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IM VS EM income


Handsome88

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I understand the fact that everybody wants to know how much each specialty makes, but really, there is no simple straight forward answer to this question. There are many different ways of reimbursement out there. There are GIM docs who are salaried (academic centers), who make maybe 200-250K a year with benefits, there are GIM docs out in the community who acts as consultants. Typically they bill maybe about 400K a year, depending on how hard you work. EM docs can make up to 3000 bucks a shift, doing 15 shifts a month. And no there is no difference between CCFPEM and FRCPC EM. I know FM docs who bill 600-800K a year (not including privates and other sources of income). And, not only that, FM docs who own clinics can make a killing just by taking 35% overhead from other docs. My mom does the books for one popular clinic; just from overhead from other docs, the clinic posted over 1 million bucks in profit with one main owner. The doc himself billed about 400K.

 

The bottom line is with the billing structure in Canada the way it is, it really depends on how hard you wanna work and where you wanna work. There are rural stipends so rural docs make more. If you are a good business person, I would suggest you do FM and open up your own clinic (may take time but eventually you will get enough expertise to do it).

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I understand the fact that everybody wants to know how much each specialty makes, but really, there is no simple straight forward answer to this question. There are many different ways of reimbursement out there. There are GIM docs who are salaried (academic centers), who make maybe 200-250K a year with benefits, there are GIM docs out in the community who acts as consultants. Typically they bill maybe about 400K a year, depending on how hard you work. EM docs can make up to 3000 bucks a shift, doing 15 shifts a month. And no there is no difference between CCFPEM and FRCPC EM. I know FM docs who bill 600-800K a year (not including privates and other sources of income). And, not only that, FM docs who own clinics can make a killing just by taking 35% overhead from other docs. My mom does the books for one popular clinic; just from overhead from other docs, the clinic posted over 1 million bucks in profit with one main owner. The doc himself billed about 400K.

 

The bottom line is with the billing structure in Canada the way it is, it really depends on how hard you wanna work and where you wanna work. There are rural stipends so rural docs make more. If you are a good business person, I would suggest you do FM and open up your own clinic (may take time but eventually you will get enough expertise to do it).

 

EM making 540k a year working 15 shifts a month? That's hard to believe, unless you are talking about maximums. What I'm talking about are averages. Because I have heard of IM docs making 450k+ too. I found this article that says IM docs in ON make 330k average. http://www.discoveryfinance.com/national-average-income-for-medical-doctors-canada.html

 

But it says nothing about EM doctors. Sure Family docs can make 600k if they're good businessmen, but most of them don't cross the 250k mark. Hard to believe that a specialist would make less than a primary care doctor, unless you are comparing a family doctor who works in the community with an IM who is working in academic settings. So my question is who makes more if they both worked in same settings with similar hours?

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EM making 540k a year working 15 shifts a month? That's hard to believe, unless you are talking about maximums. What I'm talking about are averages. Because I have heard of IM docs making 450k+ too. I found this article that says IM docs in ON make 330k average in ON. http://www.discoveryfinance.com/national-average-income-for-medical-doctors-canada.html

 

But it says nothing about EM doctors. Sure Family docs can make 600k if they're good businessmen, but most of them don't cross the 250k mark. Hard to believe that a specialist would make less than a primary care doctor, unless you are comparing a family doctor who works in the community with an IM who is working in academic settings. So my question is who makes more if they both worked in same settings with similar hours?

 

from what I understand (based on BC numbers) for EM if you work 35 hours/week for 48 weeks out of the year at 175.00/hr (which seems to be a nice average number) you'll pull in 294k gross. That gives you 4 weeks vacation and about 3 12 hr shifts per week, or 4 10's or however you want to break it down. you wouldn't have any call, no overhead and depending upon how it works benefits might be included. my family physician billed msp for 200k last year and he works about 40 hours per week... he also takes about 6 weeks off every year and probably had some other billings for ICBC, WCB, private setting that aren't accounted for.

 

he takes it easy though in terms of his practice.

 

in winnipeg quite a few EM physicians are pulling in over 500k... it's not the average, but there was a report that quite a few were making around that mark.

 

if you do rural em work in Manitoba (up north) you can make close to 1 million (what I've heard from people in Manitoba) if you work about 50 hours per week for a year... apparently it wouldn't be an idea situation, but somebody could theoretically do it.

