shahine.com/omar/

A couple of people made some comments in my 35 hour work week post asking what it is my wife does that requires that she work 80 hours a week (and why she gets paid for only 40). I will clarify here.

My wife is a Doctor. When you graduate from Medical School in this country you cannot practice medicine till you get board certified. Board certification is actually a 4 step process. Here is how becoming a doctor works:

1. In College you usually take 5 courses, each 1 year to be considered "pre-med". These are Biology, General Chemistry, Organic Chemistry, Bio-Chemistry and Physics.
2. In your junior year you take the MCAT, a standardized test that lasts 8 hours for which you prepare for 1 year. It's fairly grueling.
3. You then apply and pray that you get into Medical School.
4. If you get in, you then spend 4 years in Medical School till you graduate with a Medical Degree (MD). You now have "Dr." in your title, and the average medical student now has $180,000 in school debt. You also take what is known as USMLE Step 1 and Step 2 in medical school. Passing these is required to graduate, and the year after you graduate you take the final Step 3.
5. In your 4th year of medical school you apply to a residency program. Each medical field has various programs throughout the country. Each program has a very specific number of spots. These spots are determined by how the program is accredited and how much funding they get per resident. It's a little known fact that Medicare actually funds the Residency programs in the US.
6. If you get "matched" into a Residency program, you then spend 3 - 8 years there.
7. In your first year of residency you take USMLE Step 3. If you pass you are now certified to practice medicine. However, you must still apply for state certification in the state you are working, and you still must apply for a licence to prescribe medication from the DEA.
8. Still with me? Ok, during your residency you work about 80 hours a week. This is actually an improvement as 2 years ago the American Medical Board started to enforce work hours that require that:
   1. In a 4 week period a resident cannot average more than 80 hours a week.
   2. In a 36 hour period, you cannot work more than 24 hours.
   3. In a one week period you are required to have 24 hours off.
9. When you graduate from your residency program, you take a final exam where you get board certified in whatever your are doing your residency in. This allows you to go work as an MD in a practice, teaching institution or hospital. Many residents go on to do Fellowships (more specialization) that basically extends this process but isn't quite as harsh in terms of work hours and pay (but not good either).

To make matters worse, payroll departments pay you for 40 hours of work, and on average residents make between 35K and 45K a year. Now the harshness of the work week is a tad better since the new rules went into affect, as before my wife could easily work 100 hours a week and spend 36 hours straight in the hospital. That's about $10 AN HOUR!!! to save people's lives, to do surgery, to care for us in our greatest times of need! ($20 an hour if you assume 40).

Now compare this to Nursing. Nurses typically work 3-4 days a week in anywhere from 8-12 hour shifts and get paid substantially more.

So the next time you go to the doctor/hospital and you are being treated by a Resident (most likely the first person you'll see that is an MD), remember, they aren't in this for the money. They are there because they are willing to go through steps 1-9 and still spend a substantial part of their lives making a rather significant sacrifice (time, money, lifestyle) to care for your health.

We would not have the health care system we have in this country if it weren't for the hundreds of thousands of sleep deprived, low paid residents that take care of us regardless of our ability to pay for that care (a big % of Americans do not have Insurance, yet Hospitals are obligated to treat them, and that money comes from somewhere, usually in the form of blood, sweat and tears of our Residents).

When my wife is completely done with her training, she will have spent 11 years as a medical student, resident, fellow working for little to no pay commiserate to what she actually does every day.

PS - for the curious, I actually made it to step 3 (I was pre-med, took my MCATs and applied to medical school) and am thankful that Microsoft found me before I went down the path my wife has. I know I was not cut out to be a Doctor, and as a result, have an immense respect for the work our residents do in this world.

PPS - My personal opinion is that this is a totally screwed up system that does not operate under a free market system. Residents are screwed from the get go because they are at the mercy of dozens of licensing boards, government institutions and funding programs that are not adequate. Hospitals do not need to compete for residents and they will work for whatever the pay is because they have to in order to practice medicine. Finally, the # of MDs that this country produces each year is artificially controlled (indirectly) by Medicare which in tern dictates how may slots we have in Medical Schools and Residency programs.

note: if any of my facts are incorrect, please correct them in the comments. Most of this is based on my own first hand knowledge and I'm sure there are residents out there that have some corrections to what I think.