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Real Beef

NOSM Family physician 2 years out now

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I haven't been active on this forum for a number of years now. Now two years out from family medicine graduation and I can tell you life improves significantly from medical school and residency. Don't think for a second that life slows down unless you want to coast in a part time fashion. 

People are always interested in money but people never want to talk about it.

For those people that are worried about not making enough money as a family doctor I can reassure you with the fact that if you want to work your guts out that you can earn plenty ... I grossed $647k last year and I'll be adding an additional $80k this upcoming year I added 288 extra patients to my roster, most of them diabetics which will account for half the raise. So next year I should gross $727k - which is akin to a lasy cardiologist's earnings (?) lol. Also don't just concentrate on medicine as a money making endeavour - as soon as I came out of the gate I bought an investment property, a triplex, also fixed up an old pre-residency house I couldn't sell before moving for residency ... got a property management to manage it. I am months away from buying a Four-plex which will all gross $113k when all properties combined and plan on buying one investment property a year for the next 10-15 years. So from all sources Ill have gross earnings of $840k next year. 

So as a family doc I won't ever make a million from family medicine exclusively unless I become one of those shady 5-minute per patient docs but I don't want to practice medicine like that and you will certainly be comfortable. Sure I have colleagues who have graduated and when I spoke to them they said that they 'only' made $200k last year but thats because they do clinic from 9 am to 3 pm 4 days a week lol. I do inpatients at 0700 in the hospital, clinic from 0900 to 4 pm, do walk in clinics a couple times a month, weekend walk in clinic every 2 months, do 100 hrs of rural and city ER a month  and during COVID-19 have put myself on the list for on-call COVID shifts. So if you want to kill it in your bank account you have to work hard almost until you kill yourself. I do have a reasonable balance though as I do go to the gym 4x a week, now home gym with covid closing things. Hope that gives a bit of insight 2 year post grad for someone who wants to put the pedal to the metal from an earning potential.

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I've never really understood why they say rural docs make more than urban ones when the billing codes are the same (they are, right?) People talk about rural incentives and whatnot but none of them come anywhere close to numbers you're describing afaik and you don't seem to be factoring that in anyway. So can FM docs in urban places make as much if they do as much work as you do? Or is there some sort of built in limit?

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2 hours ago, Hanmari said:

I've never really understood why they say rural docs make more than urban ones when the billing codes are the same (they are, right?) People talk about rural incentives and whatnot but none of them come anywhere close to numbers you're describing afaik and you don't seem to be factoring that in anyway. So can FM docs in urban places make as much if they do as much work as you do? Or is there some sort of built in limit?

Maybe province specific? the billing codes for rural here are definitely a decent amount higher. Base billing + % more for being rural. Then as well rural retention bonuses. Cheaper cost of living etc

Rural isn't for everyone though.

Also, for rural, sometimes opportunity is more readily available - for in-hospital care, ER care etc, that is a 5-10 min drive away. Often when you're in a big city, travel time/traffic gets factored in, and saturation of some opportunities etc.  

 

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5 hours ago, Real Beef said:

I haven't been active on this forum for a number of years now. Now two years out from family medicine graduation and I can tell you life improves significantly from medical school and residency. Don't think for a second that life slows down unless you want to coast in a part time fashion. 

People are always interested in money but people never want to talk about it.

For those people that are worried about not making enough money as a family doctor I can reassure you with the fact that if you want to work your guts out that you can earn plenty ... I grossed $647k last year and I'll be adding an additional $80k this upcoming year I added 288 extra patients to my roster, most of them diabetics which will account for half the raise. So next year I should gross $727k - which is akin to a lasy cardiologist's earnings (?) lol. Also don't just concentrate on medicine as a money making endeavour - as soon as I came out of the gate I bought an investment property, a triplex, also fixed up an old pre-residency house I couldn't sell before moving for residency ... got a property management to manage it. I am months away from buying a Four-plex which will all gross $113k when all properties combined and plan on buying one investment property a year for the next 10-15 years. So from all sources Ill have gross earnings of $840k next year. 

So as a family doc I won't ever make a million from family medicine exclusively unless I become one of those shady 5-minute per patient docs but I don't want to practice medicine like that and you will certainly be comfortable. Sure I have colleagues who have graduated and when I spoke to them they said that they 'only' made $200k last year but thats because they do clinic from 9 am to 3 pm 4 days a week lol. I do inpatients at 0700 in the hospital, clinic from 0900 to 4 pm, do walk in clinics a couple times a month, weekend walk in clinic every 2 months, do 100 hrs of rural and city ER a month  and during COVID-19 have put myself on the list for on-call COVID shifts. So if you want to kill it in your bank account you have to work hard almost until you kill yourself. I do have a reasonable balance though as I do go to the gym 4x a week, now home gym with covid closing things. Hope that gives a bit of insight 2 year post grad for someone who wants to put the pedal to the metal from an earning potential.

Thank you for sharing your story. In a typical week, how many hours do you work on average (before this whole pandemic started)?

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That's incredible. Thanks for sharing your story. I'd also like to know how many hours a week you work? And if you didn't do any rural, how much would your billings be?

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On 4/19/2020 at 9:06 AM, Real Beef said:

I haven't been active on this forum for a number of years now. Now two years out from family medicine graduation and I can tell you life improves significantly from medical school and residency. Don't think for a second that life slows down unless you want to coast in a part time fashion. 

People are always interested in money but people never want to talk about it.

