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Valentine

If the gov't is so concerned about the FP shortage...

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Are you sure about that? They generate a lot more money than they make...

This is healthy for the economy. Wouldn't you say that's important?

 

 

 

The fact of the matter is that for most sports you would still see players who are making a career of sports even if they are only making $100,000 a year instead of these million dollar contracts we always hear about. Frankly I would honestly like to see them making between $75,000 - $80,000 a year because then you would have people who are playing purely for the passion of the game and I believe that is what makes for a better game.

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I guess I agree with you to some extent. However, what's to say we can't have doctors with BOTH great bedside manners and diagnostic competency? If we had a better way at selecting applicants, we could certainly achieve that, in my opinion.

 

Statistically I don't think we have enough to fill the required doctor spaces, I also believe that generally where you find greatness, you see the person lacking in their mannerisms, but this is a matter of opinion.

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The fact of the matter is that for most sports you would still see players who are making a career of sports even if they are only making $100,000 a year instead of these million dollar contracts we always hear about. Frankly I would honestly like to see them making between $75,000 - $80,000 a year because then you would have people who are playing purely for the passion of the game and I believe that is what makes for a better game.

 

This exists - it's called the CFL: the average salary's about $40-45k. Most of the non-star/first-line players have other jobs during the off-season!

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For the record, I met with an advisor from MD Management last night; he told me that family doctors in Ontario can make up to $250-300k/year. Plus, it's the specialty with the (or one of the) fastest-rising compensation rates.

 

That's can BILL 250-300K/year. Add up your expenses and take off your tax rate first. You might pocket 100K in Ontario. You have to see quite a few patients to do that. The province pays $38 per visit to a GP and $15 for a follow-up visit. You do the math, I already have.

 

At least the media is starting to recognize the reality:

 

 

MEDICAL CARE

Forget the country club image, it simply doesn't pay to be a family doctor

 

GARY MASON

 

gmason@globeandmail.com

 

 

April 29, 2008

 

You want to know why fewer students entering medical school these days want to become family doctors? Or why those who are general practitioners sometimes refuse to take patients with the kind of complex, time-consuming problems that cost doctors money?

 

Or why young GPs are gravitating to walk-in clinics where they can share overhead costs while tending to patients who generally have problems that are easy to fix?

 

Have you ever considered that maybe it's because we don't pay our family doctors enough?

 

I think there are many of us who still cling to this outdated notion of the family doctor who lives in the best part of town and who regularly knocks off early from work to make his tee-time at the local country club.

 

Well, that doctor doesn't exist any more. Not to mention the fact that the doctor in that stale image is male when in fact there are more women entering medical schools these days than men.

 

But back to money.

 

The average gross salary for a GP in British Columbia in 2006-07 was just over $160,000. In other words, that is the amount for which he or she billed the Medical Services Plan. And that doesn't sound too bad.

 

But now that same typical GP has to start paying overhead costs such as rent, the salary for a receptionist, malpractice insurance, association dues, medical supplies, medical equipment, computer, telephone, photocopier, fax, heat and lots more.

 

So let's do a little math. A GP in B.C. is paid $30 by MSP for a standard patient visit. And let's say the doctor sees 15 patients in an average day. So she's making $450 a day. According to the B.C. Medical Association, a doctor's overhead in B.C. averages about 40 per cent of total billings. So that doctor who billed the system $450 for a day's work yesterday actually took home $270.

 

And that is before taxes and other outside-work but work-related expenses such as child care.

 

Now the doctor who has seen 15 patients also needs to spend an hour or more at the end of the day making calls and doing paperwork associated with the patients he or she has seen. Most GPs work a minimum nine-hour day. So, nine hours divided by the $270 the doctor took home after expenses works out to about $30 an hour.

 

And unlike many of us out in the work force, this doctor gets no benefits, no pension and no paid holiday.

 

Oh, I almost forgot one thing: the debt this GP will likely be carrying before she has seen her first patient.

 

According to a 2006 survey carried out by the Canadian Medical Association, the average debt of a postgraduate medical student in this country was $158,728.