 

hopefully those numbers help (albeit I have no personal experience, just what I've been able to glean from other sources)

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from what I understand (based on BC numbers) for EM if you work 35 hours/week for 48 weeks out of the year at 175.00/hr (which seems to be a nice average number) you'll pull in 294k gross. That gives you 4 weeks vacation and about 3 12 hr shifts per week, or 4 10's or however you want to break it down. you wouldn't have any call, no overhead and depending upon how it works benefits might be included. my family physician billed msp for 200k last year and he works about 40 hours per week... he also takes about 6 weeks off every year and probably had some other billings for ICBC, WCB, private setting that aren't accounted for.

 

he takes it easy though in terms of his practice.

 

in winnipeg quite a few EM physicians are pulling in over 500k... it's not the average, but there was a report that quite a few were making around that mark.

 

if you do rural em work in Manitoba (up north) you can make close to 1 million (what I've heard from people in Manitoba) if you work about 50 hours per week for a year... apparently it wouldn't be an idea situation, but somebody could theoretically do it.

 

hopefully those numbers help (albeit I have no personal experience, just what I've been able to glean from other sources)

 

Thanks for the information. That's impressive, didn't know EM docs can make more than GIM with fewer hours!

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from what I understand (based on BC numbers) for EM if you work 35 hours/week for 48 weeks out of the year at 175.00/hr (which seems to be a nice average number) you'll pull in 294k gross. That gives you 4 weeks vacation and about 3 12 hr shifts per week, or 4 10's or however you want to break it down. you wouldn't have any call, no overhead and depending upon how it works benefits might be included. my family physician billed msp for 200k last year and he works about 40 hours per week... he also takes about 6 weeks off every year and probably had some other billings for ICBC, WCB, private setting that aren't accounted for.

 

he takes it easy though in terms of his practice.

 

in winnipeg quite a few EM physicians are pulling in over 500k... it's not the average, but there was a report that quite a few were making around that mark.

 

if you do rural em work in Manitoba (up north) you can make close to 1 million (what I've heard from people in Manitoba) if you work about 50 hours per week for a year... apparently it wouldn't be an idea situation, but somebody could theoretically do it.

 

hopefully those numbers help (albeit I have no personal experience, just what I've been able to glean from other sources)

 

Sorry for the double post. But I am wondering if EM docs certified through the 2+1 route have to work a certain number of hours in FP or are they free to work as 100% emergency docs.

Also if you know anything about GIM lifestyle in Canada. Seems like it is actually competitive, so what makes it so if it doesn't have the pay? Is the lifestyle better? What are the hours like, 9-5 with call or shift?

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Sorry for the double post. But I am wondering if EM docs certified through the 2+1 route have to work a certain number of hours in FP or are they free to work as 100% emergency docs.

Also if you know anything about GIM lifestyle in Canada. Seems like it is actually competitive, so what makes it so if it doesn't have the pay? Is the lifestyle better? What are the hours like, 9-5 with call or shift?

 

I don't know anything about GIM lifestyle in Canada... perhaps someone else can fill that piece in.

 

Like A-stark indicated- a CCFP-EM physician can work as much Emerg/FM as they like... but in Vancouver they are limited in terms of the hospitals that they can work at as an EM physician.

 

It's funny because I was discussing the 2+1 route with my family physician and he said that he thought that was no longer possible to do... I know he may not be the most in touch with CaRMs and the various residency options out there, but I wonder if he heard something through different sources that may have more reliable information.

 

Anyways, as it stands right now- 2+1 still exists, no set limit on number of hours you have to work in FM or EM, but you are limited to the less academic centres (they like to have 5 yr EM's).

 

Hope that helps.

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It's funny because I was discussing the 2+1 route with my family physician and he said that he thought that was no longer possible to do... I know he may not be the most in touch with CaRMs and the various residency options out there, but I wonder if he heard something through different sources that may have more reliable information.

 

Regarding the existence of the 2+1 emerg option, this has been discussed in a previous thread. To summarize, people seem to hear a lot of conflicting information about how much longer the program will be around. Some have heard that it won't be around too much longer, others think that the 5 year program will be merged with the 3 year program to find a happy medium (a 4 year program?), and yet others think that the 2+1 program isn't going anywhere in the foreseeable future.

 

Here's one way to view the situation: there were a total of 75 spots in the 5 year emerg program in 2010 across the entire country. This is not nearly enough ER docs to staff all ERs across the country, which is exactly why there are a lot of family docs with no additional 'formal' ER training staffing ERs across the country.

