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About Wachaa

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  1. I have heard it is more of a medical legal "strong suggestion". Hence some surgical procedures may have an additional MD scrubbed in, just in case for emergencies that happen. There's also a bit of on-call duty so I suppose it is more feasible to have an MD on-call than an allied health provider PLUS an MD on-call for back-up support if needed. There's a fair amount of "reputation" attached to our jobs, right? I suppose some people don't want to be known as a methadone/ marijuana doctor when their friends/ family ask them what they do for work. The item that gets me more personally is that a lot of these clinics are inner-city locations, which should make some people concerned. I checked for anyone following me >10 times walking back to my car after a shift during residency. It was dark and the parkade was very quiet. Homeless people in the stairwells. That sort of thing.
  2. Different things make people happy. Only problem I see is that paperwork, emails, chasing labs are still part of everything you listed above. You are usually on-call for whichever service requires you to be present to assist. Could be OB/gyne, Gen surg, etc. Specialized services/ procedures may require further training eg. Cardiothoracics. Your work is usually in the OR... and reimbursed based on the procedure carried out. It's common for fees to pay differently for after-hours, etc. It's not uncommon to have gaps in your day if surgeries get canceled. On the contrary. Ads are posted almost year-round looking to fill those spots. Either marijuana/ methadone clinics. You need additional training and approval from the College but it's not that onerous. One reason it doesn't attract many people to practice in methadone clinics is that the clientele/ location may not be suitable for everyone. For telemedicine, I think most people would agree it has just as much paperwork as a regular clinic. Maple, Babylon, and other companies often pay doctors a fee per hour with a guaranteed minimum. It is sort of shady. You give them your billing number with no control what they're billing. If you ever get audited that would be a s***show. Babylon, for example, records a video of the encounter. Not sure how that will get viewed in terms of a medical legal dispute or privacy concern if it ever came up. It's very province-specific. BC just raised GP telemedicine fees to match that of an in-person visit. I suspect people's take-home incomes are down if they work exclusively in walk-in clinics (less traffic overall, and more competition with the virtual care apps). True. Funding models can change at any time. Or take COVID for example. I see several cosmetic clinics close to shutting down. And walk-in clinics suffered also.
  3. @windsormd1 I'm assuming it is because spouse pays taxes according to his own personal tax bracket on the 95k part of the household income. Still not totally 21k/ month, but roughly there.
  4. I think therein lies the problem with your plan. If you go into Rural (and I mean rural like...5 acre horse ranches within 5-10 km of your work place), you need to enjoy doing hospital work and possibly cover ER, in-patients, long term care, take overnight call. Otherwise, who else is going to do it? There is almost no chance you can do 4 days a week AND still make a great living. If you do four days a week you're likely looking at <200k after overhead. You'll beg on both knees to find a locum to cover for you if you're away long periods of time. There is literally no incentive for your colleagues to cover you because they're likely overworked themselves. In most rural places like the ones I've described, you're likely looking at 60 hours per week, in my honest opinion. Typically 8AM rounds at hospital, 9-5PM clinic, 5-6PM hospital, and then possible overnight coverage. Weekends: round on hospital patients, round on long term care, possibly overnight coverage or ER coverage. If you're looking at Victoria/ Nanaimo, I don't know the real estate situation there, but I suppose you can get away with doing only clinic work. However, their walk in clinics are shutting down in spades due to poor remuneration. Meanwhile patients there have a huge waitlist problem and cannot find a family doctor.
  5. Don't take this the wrong way. I don't think we're trying to dissuade you from pursuing your dream to become a rural doc. Simply pointing out that your financial goal is attainable by keeping on the current path. Refer to @1D7 post above for how long it takes to break even.
  6. Forget the admissions process just for a second. Even if you got in today: You'll stop getting a salary from your current job ($71-80k X 6 years, plus whatever your partner needs to take time off to look after kids), plus you'll owe around $150k of tuition when it's all said and done = ~$580k as a conservative estimate. That's not including costs of moving if you have to move or if your partner is unemployed as a result of the move. If your dream is to own property, I don't see how being a rural doc allows you to attain that sooner PLUS have the time to enjoy it. i mean it’s fine if you want to be a rural doc and help people, do what you have to do. But if you just want the property and you and your partner have the freedom to move now, just do the math yourself.
  7. At least in BC, when you fill out the College license annual renewal, you have to declare if you've been off work, as well as other questions related to your scope of practice, plans to retire, and so on. Here are a few of the relevant questions: "Have you been absent from clinical practice for three continuous years" (Yes/no) "Identify the clinical hours you were professionally active in the past 12 months" (Number of weeks, average number of hours per week) "Do you have plans to significantly change, expand or reduce your scope of practice in the next 12 months" etc
  8. Surprisingly, what walks through your door in day to day practice is very different depending on your practice location and work type. For example: urban vs rural, affluent neighborhood vs not, hospital vs clinic. The good news is that each program across Canada is fairly consistent in terms of how many weeks dedicated to each block, as well as elective time. I'd favor choosing electives that meet your goals. For example, all my electives were done in urban family practice community clinics because that's where I knew I would practice once residency was over. Other people picked rural, and some people chose ICU, etc since they were going for ER+1. Some did more maternity care, whereas I did the absolute minimum. Even on blocks such as Internal/ Surgery/ OB/ Ortho, etc, I tried to get as much time working with preceptors in their clinics as much as possible. That way I would see more cases (eg. 4 office presentations vs 1 hour of a single surgery case in the OR). I'd also see the variety of cases that family doctors would refer to specialists.
