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internal medicine - income/lifestyle as a hospitalist or subspecialists


daleader

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1. Can we chat about how much a general internist can expect to make (before/after overhead) working in Canada (smaller cities in Ontario like mississauga, brampton, markham or other provinces). What the hours/lifestyle typically are? The possibility of doing scopes or cardiac stuff or too saturated now?

2. How competitive is getting into GI/Cardio? Is it ophtho-competitive or internal-competitive? How much can you expect to make in GI/Cardio.

 

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8 hours ago, daleader said:

1. Can we chat about how much a general internist can expect to make (before/after overhead) working in Canada (smaller cities in Ontario like mississauga, brampton, markham or other provinces). What the hours/lifestyle typically are? The possibility of doing scopes or cardiac stuff or too saturated now?

2. How competitive is getting into GI/Cardio? Is it ophtho-competitive or internal-competitive? How much can you expect to make in GI/Cardio.

 

1. as mentioned, those defs aren't smaller cities. plenty of internists at trillium in mississauga are making 350-450k gross with minimal overhead as compared to academic centres. lifestyle will be dependent but most GIM staff work 0-6 nights per month with no home call since the in-house internist are covering the ED + admitted GIM patients. plenty of the night shifts are covered by early career internists doing locums. otherwise, you're either on MRP service, your own clinic, a subspecialty service, or IMRAC (ie. the usual). long gone are the days in southern ontario of an internist doing bronchs/EGD/echo.

2. GI/Cardio can vary in competitiveness year-to-year just like every other subspec. it's not optho/plastics competitive, but some years can get bad. there are some community GI docs making over 500k-600k gross but keeping in mind their overhead to maintain a clinic that does invasive procedures.

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10 hours ago, daleader said:

1. Can we chat about how much a general internist can expect to make (before/after overhead) working in Canada (smaller cities in Ontario like mississauga, brampton, markham or other provinces). What the hours/lifestyle typically are? The possibility of doing scopes or cardiac stuff or too saturated now?

2. How competitive is getting into GI/Cardio? Is it ophtho-competitive or internal-competitive? How much can you expect to make in GI/Cardio.

 

Missisaugga's population is greater than that of the city of Vancouver, dude.

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4 hours ago, ploughboy said:

Sorry for piling on, but this gave me a morning chuckle.  ;)

 

6 hours ago, IMislove said:

Those are not smaller cities. Maybe try cities like Woodstock, brantford, cambridge, collingwood, Owen sound, etc. Also interested to hear the life style in these places.

heard not a lot of jobs in either GI/cardio and gotta fellowships for sure. Residents can definitely comment on that.

 

4 hours ago, hamham said:

 

Missisaugga's population is greater than that of the city of Vancouver, dude.

 

haha totally understand where you guys are coming from... by "small-er" I didn't mean small cities, but you are all right in pointing that out, mah bad lol 

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I want to echo what has been said before. 

1. 300-450 gross. Income and lifestyle are dependent on how much you want to work. You will likely take on night call which can vary in intensity depending on your luck. A lot really depends on the group/hospital. You would have to go rural in my opinion to do things like scopes. Even "smaller" community hospitals have gen surg that will handle things like scopes. 

2. Competition varies year to year for subspecialties and some years lots of people get burned while other years are much easier. Income for my GI/Cardio friends varies greatly depending on the type of practice they have and how procedural they are. Procedures pay. 

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20 minutes ago, blah1234 said:

I want to echo what has been said before. 

1. 300-450 gross. Income and lifestyle are dependent on how much you want to work. You will likely take on night call which can vary in intensity depending on your luck. A lot really depends on the group/hospital. You would have to go rural in my opinion to do things like scopes. Even "smaller" community hospitals have gen surg that will handle things like scopes. 

2. Competition varies year to year for subspecialties and some years lots of people get burned while other years are much easier. Income for my GI/Cardio friends varies greatly depending on the type of practice they have and how procedural they are. Procedures pay. 