For those people that are worried about not making enough money as a family doctor I can reassure you with the fact that if you want to work your guts out that you can earn plenty ... I grossed $647k last year and I'll be adding an additional $80k this upcoming year I added 288 extra patients to my roster, most of them diabetics which will account for half the raise. So next year I should gross $727k - which is akin to a lasy cardiologist's earnings (?) lol. Also don't just concentrate on medicine as a money making endeavour - as soon as I came out of the gate I bought an investment property, a triplex, also fixed up an old pre-residency house I couldn't sell before moving for residency ... got a property management to manage it. I am months away from buying a Four-plex which will all gross $113k when all properties combined and plan on buying one investment property a year for the next 10-15 years. So from all sources Ill have gross earnings of $840k next year. 

So as a family doc I won't ever make a million from family medicine exclusively unless I become one of those shady 5-minute per patient docs but I don't want to practice medicine like that and you will certainly be comfortable. Sure I have colleagues who have graduated and when I spoke to them they said that they 'only' made $200k last year but thats because they do clinic from 9 am to 3 pm 4 days a week lol. I do inpatients at 0700 in the hospital, clinic from 0900 to 4 pm, do walk in clinics a couple times a month, weekend walk in clinic every 2 months, do 100 hrs of rural and city ER a month  and during COVID-19 have put myself on the list for on-call COVID shifts. So if you want to kill it in your bank account you have to work hard almost until you kill yourself. I do have a reasonable balance though as I do go to the gym 4x a week, now home gym with covid closing things. Hope that gives a bit of insight 2 year post grad for someone who wants to put the pedal to the metal from an earning potential.

Thanks for this write up, makes me excited to work in the North in the near future! As NOSM continues to supply new graduates to the North year after year, do you foresee this practice style to be sustainable for new family medicine grads (I.E., mix of inpatient, clinic, walk-in, for others ER/OB/etc)?

That is, do you predict that there will be plenty of practice opportunities for new grads in rural (or northern urban) locations in the coming years, perhaps with new grads being offset by retirements of older physicians and physicians moving away? Or is there a possibility that we see the non-specialist physician job market it Northern Ontario tighten up in the future as additional classes from NOSM graduate?   

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Thanks so much for coming back here to update us, Beef. I remember chatting with you way back when I was starting my dietetics degree- you've always been super helpful.

Just to clarify, you did not do a +1 in EM--so what you've achieved is possible for any FM doc in your area, correct?

Did you keep your RD license or got to use it in any way as a MD?

Also, how did you learn about real estate investment?

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On 4/19/2020 at 10:44 AM, jkadsjfpewklcxnlkasdjpw said:

As for gross, is there any overhead? I heard from some people that in remote/rural communities working in community hospital/medical centers, there's minimal expenses.  Is there extra training needed beyond the 2 years for EM work?

Yes I have overhead of a secretary who gets paid $52k/yr, part time nurse $21k/yr, rent $9000/yr, everything is quite marginal. My community is in a city so it is not remote or rural, just northern. You don't need the extra training for ER in rural community but I would highly recommend a keen interest in ER during family med and additional courses. You would be better prepared for ER if you had the +1, and full disclosure I applied to the +1, interviewed at two sites, made it to the final interview but didn't get a spot. So I wanted the extra training. But being an ER keener I do feel I continue to learn and grow to become the ER clinician I want to be ... it will just take longer. Between $6000-20,000/month is from ER income - so I try to do as much as I can.

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On 4/19/2020 at 11:25 AM, Hanmari said:

I've never really understood why they say rural docs make more than urban ones when the billing codes are the same (they are, right?) People talk about rural incentives and whatnot but none of them come anywhere close to numbers you're describing afaik and you don't seem to be factoring that in anyway. So can FM docs in urban places make as much if they do as much work as you do? Or is there some sort of built in limit?

I did not factor in the northern rural and retention program into my gross billings because it is deposited into my personal account not the corporate account - so that $40k in first year of practice went into my personal account not to the corporate account. Sure urban doctors can make as much but big city family docs tend to only do office practice with no hospitalist. Often IM or a specific hospitalist service covers inpatients. Also ER is done by full time ER docs so there is not much opportunity for 'only' family physicians to participate in ER. Lucky where I live, it is a small city and they have many FT ER docs who don't have a +1 but are excellent clinicians so I am able to work there - feel very lucky to work there as well I am close to many communities who are in dire need of locus ER docs so I do lots of shifts in places like that. A 24hr shift @ 163$/hr + billings is what? close to $4k. I also go to a community where I can get through a $48 shift @ $143/hr$ ~ $6800. 

I just want to talk about money because so few people do talk about this. Whether you think the values I talk about are low or high I don't know - but I am happy with them and it is providing the lifestyle I am happy with.

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On 4/19/2020 at 2:30 PM, Fortress said:

Thank you for sharing your story. In a typical week, how many hours do you work on average (before this whole pandemic started)?

Probably 60-100hr/week. I mean if I work 50 hrs of office then go do a 48hr rural ER shift there is the 98 hrs lol. Usually closer to 60-70 though.

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C

On 5/11/2020 at 6:08 PM, Real Beef said:

Probably 60-100hr/week. I mean if I work 50 hrs of office then go do a 48hr rural ER shift there is the 98 hrs lol. Usually closer to 60-70 though.

That's insane, how long do you think you will sustain this? Are you working harder right now because you're young and want to put as much as possible into passive income investments?

Can you do a breakdown of how much you make from each type of physician activity (ex: 50 hrs of office = x $, etc., x hrs of walk in = x $)? (To have an idea of how each type of activity compensates)

I'm assuming you do all of these and are working your ass off because you enjoy doing it, have you considered lucrative/lifestyle family med practices such as pain medicine? You could probably hit similar numbers with less hours

Thanks for doing this!

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Just want to say thanks for posting this. I’m 9mos out from finishing FM and while my current attending is amazing at chatting numbers with me, so few are so it’s hard to make projections. Planning to do rural FM plus part time EM (applying for +1) so this is helpful perspective. 

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