American College of Physicians: Internal Medicine — Doctors for Adults ®

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Resident pay remains flat, but benefits improving

From the March 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

Mean stipends for U.S. housestaff
Residents and medical benefits: who gets them?

By William Hoffman

While housestaff stipends fell slightly behind inflation last year, analysts say that residents’ non-cash benefits have improved considerably in recent years.

According to data recently released by the Association of American Medical Colleges (AAMC), mean stipends for PGY-1 residents climbed 2.8% in 2000 to a mean of $35,728. Stipends for second-year residents grew 2.7% to a mean of $37,331 and stipends for PGY-3 residents grew by 2.4% to a mean of $39,008. (The AAMC survey was conducted with the assistance of the Council of Teaching Hospitals.)

By comparison, the federal Bureau of Labor Statistics' benchmark consumer price index (CPI) of all urban consumers rose 3.4% in 2000.

Analysts say that while increases in resident stipends have oscillated above and below the CPI for years, long-term pay for housestaff has generally kept pace with the inflation measure. In 1999, for example, mean first-year housestaff stipend nationwide grew 2.6%, compared with a 1999 CPI of 2.7%. When mean first-year stipends rose 2.1% in 1998, the CPI was 1.6%.

While resident pay has generally followed cost-of-living increases, there is still some significant variation geographically. Last year’s stipend figures, for example, show that residents in the Northeast saw marginally better stipends than housestaff in the South, Midwest and West. PGY-4 residents in the Northeast, for example, earned $43,321 in 2000, compared to $38,151 for PGY-4 residents in the South, $40,422 in the Midwest, and $42,001 in the West.

Stipends in 2000, however, grew slightly faster in the Midwest (3.1% for PGY-4 residents), compared to 2.6% for PGY-4 residents in the South, 2.3% in the West, and 1.7% in the Northeast.

While pay varied geographically, benefits differed even more by location. In the West, for example, 75% of residents received fully paid individual group medical insurance, compared to 31.6% of residents in the Northeast. And while half of residents in the West received fully paid vision benefits, only 9.7% of Northeastern residents did.

Despite such regional variations, the good news for all residents is that the benefits picture for everyone has improved. "Compared to 20 years ago, benefits have substantially improved," explained Robert Dickler, senior vice president for health care affairs at the AAMC in Washington.

For instance, data show that nearly half of all internal medicine training programs provide some kind of vision benefits and that nearly two-thirds offer some coverage for prescription drugs. Even perks like parking are now subsidized by more than two-thirds of all programs.

Mr. Dickler credited recent institutional requirements promulgated by the Accreditation Council on Graduate Medical Education and increased awareness among residency program administrators of the need for better benefits.

Eric Milbrandt, ACP-ASIM Associate, Chair of the College’s Council of Associates, noted that despite better benefits, money remains a top concern for many residents. Average educational debt has more than doubled since 1985, he said, and nearly a third of today's residents owe more than $100,000. That trend coupled with a 1996 change in the federal student loan program requires students to start repaying loans two years after graduation has meant that more residents must moonlight just to make ends meet.

"If you're trying to trying to raise a family or buy a house, that becomes a real burden," he said. As a result, many residents are moonlighting "at a time when they're supposed to be expanding professionally and just learning to be a doctor," he said.

While Dr. Milbrandt said residents still complain about pay, experts agree that few use it as a deciding factor when choosing an institution for their training. "The reputation of the training program and the quality of the faculty are more important than residency stipends," said Dema C. Daley, executive director of the Washington-based Association of Program Directors in Internal Medicine.

Instead, Mr. Dickler said that medical students look at other considerations, such as faculty availability for answering residents’ questions, current housestaff opinions of the program, opportunities for advancement, and the institution's history of preparing students for board examinations.

For more detailed information from the report, visit the Web at www.aamc.org/hlthcare/coth-hss/stip00.htm.

William Hoffman is a freelance writer in Fairfax, Va.

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Mean stipends for U.S. housestaff

Year of training Mean Change from '99
PGY-1 $35,728 +2.8%
PGY-2 $37,331 +2.7%
PGY-3 $39,008 +2.4%

Source: "2000 AAMC Survey of Housestaff Stipends, Benefits and Funding."

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Residents and medical benefits: who gets them?

  Northeast South Midwest West
Individual medical        
Fully paid 31.6% 66.1% 59.6% 75%
Cost shared 67.1% 32.1% 40.4% 25%
         
Family medical        
Fully paid 25% 26.8% 33.3% 39.3%
Cost shared 73.7% 58.9% 63.2% 53.6%

Source: "2000 AAMC Survey of Housestaff Stipends, Benefits and Funding."

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