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gogogo

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gogogo last won the day on October 23

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  1. For sure, but looking at the same 2018 document on FHOs I posted (found here), it says the average FHO capitation per patient is $139.12 (page 16 of the pdf in the "Key Features of FHO Models" section). $139 x 1000 patients lines up pretty well with the $150,000 quoted by the 2 FHO doctors I spoke to. Of course, you could have a panel that gets more per patient, but by these calculations, it seems that the vast majority of patients would have to be elderly and complex. My calculations must be wrong/missing something given that people always say FHO is lucrative (e.g., the quoted 400k for 1300 patients) and I doubt--though may be wrong--that the only lucrative FHOs are the ones with a very old and complex panel. So, I'm trying to understand where I'm going wrong.
  2. I read that article too, hence my confusion with how it doesn't line up with what the FHO doctors told me. I don't think either of them had any motivation to obfuscate their true earnings. Having said that, I think the 3.5 days noted is wrong. The FHO GP I shadowed with the 2000 roster building to 3000 would wake up every weekday at 4, study until 7, run errands, then be at his clinic seeing patients from 9-5. No work when he got home or on weekends; he did this 5 days a week. And he was never not working from 9-5...jumping from room to room, filling charts, making referrals, etc.
  3. If you're willing to share and out of curiosity, how much are they actually making (i.e., how much does it differ from perceptions of them being insanely rich)?
  4. Thanks for answering. What number would you put on "+++ hours"? I don't judge the doctors for doing so because I'm not there yet, but it's unfortunate to see this type of care. Do you know much about the FHO model I'm describing? Is a 1200 roster closer to 240k billing or 400-500k?
  5. You could just create a section in your CV that's "Submitted Manuscripts" and list them there. It's not as impressive as a list of publications, but at least it lets you show your work and commitment to the specialty.
  6. It seems accepted wisdom that FHO GPs are typically making a comfortably high salary; I've seen it mentioned here that billings of 400k-500k is the FHO ballpark before overhead. I've just shadowed 2 FHO GPs, and both told me that with a roster of 1000, you bill ~150k before overhead. I've heard that the average roster is ~1200 patients (corroborated by data on page 14 here). Extrapolating, that means the average FHO GP should be billing 1.2 x 150k = 180k. I know they can also bill a small percentage of FFS for each visit, but that's capped around 60k, so even with that maxed, they should be billing 240k with an average roster of 1200. What explains the 160k-260k difference between the math I'm doing here and the hearsay of 400k-500k billings? I can't imagine most FHO GPs just compensating by having a larger roster to make the higher billings. One of the ones I shadowed has a roster of 2000 and expects it to build to 3000 before 2022. At this roster size, all he was doing was renewing meds, referring, routine bloodwork, and brushing off a lot. I'm no expert and he may be managing his patients well, but I don't see how most could handle such a large patient load without taking shortcuts.
  7. Hey, I would love to be wrong about this, because I could've pursed another career after my previous degree, made low six figures without any school debt, and called it a day. Instead, I chose med because of many reasons, one of which is that I thought it would be financially smarter. Too bad I only realized what I wrote in the other post once I got into med school.... But tell me, how am I underplaying it? I showed how the net worth is essentially equal for both careers with very simple math. The "double increase" that FM is making is simply compensation for the head-start that the PA (or any other reasonably earning professional) started making years earlier without any debt. The extra $65,000 dollars that the FM is making per year is money that the PA has already accumulated and the FM is just playing catch up. By the way, this reasoning also applies to FM vs. other higher-earning specialties. For instance, let's say I start med at 27, and then I can choose between FM (250k/year for 33 years) vs. a surgical specialty (450k for 30 years; it's 30 years because I spent 3 extra years in residency, and that's a conservative estimate). The surgery specialty pulls ahead at 38...by $78,000, which isn't that much to me. I'd consider several hundreds of thousands of dollars to be approaching a significant difference in net worth. When does that happen? At 41-42, where the surgical specialty has ~400k more than FM. At 48, the surgical specialty is 1 million dollars ahead. But seriously, what's