Income and Lifestyle

[medigeek]

9 minutes ago, booradley83 said:

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...........

 

FHOs also do shadow billing plus earn money when they aren't seeing patients. So no, non-FHOs can't win. But you do bring a good point about walk-in use in the city.

Anyway plenty of small towns attached to the GTA perimeter. If you want to make the big bucks and crack past mid 6 figures, you need to give something up. 

[LittleDaisy]

4 minutes ago, medigeek said:

FHOs also do shadow billing plus earn money when they aren't seeing patients. So no, non-FHOs can't win. But you do bring a good point about walk-in use in the city.

Anyway plenty of small towns attached to the GTA perimeter. If you want to make the big bucks and crack past mid 6 figures, you need to give something up. 

True...but if your FHO has evening walk-in hours with weekend clinics, and with DUTY MDs Monday-Friday who see same day patients, the patients in large academic FHO with good after hours go to walk-in less often than smaller FHO with just weekday evening hours. 

For overhead, if you happen to be in a large FHO, the overhead costs go down for office supplies, office rent, clerical staff, etc...

The cost of living is so high in GTA, if OP wants a more comfortable living, definitely go practice in one of the smaller suburbia or cities around GTA. At least in family medicine, you have the luxury to choose where you want to practice without extra fellowships, which is rare in specialties nowadays. 

[booradley83]

1 hour ago, medigeek said:

FHOs also do shadow billing plus earn money when they aren't seeing patients. So no, non-FHOs can't win. But you do bring a good point about walk-in use in the city.

Anyway plenty of small towns attached to the GTA perimeter. If you want to make the big bucks and crack past mid 6 figures, you need to give something up. 

You'd be surprised how many FHO physicians are getting capitation payments of 10-20k monthly; and not much else outside of this.  

[LittleDaisy]

1 hour ago, booradley83 said:

You'd be surprised how many FHO physicians are getting capitation payments of 10-20k monthly; and not much else outside of this.  

With FHO, you get annual bonus for primary prevention, primary mental health, meeting certain percentage for Pap test, flu shots, FOBT distribution, complex patients from health connect. Etc, for example, you will get 2000$ for having > 5 bipolar or schizophrenia patients. > 2000$ if more than 60 percent of your female patients are getting Pap tests, etc. > 2000 for having > 5 prenatal patients, etc,  350$ for a complex patient referred from health connect, etc . 

The average projected income of a FHO physician with 1000 roster patients (full-time) is 357,000 $ . The data is pulled from OMA's presentation. The nice thing about capitation payment is that you are getting paid while on vacation or on leave for emergency familial situations. 

The only downside is that the Ontario government is limiting 20 FHO spots q monthly in high need areas, for FM residents who are working at FHOs, the majority of us will be working with the FFS model, which is unfortunate, and prompts physicians to favour volume > quality of care offered to complex patients. 

[medigeek]

3 hours ago, booradley83 said:

You'd be surprised how many FHO physicians are getting capitation payments of 10-20k monthly; and not much else outside of this.  

Then roster more patients. 

1 hour ago, LittleDaisy said:

With FHO, you get annual bonus for primary prevention, primary mental health, meeting certain percentage for Pap test, flu shots, FOBT distribution, complex patients from health connect. Etc, for example, you will get 2000$ for having > 5 bipolar or schizophrenia patients. > 2000$ if more than 60 percent of your female patients are getting Pap tests, etc. > 2000 for having > 5 prenatal patients, etc,  350$ for a complex patient referred from health connect, etc . 

The average projected income of a FHO physician with 1000 roster patients (full-time) is 357,000 $ . The data is pulled from OMA's presentation. The nice thing about capitation payment is that you are getting paid while on vacation or on leave for emergency familial situations. 

The only downside is that the Ontario government is limiting 20 FHO spots q monthly in high need areas, for FM residents who are working at FHOs, the majority of us will be working with the FFS model, which is unfortunate, and prompts physicians to favour volume > quality of care offered to complex patients. 

