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booradley83

Income and Lifestyle

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15 hours ago, booradley83 said:

Why would income go up relatively compared to the mortgage? If anything; the mortgage rates are at historic lows; the mortgage might go up................and the incomes might actually come DOWN with this stupid government..........

Inflation. This is why in the low interest world we lived in over the last 10 years, it makes a lot of sense to go with a longer mortgage. Halfway through your career, you will notice your mortgage payments are easy as pie to make.

Also amazed that anyone can spend $2K per month discretionary with the budget you've presented.

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3 hours ago, GrouchoMarx said:

being forced to work for free is a bigger source of burnout than working more and getting paid for that work.

in ontario pathologists dont even get paid to be on call.  residents in pathology get more pay for their call work than the staff do! 

the job markets bad enough in ontario that the only place thats consistently advertising positions is thunder bay, and i cant imagine being stuck there on a weekend without being able to drink myself into a coma, let alone not being paid for it!

the paradigm that pathologists lead idyllic lives is one of times past. government and admin pressures coupled with an overabundance of insourced cheap labor from india/pakistan/other has made the field one where you are looking over your shoulder constantly as your replacement may be just around the corner.

What kind of requests do pathologists get while on call?

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Exactly, grass is always greener, a very human and common feeling. As long as one's expectations do not meet reality, it's difficult to be content no matter what your situation.

Sure, one could compare specialist billings to FM. But how easy would it be for a new specialist grad to land that coveted position in a downtown metropolis, compared to FM which actually lets you choose where to work to a much greater extent? And if lifestyle is a concern, how would you feel about spending much of your free time (including "vacation") to prepare talks, write papers, etc. to meet the expectations of such a position? 

Everything has a tradeoff, which may not be apparent until you are in the other position. As above, pathology has regular hours and pension/benefits etc., but suffers lack of autonomy which leads to dissatisfaction. I know friends who worked in family medicine and then entered radiology found that the workload and hours were not what they expected. (The data in the CMA specialty profile almost certainly are averaged with many 65+ part-timers; obviously no full-time person works 30-something hours/week in patient care, can be as much as 2-3x that for rads starting out). Not a problem if you have intrinsic interest in the work, but would be disillusioning for anyone who expected a "deal".

In the end, happiness comes from adjusting one's own expectations. I entered medicine with the expectation of meaningful work and a stable income, and I have not been disappointed. Never had a wish for "lifestyle" in terms of house/car etc. If contentment is not found in one's current situation (presumably young, healthy, with stable family situation and career), I doubt any changes in one's external situation will solve the matter, as it is primarily internal. There can always be an upward comparison to be made - how about someone lucky enough not to need to work at all... but perhaps they might look at you and envy your accomplishments and sense of purpose in getting to this point. 

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43 minutes ago, Lactic Folly said:

Exactly, grass is always greener, a very human and common feeling. As long as one's expectations do not meet reality, it's difficult to be content no matter what your situation.

Sure, one could compare specialist billings to FM. But how easy would it be for a new specialist grad to land that coveted position in a downtown metropolis, compared to FM which actually lets you choose where to work to a much greater extent? And if lifestyle is a concern, how would you feel about spending much of your free time (including "vacation") to prepare talks, write papers, etc. to meet the expectations of such a position? 

Everything has a tradeoff, which may not be apparent until you are in the other position. As above, pathology has regular hours and pension/benefits etc., but suffers lack of autonomy which leads to dissatisfaction. I know friends who worked in family medicine and then entered radiology found that the workload and hours were not what they expected. (The data in the CMA specialty profile almost certainly are averaged with many 65+ part-timers; obviously no full-time person works 30-something hours/week in patient care, can be as much as 2-3x that for rads starting out). Not a problem if you have intrinsic interest in the work, but would be disillusioning for anyone who expected a "deal".

