Situation in Alberta?

[MedicineLCS]

26 minutes ago, blah1234 said:

Any chance some of these billing codes represent groups that pool their billing under one person for administrative and reimbursement ease? The end number is still probably high but not as high as what is reported on those statements? Also hard to get a good picture without de aggregating the overhead as well. I suspect in some cases some individuals with high billing amounts also have much higher overhead for buying their own equipment or something.

Doesn't really change your argument that MDs are compensated well which I agree with. However, I am skeptical about some of outliers though. I haven't worked in Alberta though so I only know what my colleagues tell me.

I seem to remember some story coming out how the highest grossing Derm/Optho was actually group billing, but I can't remember for sure since this was back in 2015/16 when there was the last major kerfuffle about compensation. At the same time, I've heard some stories about what kind of "business optimization" happens to be a top percentile earner and I'd rather not take that path myself. 

I do see now what you're saying about not averaging everyone, as I was doing, but even then, redoing the math to throw out everyone <200K (which is where you see a big change from n=182 to n=932), it's still not that high.

2843 Albertan GPs made between 200K and over 2 Mil, 50th percentile for this group is in the 300-400K GROSS range (50th percentile for ALL GPs is in the 200-300K range), so about 222K NET (assuming the max 400K gross), which is higher than the table on page 9, but not significantly so. It's possible that there's some other forms of compensation that bump this up to 300K but I'm not sure where the proof for that would be found. For reference, 67th percentile is in the 400-500K gross range. So in the end, it looks like the spread between averages shown on page 9 (at least for GPs, other disciplines the gap is likely bigger) isn't that large once you throw out the lower-earner data. 

We all know that there are business oriented physicians to be found in most disciplines making bank out there, some of them using outdated billing codes/sketchy business-oriented policies (definitely not all though, some people just work really hard and hustle for that private $$$), but I don't see any proof that the average GP has a net income of 300K, even when you ditch lower earners. It's also worth noting, as I understand it, that those "net" earnings are not true net earnings since they haven't been taxed yet, not that it makes a huge difference to the average Canadian that their average GP is "only" getting in the 100,XXX range after tax comes out of their 220K, that's still a lot of money. 

 

[offmychestplease]

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[blah1234]

4 minutes ago, MedicineLCS said:

I seem to remember some story coming out how the highest grossing Derm/Optho was actually group billing, but I can't remember for sure since this was back in 2015/16 when there was the last major kerfuffle about compensation. At the same time, I've heard some stories about what kind of "business optimization" happens to be a top percentile earner and I'd rather not take that path myself. 

I do see now what you're saying about not averaging everyone, as I was doing, but even then, redoing the math to throw out everyone <200K (which is where you see a big change from n=182 to n=932), it's still not that high.

2843 Albertan GPs made between 200K and over 2 Mil, 50th percentile for this group is in the 300-400K GROSS range (50th percentile for ALL GPs is in the 200-300K range), so about 222K NET (assuming the max 400K gross), which is higher than the table on page 9, but not significantly so. It's possible that there's some other forms of compensation that bump this up to 300K but I'm not sure where the proof for that would be found. For reference, 67th percentile is in the 400-500K gross range.

We all know that there are business oriented physicians to be found in most disciplines making bank out there, some of them using outdated billing codes/sketchy business-oriented policies (definitely not all though, some people just work really hard and hustle for that private $$$), but I don't see any proof that the average GP has a net income of 300K, even when you ditch lower earners. It's also worth noting, as I understand it, that those "net" earnings are not true net earnings since they haven't been taxed yet, not that it makes a huge difference to the average Canadian that their average GP is "only" getting in the 100,XXX range after tax comes out of their 220K, that's still a lot of money. 

 

Thanks for doing the math. Still lots that we don't know as so much of the data is obfuscated. WIsh we had access to the CRA returns but that's an impossible wish haha. I do think pre-tax income is the best way to look at this as most public salaries are pre-tax anyway.

Another interesting metric would be layering on hours worked/responsibilities. Some elements would be difficult to quantify but in my personal experience some of my hours are relatively relaxed and I feel overpaid while others are extremely stressful and I'm 100% underpaid. Maybe I'll take a position with the government one of these days to figure out the truth as they have the most complete data set haha.