Aren't you able to bypass the 20/month thing? Lots of guys join just a little while after residency. 

[LittleDaisy]

27 minutes ago, medigeek said:

Then roster more patients. 

Aren't you able to bypass the 20/month thing? Lots of guys join just a little while after residency. 

Unfortunately I don't think . FHO costs a lot of money to the ministry of health, with all the health professionals (physio, OT, psychologists, chiropractors, nurse practitioners, dietitians, social workers, counselors, pharmacists, the list goes on) , and the fact that FHO physicians practice more <<comprehensive primary care>> which in itself rosters a lot of complex undeserved patient population---> who are in need of more services . 

The people that you were referring to perhaps are locumming for FHO physicians, or taking over the practice of retiring physicians. 

The ministry of health creates the FHO to provide more comprehensive care to the marginalized population, and then quickly realizes the higher costs come with this, and restricts unfortuantely to 20 per month for new grads in FM (which is not a lot). You have to get the approval of Ministry of Health before joining the FHO, it has to be in an underserved area (definitely not downtown Toronto), and you have to compete with other new grads as well. 

[medigeek]

5 minutes ago, LittleDaisy said:

Unfortunately I don't think . FHO costs a lot of money to the ministry of health, with all the health professionals (physio, OT, psychologists, chiropractors, nurse practitioners, dietitians, social workers, counselors, pharmacists, the list goes on) , and the fact that FHO physicians practice more <<comprehensive primary care>> which in itself rosters a lot of complex undeserved patient population---> who are in need of more services . 

The people that you were referring to perhaps are locumming for FHO physicians, or taking over the practice of retiring physicians. 

The ministry of health creates the FHO to provide more comprehensive care to the marginalized population, and then quickly realizes the higher costs come with this, and restricts unfortuantely to 20 per month for new grads in FM (which is not a lot). You have to get the approval of Ministry of Health before joining the FHO, it has to be in an underserved area (definitely not downtown Toronto), and you have to compete with other new grads as well. 

I'll PM you

[GrouchoMarx]

On 9/15/2018 at 3:39 PM, ArchEnemy said:

What kind of requests do pathologists get while on call?

intraoperative consults and stupid autopsies.

i dont blame people not wanting to pay for autopsies. im sad to say that staff feel compelled to do them on weekends for free because if they dont the admin will tarnish their names and replace them with foreign trained insourced labor.

the intraoperative consults however are very important and can have major implications. these are high stakes, high pressure situations, and do happen at odd hours. yet pathologists are not paid for it.

in some hospitals theyre expected to perform the technical work required to obtain the slide for the frozen section. this is like asking a radiologist to position the patients on call. fat fucking chance they will. pathologists though, theyll cut a slide. theyll do anything. 

the call burdens are even bigger if in general path as weird results can get you woken up at night.

 

 

[W0lfgang]

OP, would you pick family if you had to do carms again?

[#YOLO]

i would..simply because i hate being a resident. i hate having a boss and having someone tell me what to do. 

[LittleDaisy]

33 minutes ago, #YOLO said:

i would..simply because i hate being a resident. i hate having a boss and having someone tell me what to do. 

I think that for medical students, they should pick a specialty out of pure interest, while still taking into consideration the current job market. 

I have seen a few colleagues in FM by default (spots created after 2nd spot of CaRMS), they are not very happy with their choice. It's not fun to wake up every morning to do things that you don't like doing. You do have to be patient and able to tackle minor "complaints" and make sure that there are no clinical red flags, which could be taxing emotionally. Also, as you are the MRP of your patients, it is very difficult to end a therapeutic relationship, unless you have good reasons (you are not allowed to end a therapeutic relationship for a psychiatric patient with frequent no shows, and who goes to walk-in all the time, and with whom you have had a frustrating experience---> one staff had to go through the registration committee of CPSO and finally was told that he & she didn't advocate enough for the patient, and now has a record on his & her file even with CMPA's help).

