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About Wachaa

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  1. 400k is very reasonable. It varies. You do a bit more or less work and income can fluctuate by +/- 50-100k+ However, the expectation for 8-5PM is not typical. I think most people carry over some work to do at home. You would have to stop seeing patients around ~3:30 in that case.
  2. Definitely. You can work as pure outpatient GIMs, especially in a large urban city. You need to get your name out there and have GPs refer to you, typically for diagnostic clarification, chronic disease management, medication optimization, etc. In the age of electronic communication, your name would get out there quickly, especially if you have a shorter waiting list. Most would work together in an office with other GIMs or subspecialists. GIMs are often a very good resource for GPs to refer to. GIMs can then triage to the appropriate subspecialist. For example, if a GP discovers microalbuminuria, refers to GIM.... who does a workup and suspects likely IgA nephropathy. That patient then gets sent to Nephro. That specialist clinic can be even more lucrative with ECGs, Holters, stress tests, etc. They'll receive referrals from GP offices for those services, or, GIMs can direct their patients to do tests at their own clinic. There are billings for those services.
  3. It's possible to get the training and do it, but the FPs who do colonoscopies would then typically work in a remote area that HAS an operating room but does NOT have a surgeon practicing in the city. Not many desirable places to live in which fit that description.
  4. Then pick something that you like the JOB, not necessarily because you like the MEDICINE. Your job IS your lifestyle because it's likely what you'll spend a major part of your time doing. I don't go into peds because I don't like to talk like I'm 5 years old, and then have to try convincing the parents my medical degree > their google search. Do you like peds just because of kids? Because not all of them are healthy or curable. Do you like talking to people to solve their problems quickly or spending 30+ minutes with them and NOT have a solution for their problem? Do you like working in a hospital or working in a clinic? Do you like procedures or do you try not to get your hands dirty? Etc
  5. In fee-for-service models it all comes down to volume. For example, Dermatology in BC has low consult fees but the sheer volume (50+ patients a day) gets them high income. In Peds, even for something simple like eczema, unless you are willing to say "Here's the cream, it's eczema, see me again in 1 month", you'll end up answering 15 minutes of questions on homeopathic remedies and other Dr. Google stuff. But in general peds, most of the patients aren't as complex. For ophtho, most people assume the high billings are just from the surgeries...but I'm sure it also has something to do with 80+ patient visits per day (your techs doing the eye exams).
  6. Wachaa

    Medical Oncology Questions

    I'm not in oncology, but had a lot of interest in it during med school. Below information pertains to large, urban, academic sites. A lot of jobs won't be posted publicly, so don't feel too worried about that. Best advice would be to talk to soon-to-graduate residents or fellows about what their plans are, but I'm sure you know that already. In large cities, you'll likely want to work at an academic site, so fellowships are often necessary. You can expect to be doing a fellowship or some sort of Masters degree. I'm told that research opportunities are more...prolific, in med onc. So there should be some interest in doing research if you're considering the field. There's tons of research opportunities in rad onc also, but in med onc there's just a lot more drugs, etc. As staff, your time is likely going to be divided between clinical and administrative (incl teaching, research, faculty/ meeting type stuff). It's not uncommon to travel a fair bit to attend conferences/ research meetings several times a year. Also, since a lot of administrative work happens outside of "regular hours", you can expect your typical 9-5 pm day to run into the evenings if you have to write a paper/ grant. After hours/ weekends, you can be on call, but at an academic site, it's usually not onerous due to residents/ fellows covering. Unlike other specialties, there aren't many ways to "increase" your income since you can't "recruit" more work. Many are under salary, which can be good or bad depending on how you view it (another topic of debate).
  7. Wachaa

    FM in Canada Vs USA

    But you're assuming that they aren't taking pride in their work and not practicing good medicine. Like the above poster said, "They're all very well reviewed, get 0 complaints and it works quite well". Personally I've seen this as well. A lot of patients DON'T need you to build a relationship, or to be super friendly. They just want to come and and leave ASAP with their prescription or whatever.
  8. Wachaa