[Coldery]

2 hours ago, ZBL said:

In your previous career, did you need to pay 200K just to get through school? Did you have to be up at 3:30am running on zero food or sleep as you are making life and death decisions or physically intervening to save a life? Did you have to work Christmas, take 26h call q3 days, and regularly work 70-90h weeks? Just curious, because that's what a first year resident does. There's a reason doctors are paid well. 

You are quoting an AB earnings report as all-encompassing fact without really knowing where the data came from, why the data was collected to begin with, and what actually came of all of it, to say nothing about how much you may or may not know about what actually goes into physician billing, operating expenses, or how a practice is run etc. Also, no idea where you are getting the private earnings estimates since they are, you know, private.... and it seems you are assuming that if government billings are low, a physician's private billings must be huge? You are making a lot of data assumptions that are incorrect or unsubstantiated. 

Not going to argue these points any further than what I have here.

$200k to get through school is misleading. We're Canadian, not American. Tuition is $20k per year for four years: $80k. Presumably you're taking living expenses into account to fill the $120k gap. If so, the same can be done for a BFA, BSc, or whatever other degree you'd like to consider. I'm also assuming medical students don't have a sudden urge to spend when they matriculate.

MD (4 years): 4 years x $20k/year + 4 years x $30k/year = $80k + $120k = $200k

Any Bachelor degree: 4 years x $6.5k/year + 4 years x $30k/year = $26k + $120k = $146k

If you are any run-of-the-mill physician (not working in a saturated area), you'll net at least $150k/year: pre-tax, after overhead. Theoretically, you can pay off your student loans within 2 years assuming you hadn't already done so before finishing residency.

Run the same calculations for someone coming out of a bachelor program, average starting wage $50k-$60k. We are privileged members of society. The (not really) massive MD tuition fee argument would actually be an argument in favour of your opposition. Better arguments could be made.

[petitmonstre111]

52 minutes ago, Coldery said:

$200k to get through school is misleading. We're Canadian, not American. Tuition is $20k per year for four years: $80k. Presumably you're taking living expenses into account to fill the $120k gap. If so, the same can be done for a BFA, BSc, or whatever other degree you'd like to consider. I'm also assuming medical students don't have a sudden urge to spend when they matriculate.

MD (4 years): 4 years x $20k/year + 4 years x $30k/year = $80k + $120k = $200k

Any Bachelor degree: 4 years x $6.5k/year + 4 years x $30k/year = $26k + $120k = $146k

If you are any run-of-the-mill physician (not working in a saturated area), you'll net at least $150k/year: pre-tax, after overhead. Theoretically, you can pay off your student loans within 2 years assuming you hadn't already done so before finishing residency.

Run the same calculations for someone coming out of a bachelor program, average starting wage $50k-$60k. We are privileged members of society. The (not really) massive MD tuition fee argument would actually be an argument in favour of your opposition. Better arguments could be made.

Hmmm I feel like you should account for the fact that most people that get info medical school also have a bachelors?

Not that I disagree with your argument, but it’s not quite an accurate picture.

[indefatigable]

17 hours ago, Coldery said:

 

MD (4 years): 4 years x $20k/year + 4 years x $30k/year = $80k + $120k = $200k

Any Bachelor degree: 4 years x $6.5k/year + 4 years x $30k/year = $26k + $120k = $146k

If you are any run-of-the-mill physician (not working in a saturated area), you'll net at least $150k/year: pre-tax, after overhead. Theoretically, you can pay off your student loans within 2 years assuming you hadn't already done so before finishing residency.

Canada is far from a tax haven - that 200K debt would have to be paid for with after tax earnings and thus would take much longer to payoff than two years at that pay rate.  

Another item that people seem to forget is pensions and benefits.  There’s no public or privatE institution paying for either and that also has to be taken from earnings as well.    

For comparison with a very well paid job - a major university president is making usually at least 400K+massive benefits including housing and Generous pension (actually quite a bit more than the PM).  But that would be like a physician billing 1 to 1.5 Million - yet there’s hardly any outcry.  People mentioning gross billing’s makes physicians look like they’re doing much better than they are - no one is disputing that generally speaking physicians do well .. but I think it’s easy to get blinded by the big gross numbers.

[offmychestplease]

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[indefatigable]

3 minutes ago, offmychestplease said:

um no...for example derm has a 25% overhead....to get 400K/year after overhead a derm needs to bill 550K/year, which is what they can bill in AB after working 2.5 days a week...

