medisforme

That is the key point, the actual 300K salary is merely a proposal from the nursing union a this point. I don't see any way they will be paid that number when all the negotiations are complete.

The independence (including creating your own schedule) and financial compensation makes life as a family physician much more enjoyable than a FM resident. Though I will just add unless you are planning on working only in your +1 you will only have so much control over your patient panel. With some (relatively rare) exceptions, you are required to take on patients that come to you, if you are advertising that you are accepting new patients. Provincial physician colleges look very unkindly on family docs that cherry pick their patient panel.

It depends what type of practice you have. I think somewhere between 50-60% of FP's in BC have switched over to the new payment model. For those with young practices/healthy familieis or those with a lot of mental health patients, it apparently pays more than the previous model. It also pays much more for those doctors who are inefficient and/or don't chart in a timely matter as these are all things you can bill for under the new payment model (that includes checking labs etc...). Most doctors with elderly practices (myself included) who have a lot of patients with chronic conditions stayed with the old fee for service model as it pays more for visits with older patients and also has a lot of bonus fees/incentives for chronic disease management and complex care management. Those doctors who are really efficient in their day to day practice (ie. I will spend 45 seconds checking labs in between almost every patient) will also not benefit as much in the new model as you have to block off chunks of your day to check labs, review consults etc.. if you want to get paid for it. The one issue that i have seen plague some docs under new model is that they typically see less patients in this model and so the wait for a patient to see them grows and grows which tends to lead to more disatisfied patients. If you want a rough breakdown of new payment model, I think you get an hour rate of $130/hr while you are seeing patients or checking labs/doing administration, then you bill $25 per patient visit on top of that (for the time you are seeing patients). There are a couple of extra codes on top of this but I am not familiar with all the nuances.

I agree, FM training in US is 3 years and there is essentially no prestige whatsoever associated with being a family physician there. From talking with residents and viewing discussions on studentdoctornetwork it appears that with obvious exceptions, FM is either a choice for those with less than stellar grades/CV's or relegated to back up choice for almost everyone. Also, to address several posts that commented on CFPC having the best interests of rank and file family physician as their priority (in regards to proposed change to 3 year residency), I couldn't disagree more. A lot of the board lives high up in ivory towers and do not have their ears to the ground in terms of current issues affecting FP's. For example, there have been at least 3 extremely controversial (basically tone deaf ignorant) editorials in Canadian Family Physician (basically the journal CFPC puts out) over past 1.5 years that have drawn a lot of outrage from family docs in the trenches. The one that comes most to mind was from June of 2021 basically criticizing family docs for being overly focused on finances and not on patient care (I believe the title of the article was Family Medicine is not a business); completely tone deaf to the crisis in family medicine with more and more docs walking away from office based primary care due to high overhead costs.

Just to jump in on the discussion re: whether family medicine will increase with more years of training. I personally feel that is wishful thinking that will never happen, but lack of pay isn't the issue with family medicine, it is the relatively enormous overhead costs that we have compared to what we bill (20-35% of billing goes to overhead depending on where you live in province). Its also the specialty with by far the most unpaid time (admin, staff mtgs, hiring/firing staff, paying bills, basically running a business, stuff they don't teach you in med school/residency). I can only speak for BC with the following. Yes, peds and psych bill roughly the same as FM, but office based peds has no where near the overhead that community FM does and psych has essentially no overhead as almost all psych in BC are either hospital based and/or health authority based. Basically they have more take home pay compared to family docs (when you see people quoting the blue book etc... re: MSP billing numbers and how much docs are billing, that does not take overhead into consideration). Any increases in FM pay over past 20 years (aside from recent LFP model, which in my opinion is the first step in BC gov't taking over and controlling all facets of primary care but that is a discussion for another time) has not even kept up with inflation. Given the obsession with provincial governments with controlling health care costs (Adrian Dix has made numerous comments re: his bias towards NP's vs family docs here in BC) I don't see any way FM could expect a pay increase just because of another year of residency. Additional training for family docs at present has not resulted in increased pay for that cohort as far as I am aware. (FM+1 in care of the elderly, maternity, sports med etc.). Even if I were to concede that an extra year of training will result in more pay (which I don't), it would likely have a neutral affect on FM income as overhead costs/MOA salaries etc... will continue to rise as well, probably outpacing any pay increase.