 

7 hours ago, ParkourParkour said:

1. as mentioned, those defs aren't smaller cities. plenty of internists at trillium in mississauga are making 350-450k gross with minimal overhead as compared to academic centres. lifestyle will be dependent but most GIM staff work 0-6 nights per month with no home call since the in-house internist are covering the ED + admitted GIM patients. plenty of the night shifts are covered by early career internists doing locums. otherwise, you're either on MRP service, your own clinic, a subspecialty service, or IMRAC (ie. the usual). long gone are the days in southern ontario of an internist doing bronchs/EGD/echo.

2. GI/Cardio can vary in competitiveness year-to-year just like every other subspec. it's not optho/plastics competitive, but some years can get bad. there are some community GI docs making over 500k-600k gross but keeping in mind their overhead to maintain a clinic that does invasive procedures.

8

 

Thanks, very helpful!

Any thoughts on other IM subspecialties like rheum/endo in terms of (1) compensation (2) job outlook/availability? 

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3 hours ago, daleader said:

 

 

Thanks, very helpful!

Any thoughts on other IM subspecialties like rheum/endo in terms of (1) compensation (2) job outlook/availability? 

1. Around the same gross as GIM, but much more overhead because it's mostly private clinics in the community.

2. Good since no OR time or hospital privileges needed. You can open a clinic in these specialties anywhere and be busy right away.

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9 minutes ago, Monkey D. Luffy said:

1. Around the same gross as GIM, but much more overhead because it's mostly private clinics in the community.

2. Good since no OR time or hospital privileges needed. You can open a clinic in these specialties anywhere and be busy right away.

So to sum it up:

- GIM - shorter, more options and variability, but less specialized - 300-400k (~150k after taxes/overhead?)

- Endo, Rheum: longer training, less earning after overhead, but a better lifestyle - 300-400k (~150k after taxes/overhead?)

- Cardio/GI: longer training, more earnings, but competitive to get into! - 450-550 (~250k after taxes/overhead?)

 

This is after 8-10 years of training 

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1 hour ago, daleader said:

So to sum it up:

- GIM - shorter, more options and variability, but less specialized - 300-400k (~150k after taxes/overhead?)

- Endo, Rheum: longer training, less earning after overhead, but a better lifestyle - 300-400k (~150k after taxes/overhead?)

- Cardio/GI: longer training, more earnings, but competitive to get into! - 450-550 (~250k after taxes/overhead?)

 

This is after 8-10 years of training 

Cardio can make much more than just 450-550 gross. In BC the gross billings are made public and the interventionalists bill 1-1.3 mil, EPs 800-1 mil, the echos bill in the 700-800 and general cardiologists often bill 500-700. 

Jobs though are a whole different story. 

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50 minutes ago, blah1234 said:

People always underestimate the challenge of job availability and location in medicine. The work isn't that fun if you're under/unemployed or if you're in the middle of nowhere away from family and friends. 

job availability, location, income, length of training, lifestyle, passion

difficult to have them all

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40 minutes ago, IMislove said:

well if we consider just job market and location, we're pretty limited to what we can do which is definitely disheartening :(.

 

10 minutes ago, daleader said:

job availability, location, income, length of training, lifestyle, passion

difficult to have them all

Medicine can still be a rewarding career but be prepared to make some (maybe many) compromises. It likely won't be the perfect job that was advertised to you by society.

I have friends who struggle with underemployment in their field of choice I can say that passion alone cannot sustain you or pay off your student loans in a timely fashion. 

I think this mismatch of expectation and reality in medicine is one of the root causes of burnout and disillusionment that I see in my colleagues 10 years ahead of me and in my junior colleagues who are just finishing their training.  

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1 hour ago, blah1234 said:

 

Medicine can still be a rewarding career but be prepared to make some (maybe many) compromises. It likely won't be the perfect job that was advertised to you by society.

I have friends who struggle with underemployment in their field of choice I can say that passion alone cannot sustain you or pay off your student loans in a timely fashion. 

I think this mismatch of expectation and reality in medicine is one of the root causes of burnout and disillusionment that I see in my colleagues 10 years ahead of me and in my junior colleagues who are just finishing their training.  

I totally agree with you which is why  I personally think that we shouldn't be picking our specialties purely based on our interests. For me at least personally remuneration, length of training, life style are all very important factors. I've really enjoyed pediatric subspecialties but if I'm not going to  be making a reasonable income or going to have a lot of difficulty finding a job, I'd rather do something else that I enjoy almost equally or perhaps slightly less but has a better future. Now I agree that things change a lot from years to years and nothing is guaranteed but I think its reasonable to be thinking about all the other factors and not just "choose what you think you like". 

