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About Wachaa

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  1. IMO if you're planning on seeing 20-25 people a day as FM you should go into IM and see 10-12. Pay would be better. It would be more suitable for you if you want to spend that much time per patient. It's not realistic to expect billings over 250k if you see 20-25 people per day working 4-5 days a week. It'll be closer to 200k and after overhead, you might make less than a nurse practitioner. *The 1000 patient panel is neither large nor small. It depends how sick the patients are and how often they need to come in and see you. Obviously if they have higher needs, then seeing 20-25 a day may not be sufficient. Hospitalist work is not that difficult to come by. You can locum and try it out.
  2. Something about affecting the ability to detect "ferning". When I was in residency, I was told you could use a small amount of lubricant still. It was never a problem for me.
  3. It's hard to have a resource that has everything up to date AND specific to your province. But in general you can rely on what you learned in residency, and then tailor that to the approach specific to that province you're working in. But just for some province-specific examples: Alberta: http://www.topalbertadoctors.org/cpgs/ BC: https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines
  4. Yes and no. Overall, if rural is something you're interested in, then go for it. Besides the more interesting medicine, there are incentives and bonuses that make it financially worthwhile. But as alluded to earlier, if you're willing to work hard, you can make a lot while staying in the city and enjoying the lifestyle that comes with staying in urban centres. I have friends who did rural locums and none of them would call it a walk in the park. You're on call frequently, dealing with serious cases, and have less backup, which can also lead to high stress. In the city, if a patient is more acute and sick I'd send them to ER. In rural... you might be the one to still see them in the ER or admit them. You might be on call to take care of them all night also. All the while you have clinic and other responsibilities at the same time. To tie this back to the original topic, FM hospitalist and GIM can both do in hospital work or outpatient work at their choosing. The level of complexity can differ greatly depending on the city/ centre that you're at. If you're a GP you can do hospitalist without additional training, but in major centres would likely be looking after bread and butter cases (an elective or rotation would give you a very good idea). GIM would be more of a consulting service but certainly do admitting as well.
  5. As a GP myself, 62k for that amount of work is very attainable. I know quite a few people think you need to go rural or into a specialty for that kind of pay, but really you just need to put in the hours/ volume (fee for service).
  6. I know this is generalizing, but here's what a lot of physicians say when they talk about walk in clinics -Lack of continuity of care -Picking the simple cases -Not following standards for narcotic/ benzodiazepine prescribing -Incentive to see higher volume in a fee for service payment structure -etc No doubt the College takes note of that and frequently audit you to see if you're following the standards. So you just have to be more careful.
  7. There are a lot of different ways. Including what's mentioned above, even simply doing walk in clinics 4 days x 7 hours a week, ~6 pts an hour is usually 300-400k before overhead/taxes in BC. Other provinces may be higher or lower. Once you're staff you immediately become aware of the College and CMPA breathing down your neck so it's important to minimize doing anything that flags you. If you see 36 people an hour that'll likely flag you for a billing audit. If patients complain, that'll most likely raise a red flag regarding the quality of care. If you do pain clinics and prescribe a lot of opioids that'll likely raise a red flag for the College's Controlled Prescription Program. Working in walk in clinics flag you too. Likely since the College has frowned on walk in clinics for years. But at least the consequence is just filling out quality improvement surveys. You can do everything "by the book" but you'll still have to deal with the hassle of getting audited and investigated more often than your colleagues if you make more money.
  8. Just for the money? I wouldn’t. Think of all the things in life you would otherwise be missing out on. Especially if you’re already in your 30s or near there.
  9. What province are you in? (Sorry if you mentioned it earlier) 15 new consults is decent. In reality you'll have a bunch of fast follow ups in the day too. I think the math should work in your favor
  10. I'll try to comment a bit here and there Of course. The 400k gross is not by any means "outlier". I wouldn't say it's "average", but it's not unreasonable. Overhead is difficult to estimate. Even those who do a lot of OUTpatient do some of INpatient too. Or, they don't work in one office but several, each with different splits. I suppose 25-30% is reasonable. Totally agree. There'll be a niche that you enjoy working in. You get really efficient and your name gets out there. For example, some IMs do mainly DM, so they will be known for seeing gestational DM too. I don't think it can get "boring" because it's what you like. Some people might find it repetitive. Definitely. I was specifically talking about urban, where the large majority of GPs don't even have hospital privileges.
  11. Yeah no kidding. But NPs aren't cheap either. In BC the government created positions where essentially they're paying NPs salary near $160k plus additional $85k for overhead expenses (1680 hours, 220 days per year) . - you can DM me for the reference if you want. But getting back to OP. As some people have mentioned, one of the possibilities to not burn out is just to see simpler cases (HTN DM etc). Or at least a higher proportion of these.
  12. Haha it was just an example. Having supervised medical students and residents in rotations, exams, etc, I would say nearly all of them, when their patient is <12 years old, would speak in that level. It's not so much an issue when you work in acute settings where the patient is very sick, but when the patient is 100% healthy and the parents are paranoid, whatever BS they dig up in an online search will be worth more than what you have to say. People come all the time asking for referrals for second opinions.
  13. I know, haha, I only meant just because it is dull doesn't mean we can't choose it as a career. Because like it or not, most of what an MD does is going to be dull + unstimulating because it's mostly repetitive. I'm pretty sure when the surgeon is dictating his 5th cholecystectomy report of the day, happy hormone rushes aren't going off in his brain. Or the OB doing the C-section at 3 AM in the morning on back to back calls. Or the radiologist reading 50 mammograms. Etc.
  14. I agree that is one reason why most people don't want to go into family. Many people enjoy the complexity and want to delve into the details, therefore they choose specialty. Family medicine isn't supposed to get into the details. That's why the government pays that small amount. That's why 10 minutes is actually a really long time for many cases. If I can see 6-8 people in the same time it takes a specialist to see 1 person, then the income difference is reduced. But........ not many IM/ psych specialists can take 1 hour to see people either. It's not uncommon that IM/ psych specialists working fee-for-service are doing new consults in 15-30 minutes, and follow up appointments in 10-15 minutes. It's not just the desire for money that drives the "rush", but also the waiting lists. You honestly can't expect things to grind that slowly if you have a 6+ month waiting list of new consults, and a ton of follow ups to see. You also can't expect to solve every single problem, so you only focus on one or a few problems per visit. In my office, GPs see 40-50 people/ 7 hours while IM sees 15-25 in the same time depending on the ratio of new consults to follow ups. Billings in office are roughly the same, but IMs go do hospital work/ call on top of that. I only partly agree with this. Granted, you shouldn't hate/ despise your job. But most people in today's world also don't love their jobs. If you paid me $500k a year to answer telephones I'd gladly switch my from MD job due to the lesser pressures and liability. I probably wouldn't need to work that many hours a week nor that many years of my life and can retire sooner.
  15. Estimates vary among provinces and work locations (outpatient hospital clinic vs outpatient privately-owned clinic vs inpatient mix). Overall income varies with how much work you do. It's also personal preference and job market that affect where you'll work. For example, there may not be that many outpatient hospital clinic jobs available. Or, you want more control over your work hours/ work-life balance, or maybe you want to run a clinic as a business, so you choose to work in an outpatient privately-owned clinic instead (either starting your own clinic, or joining an existing one with other endos or IMs/ subspecialists).
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