 

If you ask me, the 2+1 emerg option will be around for a long time.

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Regarding the existence of the 2+1 emerg option, this has been discussed in a previous thread. To summarize, people seem to hear a lot of conflicting information about how much longer the program will be around. Some have heard that it won't be around too much longer, others think that the 5 year program will be merged with the 3 year program to find a happy medium (a 4 year program?), and yet others think that the 2+1 program isn't going anywhere in the foreseeable future.

 

Here's one way to view the situation: there were a total of 75 spots in the 5 year emerg program in 2010 across the entire country. This is not nearly enough ER docs to staff all ERs across the country, which is exactly why there are a lot of family docs with no additional 'formal' ER training staffing ERs across the country.

 

If you ask me, the 2+1 emerg option will be around for a long time.

 

That's what I thought. Thanks for the clarification.

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GIM is what you make of it. Many options:

 

1 - academic doing CTU, med consults, teaching/research - average 250-300K, mostly because academic practice plans drain off ~30% of your billings

2 - community GIM doing some CTU, med consults, outpatient, and nighttime ER coverage - average 350-450K depending on the amount of night call, which is quite lucrative

3 - hospitalist GIM - again 350-450K depending on the amount of night call and volume at your centre

 

There are ways to make more money by specializing your services. Generally, the more you act as a consultant rather than MRP or outpatient work, and the more you work nights/evenings, the more you will make. Also, in smaller centres, you can read ECGs, holters, stress tests, and in even smaller centres occasionally do endoscopy/bronchoscopy, all of which can add to your bottom line.

 

On top of this, IM subspecialists can earn significantly more (GI, Cardiology, etc.)

 

Also, IM locums can be very lucrative (mainly ER coverage). I billed ~100K in 3 months last year just locuming in addition to my fellowship.

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GIM is what you make of it. Many options:

 

1 - academic doing CTU, med consults, teaching/research - average 250-300K, mostly because academic practice plans drain off ~30% of your billings

2 - community GIM doing some CTU, med consults, outpatient, and nighttime ER coverage - average 350-450K depending on the amount of night call, which is quite lucrative

3 - hospitalist GIM - again 350-450K depending on the amount of night call and volume at your centre

 

There are ways to make more money by specializing your services. Generally, the more you act as a consultant rather than MRP or outpatient work, and the more you work nights/evenings, the more you will make. Also, in smaller centres, you can read ECGs, holters, stress tests, and in even smaller centres occasionally do endoscopy/bronchoscopy, all of which can add to your bottom line.

 

On top of this, IM subspecialists can earn significantly more (GI, Cardiology, etc.)

 

Also, IM locums can be very lucrative (mainly ER coverage). I billed ~100K in 3 months last year just locuming in addition to my fellowship.

 

First of all thanks for taking the time to answer my questions!

 

Being an SDNer for a long time I've gotten a totally different picture of GIM (where they call it "the dumping ground doctor" :( ). But I really like the flexibility of it in Canada (really surprised that they can also do ER-one of my favorite fields) and hope it stays that way.

 

I want to also find out about the lifestyle of the Canadian GIM. Is it as bad as it is in the US (50+ hours a week, spending most of your time with paper work, treated like a glorified GP/FP)? I know it depends a lot on which option (from the ones you mentioned above) you partake, but I'd like to work somewhere between 2nd or 3rd option (with ROS It will be 2nd option for the first years of my career).

 

My dream is to become a Cardiologist (certainly not for the money) but I know it is not guaranteed and might have to settle with GIM and I don't mind as long as it is bearable (doesn't seem like it in the US). So I want to make an informed decision. Thank you for the help once again.

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But I really like the flexibility of it in Canada (really surprised that they can also do ER-one of my favorite fields) and hope it stays that way.

 

Hey,

 

By "ER coverage" I believe cheech10 is referring to covering medicine consults/admissions from the ER; not acting as an ER physician (eg Mrs Snickerdoodle comes in at 03h00 with a case of the dwindles and needs to be admitted...the ER doc consults cheech who admits her and lays the groundwork for a little tune-up)

 

On the other hand, I'm pretty sure there are combined IM/ER programs in the States.

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Ploughboy's right. Internists don't do the initial ED assessment, but consults to the ED make up the majority of a call night in GIM.