Given that we have spent so many years in post-secondary training, I don't see much difference between a 2 year residency and 5 year residency. If being miserable as a resident for > 3 years could guarantee that you will enjoy doing something you love, with higher earning potential, I don't see why not?

[shematoma]

1 hour ago, LittleDaisy said:

I think that for medical students, they should pick a specialty out of pure interest, while still taking into consideration the current job market. 

I have seen a few colleagues in FM by default (spots created after 2nd spot of CaRMS), they are not very happy with their choice. It's not fun to wake up every morning to do things that you don't like doing. You do have to be patient and able to tackle minor "complaints" and make sure that there are no clinical red flags, which could be taxing emotionally. Also, as you are the MRP of your patients, it is very difficult to end a therapeutic relationship, unless you have good reasons (you are not allowed to end a therapeutic relationship for a psychiatric patient with frequent no shows, and who goes to walk-in all the time, and with whom you have had a frustrating experience---> one staff had to go through the registration committee of CPSO and finally was told that he & she didn't advocate enough for the patient, and now has a record on his & her file even with CMPA's help).

Given that we have spent so many years in post-secondary training, I don't see much difference between a 2 year residency and 5 year residency. If being miserable as a resident for > 3 years could guarantee that you will enjoy doing something you love, with higher earning potential, I don't see why not?

3 years is still 3 years extra, and many specialties require a fellowship. So it's anywhere from 3-5 years extra on top of FM to do a specialty. A lot of people in FM didn't actually want to be there but as you know CaRMS is a one shot deal in most cases and if you back up to FM and match... which happens to a lot of people every year, you're generally stuck.

Just look at the recent CaRMS statistics... most specialties have more interested applicants than spots. Even psychiatry became competitive. So it's not like people aren't picking specialties out of interest, in many cases there just aren't enough spots and someone's going to get the short end of the stick.

If your colleagues got into FM by default after 2 rounds of CaRMS then I doubt they got into FM by choice. More like the school took mercy on them and created spots.

 

[NLengr]

6 hours ago, shematoma said:

3 years is still 3 years extra, and many specialties require a fellowship. So it's anywhere from 3-5 years extra on top of FM to do a specialty.

 

And on top of that once you finish you're fellowship (or your second fellowship and your masters/PhD) you need to find a job, which is easier said than done. At least family you have flexibility. With many specialties (especially surgery) the jobs are few and far between. And what exists is usually a shit job, shit location or both. Or the USA.

/Typed in a dying rural shit town by an overworked specialist with a fellowship. There are lots of days I wish I had picked FM solely so I could leave this place easily.

[LittleDaisy]

7 hours ago, shematoma said:

3 years is still 3 years extra, and many specialties require a fellowship. So it's anywhere from 3-5 years extra on top of FM to do a specialty. A lot of people in FM didn't actually want to be there but as you know CaRMS is a one shot deal in most cases and if you back up to FM and match... which happens to a lot of people every year, you're generally stuck.

Just look at the recent CaRMS statistics... most specialties have more interested applicants than spots. Even psychiatry became competitive. So it's not like people aren't picking specialties out of interest, in many cases there just aren't enough spots and someone's going to get the short end of the stick.

If your colleagues got into FM by default after 2 rounds of CaRMS then I doubt they got into FM by choice. More like the school took mercy on them and created spots.

 

I was referring to colleagues who got into FM after 2nd round of CaRMS, the spots created by ministry of health, and the FM program director was <<encouraged>> to take them. They are not very happy of their current program, and are hoping to switch programs, which are difficult to do so in residency. It also didn't help that all the FM site program directors were aware of the extra residents added to their program. 

For job market, for most primary care specialties, like psychiatry and general internal medicine, the job market is pretty good actually. I won't encourage people to go into FM for purely flexible job market and shorter training. 

[heydere]

 

3 hours ago, LittleDaisy said:

I was referring to colleagues who got into FM after 2nd round of CaRMS, the spots created by ministry of health, and the FM program director was <<encouraged>> to take them. They are not very happy of their current program, and are hoping to switch programs, which are difficult to do so in residency. It also didn't help that all the FM site program directors were aware of the extra residents added to their program. 