 

Knowing you are going to finish medical school with that kind of debt, is it any wonder fewer students want to become GPs where you can make $30 an hour?

 

I could list 30 jobs right now where you could make $30 an hour or more and not need any postsecondary experience. Our typical family doctor, meantime, needs four years of undergraduate study, four years of medical school and then another two years for a family practice residency.

 

And on top of all that there is the constant worry that accompanies the responsibility a family doctor has. That one mistake could potentially kill someone. Who'd want that headache for $30 an hour?

 

My point is it's easy to rail against doctors for refusing to take on new patients with cancer because they gobble up so much time during consultations that cost a doctor money, but perhaps now you can see why money might be a concern.

 

Doctors have mortgages (and often a student loan bill the size of a small mortgage) just like the rest of us.

 

There is nothing in a doctor's Hippocratic oath that says he or she has to make financial sacrifices for the good of the world. Yes, there are some GPs who work the system and bill MSP for far more than $160,000 a year. And, of course, there are specialists who are multimillionaires. But the average family doctor is not a rich woman or man and does not live in the fancy part of town with memberships to all the right clubs.

 

Those are the plumbers and electricians.

 

But as we boomers age, we are going to need family doctors more than ever. We are going to need them to diagnose those weird aches and pains we never got before and now worry could be the sign of something serious. The family doctor is going to become our best friend.

 

As such, I think we'd better begin treating them much better. And that starts with paying them much better.

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This exists - it's called the CFL: the average salary's about $40-45k. Most of the non-star/first-line players have other jobs during the off-season!

 

 

I meant all sports should be that way, hockey, soccer, women's jello wrestling...lol ok maybe not the last one.

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Time for a little critical thinking.

 

The average gross salary for a GP in British Columbia in 2006-07 was just over $160,000. In other words, that is the amount for which he or she billed the Medical Services Plan.

 

This statistic would tally ALL GPs in BC. Therefore, it will be negatively skewed by the very significant proportion of GPs who choose to work less.

 

But now that same typical GP has to start paying overhead costs such as rent, the salary for a receptionist, malpractice insurance, association dues, medical supplies, medical equipment, computer, telephone, photocopier, fax, heat and lots more.

 

This is very true, and, it's why the day of the solo practioner has come and gone. However, the most substantial costs here are fixed and readily reduced by smart practice management as simple as getting together with a few other docs and buying your office space rather than renting. A little financial saavy (not taught in residency unfortunately) and you're laughing at people losing 40% of gross billings to overhead.

 

 

So let's do a little math. A GP in B.C. is paid $30 by MSP for a standard patient visit. And let's say the doctor sees 15 patients in an average day. So she's making $450 a day. According to the B.C. Medical Association, a doctor's overhead in B.C. averages about 40 per cent of total billings. So that doctor who billed the system $450 for a day's work yesterday actually took home $270.

 

So let's do a little math. Let's say you work an 8 hour day. Not overly strenous. You see......15 patients? As in just under one every 1/2 hour?!? And obviously we're going to use the absolute minimum $30 per visit. Sure. In Ontario you get $10 for just saying "have you considered quiting smoking?....." (followed by a pregnant pause-and there's your smoking cessation counselling-they're clearly pre-contemplation)

 

And that is before taxes and other outside-work but work-related expenses such as child care.

 

So what? Are doctors special so we shouldn't have to pay taxes or pay for child care?

 

Oh, I almost forgot one thing: the debt this GP will likely be carrying before she has seen her first patient. According to a 2006 survey carried out by the Canadian Medical Association, the average debt of a postgraduate medical student in this country was $158,728.

 

And it sucks...... No arguement here. I think the debt load is what gets alot of us down. Unfortunately, that is unlikely to change.

 

As a daily Globe and Mail reader, I've been quite disappointed with the quality of their reporting on health care. Not a whole lot of it shows very much thought or introspection. As an aside, the author of this article pretty much writes op-ed pieces with a smattering of facts. Interesting to read, but not that insightful.