As someone above posted, its not the actual schools, its the location of your program that determines how much CTU etc... you have to do. I can only speak for BC, here if you do FM residency outside of the provincial academic centers/campuses (Vancouver, PG, Victoria, Kelowna) there is basically no CTU. GenSx and Obsgyne likely also variable between all the individual satellite programs. GenSx at my program it was just you and the surgeon and they were really aware of making your experience family medicine based (ie. limited OR time holding a retractor [unless you want to that is], more focus on ER consults, outpatient clinics, lumps and bumps etc... There really wasn't even a focus on rounding as the surgeons you weren't preceptoring with don't really want you rounding and giving orders on there patients as this just slows them down (usually each surgeon only would have 3-4 patients on the unit at a time which made rounding quite easy). IM at my school was basically consult based (did separate rotations in IM, cardiology and nephrology with option for ICU elective if you wanted).

Some reasons for the grass is greener on the other side thinking in family medicine Unlike FM (I can only speak for BC), other specialities are adequately compensated for the shit they have to go through. The amount community GP's are paid is actually quite embarrassing. Other specialties aren't doing scut work for each other (ie. doing a consult then telling referring doctor what tests to order instead of ordering those tests themselves thus taking away the follow up onus, which is a common theme in BC) Community GP's (again this only applies to BC) are expected to be "on-call" 24hrs/365 as per CPSBC guidelines (with zero financial compensation in BC). I can assure you, a COMMUNITY urologist isn't on call at 10pm to answer questions about the flomax they ordered or COMMUNITY ortho isn't around at that time for ongoing post surgical pain (if you don't believe me, call a specialty office number after hours, most answering machines say to go to ER or f/u with your GP). the amount of unpaid work in family medicine is enormous (obviously i can't speak for other specialities, but I am guessing FM is one of the specialties with the most unpaid work (ie. you are reviewing your lab work as well as lab work ordered by any specialist and are expected to follow up whether your ordered it or not, exact same issue with radiology/nuclear medicine tests, you are also reviewing consults and going in to EMR to change medication list etc... based on said consult, there are numerous forms you need to do continuously that you can try and charge for but you won't get any money from those who are low income, also the number of no shows in longitudinal family medicine is absolutely insane and unlike COMMUNITY specialists, we are not allowed to withhold care/refuse to book a visit until a no show fee is paid which leads to almost no one paying a no show fee)

I am a Fam Doc in BC and consider myself extremely efficient and someone who probably overcharts/documents slightly. I see approximately 15-16 patients per half day clinic. 45min each morning prior to clinic reviewing charts for the day, pre-ordering imaging, lab test and getting templates set up to help shorten actual appointments Any time I have even 1 free min during the day, i am going to my task box to review labs, consults etc... This means there is essentially no down time between 0900-1645 or so daily 20min of lunch hour spent catching up on charting, reviewing labs 20-30min at end of the day spend catching up on charting and reviewing labs 20-30min every evening at home once kids are in bed spent either catching up on documentation or else reviewing labs etc... spend approximately 1-2hr a week doing forms etc... all of which I charge for unless I know patient has extreme financial stress It took a lot of EMR review, set up time and practice to get to the above. When I first started out, I was spending 1-2 hrs a night charting/reviewing labs which I hear is the norm for a lot of family doctors. The unpaid paperwork and review is a major reason why many new grads do not go into longitudinal family medicine. None of the above applies to hospitalist or niche areas of family medicine.