In the end, happiness comes from adjusting one's own expectations. I entered medicine with the expectation of meaningful work and a stable income, and I have not been disappointed. Never had a wish for "lifestyle" in terms of house/car etc. If contentment is not found in one's current situation (presumably young, healthy, with stable family situation and career), I doubt any changes in one's external situation will solve the matter, as it is primarily internal. There can always be an upward comparison to be made - how about someone lucky enough not to need to work at all... but perhaps they might look at you and envy your accomplishments and sense of purpose in getting to this point. 

Well, sure - I agree with most of your conclusion.  Nonetheless, there are nuances - people want to generally be close to friends/family, for example.  Being in smaller unfamiliar communities has been a source of discontent for some.  Sure some specialties may facilitate this to different degrees, but not everyone enjoys the same type of work.

 With respect to profiles, the data for FM would be averaged too.  Would it be somehow more non-representative for radiology, which was the original comparison?  I mean radiology seems to be an outlier in terms of income, which is being brought to the forefront with the name the billings court case - it's not pediatricians.  

One thing that surprised me in the CMA data was that the overhead seemed so similar to FM - I would have thought that radiologists equipment expenses are much higher.  But, maybe there's some sort of averaging effect going on between hospital and non-hospital based or different provincial standards?  Do some radiologists have minimal overhead?  

Personally - I understand the pressure of academic lifestyle, but I would agree that I have a somewhat unique background and that academia is really it's own domain.   
 

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21 hours ago, Wachaa said:

Not that hard actually. Just bill higher. Find your extra $50k.

That's one of the best things about fee for service. You do more service, get more money.

 

21 hours ago, booradley83 said:

I wish it was that easy buddy!  Billing $350k already requires a full-time committment..................it's already bordering on rushing patients out and doing a sloppy job sometimes...........

Or join a FHO... 

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1 hour ago, tere said:

Well, sure - I agree with most of your conclusion.  Nonetheless, there are nuances - people want to generally be close to friends/family, for example.  Being in smaller unfamiliar communities has been a source of discontent for some.  Sure some specialties may facilitate this to different degrees, but not everyone enjoys the same type of work.

 With respect to profiles, the data for FM would be averaged too.  Would it be somehow more non-representative for radiology, which was the original comparison?  I mean radiology seems to be an outlier in terms of income, which is being brought to the forefront with the name the billings court case - it's not pediatricians.  

One thing that surprised me in the CMA data was that the overhead seemed so similar to FM - I would have thought that radiologists equipment expenses are much higher.  But, maybe there's some sort of averaging effect going on between hospital and non-hospital based or different provincial standards?  Do some radiologists have minimal overhead?  

Personally - I understand the pressure of academic lifestyle, but I would agree that I have a somewhat unique background and that academia is really it's own domain.   
 

Yes, that was the point of my response in the context of OP's post - there is always a tradeoff. If you prioritize location, as to be closer to family and friends which is understandable, then your options with regard to specialty choice narrow. High billings don't come without high workload, period. Expecting a career that fits all of our criteria perfectly is a setup for disappointment.

If we're looking at the same CMA specialty data - they don't really support your assertions about relativity in income, so how reliable do you feel the data would be overall for other things like overhead and hours? Individual outliers are just that, outliers, and mashing together data from different practice settings/styles doesn't really give someone a full picture of what someone can expect in terms of lifestyle/workload, as evidenced by OP's unmet expectations. Many differences between urban FM working office hours, versus rural GP available around the clock, but everything gets lumped together under those aggregate profiles.

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2 hours ago, Lactic Folly said:

Yes, that was the point of my response in the context of OP's post - there is always a tradeoff. If you prioritize location, as to be closer to family and friends which is understandable, then your options with regard to specialty choice narrow. High billings don't come without high workload, period. Expecting a career that fits all of our criteria perfectly is a setup for disappointment.

If we're looking at the same CMA specialty data - they don't really support your assertions about relativity in income, so how reliable do you feel the data would be overall for other things like overhead and hours? Individual outliers are just that, outliers, and mashing together data from different practice settings/styles doesn't really give someone a full picture of what someone can expect in terms of lifestyle/workload, as evidenced by OP's unmet expectations. Many differences between urban FM working office hours, versus rural GP available around the clock, but everything gets lumped together under those aggregate profiles.

