Dr. Daniel Mullin's letter inaccurately portrays the government subsidy for medical residency as a one-sided handout. (“A Letter from America to an Emergency Physician,” EMN 2013;35:4; http://bit.ly/Z9EoxS, in response to “A Letter to the Country from an Emergency Physician by Michael Jacobsen, DO, EMN eNews 2012 Nov 1; http://bit.ly/QWIY4u.) No cited benefit or payback to the government or taxpayer was recognized. It was characterized as “free. That's right: free! You're welcome.”
The statement was made that three years of residency training cost the government $270,000. The author fails to acknowledge that the government receives as a payback three years of resident physician services at below-poverty-level wages ($45,000). These low wages become the cornerstone that enables many hospitals to survive financially. The program permits hospitals to fulfill their mission to provide care to indigent patients and those with government insurance. Residents in their formative years of training assist attending physicians to practice more efficiently, enabling them to manage large numbers of patients. A resident in his final year carries out nearly the same duties of an attending with equal responsibilities.
The governmental outlay is $45,000 for work valued at $300,000, per the median on the ACEP salary scale, shortly after graduation from residency. This offset in wages is the return on the government subsidy. Although the author claims that the emergency physician did not receive a bill for his residency education, no recognition was given for the benefit received from the government or the hospitals for the resident's 80-hour work weeks, circadian rhythm disruptions, and on-call coverage which include weekends and holidays for three years at below-poverty wages. The poverty level wages do not create excessive salary to pay off compounding college and medical school loans. Despite the high level of indebtedness, these physicians will eventually pay a higher proportion of taxes and further contribute to the tax base throughout their career.
Ask any resident. The preparation for residency was not “free.” It required four years of dedicated college studies competing for straight As. It required admission into medical school. Not everyone is capable of applying and absorbing the volume of medical information required. It is equally true that not everyone can play basketball like Michael Jordan, despite how hard he might try.
The author stated that we the people “also gave him very low interest rates on education loans,” but taxpayers took their hard-earned dollars and received their principal back with interest. The interest on Stafford loans is now 6.8 percent, which far exceeds interest paid by CDs, banks, or Treasury bills at one or two percent. It is another example where the taxpayers received not only principal but above-average rates of return. These residents are the individuals most likely to not default on their Stafford loans in the future.
We the people created residency programs because we needed them to take care of our citizens. They are a source of cheap labor, and they ensure our country that it will have the necessary caregivers to take care of our growing elderly population. To say that physicians in their residency receive a free handout and they are never required to provide an equally valuable return of service demonstrates a complete lack of understanding of the medical education system. Ask any resident; he will tell you that through four years of stellar performance in college, three years of medical school, and three years of residency combined with 80-hour work weeks played a large part in providing a return on the government investment. In fact, they might even say “they built it.”
Ronald J. Milewski, MD Pinehurst, NC