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MdMatt

FM in Canada Vs USA

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Any suggestions on family medicine career. Where would u make more $$ Canada Vs US. Anyone share their experiences?

Has anyone moved from USA to Canada or vice versa. 

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Family medicine salary will vary so much based on how you practice and where you practice, and the variation in taxes/cost of living, means that comparing US vs Canada isn't vary helpful. General statistics I've seen are $220 000 USD vs $250 000 CAD, but these are old numbers.

https://www.medscape.com/slideshow/2018-compensation-family-physician-6009655#2

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On 3/12/2019 at 10:21 PM, bearded frog said:

Family medicine salary will vary so much based on how you practice and where you practice, and the variation in taxes/cost of living, means that comparing US vs Canada isn't vary helpful. General statistics I've seen are $220 000 USD vs $250 000 CAD, but these are old numbers.

https://www.medscape.com/slideshow/2018-compensation-family-physician-6009655#2

 

This. Especially because family medicine in Canadian rural community even just 1-2 hours out of Toronto unlocks emergency medicine and a lot of other practice options without any +1.

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You can make more in Canada, especially if you're efficient. You can actually make a lott more. If you're slow and want a slow and easy 9-5, USA is generally better. Work atmosphere and logistics are much better in Canada too.

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19 hours ago, medigeek said:

You can make more in Canada, especially if you're efficient. You can actually make a lott more. If you're slow and want a slow and easy 9-5, USA is generally better. Work atmosphere and logistics are much better in Canada too.

Not true; you are comparing apples to oranges.  The above post shows $220k USD vs $250CAD - first of all; the US doc also gets benefits, cme, and vacation time built in.  This is for an EMPLOYED US physician.  As somebody with experience on both sides of the border.............the ceiling is high if you are efficient no matter what.  The US also has telemedicine opportunities, directorships, insurance company advisors, and other opportunities for physicians as well.  

 

If an employed average physician in the US is making $220k USD, that's already more considering benefits etc compared to $250k CAD.  Also, say you are billing 400k CAD, and netting ~300kCAD with no benefits.  That is equal to somebody making $240-250k USD with benefits and a higher valued currency.  Even our 'higher end FM docs' are nowhere near the ceiling for US doctors.  
 

I agree that the atmosphere and logistics is better in Canada; no argument there.  But don't kid yourself about income, you are comparing apples to oranges; and factor in benefits and currency value.  Also, if you want to work hard, you can easily make more in the US compared to Canada; not to mention TAXES which are favorable down south.  

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3 hours ago, windsormd1 said:

Not true; you are comparing apples to oranges.  The above post shows $220k USD vs $250CAD - first of all; the US doc also gets benefits, cme, and vacation time built in.  This is for an EMPLOYED US physician.  As somebody with experience on both sides of the border.............the ceiling is high if you are efficient no matter what.  The US also has telemedicine opportunities, directorships, insurance company advisors, and other opportunities for physicians as well.  

 

If an employed average physician in the US is making $220k USD, that's already more considering benefits etc compared to $250k CAD.  Also, say you are billing 400k CAD, and netting ~300kCAD with no benefits.  That is equal to somebody making $240-250k USD with benefits and a higher valued currency.  Even our 'higher end FM docs' are nowhere near the ceiling for US doctors.  
 

I agree that the atmosphere and logistics is better in Canada; no argument there.  But don't kid yourself about income, you are comparing apples to oranges; and factor in benefits and currency value.  Also, if you want to work hard, you can easily make more in the US compared to Canada; not to mention TAXES which are favorable down south.  

FHOs have made it possible to bill a lot higher than 400k. You can always have a huge roster and still do other highly profitable things like nursing home etc. Overhead is also MUCH lower in Canada. You can get away with 20%. Overhead in USA is generally around 60%, you need staff to do billing for you. Hence most doctors are employed and I don't see how you have much of a high ceiling when your employer dictates your terms. Also, good luck with creating a large roster in USA. 

If you're FFS in Canada, you can absolutely see a very high volume of patients per hour/day. In USA? Not so much. The necessary documentation and paperwork and insurance etc makes it impractical. Also, midlevels have taken a huge chunk of the patient load. You can see 50 patients a day in Canada, or 1.5x that in an urgent care/walk in. Good luck trying to pull those numbers off in USA. 

Also, what happens if you bill OHIP 650k FFS? You get paid. Bill medicaid/medicare/x insurance that much? You will not get paid the full amount and if you are billing that much you will be audited. 

And Canada has plenty of side gigs too, which are more reasonable to actually do when you're a small business owner and not doing what the MBA guy tells you to do. 