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"This is very true, and, it's why the day of the solo practioner has come and gone. However, the most substantial costs here are fixed and readily reduced by smart practice management as simple as getting together with a few other docs and buying your office space rather than renting. A little financial saavy (not taught in residency unfortunately) and you're laughing at people losing 40% of gross billings to overhead."

 

 

Most group practices, the last time I looked, collect 30% of your gross billings.

More irritatingly, you are now an employee, there is usually a community board, to whom you must report every quarter.

 

An interesting anecdote, I have a friend who left a group practice, to start a lone practice. This was after 30 minutes of a meeting that was wasted deciding where to place a new garbage receptacle.

 

One of the reasons I went into medicine was to be my own boss, that is being lost. Personally, I would trade 10% of my gross income for the freedom of making decisions for myself and not having to explain my decisions to a nurse manager or layperson.

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As a daily Globe and Mail reader, I've been quite disappointed with the quality of their reporting on health care. Not a whole lot of it shows very much thought or introspection. As an aside, the author of this article pretty much writes op-ed pieces with a smattering of facts. Interesting to read, but not that insightful.

 

Eh, Gary Mason's columns usually leave me pretty empty - in the Globe, Andre Picard is where it's at insofar as good health care reporting goes.

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An interesting anecdote, I have a friend who left a group practice, to start a lone practice. This was after 30 minutes of a meeting that was wasted deciding where to place a new garbage receptacle.

 

That's awesome! ;)

 

Similar story. At the small-town FHN where I did my clerkship, there was once a ~30 minute discussion during monthly staff meeting about whether or not we need a policy in place to call 911 if somebody collapses in the waiting room (which actually happened earlier in the year).

 

Keep in mind that the local hospital emergency room, which is staffed by the very same docs who work in the clinic, is just across the driveway about 20' away.

 

*facepalm*

 

The discussion was more legal than medical and was being driven by some admin types, but it still left me shaking my head...

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Everything being tried now in Ontario has already been tried in the UK. The MOHLTC thinks the NHS is the "bees knees" of public health care.

 

Here is the honest truth, the government will NEVER significantly increase doctors incomes, meaning increases at least at the level of inflation.

 

Why? They do not want to look weak.

 

Here is another truth, it's not how much you earn, it's how much you keep.

 

Work hard in your first ten years of practice, save most of it and invest it in dividend paying income trusts/stocks/mutual funds. That will supplement your income. Then you can chose your pace.

 

It's the docs who go out and buy the big house and fast car right away who become slaves to their work.

 

And, because everyone thinks your rich and will already give you unsecured LOC's at prime when you have no income! You can use that to invest too, if you take the time to learn how.

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When you do get rich, if you do, I think the charities you give to should be focused on children. Health care and social services for kids are being cut to pay for the baby boomers' new knees, hips, and angioplasties.

 

When you do get rich, if you do, I think the charities you give to should be focused on children. Health care and social services for kids are being cut to pay for the baby boomers' new knees, hips, and angioplasties.

 

 

It is the old that should be getting out of the way for the next generation. It angers me to no end when the old generation take away from what belongs to the new generation. The future belongs to the next generation and the old should be doing whatever they can to pave the way for the next generation.

 

 

Another Idea for what to do with you money, if your willing to risk some of it (and have experience already with business) would be to start up a small business or two and hire someone competent to run it. You might not make as much as if you ran it yourself, but it does provide you with a steady source of income. Which depending on the success of your business can be very good, I have a friend who did just that and after a couple years of owning a Domino`s Pizza he could afford to build his expensive as hell dream home.

 

 

Me? I have to start a couple small businesses after I have saved up some money. Then the rest that I won`t be living off of per say will go to my family, especially my cousins in school to help them better enjoy university.

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I'm aware that there are some FPs who make a lot of money. However, I'm at a loss on how they actually do this.

 

Does it require they practice short-visit, somewhat poor, medicine(one complaint per visit, 2 min per patient, no smokers, no old people with multiple comorbidities)?

 

Does it require they work in an extremely backwoods community?

 

Does it require they don't practice traditional office medicine at all?