so great about 1 million dollars extra when you've nearly hit 50? Especially given that surgery has a much more stressful lifestyle that involves trading away every other aspect of your life. Is your freedom and last remaining youth worth trading for 1 million dollars at 50? So while the 450k salary sounds amazing vs. the "low-paying" 250k of FM, it only shows itself once I hit my 40s-50s. That's not a great trade to me. You're right though, with the right investments, FM could pull ahead. But do you really want to justify this difficult path based on speculations regarding the stock market? The prospect of 5.5 million dollars that I can "cash in" when I'm 60 isn't that appealing. Any day of the week, I'd trade the potential/speculative 3 million dollars at 60 for a more normal youth that wasn't so high-stress and hell-bent on being academically exceptional. What I want to stress to premeds and potential career-switchers is that you should make sure you're going into med for the right reasons. Going into it because you think it'll elevate your life beyond what you have (as long as you're in a decent place right now) is an illusion. Don't underestimate the precious value of youth, lower stress, freedom, etc. One day you'll wake up and wonder where it all went. I'm not old by any means, but now that I'm seeing my 20s come to an end, I reflect on the fact that I've spent the last two decades in school, and will do so for the next several years. If I live to my early 70s, I'll have spent nearly half of my life in school/training. This is time I will never get back and time that was full of unnecessary striving. I often envy my friends/family who took a much more normal path. Sure, I might drive a slightly nicer car, have a somewhat nicer house, be able to eat at nicer restaurants, etc. but none of those things can compensate for lost youth and the high stress that I will carry with me for my adult years as a physician. Freedom, lack of stress, time for family, a calm mind...these are the luxuries of life, not a car or house just to show off to others. I look at my classmates in their early 20s and I think that they, like me until very recently, don't realize that we're on a hamster wheel and that this never-ending race doesn't end until we decide that it ends. We imagine that once we become staff, then we'll have reached the promised land. But, I look at the staff and so many of them are burnt out, lacking relationships with their kids, and it's tragic, because they lost their one chance at a normal life. It's not all doom and gloom, of course, many staff are happy. But I just want to emphasize to any one younger than me in this thread that it's not all about making 250k+. Like blah1234 said, many of my lower-earning friends are living great lives. I have one friend who only did college and has worked since high school. He just bought a house in a desirable GTA suburb, is living with his fiance, has a 9-4 schedule, and will soon be buying a rental property to make extra income. He's achieved this by making between 40k-70k since high school and saving diligently, and with his girlfriend making 70k, them having no debt, they are in a great place. This is already a terribly long post, so I'll end with something more positive. We are very lucky in medicine to make the money that we do with the stability that we have and the impact we can have on people. I don't want to come off as if I'm complaining about making an income that puts me in the 1%. Just recognize that there is more to life than making an amazing salary, and that being "average" is perfectly okay and more desirable in many ways.
  8. From a purely economic perspective, it depends on how old you are, how much you expect to make as a family physician, your salary as a PA, and the expected value of your PA benefits + pension. I'll make a few assumptions to show you the math, but you can change them for a more accurate outlook. This message looks long, but it's pretty straightforward, so I encourage you to read it to the end. But for a quick spoiler: Probably not worth it. My assumptions: Age: 25 FM Ontario average income: $250,000 post-overhead = $150,000 after income tax PA salary: $120,000 = 84,000 after income tax Value of PA benefits = $2,000 per year Value of PA pension: $84,000 x 50% x 25 years (this assumes that your pension will pay half of your post-tax salary for 25 years of retirement) = $1,050,000 Now let's chart your net worth's trajectory, starting with PA, where you earn $84,000/year + $2,000 in benefits/year: $86,000 Age 25: $86,000; 26: $172,000; 27: $258,000; ...You get the point, so I'll skip ahead to age 39 ($258,000 + $86,000 x 12 years): 39: $1,290,000 I stopped at 39 because it's the first year that your net worth as a FM would be greater than your net worth as a PA. But we should also look at how much it's greater: $10,000 (i.e., FM net worth = $1,300,000 at age 39). I am also assuming that you made