 

GIM in Canada is very different from the US. There is still a bit of a "dumping ground" issue with old patients with non-specific complaints who are not well enough to go home usually get admitted to Medicine. The paperwork aspect is not that troublesome for the most part - and getting paid is certainly not a challenge - but social work/placement does take up some time. The exact model for GIM really depends on where you work. In some hospitals, it's exclusively a consult service, with FM trained hospitalists taking over the patients as MRP in the morning. This is great: the consult is the most lucrative and intellectually stimulating part of the admission, and the paperwork aspect is minimal. Many places have internists do the MRP duties instead. Call is lucrative (especially with stipends paid out for many of these shifts) but can be busy (around 30 consults per 24 hours in very busy places). Many older physicians don't want to do call and instead offer it to GIM locums (fellows and recent grads like myself).

 

In addition to the inpatient work (consults to ER/surgery/others, and MRP services), internists can have outpatient practices. These are generally as consultants for peri-operative medicine, undifferentiated complaints, or other IM issues that don't warrant a subspecialist. There is no primary care GIM in Canada - all patients need a referral from another physician to be seen. In smaller cities, some people have turned this into a non-interventional cardiology type practice. The options are many.

 

Overall, work is what you make of it. Generally I'd say most community guys work 8-6, 5 days a week, in a combination of in/outpatient practices, so 50 hours is common. Call is then on top of this, as frequent as your contract with the hospital dictates, but locums are easily found if one is not interested in call. Some recent grads have set up group practices that rotate through a week each of inpatient MRP/inpatient consults/outpatient clinic/vacation on a 4 week rota, so that's another option. The key issue to remember is that remuneration is proportional to the amount of work done, and especially consults/call.

 

I'd actually say the lifestyle is not that great unless you're willing to take a hit on remuneration, but you have flexibility in how you want to set up practice. Personally, I only do occasional GIM locum call shifts now and focus on my ICU practice, which was a much better lifestyle/remuneration balance for me.

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Hey,

 

By "ER coverage" I believe cheech10 is referring to covering medicine consults/admissions from the ER; not acting as an ER physician (eg Mrs Snickerdoodle comes in at 03h00 with a case of the dwindles and needs to be admitted...the ER doc consults cheech who admits her and lays the groundwork for a little tune-up)

 

On the other hand, I'm pretty sure there are combined IM/ER programs in the States.

 

IM/ER programs in the states are 5 years. Do you think if someone completed one of these programs he would be eligible for canadian boards? I guess total IM time in such programs would be <3yrs and total ER time <3yrs. But you could also argue that all 5yrs count as IM and/or all 5yrs count as ER?

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Also, in smaller centres, you can read ECGs, holters, stress tests, and in even smaller centres occasionally do endoscopy/bronchoscopy, all of which can add to your bottom line.

 

On top of this, IM subspecialists can earn significantly more (GI, Cardiology, etc.)

 

 

I don't want to sound like I'm only using IM as a gateway to Cards, but I would be happier doing Cardiology (I want to do procedures and consults, working with actual sick patients and less social admits) than IM. How risky/uncertain is it for someone (an IMG if it matters) to subspecialize in Cards?

From what I can tell in the US you basically have to take years off to get multiple published papers, many research experiences, doing cheif years...etc So it a very difficult road. How is it in Canada? I get conflicting information, some say if you want it you will get it, others say forget about it.

 

On another topic, how do you compare ICU lifestyle with GIM? Any reasons you prefer it over GIM?

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Most Canadian grads that want cardiology and are flexible in terms of location can get a spot. There have definitely been those that could not find a spot though, so research or something else to set you apart is definitely helpful. If you're not flexible about location, then it's more difficult.

 

I don't know what the situation is like for IMGs. My speculation is that it would be very difficult unless one did a Canadian residency, or prestigious American residency (Harvard, Hopkins, etc.), or the IMG has outside funding (some middle eastern countries).

 

As for why I like ICU over GIM - really sick patients so you see yourself making a difference quickly, good mix of procedural vs non-procedural work, minimal paperwork/placement issues, no outpatient component, no work involvement when not on service, and 2-3 weeks off per month. Getting 2-3 weeks off per month and no phone calls at all during that time is exactly the kind of lifestyle I want, very family-friendly (for me, anyway), and well worth the crazy hectic weeks on service in exchange. But it's definitely not for everyone.

