How much do family doctors actually make?

[LittleDaisy]

On 10/8/2019 at 8:30 PM, windsormd1 said:

I'm not sure why the consensus among some family doctors here is that we make more than down south.  Even if you compare the 'average' salary in the USA of 225k USD(which is 300K CAD!!!) NET for an 'employed USA physician' with 'above average canadian billings of 375k CAD minus a generous 25% overhead which equals 262.5k CAD NET', the USA family doctor still wins out.  And they get reimbursed for licenses, have time off, benefits, etc.  The difference is that we are 'independent'; for whatever that's worth.  IMHO, I still don't see how we win out in any other sense aside from independence and 'lack of insurance hassles.'  

Out of my residency class, 4 out of the 8 graduates went down South.

Thanks for letting us know! There was an infuriating post by another forum member asking why Canadian GPs are more "overpaid" compared to American GPs?

[windsormd1]

11 hours ago, LittleDaisy said:

Thanks for letting us know! There was an infuriating post by another forum member asking why Canadian GPs are more "overpaid" compared to American GPs?

There is actually a simple ridiculous reason for this.  When Canadian docs talk about how much they make, they refer to 'gross billings.'  When American docs refer to what they make, its 'Net salary after expenses.'  The reason is because we are business owners, and they are employees.  Nobody takes into account that we have to actually pay our own expenses including malpractice, overhead, CME, retirement, benefits, etc.  Also, nobody really takes into account the difference in currency.  It's an apples and oranges comparison.  Things have changed here in Canada compared to the 90's and early 2000's, we are definitely better renumerated than in the past.......................but to say we make more than US docs is laughable............

[medisforme]

In my limited experience, when family doctors discuss "what they make," it's always after overhead is taken into consideration, not gross billings.   Most clinics deduct the overhead every paycheque.  The overhead is a major determining factor on overall income.  I have seen it range from 15-35% in BC, that is a massive range.  The larger overheads tend to be closer to Vancouver. 

 

[deathvvv]

I do not think Canadian family physicians are overpaid. The us is definetely underpaid. Yes, when converted in CAD us family docs make more. But you also have to take account for that you live in the US and spend USD. In desirable locations (cali, nyc), 250 k is nothing once you take out taxes and cost of living. So your spending power does not necessarily increase significantly. Second, there is way more medical legal problem and the stressors of being sued daily is a big negative IMO. Thirdly, in the US family med tend to be a dumping ground for the uninsured and medically complex. So patients often come with multiple medical problems that you need to address in 10-15 min in order to meet your "productivity quota" further exacerbating the stress. Then you bill their insurance/medicare/medicaid and pray that you get reimbursed for what you billed. Last, in many areas of us (east coast, midwest), there is no culture of going to family docs for primary cares. Many will goto specialist directly or goto internal med docs who specialize in primary care. So competition for patients may be a problem. Don't get me wrong, there are sweet spots for family docs in the US but they are not the norm. Things are changing slowly but overall from a lifestyle and income perspective I think Canada overall is better. When it comes to specialist who are procedure heavy (ie ortho) its another story entirely.

source: USMD grad, working in Canada

[windsormd1]

1 hour ago, deathvvv said:

I do not think Canadian family physicians are overpaid. The us is definetely underpaid. Yes, when converted in CAD us family docs make more. But you also have to take account for that you live in the US and spend USD. In desirable locations (cali, nyc), 250 k is nothing once you take out taxes and cost of living. So your spending power does not necessarily increase significantly. Second, there is way more medical legal problem and the stressors of being sued daily is a big negative IMO. Thirdly, in the US family med tend to be a dumping ground for the uninsured and medically complex. So patients often come with multiple medical problems that you need to address in 10-15 min in order to meet your "productivity quota" further exacerbating the stress. Then you bill their insurance/medicare/medicaid and pray that you get reimbursed for what you billed. Last, in many areas of us (east coast, midwest), there is no culture of going to family docs for primary cares. Many will goto specialist directly or goto internal med docs who specialize in primary care. So competition for patients may be a problem. Don't get me wrong, there are sweet spots for family docs in the US but they are not the norm. Things are changing slowly but overall from a lifestyle and income perspective I think Canada overall is better. When it comes to specialist who are procedure heavy (ie ortho) its another story entirely.