Radiologists and Optho have some of the largest overhead in medicine at 55%....so to get 400K/year, they would need to bill 900K/year, which is below 50th percentile for both radiologists and optho in AB. 

A family doctor with 25% overhead needs to bill 550K/year to get 400K/year which 30% of FM doctors do in AB. I'll say it again....30% of FM doctors in AB make more than your university president in your example.

Does that before after overhead pay come with a house and pension?   25% overhead seems low as well.

[offmychestplease]

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[indefatigable]

7 minutes ago, offmychestplease said:

no but it comes with decades and decades of guaranteed income and not a 4 or 5 year term that a university president is on until they find a different one..

I think people too readily discount pension and equate gross billings with take home pay.  The previous president at Calgary walked out with a 5 million dollar pension (in 2009).  That’s a lot of after overhead billings

https://www.cbc.ca/news/canada/calgary/faculty-calls-president-s-pension-obscene-1.845250

[offmychestplease]

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[ZBL]

lol this thread is a joke. I wish you all the best. 

[petitmonstre111]

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[offmychestplease]

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[capoo]

1 hour ago, petitmonstre111 said:

Hmmm I feel like you should account for the fact that most people that get info medical school also have a bachelors?

Not that I disagree with your argument, but it’s not quite an accurate picture.

not to mention the only place in Canada where it's possible to be in med school without an undergrad degree (Quebec) has med school tuition way cheaper than 20k/year (only around 6k/year)...

[QueenStan]

I'll never understand why people fight so hard to not be paid well for the hard work they do

[Coldery]

4 hours ago, indefatigable said:

Canada is far from a tax haven - that 200K debt would have to be paid for with after tax earnings and thus would take much longer to payoff than two years at that pay rate.  

Another item that people seem to forget is pensions and benefits.  There’s no public or privatE institution paying for either and that also has to be taken from earnings as well.    

For comparison with a very well paid job - a university president is making at least 400K+massive benefits including housing and Generous pension (actually quite a bit more than the PM).  But that would be like a physician billing 1 to 1.5 Million - yet there’s hardly any outcry.  People mentioning gross billing’s makes physicians look like they’re doing much better than they are - no one is disputing that generally speaking physicians do well .. but I think it’s easy to get blinded by the big gross numbers.

$150k is bare minimum with approximately $200k billing at 25% overhead. Overhead is pretty middle of the road for a GP with minimal procedures whereas $200k is very low relative to regular GP physicians, let alone specialists. In BC, $150k books $100k post-tax, assuming every dollar is taken home as income instead of the other tax schemes available (incorporation, dividends, etc.). Depending on how you allocate that, you can get that debt done quick. To put it in perspective, there are teachers in their mid-40s still paying off their student debt with $50k/year salary pretax. 

If you are doing $300k/year (still below average for GPs and specialists), the numbers go up. Once you get to $400k/year, $500k/year, etc. you'll eventually get to a point where student debt becomes a joke. 

For a debt that normal BSc grads will take about 10 years to pay off, MDs will pay off in <5 easily, 2x over.

A university president is a very big job and relatively influential people take such positions. Eisenhower was a university president just before he was elected as the 34th president of America. Not the best example.

We could make an equivalent comparison with the PM of Canada. He's got the biggest job in the country. He books $357k/year. 

[Coldery]

3 hours ago, QueenStan said:

I'll never understand why people fight so hard to not be paid well for the hard work they do

What about doctors in UK, France, Germany, Taiwan, Sweden, etc. Almost no doctor in any of those countries bill any more than $200k. Most of the other developed nations have training that is equal in length, if not longer than ours. In the UK, it takes 5 years of post-MD training to become a GP, approx. 8 years post-MD training to become a specialist. If they all had your POV, they would've walked off the job a long time ago. The NHS is not very forgiving when it comes to cash. In Taiwan, they aren't earning much more than $100k/year at the most senior positions.

North America is the anomaly (ps: also worse health outcomes, mainly due to lifestyle factors but still). lol

Australia is one of the only other developed countries that offers anything close to what NA offers in terms of cash. Likely one or two others but Canada and America are the top 2, eyes closed.