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IM/ER programs in the states are 5 years. Do you think if someone completed one of these programs he would be eligible for canadian boards? I guess total IM time in such programs would be <3yrs and total ER time <3yrs. But you could also argue that all 5yrs count as IM and/or all 5yrs count as ER?

 

Good question. I don't know if copacetic's answer is right or wrong. Suggest if you're seriously considering this that you contact the College of Physicians in the province where you ultimately hope to practice.

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1 - academic doing CTU, med consults, teaching/research - average 250-300K, mostly because academic practice plans drain off ~30% of your billings

2 - community GIM doing some CTU, med consults, outpatient, and nighttime ER coverage - average 350-450K

3 - hospitalist GIM - again 350-450K

 

There are GIM docs who are salaried (academic centers), who make maybe 200-250K a year with benefits.

 

 

Academic: 200-250k or 250-300k+? These are very different numbers. I don't know who to believe. Are you two from different provinces?

What are your sources. I don't think it's typical for a GIM (forget about the specialists), hospitalist or not, doing their bread and butter cases (no procedures), to make more than 250k in big cities like Toronto (and GTA) & Vancouver. And here you are saying they make up to 450k?! What is left for the subspecialists? Correct me if I'm wrong but this doesn't sound right, unless these are rare cases in rural areas (where GIM could do procedures). I think your typical GIM working in average volumes, for average hours, makes ~220k on average. While the typical Hospitalist makes ~250k (NOT 450k!). This number is going to decrease as they get to do less and less procedures that subspecialists are now monopolizing. Again, correct me if I'm wrong...

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I'm in Toronto. And my sources are my colleagues and myself, who are all practising currently:

 

1 - a friend recently hired to do GIM at a Toronto teaching hospital, billing 20-25K per month

2 - my own experiences doing locums, and talking to other internists in Toronto urban community hospitals

3 - a friend who graduated 2 years prior to me at a community hospital in the GTA. Actually on a rotational schedule doing 1 week of hospitalist/MRP coverage, 1 week ER/med consults coverage, and 1 week outpatient clinic.

 

The stipends provided for ER call, and for academic practice, have made a HUGE difference in IM reimbursement. Note that the numbers I provided are just billings; overhead (low) and taxes (high) have to be taken out, so about ~50% ends up being take-home pay. They also assume a fair amount of ER call, as we are all young and eager to make extra money. Academic physicians may have less overhead, but often hafe to pay into a practice plan to split income across the department. And for hospitalists, I'm talking about internists doing it rather than family docs; there are certain fee codes that pay more for internists.

 

As for specialists, I can't comment on most, but in my Toronto communityICU practice I bill significantly more, and have no overhead.

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I'm in Toronto. And my sources are my colleagues and myself, who are all practising currently:

 

1 - a friend recently hired to do GIM at a Toronto teaching hospital, billing 20-25K per month

2 - my own experiences doing locums, and talking to other internists in Toronto urban community hospitals

3 - a friend who graduated 2 years prior to me at a community hospital in the GTA. Actually on a rotational schedule doing 1 week of hospitalist/MRP coverage, 1 week ER/med consults coverage, and 1 week outpatient clinic.

 

The stipends provided for ER call, and for academic practice, have made a HUGE difference in IM reimbursement. Note that the numbers I provided are just billings; overhead (low) and taxes (high) have to be taken out, so about ~50% ends up being take-home pay. They also assume a fair amount of ER call, as we are all young and eager to make extra money. Academic physicians may have less overhead, but often hafe to pay into a practice plan to split income across the department. And for hospitalists, I'm talking about internists doing it rather than family docs; there are certain fee codes that pay more for internists.

 

As for specialists, I can't comment on most, but in my Toronto communityICU practice I bill significantly more, and have no overhead.

 

What is the difference between EM overhead and IM overhead? I've heard about doctors "incorporating", where they pay 18% business tax and give themselves a salary or something like that. Is that only for Family doctors or can the General Internist or Emergency doctor do that?

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As for why I like ICU over GIM - really sick patients so you see yourself making a difference quickly, good mix of procedural vs non-procedural work, minimal paperwork/placement issues, no outpatient component, no work involvement when not on service, and 2-3 weeks off per month. Getting 2-3 weeks off per month and no phone calls at all during that time is exactly the kind of lifestyle I want, very family-friendly (for me, anyway), and well worth the crazy hectic weeks on service in exchange. But it's definitely not for everyone.

 

 

And how is the job market these days for ICU?

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