For job market, for most primary care specialties, like psychiatry and general internal medicine, the job market is pretty good actually. I won't encourage people to go into FM for purely flexible job market and shorter training. 

Are there many such people unhappy with the extra spots? 

[LittleDaisy]

3 hours ago, heydere said:

 

Are there many such people unhappy with the extra spots? 

I just encountered a few, but overall, I think that they were more than happy to match after 2 iterations, but unhappy with their specialty by default. I think that it is common sense to be unhappy in a residency when it is not your first choice, let alone your last choice. 

[rmorelan]

55 minutes ago, LittleDaisy said:

I just encountered a few, but overall, I think that they were more than happy to match after 2 iterations, but unhappy with their specialty by default. I think that it is common sense to be unhappy in a residency when it is not your first choice, let alone your last choice. 

I has to be an emotional roller coaster I would think- so much stress in so little time with no decompression time. Then bam new job, probably new city, field you originally didn't consider and therefore isn't your first choice. 

 

 

[NeuroD]

19 hours ago, LittleDaisy said:

I think that for medical students, they should pick a specialty out of pure interest, while still taking into consideration the current job market. 

I have seen a few colleagues in FM by default (spots created after 2nd spot of CaRMS), they are not very happy with their choice. It's not fun to wake up every morning to do things that you don't like doing. You do have to be patient and able to tackle minor "complaints" and make sure that there are no clinical red flags, which could be taxing emotionally. Also, as you are the MRP of your patients, it is very difficult to end a therapeutic relationship, unless you have good reasons (you are not allowed to end a therapeutic relationship for a psychiatric patient with frequent no shows, and who goes to walk-in all the time, and with whom you have had a frustrating experience---> one staff had to go through the registration committee of CPSO and finally was told that he & she didn't advocate enough for the patient, and now has a record on his & her file even with CMPA's help).

Given that we have spent so many years in post-secondary training, I don't see much difference between a 2 year residency and 5 year residency. If being miserable as a resident for > 3 years could guarantee that you will enjoy doing something you love, with higher earning potential, I don't see why not?

While I agree with the spirit of your argument, I don't think it pans out. It's almost impossible to really know what specialty you would enjoy day to day for the rest of your life. Electives aren't adequate enough to paint that picture for you. And even if they were, no body has a single field of interest for very long. So an extra 3 years, or 5 years for that will almost certainly NOT guarantee that you're doing something that you love. Otherwise the satisfaction rates in medicine wouldn't be so low. I definetely get where you're coming from, I just don't think it seems to work out that way.
 

[LittleDaisy]

4 minutes ago, PhD2MD said:

While I agree with the spirit of your argument, I don't think it pans out. It's almost impossible to really know what specialty you would enjoy day to day for the rest of your life. Electives aren't adequate enough to paint that picture for you. And even if they were, no body has a single field of interest for very long. So an extra 3 years, or 5 years for that will almost certainly NOT guarantee that you're doing something that you love. Otherwise the satisfaction rates in medicine wouldn't be so low. I definetely get where you're coming from, I just don't think it seems to work out that way.
 

I understand your point PhD2MD. I just have encountered and get acquainted with a few colleagues of mine who are in family medicine by default (after 2 iterations of CaRMS, or last choice in their rank list). In retrospect, some of them have regretted of choosing family medicine out of desperation, and are trying to switch residency, which is very difficult. 

Family medicine is definitely not for everyone, you have to be very patient and able to deal with every sort of clinical presentation, be willing to admit your knowledge weaknesses and be comfortable with ambiguities , and learn how to deal with difficult patients and set boundaries. You also have to be comfortable with socio-economic aspects of medicine: filling out disability forms, insurance forms, and advocate for the most vulnerable patients----> I have seen a lot of staff physicians doing these non-OHIP billable services for free as they know that our patients could barely make ends meet, which takes a large chunk of your time depends on where you practice. 