Taxes are better in USA obviously, but this is only true after Trudeau won. Income splitting made taxes far better for Canadian doctors than American. You can still employ family members with part time work and pay them generously though. 

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1 hour ago, medigeek said:

FHOs have made it possible to bill a lot higher than 400k. You can always have a huge roster and still do other highly profitable things like nursing home etc. Overhead is also MUCH lower in Canada. You can get away with 20%. Overhead in USA is generally around 60%, you need staff to do billing for you. Hence most doctors are employed and I don't see how you have much of a high ceiling when your employer dictates your terms. Also, good luck with creating a large roster in USA. 

If you're FFS in Canada, you can absolutely see a very high volume of patients per hour/day. In USA? Not so much. The necessary documentation and paperwork and insurance etc makes it impractical. Also, midlevels have taken a huge chunk of the patient load. You can see 50 patients a day in Canada, or 1.5x that in an urgent care/walk in. Good luck trying to pull those numbers off in USA. 

Also, what happens if you bill OHIP 650k FFS? You get paid. Bill medicaid/medicare/x insurance that much? You will not get paid the full amount and if you are billing that much you will be audited. 

And Canada has plenty of side gigs too, which are more reasonable to actually do when you're a small business owner and not doing what the MBA guy tells you to do. 

Taxes are better in USA obviously, but this is only true after Trudeau won. Income splitting made taxes far better for Canadian doctors than American. You can still employ family members with part time work and pay them generously though. 

You can employ family members and do income splitting regardless of country.  Taxes aren't better before/after Trudeau.  Taxes were always worse in Canada.  Just because you can keep money in a corporation and get taxed 'corporate rates' doesn't make taxes better here in Canada; you still have to pay the full tax rate if you want to withdraw and spend the money.  Similar vehicles are also available in the USA.  And taxes currently in 2019 (that's what year we are in, correct?) are far better in the USA.

FHO's billing higher than 400k are outliers.  I can also quote outliers in the USA.   FHO's aren't easily available in all desirable areas in Canada.  Most FFS bill nowhere near 400k.  So averages to averages are still better in the USA.  220K USD is better than 250k CAD with no benefits especially when you factor in cost of living/taxes.

Overhead in the US depends on how business savvy you are; you can also get to 20% depending on how savvy you are.  Also, the average FFS billings/collections in private practice are closer to 500k.  

 

Do you really think seeing 50 patients a day is sustainable?  Urgent care also averages 50-70 visits a day in the USA as well.  Ie. Citymd.com - look them up.

Billing OHIP 650k is such an outlier it's not even realistic.  Knowing physicians on both sides of the border, average docs are pulling in 200-250k NET on both sides.  The harder working/entreupruenal physicians on either side of the border can make 300-400k NET.  But that is HARD WORK no matter where you are.  

Income and looking at dollars without context regarding taxes, cost of living, NET after overhead, and other opportunities is comparing apples to oranges, like I said before.   We can agree do disagree; but quoting outliers and 95th percentile earnings can be said in either USA or Canada. 

 

Don't think we have some magical situation here in Canuckland; overall income opportunities are always better in the USA than Canada; no matter what profession you are in.  Here's an example; look them up; look up Teladoc, Doctor on Demand, MDLive, and American well; these are telemedicine companies in the USA; I know a guy who is a nomad; literally all FFS telemedicine practice; dude makes $350K NET USD (NO OVERHEAD!!!).....................YOU need to bill 600k CAD to earn the equivalent of what that dude is doing in Canada.  Enjoy sitting on that high horse here in Canuckland!

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16 hours ago, medigeek said:

FHOs have made it possible to bill a lot higher than 400k. You can always have a huge roster and still do other highly profitable things like nursing home etc. Overhead is also MUCH lower in Canada. You can get away with 20%. Overhead in USA is generally around 60%, you need staff to do billing for you. Hence most doctors are employed and I don't see how you have much of a high ceiling when your employer dictates your terms. Also, good luck with creating a large roster in USA. 

If you're FFS in Canada, you can absolutely see a very high volume of patients per hour/day. In USA? Not so much. The necessary documentation and paperwork and insurance etc makes it impractical. Also, midlevels have taken a huge chunk of the patient load. You can see 50 patients a day in Canada, or 1.5x that in an urgent care/walk in. Good luck trying to pull those numbers off in USA. 

Also, what happens if you bill OHIP 650k FFS? You get paid. Bill medicaid/medicare/x insurance that much? You will not get paid the full amount and if you are billing that much you will be audited. 

And Canada has plenty of side gigs too, which are more reasonable to actually do when you're a small business owner and not doing what the MBA guy tells you to do. 

Taxes are better in USA obviously, but this is only true after Trudeau won. Income splitting made taxes far better for Canadian doctors than American. You can still employ family members with part time work and pay them generously though. 