The income reported in the CMA profile is based on all medical specialties - not exclusive to radiology at all.  So I agree, it's not accurate for radiologist income.  It does say the overhead is specifically for radiology, however.

 I was simply trying to understand the situation with Ontario radiologists - the OMA is going to appeal to the Supreme Court to protect the names of mostly radiologists from being published by the Star, a move which is being greeted skeptically by some.  A couple years ago another article came out saying that radiologists also formed the greatest proportion of 1 mill+ billers, in ON.  So, given this context and the numbers being thrown around for different specializations, I was curious as to what the radiologist situation in Ontario exactly was - and how it might differ from the national portrait of radiologists.  Some other threads on this forum looked at older reported income levels in ON showing that radiologists were indeed the big billers in ON post-overhead.        

Unfortunately, as far as I know, there's very little data specifically to Ontario - it could be they have much higher overheard? or work longer? and I was simply curious as to what specifically the differences may be.  

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The CMA profiles do give different income stats for each specialty as well, but I agree it's not data to hang your hat on without a better understanding of the context re: overhead, hours. I don't have the knowledge to comment on how conditions vary across the nation.

It is my understanding that the Toronto Star has filed a FOI request for *all* physician billings and names, not just the top billing names or likely more accurately groups (although those obviously make for the best headlines). The OMA is attempting to appeal this on behalf of all physicians in Ontario.

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8 minutes ago, Lactic Folly said:

The CMA profiles do give different income stats for each specialty as well, but I agree it's not data to hang your hat on without a better understanding of the context re: overhead, hours. I don't have the knowledge to comment on how conditions vary across the nation.

It is my understanding that the Toronto Star has filed a FOI request for *all* physician billings and names, not just the top billing names or likely more accurately groups (although those obviously make for the best headlines). The OMA is attempting to appeal this on behalf of all physicians in Ontario.

Well radiology is complicated, clearly.  The income stats on the CMA profile for radiology report an aggregate for *all* medical specialties together.  However, other components like overhead and hours worked seem to be specific to the discipline.         

With respect to the legal case, according to the Star, their FOI was specifically for the top 100 billers:

"The case originated in early 2014 with a Freedom of Information request from the Star to Ontario’s health ministry for physician-identified data on the top 100 OHIP billers. In its FOI request, the Star asked for physician-identified billing data on the top 100 billers for the most recent five years available, which back then was 2008 to 2012, inclusive. The request captures about 160 doctors."

https://www.thestar.com/news/gta/2018/08/03/appeal-court-ends-secrecy-of-public-payments-to-mds.html

 

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5 hours ago, tere said:

Well radiology is complicated, clearly.  The income stats on the CMA profile for radiology report an aggregate for *all* medical specialties together.  However, other components like overhead and hours worked seem to be specific to the discipline.         

With respect to the legal case, according to the Star, their FOI was specifically for the top 100 billers:

"The case originated in early 2014 with a Freedom of Information request from the Star to Ontario’s health ministry for physician-identified data on the top 100 OHIP billers. In its FOI request, the Star asked for physician-identified billing data on the top 100 billers for the most recent five years available, which back then was 2008 to 2012, inclusive. The request captures about 160 doctors."

https://www.thestar.com/news/gta/2018/08/03/appeal-court-ends-secrecy-of-public-payments-to-mds.html

 

Since then they've filed another case for all physicians. That case is on hold until the rulling for top-100 billers case is made.

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8 hours ago, tere said:

The income reported in the CMA profile is based on all medical specialties - not exclusive to radiology at all.  So I agree, it's not accurate for radiologist income.  It does say the overhead is specifically for radiology, however.