zero investments as a PA (e.g., stocks that appreciate in value), that you have zero savings right now (that would only make your net worth as a PA look better), that there is no interest on your med school debt (which only makes your net worth as FM worse), and that you will never slow down productivity as FM (e.g., taking parental leave, working fewer hours in your late 50s and early 60s). Even ignoring these exacerbating factors, you are essentially saying that you want to sacrifice 6 years of your life (med school and residency are not chill) so that at age 39, you can have $10,000 more as a FM vs. just staying a PA. Alternatively, you can stay a PA, which would mean enjoying the rest of your 20s, having stable hours, better wellbeing because of relatively lower stress, vacations, etc. Is that worth it to you? But wait, there's also your pension, which is valued at $1,050,000. As FM, you'd have to save $35,000/year over a 30-year career to equal that pension value. In other words, let's subtract $35,000 from the FM post-tax salary, making it equal to $115,000. If we do that, then it would take until age 50 for your FM net worth to be higher than your PA net worth. Again, the net worth difference isn't much: $14,000. So up to you, but to me, putting up with all of med school, etc. isn't worth it to just be $14,000 ahead at age 50. Of course, you can make more than $250,000 pre-tax/post-overhead as FM, but after speaking to several FM physicians and shadowing them, that would be working very, very hard...for *most* physicians, that requires much more than the 37.5 hours/week you currently work. Even the $250,000 post-overhead is not easy; FM physicians are going from room-to-room, doing quick 10 to 15-minute appointments, lots of paperwork, etc. It's hard work and you really have to earn every dollar you make. There are those who do walk-ins exclusively and make crazy money, but not everyone can handle the 2-5 minute walk-in appointments, and who knows, the government may restrict walk-in practice because it is very lucrative. So all in all, if it's just about the money, I agree that you're already in a great place and should just enjoy your life now. There is a reason that residents, even with the prospect of making multiples of your salary in a few years, are telling you that you've got a good gig. It's not always about salary in an absolute sense, but everything else that comes with it (lifestyle, how early you earn that salary, pension, benefits, stress, etc.). Also consider that many physicians will have a partner who stays home to take care of the family (i.e., no income earned from the partner). Given your hours and benefits, you can just find a partner who makes a similar salary to you and be a double-income household with a reasonable lifestyle, and then be close to earning what a FM makes. For completeness, here's the math for family medicine, assuming your cost of living + tuition is 45,000 per year (25,000 tuition + 20,000 for living, rent, etc.), and then ~65,000 income as a resident, and then $250,000 pre-tax income as FM: Age 25 (M1): $-45,000; 26 (M2): $-90,000; 27 (M3): $-135,000; 28 (M4): $-180,000; 29 (PGY1): $-115,000; 30 (PGY2): $-50,000 31 (FM): $100,000 32 (FM): $250,000 ...Skip to 39 ($250,000 + $150,000 x 7): 39: $1,300,000
  9. Wouldn't a leave of absence hurt down the line? I know that when you renew your license, you have to indicate whether you took leave and whether you've had a medical condition that could affect you as a physician. Checking both of those boxes sounds like a red flag, but I'm not sure how the college treats you if you check those boxes. Edit: Of course, I'm not suggesting that LoA shouldn't be taken, but am hoping that more experienced members can chime in about whether that will have implications for the career/licensing in the future.
  10. What draws people away from methadone/marijuana clinics? Addictions medicine is pretty interesting to learn about, but I don't have first-hand experience yet.
  11. Several residents and staff have told me that they dread regular 9-5 FM clinic, with all its paperwork, emails, chasing labs, etc. If I end up disliking it too, could I fill my week with niches instead? E.g., walk-in 2x week, telemedicine 1x week, addictions 2x week (other niches would be surgical assist, urgent care, psychotherapy, ER in a small town, cosmetics, etc.). Do you see any problems with this plan? I think I'd prefer the shift or freelance nature of the niches rather than 9-5 FM clinic.
  12. Thanks. I'm very interested in sports med. Is practicing exclusively sports med as a GP possible in the GTA? Does it come with sacrifices (e.g., tight job market or lower pay)? And what about GPs doing just pain?
  13. Thanks for the brutal honesty. It's sobering to someone interested in FM. I hope you find some joy in the career. Do you think the same thing about niche FM practices (e.g., GP derm/psychotherapy/sports/addictions/etc.)?