[indefatigable]

12 hours ago, Coldery said:

$150k is bare minimum with approximately $200k billing at 25% overhead. Overhead is pretty middle of the road for a GP with minimal procedures whereas $200k is very low relative to regular GP physicians, let alone specialists. In BC, $150k books $100k post-tax, assuming every dollar is taken home as income instead of the other tax schemes available (incorporation, dividends, etc.). Depending on how you allocate that, you can get that debt done quick. To put it in perspective, there are teachers in their mid-40s still paying off their student debt with $50k/year salary pretax. 

If you are doing $300k/year (still below average for GPs and specialists), the numbers go up. Once you get to $400k/year, $500k/year, etc. you'll eventually get to a point where student debt becomes a joke. 

For a debt that normal BSc grads will take about 10 years to pay off, MDs will pay off in <5 easily, 2x over.

A university president is a very big job and relatively influential people take such positions. Eisenhower was a university president just before he was elected as the 34th president of America. Not the best example.

We could make an equivalent comparison with the PM of Canada. He's got the biggest job in the country. He books $357k/year. 

5 years is quite a bit longer than less than 2 years which was your original statement which I think is still too short considering the accumulated compounded interest using the original proposed pay.

I think it's unfortunate there's so much lack of knowledge regarding what salary typically means vs net pay.

Depending when you start and when you retire you have to save money with a pension - that will easily take 20-30K/year if not a whole lot more.  That doesn't get factored in when you look at even net pay - you probably won't be retiring in your mid fifties with a 5 mill pension, no matter (and also get a new big paying job at the same time). You don't get paid for a long maternity/paternity leave either, unlike nurses and teachers, and have to save money.  

Teacher is a bad example at least in Ontario.  Yes it can be difficult to get a job, but the average pay in Ontario was 90k/year + benefits including pension and summer vacation, etc..  (https://www.thespec.com/news/ontario/2020/02/21/does-money-matter-a-look-at-one-of-the-key-issues-in-ontario-teachers-battle-with-the-province.html).  The starting pay is 40-50K/year.  Canada's teachers are also among the world's best paid.

I already mentioned that PM is paid less than university president - which I would think is a much, much, more influential position.  The point was that people somehow don't notice all the other components of a generous pay package that occurs in both public and private sectors and focus on gross billings which doesn't represent the same amount at all (not to mention major regional disparities).    

I won't be responding to any more of these posts either.  

[popfossa]

5 hours ago, Coldery said:

What about doctors in UK, France, Germany, Taiwan, Sweden, etc. Almost no doctor in any of those countries bill any more than $200k. Most of the other developed nations have training that is equal in length, if not longer than ours. In the UK, it takes 5 years of post-MD training to become a GP, approx. 8 years post-MD training to become a specialist. If they all had your POV, they would've walked off the job a long time ago. The NHS is not very forgiving when it comes to cash. In Taiwan, they aren't earning much more than $100k/year at the most senior positions.

North America is the anomaly (ps: also worse health outcomes, mainly due to lifestyle factors but still). lol

Australia is one of the only other developed countries that offers anything close to what NA offers in terms of cash. Likely one or two others but Canada and America are the top 2, eyes closed.

You're forgetting to note that you do not need to complete an undergrad in Europe. You go to medical school right out of high school which already saves you a lot of money. Additionally, tuition is a lot cheaper in Europe. For example, tuition in Germany and Sweden is pretty much free (you pay about 500 dollars per semester for fees) lol. 

[QueenStan]

7 hours ago, Coldery said:

What about doctors in UK, France, Germany, Taiwan, Sweden, etc. Almost no doctor in any of those countries bill any more than $200k. Most of the other developed nations have training that is equal in length, if not longer than ours. In the UK, it takes 5 years of post-MD training to become a GP, approx. 8 years post-MD training to become a specialist. If they all had your POV, they would've walked off the job a long time ago. The NHS is not very forgiving when it comes to cash. In Taiwan, they aren't earning much more than $100k/year at the most senior positions.

North America is the anomaly (ps: also worse health outcomes, mainly due to lifestyle factors but still). lol

Australia is one of the only other developed countries that offers anything close to what NA offers in terms of cash. Likely one or two others but Canada and America are the top 2, eyes closed.