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Does it require they work in an extremely backwoods community?

 

You mean rural, right?

 

I only worked with guys in rural settings b/c when I was interested in family medicine I saw myself going that route. I think being rural does help because it's easy to pick up emerg shifts and do things other than plain old office visits. All the guys I worked with did ER, one did obstetrics and OB/GYn assists (2.5 yrs ob/gyn residency before FP), and another did basic general surgery and anaestheia.

 

There's also underserviced and rural bonuses (although you can get underserviced in many cities now) and your overhead and cost of living are significantly decreased.

 

The three FPs I worked with were all very quick, but 2 of 3 were very good and their patients absolutely loved them. Fast patient care does not necessarily equate to poor quality patient care. I think some people are just more efficient than others, and some people like to chat (not that these are mutually exclusive). Nothing wrong with chatting, but if a family doc isn't efficient they should probably get salaried.

 

Valentine, just curious, are you going into Family?

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Eh, Gary Mason's columns usually leave me pretty empty - in the Globe, Andre Picard is where it's at insofar as good health care reporting goes.

 

Picard is the only one that shows up for press releases and asks questions trying to understand the ins and outs of topics.

 

He actually tries to get all the facts straight and a good understanding of his topics, and just doesn't look for the flashy headline.

 

If I remember correctly, his wife works in the health care system so I am sure he has to get his facts straight otherwise he will get whats coming to him when he gets home. :P

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That's can BILL Yes, there are some GPs who work the system and bill MSP for far more than $160,000 a year. And, of course, there are specialists who are multimillionaires. But the average family doctor is not a rich woman or man and does not live in the fancy part of town with memberships to all the right clubs.

You can work anywhere in Vancouver and easily bill $240,000 if you work 40 hours/week. Take out a 35% for overhead (or lower in group practices) and you're left with $160,000 take home pay. I don't know why people are subtracting taxes from that, as if other people don't have to pay taxes, or as if doctors shouldn't have to pay taxes.

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You can work anywhere in Vancouver and easily bill $240,000 if you work 40 hours/week. Take out a 35% for overhead (or lower in group practices) and you're left with $160,000 take home pay. I don't know why people are subtracting taxes from that, as if other people don't have to pay taxes, or as if doctors shouldn't have to pay taxes.

 

If taxes are subtracted, the true amount one actually nets is revealed.

 

For FPs, its somewhere around the 80-90k range.

 

Now, this isn't a bad yearly income by any means. It's moderately higher compared to most any job.

 

However, most everything else in medicine pays better. So, aside from someone really loving FP and wanting to do it out of pure enjoyment, why should any student want to go into it? I can't really see any tangible upsides compared to any other specialty in this day and age.

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However, most everything else in medicine pays better. So, aside from someone really loving FP and wanting to do it out of pure enjoyment, why should any student want to go into it? I can't really see any tangible upsides compared to any other specialty in this day and age.

 

No offense or anything, but if you are in medicine strictly to make a lot of money, you have chosen the wrong career. People go into family medicine for a variety of reasons, such as the chance for lifelong doctor-patient relationships, the wide range of practice, the flexibility of the work, etc. But if you need somebody else to list off the benefits of being a GP to you, then you are probably in the wrong business IMO.

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No offense or anything, but if you are in medicine strictly to make a lot of money, you have chosen the wrong career. People go into family medicine for a variety of reasons, such as the chance for lifelong doctor-patient relationships, the wide range of practice, the flexibility of the work, etc. But if you need somebody else to list off the benefits of being a GP to you, then you are probably in the wrong business IMO.

 

I see in no way how my opinion that FPs are severely underpaid and how this results in far less people entering that particular field suggests I have a "desire to make a lot of money". Don't be so sanctimonious.

 

This discussion is about why the FP shortage is persisting, and how little is being done to remedy it.

 

As for your reasons that you state...:

 

1. Lifelong DP relationships: some doctors don't want to have this, and that's fine. Based on the declining interest in FP, students aren't holding this in high priority.

