Some trainees are more equal than others : the pediatric residency pay gap

Background and aims In Belgium, medical doctors in specialty training (residency years) are employed under a distinct and unique statute (sui generis). Although legal provisions exist, recent polls showed relevant heterogeneity in adherence to employment contracts, wages, and social benefits. Methods Junior representatives of the Flemish association for pediatrics (Jong VVK) conducted a descriptive cross-sectional study among trainees in pediatrics in Flanders in 2019, who are employed in both university and non-university training centers. By means of an anonymized online survey their wages, working conditions and fringe benefits were collected and studied. Results Fifty-four surveys were completed by 48 unique trainees. Data concerned employment regimens from 21 hospitals. The average gross and net monthly salary were, respectively, € 3182,63 (standard deviation € 221,86) and € 2424,28 (SD € 223,35) . Noteworthy, the difference between the most wealthy incomes (P95) versus the least (P5) was € 713,79 net per month. Only minimal effect of seniority could be found. The average extra salary for all earnings besides the standard income (e.g. on on-call duties, overtime, transportation expenses,...) was € 305,87 per month, an additional income of barely 15%. The average net income per hour (€ 9,32) only just exceeds the nationally fixed minimum wage, undervaluing the trainee’s past education, medical degree, experience and responsibility. Fringe benefits were infrequently provided. Besides 63% in the possibility of receiving a bike fee, 51% a hospitalization insurance and 45% an insurance concerning civil liability, other benefits were provided in less than a quarter of respondents with no-one receiving meal vouchers, 2% a vacation salary and 8% an end-year bonus. Conclusion The trainee in pediatrics in Flanders is being paid disproportionately and unfairly for his extensive and stressful professional activities. The roots for this inequity can be traced back to the outdated sui generis statute, an inadequate legal framework and a weak and non-vacant position of the resident on the labour market. There is a relevant heterogeneity in gross and net income and fringe benefits are unevenly provided. Moreover, it is striking that the individual trainee is not well informed about his or her employment conditions and transparency is lacking.