    Family Medicine Salary

    Good discussion. Let's keep it respectful... What most people don't realize is that the gap isn't as large. Factor in shorter work hours, benefits, and a pension starting at retirement age much younger than most doctors... and also compare how hard you had to work for that money. It's a rewarding job, but let's not kid ourselves. In terms of net worth, you aren't retiring as a doctor having "4-5 times as much" and the other professionals aren't retiring with a "fraction" of what you have. Plenty of jobs can earn $100k/yr, especially if you're comparing similar years in training/ education. Eg. net $200k/yr doctor vs $100k/yr non-doctor. That's a difference of $100k more (before taxes) working x 20 years, but the other person makes $40k/year (after taxes) x 20 years in pension funds (from age 60 to 80, possibly even longer depending on lifespan). They got that pension basically by receiving a cheque in the mail while you had to work your butt off for 20 years. Hmmm....
  9. Medicine attracts many egotistic people and I believe that many FM preceptors are thinking the same thing about people wanting to go into specialties. Why in the world would someone choose to punish themselves by choosing a career where you have to study for a Royal College exam, and even when you're done all that training (which is brutal and dehumanizing to begin with), you then begin a "life" of work longer hours than 99% people in the world, doing overnight call shifts, feeling like you have to "earn" your place among people who already think they're better than everyone else... when you could have started with a six-figure salary and a much cushier lifestyle in FM. If it's about money, I know that I already make more in FM than I need to live comfortably. If it's about status, what's better: being in your dirty scrubs in the hospital at 3AM, or staying in a king bed during a vacation I can take whenever I want? Just take it as a compliment and move on.
  10. Wachaa

    How to be a a competitive applicant

    It's just helpful to have done SOME research for any CaRMS application. Nothing fancy. Sounds better if you've published/ presented it also. It gives something to talk about in case it comes up in the interview or personal letter. For more competitive fields it demonstrates interest and perhaps helps you stand out more. Not as important as other aspects such as CV/ reference letters.
  11. You still have flexibility to do more or less. Perhaps not to the extremes, but the flexibility is there. Most people aren't working <40 hours because...well you're not making money. In hospitals, you can see consults faster and get more work done. Or, you can do them slowly or cut off after a certain time, to leave the remaining work to the next guy coming on-shift. Outside of the hospital, internists can choose to do additional outpatient clinics, or not. Likewise for other specialties. You might be a general surgeon covering calls in your call group. But you can choose to have a hemorrhoid banding/ lumps and bumps clinic, etc.
  12. Depends where you work and how much you work (days per week and volume). I don't think we can all agree on one set of numbers because some people set their consult appointments longer, some shorter. Some work in ERs, some work more in clinics. Some do more procedures or take more call shifts than others. Gross billings, generally for a 60-70 hr per week internist you're looking at 400k+, and subspecialist with procedures it's 700k+. Lifestyle is another story. Would you rather be the 800k biller working 80 hr weeks, or the guy billing 400k/ 40 hr weeks. Some people like family med for the reason you can get short days with high income ratio, job flexibility, etc
  13. Wachaa

    CFPC membership

    It's a tax deduction, not a tax credit. So you only "write off" ~15% if you're incorporated, or X% depending on your marginal tax bracket. Eg. $1000 x 0.85 = $850 post-overhead money for incorporated folks, which is equal to ~$1200 gross billings (~30% overhead), or a full day's work for most GPs.
  14. Wachaa

    Income and Lifestyle

    I don't mean to put it bluntly but do you think the Ophtho or Derm aren't working full time or rushing patients out? The examples given above for derm seeing a patient every 5 minutes or ophtho seeing a 10+ patients an hour and then bringing them back in 6 months to repeat the whole process. Or how about during surgery rounds when you go through 20+ patients in 1-2 hours. In a fee for service model if you can't extend your work hours then you have to work more "efficiently". It's not necessarily sloppy either. It doesn't take that long to look at a rash or an eyeball. The patient can give a 2 minute or 20 minute story about their progressively declining vision when they watch TV... but if it's a non-significant early cataract with no other ocular findings then it's goodbye. In family practice if patient comes in for med refill - print the prescription, give them their test result, 5-10 minutes is plenty. Each day should have 20+ of those patients per day.