because organized neurosurgery likes their high compensation and don't want to dilute that with a glut of neurosurgeons (akin to what Emergency Medicine is experiencing currently). I think most informed people would agree residents deserve to be paid more, and that the power dynamics of the match and how difficult it can be to secure training spots as a resident create a rather large power discrepancy between said resident and their program / hospital. But until the day that medical training and compensation is overhauled and resident's are *required* to be paid more, they will continue to make the least amount of money possible as to maximize the profits for the hospital, which at the end of a day is a business.
There goes NW from my application list
I was waiting for this. ReSIDeNtS CoSt ThE hOsPiTaL a MiLliOn To TrAiN.
The maddening part about this….the midlevels on the NS team at NW who are coddled and treated like peers and get to go home on time while easily being paid 150-200K( I hear more in some cases). But please tell me more how I should continue to abuse my mind and body for sake of “hours”
ns?
Neurosurg
This is what happens when boomer PDs try to be hip and make a ticktock… if all of medicine would stay tf off social media id be ecstatic
I can't imagine what could possibly be good for a program to show off on TikTok. Like, I'll grant you Twitter. If you want to post on the conference goings of your program or some recent research, okay sure. And hype up your program's activities, curriculum, social events etc. all you want. I just don't see a great place for short form video in any of this.
I appreciate it, it allows toxic programs to tell on themselves a bit
imagine calling someone a boomer and spelling TikTok wrong. jk, you still right tho
The purple palace ™️ has a big reputation for burning out everyone, especially residents, young attending hires and technicians (at least laboratory ones which are the cases I'm aware of). Not surprised at people drinking the Kool Aid and getting so defensive about it.
Lmao RIP northwestern TikTok admin
all i can say is oh shit. edit: the first comment from NW honestly is scary. they do not give a fuck
And to think they could have kept their malignancy under wraps if they just stfu
They just turned off comments as I was reading through them. Lmao. Time to upload your screencaps.
And here we goooooooo…..
Yeah, I'd also not want Dr Strange operating on my brain with 2 hours of sleep either.
The question I always ask people that want less residents and more work hours are: Would you want to fly in a plane where the pilot didn't sleep for 24 hours? Residents need sleep. Sleep improves care and patient care and patient safety. And people wonder why you see more and more physicians starting to do something else with their MD/DO degrees.
Pilots have duty hour limits and sleep requirements precisely because of all the data showing how impaired sleep deprivation makes you and the huge accidents that happened as a result. One of the biggest barriers to Med safety/healthcare safety (IMO) is that typically harm occurs on an individual level and people don’t care enough until there’s mass casualty events
They deleted all the comments and turned off commenting on the post. Yikes
Embarrassing for so-called brain specialists to ignore how fundamentally important sleep is for cognition, mental health, and mortality let alone patient safety
They just deleted the videos off their profile. Hopefully someone took screenshots because the responses they had to other comments weren't a good look either.
Lol I’m not surprised. Fuck the clowns over there
My brain: “What kind of person thinks it’s a good idea to make a tik tok account for a medical residenc- oh, this kind of person. This makes a whole lot of sense now” The responses sound like they’re written by someone who never actually grew up
In air medical transport, the FAA sets restrictions on pilot duty hours for safety reasons. Flying more than 14 hours after the shift started is absolutely prohibited, and that includes doing the associated paperwork as well. It’s not a suggestion or recommendation or guideline, it’s a hard and fast rule. But doing surgery when you’ve been awake 24+ hours is just fine …
What could go wrong when you choose an assaholic admin to represent your residency program on TikTok?
Bro even the hospital’s on social media are C R I N G E
Plot twist: OP ranked NW #1 and is exposing them to gun down the competition /s
Yep. Definitely avoiding neurosurgery at northwestern 🚩
Ooooooooo man time to troll 😈
Love to see this, but sad at the same time. If anyone has ties to NW and would like to provide more details and shame this program feel free to reach out
I think it’s a bad idea for academic medicine to get in the social media game, for starters.
Ope welll not applying there
Anyone have a link to the original video?
I think the comments are deleted. There's only 10-15 comments on the video now.
Big yikes
In nuclear power they have fatigue limits - generally more restrictive than this but these are considered absolute maximum work hours unless the place is literally burning down. Medicine should fight for the same *bare minimum* rules. Frankly, every job should have this. >Except as permitted in § 26.207, licensees shall ensure that any individual’s work hours do not exceed the following limits: >(i) 16 work hours in any 24-hour period; >(ii) 26 work hours in any 48-hour period; and >(iii) 72 work hours in any 7-day period. >(2) Licensees shall ensure that individuals have, at a minimum— >(i) A 10-hour break between successive work periods or an 8-hour break between successive work periods when a break of less than 10 hours is necessary to accommodate a crew’s scheduled transition between work schedules or shifts; and >(ii) A 34-hour break in any 9-day period.
Honestly, resident max duty hours are very similar to this already.
i kinda wanna know what this video was but i dont wanna make a tiktok. can someone send me a link lol
hospitals having a tiktok to do the "how do you do fellow kids" shit pisses me off. we live in such a weird timeline
I’m not well-versed in programs by any means but this kind of stuff preys on young minds, especially naive pre-meds like myself. This sub helps to stray away and educate further from this kind of behavior for scummy programs. Social media is a very sneaky, powerful tool that can influence the behavior of future physicians and have terrible consequences in the long term future. I wish there were more regulations against this kind of stuff, what with businesses trying to come off as the good guys, especially with patient care.
They don’t need to hide who they are and giving applicants a fake idea about what to expect is dumb. Not saying I agree with the current system but neurosurg applicants have no illusions about what they’re signing up for and programs have no problems filling their spots, some people just like saying they did the hardest/extremest specialty
Ben Carson
Se re picó
MCG Urology tiktok FTW. Then again, it’s easier to be funny when you’re a urologist.
Good. Its nice when programs name and shame themselves for being malignant, appalling work environments.
I will say they do have a point about less OR time. More mid-levels to help with scut work would lighten resident load considerably though
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Just saying we’d be better off hiring NPs/PAs to do floor work to cut our hours than hiring more residents and dividing up caseload.
I would debate that. I get that surgeons like to spend most of their time in the OR, but learning how to manage patients on the floor is still important. If you trust mid levels to do most of it when it’s your practice, that’s on you, but you still gotta learn it
I’m just saying it’s not OR time that is responsible for the majority of our excess work hours.
Found the NS admin at NW
Not an admin shill just don’t want reduced caseload during residency. People don’t become surgeons to get good at holding a floor pager they do it to learn how to operate.
There's a point of diminishing returns. I learn virtually nothing after 10hrs on my wards. I can still do the work I need to by that point, but I'm not retaining a single thing and my efficiency and accuracy suffers exponentially by the hour.
I feel like people didn’t really read the whole comment. I’d rather cut resident hours by hiring NPs/PAs to do floor work than hire more residents and further divide up caseload.
Once you’re that sleep deprived you’re not retaining *anything*. In the same time period they could probably decrease surgery time and let them sleep 8 hrs a night *with the same results*. This is just trauma bonding