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On 12/13/2018 at 8:17 PM, daleader said:

So to sum it up:

- GIM - shorter, more options and variability, but less specialized - 300-400k (~150k after taxes/overhead?)

- Endo, Rheum: longer training, less earning after overhead, but a better lifestyle - 300-400k (~150k after taxes/overhead?)

- Cardio/GI: longer training, more earnings, but competitive to get into! - 450-550 (~250k after taxes/overhead?)

 

This is after 8-10 years of training 

These numbers are way off. 

 

if you are talking large volume community hospitals like BCH and Trillium then a GIM who does mainly ER work will likely make closer to 400-500 without ANY overheard. None. So even with taxes you still make 250-300. The donshfit work mainly so more nights but some MRP and clinic and consult ward work as well. Usually have about 7 days off a month. 

 

Endo and Rheum are similar but pay overhead.  No night calls thought and day clinic work, less stressful. 

 

Cardio and GI make much more in large centres. Most are 800-1.7million range depending on what they do.  They do have overhead but still take home much more (500-1mill).

 

ICU is another good biller with lots of time off. Likely 400-700 a year with no overhead. Work invokes one week a month ICU and some base specialty work like GIM but usually 7-14 days off a month 

 

 

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I think ultimately, if a job is desirable i.e. big center, well paying, less work, etc. very soon that job is gone and there will be an oversupply. I don't think this sort of thing will ever really "change". One thing to remember is that there are hundreds of international fellows and IMGs every year who would kill to make half what we make. Many academic centers are hiring international fellows as staff at highly desirable centers even if there are Canadians without jobs. 

If you want to chase a job that is desirable, you just have to accept that it will be competitive and that you may need to put in a few extra years to get it. Truth be told, i think some of these numbers for doctors are unreal, making 500k as a physician with 7-14 days off per month is insane to me and so logically, theres no jobs in ICU. 

This kind of thing really isn't going to change. Best thing to do is to go in with lower expectations, theres lots of doctors who are working and making a more reasonable income/lifestyle that are not being mentioned as well. 

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1 hour ago, Aconitase said:

These numbers are way off. 

 

if you are talking large volume community hospitals like BCH and Trillium then a GIM who does mainly ER work will likely make closer to 400-500 without ANY overheard. None. So even with taxes you still make 250-300. The donshfit work mainly so more nights but some MRP and clinic and consult ward work as well. Usually have about 7 days off a month. 

 

Endo and Rheum are similar but pay overhead.  No night calls thought and day clinic work, less stressful. 

 

Cardio and GI make much more in large centres. Most are 800-1.7million range depending on what they do.  They do have overhead but still take home much more (500-1mill).

 

ICU is another good biller with lots of time off. Likely 400-700 a year with no overhead. Work invokes one week a month ICU and some base specialty work like GIM but usually 7-14 days off a month 

 

 

I guess my friends and I are really lazy or bad at billing. Would love to hear from other staff as these numbers seem more like outliers than the norm to me (not saying they're impossible). The lower end of those numbers seems more in line with what I've seen.

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35 minutes ago, blah1234 said:

I guess my friends and I are really lazy or bad at billing. Would love to hear from other staff as these numbers seem more like outliers than the norm to me (not saying they're impossible). The lower end of those numbers seems more in line with what I've seen.

Again depends on where you work. OP asked specifically about large volume GTA (Trillium, BCH, etc). These numbers are representative of those places 

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1 hour ago, blah1234 said:

I guess my friends and I are really lazy or bad at billing. Would love to hear from other staff as these numbers seem more like outliers than the norm to me (not saying they're impossible). The lower end of those numbers seems more in line with what I've seen.

I'm not a staff (yet), but I have talked to staff community doctors that work in those hospitals (and others in the GTA).

One said PARTIME (e.g. 20-21 weeks, so more than 1 week off a month) of work GIM work (mixture of wards, ER consults and clinics) pays $300k gross (but with minimal to no overhead), this was for Trillium.

A General Internist at North York General said working 36 weeks (considered "full time") they grossed close to 400k (again minimal to no overhead).

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