 I think that if you don't enjoy family medicine during clerkship, the likelihood of you enjoying it for a career is not very high. 

 

[NeuroD]

32 minutes ago, LittleDaisy said:

I understand your point PhD2MD. I just have encountered and get acquainted with a few colleagues of mine who are in family medicine by default (after 2 iterations of CaRMS, or last choice in their rank list). In retrospect, some of them have regretted of choosing family medicine out of desperation, and are trying to switch residency, which is very difficult. 

Family medicine is definitely not for everyone, you have to be very patient and able to deal with every sort of clinical presentation, be willing to admit your knowledge weaknesses and be comfortable with ambiguities , and learn how to deal with difficult patients and set boundaries. You also have to be comfortable with socio-economic aspects of medicine: filling out disability forms, insurance forms, and advocate for the most vulnerable patients----> I have seen a lot of staff physicians doing these non-OHIP billable services for free as they know that our patients could barely make ends meet, which takes a large chunk of your time depends on where you practice. 

 I think that if you don't enjoy family medicine during clerkship, the likelihood of you enjoying it for a career is not very high. 

 

That's a good way to put it....defaulting to family is probably different than backing up with something else...family really is its own beast. Plus I'm biased because I actually love family...in fact if there wasn't a very specific thing I wanted to accomplish in neurology, i would have chosen family with a +1 in OB without question. Even with my aspirations in mind, I find it hard not to chose family.

[marta12345]

2 hours ago, PhD2MD said:

While I agree with the spirit of your argument, I don't think it pans out. It's almost impossible to really know what specialty you would enjoy day to day for the rest of your life. Electives aren't adequate enough to paint that picture for you. And even if they were, no body has a single field of interest for very long. So an extra 3 years, or 5 years for that will almost certainly NOT guarantee that you're doing something that you love. Otherwise the satisfaction rates in medicine wouldn't be so low. I definetely get where you're coming from, I just don't think it seems to work out that way.
 

My mentor jokes with me and  tells me that choosing a speciality in medicine is like marriage, you will never have the 100% perfect fit partner, but you choose the speciality that you are attracted to/love and don't mind committing to and you are okay with its shortcomings. Finding the perfect speciality that will always make you happy during the different stages of your life does not exist. 

[LittleDaisy]

6 minutes ago, marta12345 said:

My mentor jokes with me and  tells me that choosing a speciality in medicine is like marriage, you will never have the 100% perfect fit partner, but you choose the speciality that you are attracted to/love and don't mind committing to and you are okay with its shortcomings. Finding the perfect speciality that will always make you happy during the different stages of your life does not exist. 

Wow I love this ! Your mentor is brillant lol! I am going to use this for my medical students who are undecided  

[marta12345]

17 minutes ago, LittleDaisy said:

Wow I love this ! Your mentor is brillant lol! I am going to use this for my medical students who are undecided  

It's very true statement and I love it as well but  it does not make the task of finding our partner"/aka speciality for the rest of our lives any easier. I'm still an undecided med student.

No wonder the divorce rate in our society is 50% haha

[NeuroD]

8 hours ago, marta12345 said:

It's very true statement and I love it as well but  it does not make the task of finding our partner"/aka speciality for the rest of our lives any easier. I'm still an undecided med student.

No wonder the divorce rate in our society is 50% haha

Divorce rate of 50% is exactly what was going through my mind when I read that haha....maybe it isn't a coincidence that MD satisfaction sits around 50% as well haha.

[rmorelan]

53 minutes ago, PhD2MD said:

Divorce rate of 50% is exactly what was going through my mind when I read that haha....maybe it isn't a coincidence that MD satisfaction sits around 50% as well haha.

Ha part of that is also (like marriage I guess) managing expectations. 

People in medicine are masters of delayed gratification - but eventually you do get to the so called final point. If you were expecting that to be a utopia and somehow makes up perfectly for all the work and time required to get there then you just set yourself up for major disappointment.