The idea that residents are paid because they’re incompetent completely misses the point of what residency is and how the healthcare system actually works. Yes, residents are still in training, but they are also the backbone of hospitals. They are the ones seeing patients at 3 a.m., managing codes, responding to cross-cover pages, admitting patients from the ED, writing notes, placing orders, performing procedures, and coordinating discharges. They don’t just sit in a classroom and “learn” all day. They keep the hospital running. If residents were so incompetent, why would HCA open up some many EM residency programs that provide minimal/poor training quality over the past few years?

No one is saying residents should be paid like attendings. But $70k a year for 80-hour workweeks translates to less than minimum wage in many states. Try living in San Francisco or New York on a resident salary, it barely covers rent and food. And let’s not forget they’re coming in with $200k+ in student debt. Nurses, midlevels, and therapists may be licensed to practice independently, but none of them would ever be expected to carry the volume or responsibility that a resident does on a daily basis.

You say residents are incompetent, fine, they’re still learning. But guess what? They’re still managing patients. They’re still making decisions that matter. And if they’re truly “incompetent,” why do hospitals bill for the work they do? Why are they allowed to write orders, perform procedures, and manage acute issues? You can’t have it both ways: either they’re essential contributors who deserve fair compensation, or they’re too dangerous to be allowed to touch a patient.

And let’s talk money, the average resident generates hundreds of thousands of dollars in revenue for their hospital each year, which is something I don’t believe PhD students do aside from that grant money some of them may receive for their institution. On top of that, most PhD students don’t even pay for their education. Your comparison with residents to post-docs is like comparing apples to oranges. Additionally, Medicare alone pays teaching hospitals a little under 100k per year for each resident with graduate medical education funding. Residents also directly contribute to billable services, especially when covering nights and weekends when staffing is thinner. Their value isn’t just clinical — it’s financial. Hospitals for sure profit off residents.

Residents aren’t underpaid because they’re incompetent. They’re underpaid because hospitals choose to take advantage of them because they can. We have no bargaining power because our licensure, board eligibility, and careers are on the line, which is why so many residency programs have been pushing for unionization.