  14. I am very interested in FM and definitely recognize its benefits, but it is important to be critical of any specialty so that we can understand what we are getting into. It's important to remember that all specialties will exaggerate their pros and downplay their negatives; it's marketing just like anything else. So, for the sake of being a devil's advocate, let me give a different perspective on the benefits of FM: Jobs It's true, FM has jobs everywhere. But let's be realistic: How many job openings do you actually need? It's not as if you're going to switch your clinic every year. You'll find a clinic you like and stay there, in all likelihood. I also think that the tight job market in at least some of the other specialties might be overplayed. Speaking to people in certain specialties, they seem to be confident about the job market, even in specialties that, from the outside, I'm told have a tight job market. Of course, if you want to work downtown Toronto, then it'll be difficult to get a job. But if you're okay with working in the suburbs/community, it seems there are jobs available. I think it's important to talk to people in the field, especially residents in their final year, to get a different perspective. Lifestyle FM has the best lifestyle, but other specialties have it pretty good as well, like dermatology, ophthalmology, and outpatient IM specialties. I've also been told that you have a lot of control over your hours as a staff even in the more demanding specialties. I also check the hours of FM clinics in my area, and there definitely are FM doctors who are working 50-60 hours a week, including on weekends, and pretty late into the evening. Residency lifestyle seems awful for any specialty and is temporary, so probably not worth thinking about. Income I'm still learning about FM salaries, but it seems AB is an outlier (isn't AB in the news now for trying to unilaterally slash funding?). In ON, it seems reasonable that, on average, you'll make ~200-250k as an FM working 40-50 hours/week. Some are efficient and can do more, but some are not as efficient and work more hours for less (especially when you include the time they spend doing paperwork outside of clinic hours). And being efficient to make more money might not be enjoyable for some people because it requires faster appointments. Of course, 200-250k is a good salary, but your colleagues, who only put in ~3 years more than you, are making 100-200k more (or even 2-3x more in specialties like ophthalmology or dermatology, with an equally good lifestyle). I know this shouldn't matter, but as med students with type A personalities, it's hard not to allow comparison to be thief of joy. And to elaborate, you have to be in the 80th percentile of FM in ON to make 320k after overhead (see here). It's good to be ambitious and be inspired by these numbers, but there is a reason that only 20% of FM in ON are billing that high. We can't just say that 80% of FM in ON are lazy or inefficient doctors. If so, then perhaps be prepared to be like them, because by definition, we can't all be in the top 20%. Scope There are niches in FM, but again, there is probably a reason most don't do them. For example, to be a cosmetic FM, you have to build a clientele and compete against other specialties doing cosmetics, like derm, ENT, and plastics. Splitting your time between regular FM and a niche could also prove to be difficult, because the days you spend doing the niche (e.g., cosmetics) are days that you're not giving time to your regular FM patients. The latter patients will then be angry with you. ER has a rough lifestyle, OB has a rough lifestyle and probably requires that you work outside of the city, etc. I also find it almost self-denial to say you want to go into FM because of the +1 opportunities. It's basically saying that you want to go into FM so that you can *not* do FM. If you are interested in a niche, perhaps it's better to just go into a specialty that does that niche? Matching I agree with this. But there are negatives to everything. Instead of sucking up to staff and residents to get research opportunities, as an FM doctor, you have to "suck up" to patients by putting up with their vague complaints and frustrations with the healthcare system (because you are their primary care provider/their first exposure to healthcare). For example, dealing with a chronic back pain patient who says nothing works for them is a very frustrating experience for everyone involved. Overall, despite everything I said above, based on my limited training thus far, I think FM is great. But I think it's important to critical. FM is not an easy waltz into a 300k salary and requires sacrifices just like any specialty.
  15. I have heard of people using those and they seem to like it. Part of med school nowadays is finding the resources that work for you. I don't use those because I'm satisfied with my resources. First aid has nice quick summaries of topics, but you shouldn't use that until you have the background from sources that go more in-depth (like Merck and Costanzo); First aid can be your "refresher." Pathoma is the same idea, but for diseases. Boards n beyond seems pretty good, but I don't want to pay for it. Not sure about Step 2 ck.
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