source: USMD grad, working in Canada

It really gets to be case by case; but in general this topic is about renumeration; and yea you live in the us and spend in USD; but everything is cheaper nominally because of the currency value.  So money is still money and there is a conversion factor for a reason; my point being is you'll have similar lifestyles at 225k USD or 300k Canadian; value of cars; trips to the grocery stores; taxes etc will all even out....................there isn't a HUGE discrepancy either way.  But your blanket statement of 'overall from a lifestyle and income perspective i think canada overall is better' is just completely untrue.  There are too many factors involved.  Yes, there are hassles with insurance companies; but the docs aren't doing the billing manually; you have a separate office manager/biller who handles that for you.  In the same regard, the hassle of doing your own taxes/incorporating/setting up retirement here is a pain in the @$$.  And I think we can all agree that the CPSO is literally doing highway robbery with the ABSURD fees for renewal every year lmfao.......

[1D7]

6 minutes ago, windsormd1 said:

It really gets to be case by case; but in general this topic is about renumeration; and yea you live in the us and spend in USD; but everything is cheaper nominally because of the currency value.  So money is still money and there is a conversion factor for a reason; my point being is you'll have similar lifestyles at 225k USD or 300k Canadian; value of cars; trips to the grocery stores; taxes etc will all even out....................there isn't a HUGE discrepancy either way.  But your blanket statement of 'overall from a lifestyle and income perspective i think canada overall is better' is just completely untrue.  There are too many factors involved.  Yes, there are hassles with insurance companies; but the docs aren't doing the billing manually; you have a separate office manager/biller who handles that for you.  In the same regard, the hassle of doing your own taxes/incorporating/setting up retirement here is a pain in the @$$.  And I think we can all agree that the CPSO is literally doing highway robbery with the ABSURD fees for renewal every year lmfao.......

They start out in 100k+ more tuition debt from medical school and have 1 year more of residency (100k in lost earnings). The debt amount is even greater if you count their undergraduate degrees which are on average also at least 2-3x more expensive. As said above the COL varies greatly and I don't think it's fair to assume the money will go further since many of us would prefer desirable working locations as it is not our home country. And if desired, we too have our own versions of "middle of nowhere" with low COL and high pay as well.

So at a baseline they start attending-hood at least 200k CAD down compared to us. That's a significant amount of money that could go towards passive income investments or a down payment.

And one additional work stressor that they deal with that I haven't seen mentioned are patient satisfaction scores. They are playing an increasingly large role and some doc's down there have some portion of their pay tied to these scores. Combined with greater litigation risk and insurance hassles (yes you do have to call sometimes to get paid when insurance tries to fuck you), it's not all sun and roses working in American primary care.

[windsormd1]

Well I'll tell you what; I'm netting hopefully ~260k cad this year in my 5d/week practice. I average 35-40 patients a day in the GTA. This is after overhead projections.  The job I'm looking at in the USA is going to be $260k USD Salary; 4.5 day work week; CME of $5k; full benefits; 401k contribution of 10k from the company; 4 weeks off; 12 paid holidays.  Also,patient volume will be 18-22 patients a day with a 1 hour lunch break.  This is in a MAJOR metro on the east coast; not NYC, but the DC area.........to me it's a no brainer...........to each their own.........and these jobs are a dime a dozen all over..........in MAJOR metros

[Compton]

7 minutes ago, windsormd1 said:

Well I'll tell you what; I'm netting hopefully ~260k cad this year in my 5d/week practice. I average 35-40 patients a day in the GTA. This is after overhead projections.  The job I'm looking at in the USA is going to be $260k USD Salary; 4.5 day work week; CME of $5k; full benefits; 401k contribution of 10k from the company; 4 weeks off; 12 paid holidays.  Also,patient volume will be 18-22 patients a day with a 1 hour lunch break.  This is in a MAJOR metro on the east coast; not NYC, but the DC area.........to me it's a no brainer...........to each their own.........and these jobs are a dime a dozen all over..........in MAJOR metros

I don't doubt this and I have colleagues working in the midwest (Chicago, St Louis) and west coast (Denver, Phoenix, Seattle) and those figures are the norm for FM. I've always been pro-US for med professionals since your money will go farther and have less taxes. Remember, Canada gets you with the taxes and the CAD/USD currency is just an amplifying effect on the difference. I'm sure the full benefits includes med/dent/pharm coverage, which means you will have great healthcare for you and your family. The only concern I'd have is insurance billings/lawsuits, since insurance companies will drive you crazy down south. But, quite frankly, if a PA can make 150K USD working 5 days/week with full benefits, etc in a major metro centre (or suburbs of) like Chicago, it shows the desirable market for healthcare professionals (esp MD/PA) in the US.