 I was simply trying to understand the situation with Ontario radiologists - the OMA is going to appeal to the Supreme Court to protect the names of mostly radiologists from being published by the Star, a move which is being greeted skeptically by some.  A couple years ago another article came out saying that radiologists also formed the greatest proportion of 1 mill+ billers, in ON.  So, given this context and the numbers being thrown around for different specializations, I was curious as to what the radiologist situation in Ontario exactly was - and how it might differ from the national portrait of radiologists.  Some other threads on this forum looked at older reported income levels in ON showing that radiologists were indeed the big billers in ON post-overhead.        

Unfortunately, as far as I know, there's very little data specifically to Ontario - it could be they have much higher overheard? or work longer? and I was simply curious as to what specifically the differences may be.  

Yeah it is complicated. I mean the major reason there are so many "super billers" for radiology is that we bill for both professional work (ie really the radiologists income) and the technical fees (the money charged to buy the CT scanners, US stations, Mammo machines, the building etc and pay for all the people to run those machines and to the imaging - the radiologist just manages that - that is billing that is just to keep lights on, not for profit as it were) Some of those people are billing the government for the work of a basically an entire imaging centre. Each sonographer cost full time over 100K a year, and a radiologist doing US full time needs 5-6 sonographers as an example and all the other stuff that goes a long with it. You can get these huge numbers but they don't mean anything in terms of take home. 

That is why are struggle with explaining to people these fees. Effectively the out patient clinic radiologist has an overhead that is huge. That is ok (usually) that is what the technical fees are for. Just don't confuse that with income. This is why there is just a huge range of on paper radiology billings - people that work in the hospital don't charge technical fees. People in an outpatient clinic though do, and the that guy that own that clinic may be billing for all the technical fees at that site - which to make it worse might be all the other people supporting all the rads that work there (image all the stuff needed to keep 4-5 rads busy all the time in terms of staff - it is millions and millions)

It would be nice if they at least separated those two things out - technical fees vs professional fees. It is still a bit more complex than that as often the technical fees (which haven't increased is an extremely long time) aren't enough and we subsidize them with the professional fees (which is annoying but you have to keep the lights on). Still it would be a better start at least. 

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On 9/14/2018 at 9:30 PM, Lactic Folly said:

Yes, students who have worked in other careers prior to medicine often express a greater appreciation for the security and privilege it provides, compared to many other people who also work difficult hours in less desirable occupations for much less pay and job security.

Pretty much. I mean, my PGY-1 salary is the best income I’ve ever had. I’m actually feeling pretty comfortable on it. Hours and benefits are worlds better than most jobs I’ve had previously. I’ve honestly worked a lot harder for a lot less money for most of my adult life. 

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2 minutes ago, brady23 said:

The government has imposed restrictions on new grads joining FHTs/FHOs unfortunately 

Yeah like three years ago and tons of new doctors have joined since . Why not be one of them? People join and create new FHOs regularly... 

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1 minute ago, brady23 said:

The government has imposed restrictions on new grads joining FHTs/FHOs unfortunately 

yeah which is actually a major problem - I honestly thought those were in the process of being removed but it seems not so. 

You training under a model and you then it only makes sense you want to practice in that model. They are driving people to family medicine with the overall plan but they don't seem to know what to do with them once they get out. 

 

 

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Just now, rmorelan said:

yeah which is actually a major problem - I honestly thought those were in the process of being removed but it seems not so. 

You training under a model and you then it only makes sense you want to practice in that model. They are driving people to family medicine with the overall plan but they don't seem to know what to do with them once they get out. 

 

 

It's a major problem if you're weirdly obsessed with living inside Toronto. Once you step 30 minutes out and work another 20 minutes out, problem solved. 

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Just now, rmorelan said:

yeah which is actually a major problem - I honestly thought those were in the process of being removed but it seems not so. 

You training under a model and you then it only makes sense you want to practice in that model. They are driving people to family medicine with the overall plan but they don't seem to know what to do with them once they get out. 

 

 

Agreed - it's so unfortunate because I do think it's a superior patient care model to the one we have now. 