 

2. Wide range of practice: this is only partially true and is dependent on the number of specialists in an area. If there are a lot of specialists, like in a major city, then FPs don't get to do very much. If it's in a very rural area, then FPs do everything, all of the time. However, based on declining interest in FP, students do not consider this wide range of practice to be enough to warrant entering the field unless they are one of the few students dead-set on practicing rurally.

 

3. Flexibility of the work: same argument as above.

 

The way I see it, its just a bad deal to go into it at the current time, when there are so many better options out there in medicine, both fiscally and professionally. The numbers say the same thing: students just aren't going into it.

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I see in no way how my opinion that FPs are severely underpaid and how this results in far less people entering that particular field suggests I have a "desire to make a lot of money". Don't be so sanctimonious.

 

This discussion is about why the FP shortage is persisting, and how little is being done to remedy it.

 

As for your reasons that you state...:

 

1. Lifelong DP relationships: some doctors don't want to have this, and that's fine. Based on the declining interest in FP, students aren't holding this in high priority.

 

2. Wide range of practice: this is only partially true and is dependent on the number of specialists in an area. If there are a lot of specialists, like in a major city, then FPs don't get to do very much. If it's in a very rural area, then FPs do everything, all of the time. However, based on declining interest in FP, students do not consider this wide range of practice to be enough to warrant entering the field unless they are one of the few students dead-set on practicing rurally.

 

3. Flexibility of the work: same argument as above.

 

The way I see it, its just a bad deal to go into it at the current time, when there are so many better options out there in medicine, both fiscally and professionally. The numbers say the same thing: students just aren't going into it.

 

"The way I see it, its just a bad deal to go into it at the current time, when there are so many better options out there in medicine, both fiscally and professionally."

 

-What exactly do you mean 'better options professionally'? How are you defining 'better professionally'?

 

"Wide range of practice: this is only partially true and is dependent on the number of specialists in an area."

 

This is just plain false. Have you ever done a family medicine elective?

 

"This discussion is about why the FP shortage is persisting, and how little is being done to remedy it."

 

Again, not true. Talk to any GP about the new fee-schedule for billing diabetes control, the bursaries for rural practice, etc etc.

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No offense or anything, but if you are in medicine strictly to make a lot of money, you have chosen the wrong career. People go into family medicine for a variety of reasons, such as the chance for lifelong doctor-patient relationships, the wide range of practice, the flexibility of the work, etc. But if you need somebody else to list off the benefits of being a GP to you, then you are probably in the wrong business IMO.

 

I hate it when people make that argument. Making it sound like being a doctor isn't a job and that getting a pay check isn't a factor. I can assure you, many, if not most medical students wouldn't be in medicine if physicians weren't well compensated. Is it a reason to go into medicine, of course not. The road is too long and hard to do it simply for money. But, having said that, the road is too long and hard not to consider money.

 

Valentine's post is valid in that, all things being equal, (ie. Med student "A" likes family and a different specialty), money is (and should be) a factor. Are things getting better for FPs, yes. But there is still a large disparity between the average family doc and the average specialist. Family medicine is great, and may be my future career, but there is no denying that the lure of other specialties grows ever higher when you think about the fact that you can make 2x income.

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If taxes are subtracted, the true amount one actually nets is revealed.

 

For FPs, its somewhere around the 80-90k range.

 

Now, this isn't a bad yearly income by any means. It's moderately higher compared to most any job.

 

However, most everything else in medicine pays better. So, aside from someone really loving FP and wanting to do it out of pure enjoyment, why should any student want to go into it? I can't really see any tangible upsides compared to any other specialty in this day and age.

 

I don't know what rarefied world you live in, but 80-90k after taxes (and overhead too) is pretty damn good. In a country where the median income is just over $40k before taxes, I'd say you're rather out-of-touch with what "most any job" pays.

 

Anyhow, family physicians go through shorter residencies and are on the lower end of pressure and lifestyle constraints - and it's not as bloody boring as something like dermatology, however well it does pay. You should not be choosing a specialty based on the money because, frankly, all areas in medicine pay pretty well.

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