BC family med perspective, most fam docs don't do private practice addictions work as there are just too many no shows and you have to put the word of mouth/advertising out there. You also have to content with overhead. Most work through local health authority, so you can bill sessional fees for no shows. Working through health authority is a good gig as all your overhead/staff/etc... is paid for. I do my own billing (takes about 15min/week) so i keep 100% of my billings. You get paid $23/week per patient on methadone/suboxone/kadian. Doesn't sound like much, but if you build up a large practice, and more importantly if you build up a stable patient base, you can make a lot of money. Ie. stable patients you only need to see once every four weeks so essentially you are getting paid $92 for a 10min visit. Billing might be different for psych/IM who have addictions fellowships. Pain clinic pays well if you are trained in different interventional procedures (mostly different types of injections) and likely depends on the province and what specialty you are talking about (you would have to look up the individual fee codes) usually, this is PMR or anaesthesiology. I have only seen FM docs do different types of trigger point injections (vs the variety of facet block, epidural, SI joint etc... you see at a typical pain clinic), which pay well from a BC Fam med perspective (which is actually quite pathetic to begin with), i think $76 per treatment. I have never seen methadone/opioid pain clinics, that would be an enormous headache and I suspect very unfulfilling. Given the backlash and college guidelines around prescribing opioids for chronic non-cancer pain, you would also run the risk of getting audited.

https://fraservalleytoday.ca/2022/07/12/chilliwack-primary-care-centre-to-lose-all-its-dedicated-family-doctors-by-mid-september/ Another update for those so inclined. Chilliwack UPCC losing literally all its docs, will have none remaining by mid-september. MOH apparently tried to back out of a pre-negotiated contract with some of the physicians and they had had enough. Patently obvious, there is no respect for family doctors by our current provincial government. Its incredibly frustrating seeing Horgan on TV trying to pressure Federal government to increase transfer payments as if this is the solution to get health care back on track, when his government has literally burned hundreds of millions of health care dollars on UPCC's. If the money for UPCC's had been given to support GP overhead or increase GP fee codes, that in itself would have been a large boost to our primary care system and likely resulted in increased retention and even recruitment of family physicians.

The 295k doesn't include overhead (so subtract 20-40% from that) and the signing bonus works out to $120 and change/week (no where near worth the grief you will encounter). The amount is actually insulting given the amount of unpaid work family doctors engage in. Also, the government basically has not addressed the issue of overhead costs in any way. That is the main issue preventing new grads and old grads from practicing community family medicine. Furthermore, family medicine fee codes have been stagnant for 20+ years. Check out the graph below to see how the basic visit fee (ages 2-49) code lags further and further behind inflation. Actual data used to form the graph is from Doctors of BC. . It is a joke how little family docs in BC earn compared to the amount of work they do. I honestly feel it is likely the only medical specialty where the workload increases after residency as you are sheltered from a lot of the paperwork, documentation and business side of it in residency.

I am a BC based longitudinal family physician and I can verify that the reports are not sensationalized. In victoria in particular, the number of GP's leaving longitudinal family practice is staggering. With high overhead and relatively stale fee codes, it really doesn't make sense for people to go into this line of work in BC. I certainly would never recommend a new grad go onto longitudinal family practice in BC. In the city I practice in, they are basically dependent on recruiting IMGs. I think we have attracted 3 non IMG new family practice grads in the past 5 years (and none in the past 3 years) which nowhere near makes up for the docs leaving/retiring. Unfortunately, our provincial government and health minister in particular are out of touch with reality when it comes to dealing with the current family physician crisis. Adrian Dix has met several times with GP advocacy groups but no one is holding their breath. the NDP can not stop their enthusiastic push for UPCC's (Urgent Care and Primary Care clinics), which are essentially glorified walk in clinics that cost 3-4x more to run than a typical family practice. On top of that, they can't even find physicians to work at these clinics. The UPCC in Abbotsford and another in Surrey are completely dependent on NP's to see patients because physicians won't sign on. A fast NP will see 3 patients/hr, most see less than that. Far less efficient than family physicians most of whom see 5-6 patients/hr. I am playing it by ear over the next 1-2 years, if this trend continues I plan to pursue more niche areas of family practice that I already have my foot in which have almost no overhead (addictions/OAT, LTC).