[windsormd1]

17 minutes ago, Compton said:

I don't doubt this and I have colleagues working in the midwest (Chicago, St Louis) and west coast (Denver, Phoenix, Seattle) and those figures are the norm for FM. I've always been pro-US for med professionals since your money will go farther and have less taxes. Remember, Canada gets you with the taxes and the CAD/USD currency is just an amplifying effect on the difference. I'm sure the full benefits includes med/dent/pharm coverage, which means you will have great healthcare for you and your family. The only concern I'd have is insurance billings/lawsuits, since insurance companies will drive you crazy down south. But, quite frankly, if a PA can make 150K USD working 5 days/week with full benefits, etc in a major metro centre (or suburbs of) like Chicago, it shows the desirable market for healthcare professionals (esp MD/PA) in the US.

That's my only worry as well; we'll see how it goes.  I used to be pro-Canada and all about the national healthcare system with single payor; but honestly; lifestyle to me is more important at this stage.  The government is making it tougher and tougher for doctors here and the tax burden is only going to get worse along with the cost of living.  Welcome to Turdeau's Canada!  

[BernieMac]

-

[GH0ST]

3 hours ago, Shelduck said:

a family doctor cant do anything webMD can't tbh

36 minutes ago, Shelduck said:

disprove my claim then.

Setting aside how insulting your claim is to many of my fellow colleagues... a simple logical answer would be that if WebMD is all you needed, then you should be able to diagnose among various differential diagnoses and provide comprehensive management for any variety of patients right now.

 

Do you feel confident enough to see our patients for us? 

 

Furthermore, it's also clear you don't quite understand the concept of "burden of proof." When you make a claim/argument, it is not the responsibility of others to prove you wrong in the first place. It is your responsibility to provide evidence beyond doubt to support your claim first. 

 

So the question then is... where is your proof that GPs are only as good as WebMD besides your word? 

 

- G

 

[Butterfly_]

8 minutes ago, Shelduck said:

easy. every time ive seen a family doctor (like 4 times total in my life) i already knew what was wrong through WebMD.

I’m glad WedMD works for you. I hope you never encounter a disease with an atypical presentation and that you stay healthy for the rest of your life. 

Why are you even on this forum? 

[QuestionsAbound]

16 minutes ago, Shelduck said:

easy. every time ive seen a family doctor (like 4 times total in my life) i already knew what was wrong through WebMD.

Now you’re just trying to get banned.

For context (in case he edits his post), he changed GH0ST’s signature in the quote from “-G” to “-Gaylord”

bye felicia

[GH0ST]

24 minutes ago, Shelduck said:

easy. every time ive seen a family doctor (like 4 times total in my life) i already knew what was wrong through WebMD.

Like I've said in my prior post, what evidence do you have besides your word that GPs are only as good as WebMD? 

Even this statement itself doesn't provide evidence against GPs... it just shows you were fortunate to have found a relationship between your symptoms and the diagnosis. You are not everyone and even for common conditions not everyone presents the same way. Some symptoms are not always attributable to a specific common diagnosis but could also be associated with something more insidious. 

Your statement also neglects a significant proportion of people that have "cyberchondria," a term used to describe an individual who escalates their symptoms to severe conditions that are very unlikely unless discernible through history and physical exam (which coincidentally are done by GPs). A common example of this is when a headache is assumed to be a brain tumour, which is not likely for individuals unless there are more information on history (worsening headaches, worsening neurological symptoms, family history, just to name a few). 

Having to discern between what is considered background noise vs concerning symptoms is one of many responsibilities that GPs have, in addition to individualized preventative care as well as continuity of care. 

I will still wait to see what additional evidence you have on this matter. It's important that no matter the situation and ignorance that we professionals respond with dignity and professionalism. Hopefully this will also provide some education on the matter. 

- G

[rmorelan]

Geezzz.................

anyone that thinks family doctors don't have an actual complex challenging job to do doesn't know what family doctors do. 

seems like I am doing a lot of moderating lately. 