There's a part of me that hope the Consevatives will reverse the decision of the Liberals, but not sure if that'll happen. 

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3 minutes ago, medigeek said:

Yeah like three years ago and tons of new doctors have joined since . Why not be one of them? People join and create new FHOs regularly... 

Well i didnt say it was impossible to join (but you do need to wait for someone to retire or do it in a high need service area), but there are heavier restrictions on them 

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2 minutes ago, medigeek said:

It's a major problem if you're weirdly obsessed with living inside Toronto. Once you step 30 minutes out and work another 20 minutes out, problem solved. 

So is it easy to join FHOs in suburbs away from Downtown Toronto? (Like Scarborough, Markham, North York, Ajax, Pickering, etc.)

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2 minutes ago, brady23 said:

Well i didnt say it was impossible to join (but you do need to wait for someone to retire or do it in a high need service area), but there are heavier restrictions on them 

Plenty of people retiring and you often get good deals on them. Not to mention a big roster to come with it often. 

1 minute ago, brady23 said:

So is it easy to join FHOs in suburbs away from Downtown Toronto? (Like Scarborough, Markham, North York, Ajax, Pickering, etc.)

Not in those places, but step out another 20 minutes. Your plan should be to live in those suburbs and work 20 minutes away from them. Also even if you could get a spot inside Toronto, it's a bad idea to begin with. How will you roster a lot of patients? It's much easier to do it in a growing town on the GTA perimeter. 

 

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14 minutes ago, medigeek said:

Plenty of people retiring and you often get good deals on them. Not to mention a big roster to come with it often. 

Not in those places, but step out another 20 minutes. Your plan should be to live in those suburbs and work 20 minutes away from them. Also even if you could get a spot inside Toronto, it's a bad idea to begin with. How will you roster a lot of patients? It's much easier to do it in a growing town on the GTA perimeter. 

 

has a side market appeared for selling those spots? Sounded like initially some people retiring were doing just that. 

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OP, have you thought of hiring a billing agent to look over your numbers? I bet he/she can find some leaks. It's their full time job, after all. You may be surprised. I have heard of horror stories of docs learning of their billing mistakes only after years or even DECADES of practice. They didn't know what they didn't know! I wouldn't trust that your partners know more than you do either. You have to be as much of an expert in billing as you are with medicine imo.

Consider taking on a niche, like lumps and bumps. If this works the same as in Alberta, referrals from your partners will get you a consult plus the procedure. What about doing hospitalist medicine, OB, or surgical assist? Are any of them lucrative?

Is 25% overhead not a bit high? Aren't there practice with 20%? How much do you pay your admin? Do you have an EMR system or are you paper based? There are patient-scheduling and dictation software to save you from having to pay for an extra receptionist or transcriptionist for a fraction of the cost. Push hard for money saving measures in your practice.

Also don't live in a million dollar home in Toronto haha easier said than done I know.

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Yes, everybody can be more efficient in billing.  Moving 20 minutes outside the GTA definitely has opportunities; but preferences in where you want to practice matter.  Also, the traffic in the GTA is horrendous; my first job, I was living in Mississauga and commuting to Brampton..............the commute was 35-40 minutes during my travel times.............so factoring in living area, schools, family, friends and location matter.................it's not just a matter of 'go outside the GTA 20 minutes.'  The GTA is a huge area.........................

 

FHO's are probably a better deal in smaller communities; I know several FHO physicians in the GTA; their rosters are kinda stable; but the fact that everybody uses walk-in clinics hurts the capitation amount..........................honestly, income for FHO's vs non-FHO's, at least in the GTA isn't that different...............non-FHO's might even win out if you work hard..............

 

Lastly, 25% overhead is on the lower end for the GTA currently................30% is more the norm............also with the new salary increases and minimum wage; that overhead is actually on the rise....................................so it's a tough market; definitely leaving the GTA would solve a lot of the pressures, financial troubles, etc................but family/friends play a HUGE role in where you work/live...........

 

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