Hi there, My thoughts as a longitudinal family physician 3+ years out of residency. 1) Nothing discussed here can be applied to Canada as a whole, it is really province specific, as each provincee has unique challenges and issues with primary care and family medicine. 2) I don't see any "threat" from NP's in BC in the sense that you will be able to work/get a job basically wherever you want with the possible exception of downtown vancouver. There is a lot of resentment from GP's towards NP's that work in these newly minted UPCC's as they get paid more per patient than a GP does (they do not make more as a whole, but they expectations for seeing patients basically every 20-30min vs every 10 minutes per GP. That is on top of pension and benefits which GP's do not get. 3) If things don't change with the physician master agreement/compensation, the already steep trend of new grads avoiding longitudinal family practice and opting for walk-in, urgent care, ER, sports me, obs, addictions etc... will continue. On a good day, I do about an hour of unpaid work (review labs, consult reports, offie administration, staff, meeting etc...). More often it is 2-3hrs/day of unpaid work. Unlike specialists, our college expects community GP's to be "on-call" 24hrs/day for community patients (ie. have an unpaid after hours call service). This issue is coming up frequently with college audits. I feel it is an unrealistic expectation, outside of rural family medicine. There is little that a GP can offer on the phone/being on call that is different from 811 (our nursing line) or being assessed in ER. We also have a very complicated fee for service which means you will not maximize your income unless you memorize the billing inside and out and basically spend time doing your own billing. If you put your head down and plow through patients 5 days a week, this can be very lucrative, but you have to consider that a) it is not very satisfying clinically just quickly seeing patients, making spot diagnosis and moving on and b) it is very taxing working clinic 5 days a week, I personally only know a couple of physicians that only do clinic work. For their own mental health and sanity a lot of family physicians work in other areas on the side. Also, If anyone follows the health care news in BC, our government has been quick to tout the many UPCC's(urgent and primary care clinic) every chance they get. However, when you strip these of all the silver linings they are little more than glorified walk in clinics with extra support staff. 4) if you want to subspecialize in family medicine (hospitalist, addiction, obstetric, sports med etc..), there are numerous opportunities often with less stress and expectation. Hospitalist especially is quite lucrative in BC as there is little overhead.

I would just add, the other huge benefit of FM is that you can set up shop/get a job literally anywhere in the country with almost no effort once you are done training. There is no networking, job interviews, ass kissing, resume/CV building etc... needed during residency and once you are out of residency. Even highly desirable cities have many work options (ie. every month CMAJ and BCMJ advertise several FM jobs available in downtown vancouver for example). This ease of work entry really doesn't exist with specialty residencies outside of possibly outpatient psychiatry and maybe outpatient peds. If you are set on a particular location due to family circumstances or otherwise, you really never need to worry about this if you go FM route.

It's low stress, easy work but usually the corporations that run them charge you significant "overhead" relative to their actual expenses; usually at least 30%. There is a bit of a backlash against them in BC right now from longitudinal family docs as they are not really compatible with wholistic, full scope primary care and take away all the "easy" appointments (Rx refills etc...). It is also seen as a bit of a corporate invasion of the health care system (their advertisements are splashed absolutely everywhere) trying to entice patients with quick, no frills appointments. My final comment is that while they claim to triage appointments to ensure they are appropriate, you have to consider that you can not bill for the appointments where your plan is to recommend a patient have a physical exam in person with another physician (in BC, MSP only pays out 1 FM appointment/day per patient). In my experience that would be at least 4-5 patients/day.