Edited January 6, 2020 by rmorelan

[Belle_MD]

Just to go back a few posts about FM jobs in the US - are all the USMLEs required and/or is it state dependent? Thanks!

[JohnGrisham]

1 hour ago, Belle_MD said:

Just to go back a few posts about FM jobs in the US - are all the USMLEs required and/or is it state dependent? Thanks!

You wont be able to practice in the US without adding an extra year worth of training(FM is 3 years in the US), and USMLEs will be dependent on state. If you can get ABFM via a certain pathway, its doable.  But theres some odd requirements of needing to have lived in the US for 6months and other things, so not sure if perhaps you would need to go there on a J1 or TN visa first for non-clinical purposes(like research or teaching) and then transition to trying to get your license and an appropriate work visa(again can be J1 or H1b)

 

https://www.theabfm.org/become-certified/i-am-certified-country-outside-united-states

[medigeek]

No one considering the fact of how little respect FM has in USA compared to Canada? Unless you're in Midwest areas or rural areas, your prestige is rock bottom in USA. 

[Raptors905]

On 1/6/2020 at 11:15 PM, medigeek said:

No one considering the fact of how little respect FM has in USA compared to Canada? Unless you're in Midwest areas or rural areas, your prestige is rock bottom in USA. 

I’m not sure the prestige is different here. 
 

internal medicine in the US is looked down on as primary care where as here they are not. I think FM is the same in both places. 
 

why do you people keep asking salaries? Toronto star released them just look up a bunch of GPS you know and see

[Belle_MD]

On 1/5/2020 at 11:23 PM, JohnGrisham said:

You wont be able to practice in the US without adding an extra year worth of training(FM is 3 years in the US), and USMLEs will be dependent on state. If you can get ABFM via a certain pathway, its doable.  But theres some odd requirements of needing to have lived in the US for 6months and other things, so not sure if perhaps you would need to go there on a J1 or TN visa first for non-clinical purposes(like research or teaching) and then transition to trying to get your license and an appropriate work visa(again can be J1 or H1b)

 

https://www.theabfm.org/become-certified/i-am-certified-country-outside-united-states

Interesting! I wonder if the enhanced skills aka plus one programs in FM would count as a third year for this? I’m hoping to do care of the elderly. Just curious! Thanks for the info!

[JohnGrisham]

3 hours ago, Belle_MD said:

Interesting! I wonder if the enhanced skills aka plus one programs in FM would count as a third year for this? I’m hoping to do care of the elderly. Just curious! Thanks for the info!

I would think so, but something you'll have to double check and dot your I's and cross your t's.

[medigeek]

On 1/8/2020 at 3:25 PM, Raptors905 said:

I’m not sure the prestige is different here. 
 

internal medicine in the US is looked down on as primary care where as here they are not. I think FM is the same in both places. 
 

why do you people keep asking salaries? Toronto star released them just look up a bunch of GPS you know and see

FM isn't even respected as primary care in desirable USA areas. They go to IM or Peds for their primary care. 

[thank4]

23 hours ago, medigeek said:

FM isn't even respected as primary care in desirable USA areas. They go to IM or Peds for their primary care. 

This notion of respect associated with certain specialties is so weird to me. Is it only a med student thing due to the relative competitiveness?

Respect is earned, not given. I’ve seen specialists in highly competitive fields not being respected by other docs due to the way they practice and PCP who are well respected by other specialist due to their thoroughness. 
 

If you are talking respect from patient, you realize there are patients who respect naturopath more than MDs right? 

[guy30]

I've heard that research has shown that amongst patients, trust and respect is highest with their family physicians in general compared to other specialists.

 

I think the 'lack of respect' thing is more of a perceived thing within the medical community (maybe more among medical trainees)?  I say perceived because in practice I've seen numerous specialists praise family physicians in the past but maybe those are just anomalies.

[Raptors905]

1 hour ago, guy30 said:

I've heard that research has shown that amongst patients, trust and respect is highest with their family physicians in general compared to other specialists.

 

I think the 'lack of respect' thing is more of a perceived thing within the medical community (maybe more among medical trainees)?  I say perceived because in practice I've seen numerous specialists praise family physicians in the past but maybe those are just anomalies.

Do you have a source for any of this or is it just your non evidence based opinion?