I don't see the point you're trying to make here. Because people are paid less in a different system we should be paid less too? 6-year direct entry from high school makes a huge difference. Not to mention the social supports those countries have. (France/EU university is essentially free, etc.) Engineers in Canada/US are paid better than their EU counterparts so we should pay them less here too? Or should we follow the factory worker model in Taiwan and pay ours fuck all?

Also where did I say that I wouldn't work if I was paid less? You're creating a strawman. Wanting to be paid well for the work you do is not a sin. This is the classic martyr complex that so many medical students develop and why we get taken advantage of by government cuts year after year. If you want to be paid pennies on the dollar for the rest of your life then you can keep donating 30-50% of your income to charity each year. I'm willing to bet good money that you won't. Once you have a family to take care of and bills to pay you'll get off this high horse and be thankful that other people protected you from hurting yourself in confusion

[Coldery]

Not everyone. First examples were made to illustrate disparities between the province in question and every other province. 

4 hours ago, QueenStan said:

I don't see the point you're trying to make here. Because people are paid less in a different system we should be paid less too?

Wrong question. Right question is: "Because people are paid less in a different system could we be paid less too?"

Never was an advocate of taking everyone's down. All was done to speak of the relative viability of dropping the highest paid doctors pay while retaining their (slightly) tenuous desire to live a top 1% lifestyle. 

Just check Ontario's latest government statistics. Healthcare takes up approximately 40% of total government expenditures. Of all healthcare expenditures, physician billings takes up 25% of that. So, of all taxpayer dollars at the Ontario provincial level, 10% of the $ in their public coffers are going to physicians alone. Alberta relative to Ontario (Table 2)

Quote

Also where did I say that I wouldn't work if I was paid less? You're creating a strawman. 

Of course not, extracting likely action from one's spoken word is a strawman. I may be saying this now but I would actually double our billing schedules given the chance. /s  

 

Also, that isn't a strawman.

 

A strawman involves:

1. You arguing in favour of proposition X.

2. Me falsely claiming your position is proposition Y.

 

Example: 

1. You want to maintain physician take home profits at current levels.

2. I argue about why you want to double physician take home profits.

 

What I did was not falsely restate your position. I extracted likely action from your given position. Is it rock hard evidence? No, nothing concrete has happened yet. However, if we can't extract likely action from one's stated viewpoint, then everyone everywhere is committing a logical fallacy when they make assumptions about family, friends, politicians, the bear they found in the woods, etc.

From your very strict viewpoint: Will politician A legislate voter suppression laws? No, he never said he would.

Will you necessarily walk off the job? No, of course not, but considering your viewpoint, it would make it more likely if all provincial governments suddenly slashed all fees by a factor of 4-5x.

Canada has had its fair share of physician strikes (not just one or two physicians)...

[ChemPetE]

Man, this situation keeps getting more messed up. The AMA held a non confidence vote with a 67% response rate having 98% of the votes having no confidence in the health minister. And now there are twitter posts stating that Pincher Creek docs are basically forced to cover the gaps in the Aug schedule under threat of reporting to the CPSA. Absolutely bonkers. This really has to get resolved soon for everyone’s sanity, although I don’t see that happening.

[piperacillin]

On 7/19/2020 at 4:06 PM, offmychestplease said:

And for the record, I never was arguing that doctors should be paid less or are overpaid at all. It just grinds my gears when people in medicine underestimate their earnings to the public on social media/forums to make a point.

It can grind your gears all you want, but at the end of the day, it'll be patients, especially the rural communities and other underserved populations that get the shaft from these changes. I don't think people are truly worried about a physician shortage in the city - but when rural areas already have a difficult time recruiting, this just makes it so much worse.

Go ahead and talk more about how privileged physicians are while ignoring what the government is doing. Telus Babylon, new legislation allowing private contracts with physicians instead of government, increasing surgical capacity through private centers - tell me who benefits from this. At the end of the day, doctors will come out of this relatively unscathed, patients will not.

Wonder why they can't pay doctors more for virtual visits but they're fine with paying through a private company which takes a cut for profit.

[indefatigable]

1 hour ago, piperacillin said:

Wonder why they can't pay doctors more for virtual visits but they're fine with paying through a private company which takes a cut for profit.

Private company Good - Doctor (esp Family doctor) Bad.  

Shows they're "doing something" even though I agree there's no logical coherence considering the bitter dispute.