  9. I agree that the billing schedules aren't always adjusted accordingly. And unfortunately when fee cuts are made, they tend to be made across the board. Sadly, the public already thinks that doctors as a whole are overpaid. Off topic Re: cataracts/ ophtho billing I'm not an expert. Just referencing to the fee guides. A cataract surgery, despite billing ~$400 (depending on which province you are, this has been cut by 10-25%), still takes around 15-30 minutes (including all the set up, etc). In the office, they could have seen patients and billed twice as much in the same amount of time. I'm not sure how much more they can cut the fees though. A colonoscopy is comparable to the amount of time to do a cataract surgery and billings are similar (well, I guess it depends how many polyps you also remove). I think the income disparity is created when offices are run like factories. The specialists aren't personally seeing all the patients coming into the office that day. They're being seen by trained assistants, doing OCT/ perimetry/ etc. Imagine an internist or cardiologist who is having an office with stress test visits, ECG/ Holter visits, and private consultations. This leads to high volumes. But again, this is work that needs to be done and compensated for. If they don't do it, someone else will, and perhaps in a less efficient manner.
  10. From my interpretation, @Arztin was just pointing out that a lot of things are repetitive, not exclusive to family medicine. I agree. The need to have "variety" every single day in your daily practice is grossly overrated and I would go as far as arguing that most people, whether they are doctors or any other profession, do a ton of repetitive work because that's where they are the most efficient. In the case of ophthalmology, if they don't perform those surgeries, then the waiting lists continue to grow. Plus, surgery is just one of the days of the week and I don't see a problem where they try to maximize their efficiency on that given day. The rest of the time they can do other things. It just so happens that surgeries in general, are lucrative if they don't take a lot of time. By the way, since I've been out in practice, I realize the reason ophthalmologists make more is not simply because of a certain procedure they can do over and over. But rather the sheer volume of EVERYTHING, including 60-100 of new referrals a day in the office. Similarly for other specialists like ortho, where they round on 20+ people in the AM, see 40-50 in cast clinic, and then be paid for being on call. People are working hard for the money and they deserve to get paid. This is, after all, "work". i.e. we do it to make a living, and compensation is part of that.
  11. I suppose you can. Things will be more difficult if you don't already establish electives/ references letters...both of these things are hard to get once you've completed your residency. Another reason people don't go back into residency is that you get used to the staff lifestyle and income. One other way is that you could work in an ER (eg. small community where CCFP-EM or FRCPC is not required) and challenge the exam. Here is the reference for the eligibilty to challenge the EM exam (note the 2017 link; if anyone knows the rules have changed, please comment): Eligibility and Application. College of Family Physicians Canada. http://www.cfpc.ca/EligibilityandApplication/
  12. It actual depends on the community itself and who's working there, distance from major centre, etc. Bonuses etc depend on what the province classifies as rural and as far as I know there isn't any black/ white definition based on size; just a classification "list". For example in BC, see here: https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/physician-compensation/rural-practice-programs/rural-retention-program In the Eligibility part of the page you can go to the links for rural definitions, points system, premium % etc. That's actually a very narrow view of what GIM does. GIM is there as a consultant as well as admitting patients on the wards. I would agree the rounding/ wards are similar. However the scope of the work is very different from that of a GP/ hospitalist. But yes, the argument for going to FM/ IM includes salary, residency training length...but also the scope of your future/ intended practice.
  13. Fortunately, you don't typically have to work at an academic site to be involved in med education. And you don't have to be an "Academic" staff You can get a "Clinical" faculty appointment. Usually it's "Clinical Instructor" or "Clinical Lecturer" (name varies by province/ institute). There's no annual salary and you're paid for the work you do. You can apply for promotion to Clinical Assistant Professor, etc, with more time and experience. The hourly/ pay for services remains the same, however. This is different from Academic staff, who might get an annual bonus, salary, benefits, etc, depending on their rank. For example (just to name a few) you can: -Be a preceptor for med students/ residents who come work in your clinic -Teach at the med school for a session/ lecture/ Problem Based Learning -Be an examiner/ invigilator/ interviewer -Be a site leader for residency programs in family medicine -Attend conferences as a representative of your school/ faculty
  14. I agree with all points. Couldn't agree more re: rural. In most cases the billing fee codes are identical, save for ~5% bonus. They're making more because in rural there's simply more work. It's very possible you're up all night on-call, you're in the ER, you're rounding on patients in hospital before you start your full clinic day, and you're rounding again after you leave the clinic. And then perhaps on weekends you're rounding on your nursing homes/ long term care.
  15. I think that's really splitting hairs. Don't factor that into the decision whether you go into a specialty. The 30k difference is not significant in the grand scheme. Year to year your income can fluctuate 2-3 times that amount. For FFS specialists that number can fluctuate even more year to year. If you go into FM expecting 200-250k net after overhead, I think you'll be pleasantly surprised that you can net more.
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