What did you earn last year if you don't mind us knowing? What were your hours and how many patients did you see?  I netted 200k last year after my overhead; saw a reasonable amount of patients daily and actually practiced FM the way it's supposed to be practiced(5 days a week; 25-35 patients a day).  FYI - This is in a group practice in Oakville, ON.  Increasing my workload/hours/efficiency can increase it maybe 20-30% maximum; but I'd have to work harder.  

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19 hours ago, windsormd1 said:

What did you earn last year if you don't mind us knowing? What were your hours and how many patients did you see?  I netted 200k last year after my overhead; saw a reasonable amount of patients daily and actually practiced FM the way it's supposed to be practiced(5 days a week; 25-35 patients a day).  FYI - This is in a group practice in Oakville, ON.  Increasing my workload/hours/efficiency can increase it maybe 20-30% maximum; but I'd have to work harder.  

I'm still not done training. But I've rotated with doctors who bill high 6 and also 7 figures who see 50+ patients a day. They're all very well reviewed, get 0 complaints and it works quite well. I myself have seen that many patients in a day before, finished charting in the room and it wasn't a problem at all. You have to be incredibly efficient/fast with everything else (ex. note done in <2 mins) and skip the small talk with the patient. It doesn't work quite as well I think early on in practice when you're establishing good rapport. 

I usually see doctors spend a lot of time doing their notes because they're literally slow at documenting. Or, they spend like 10 minutes having an off-topic chat with a lot of patients. 

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30 minutes ago, medigeek said:

I'm still not done training. But I've rotated with doctors who bill high 6 and also 7 figures who see 50+ patients a day. They're all very well reviewed, get 0 complaints and it works quite well. I myself have seen that many patients in a day before, finished charting in the room and it wasn't a problem at all. You have to be incredibly efficient/fast with everything else (ex. note done in <2 mins) and skip the small talk with the patient. It doesn't work quite as well I think early on in practice when you're establishing good rapport. 

I usually see doctors spend a lot of time doing their notes because they're literally slow at documenting. Or, they spend like 10 minutes having an off-topic chat with a lot of patients. 

I have seen the same my friend; both here and down south.  That’s not practicing medicine, that’s working like a washing machine.  That’s the kind of thing you might want to do if you want to gauge your eyes out.  There’s something called ‘enjoying what you do’ and also ‘pride in your work.’  Working like that gets your neither one.  Like I said before, working normally, having and building a relationship with patients, calling them back and practicing GOOD medicine takes time.  If you want to do all of that, your net income will be 225-275k NET.  

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30 minutes ago, windsormd1 said:

I have seen the same my friend; both here and down south.  That’s not practicing medicine, that’s working like a washing machine.  That’s the kind of thing you might want to do if you want to gauge your eyes out.  There’s something called ‘enjoying what you do’ and also ‘pride in your work.’  Working like that gets your neither one.  Like I said before, working normally, having and building a relationship with patients, calling them back and practicing GOOD medicine takes time.  If you want to do all of that, your net income will be 225-275k NET.  

But you're assuming that they aren't taking pride in their work and not practicing good medicine. Like the above poster said, "They're all very well reviewed, get 0 complaints and it works quite well". Personally I've seen this as well. A lot of patients DON'T need you to build a relationship, or to be super friendly. They just want to come and and leave ASAP with their prescription or whatever.

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8 hours ago, Wachaa said:

But you're assuming that they aren't taking pride in their work and not practicing good medicine. Like the above poster said, "They're all very well reviewed, get 0 complaints and it works quite well". Personally I've seen this as well. A lot of patients DON'T need you to build a relationship, or to be super friendly. They just want to come and and leave ASAP with their prescription or whatever.

Yeah I mean as long as you address the patient's questions and maybe do a more thorough physical - all that matters at that point is managing them adequately. 

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Perspectives change after becoming an attending; and what you are mentioning are 'walkins/urgent care' type of visits.  Those are there; but once you build up a roster; it'll be more of a family medicine type of practice.  Also, when you come out of residency, most docs want to make as much $$ as possible; things change after a while; and most of the docs who are seeing 50+ patients daily for years on end are the ones with no life, divorce, no hobbies, etc.   Again; this thread is about making $$; it can be done in many ways both here and in the US.  Like I said; if money is your goal, you can make money, you need to be creative and efficient.  But in terms of 'averages' both here and in the US; you are looking at making 220KUSD(275CADK) for a typical practice.  Add in nursing homes, high volume, telemedicine (in the USA), and other insurance companies/hospitalist/management/botox-cosmetic medicine and the SKY is the limit..................

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