IM VS EM income

[hking03]

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?

 

EM has overhead? I was always under the impression that working in EM meant at least two guarantees: no overhead, no call.

[medenv]

EM has overhead? I was always under the impression that working in EM meant at least two guarantees: no overhead, no call.

 

Oh sorry I didn't know that I was just asking about percentage overhead for each. So EM 0%?

[cheech10]

And how is the job market these days for ICU?

 

Not good. It's a relatively new specialty, so most of the intensivists practising are young, and most of the ICUs that were large enough to warrant intensivist staffing have already become closed units. Job prospects are slim and likely to remain that way for a few years.

[Handsome88]

Not good. It's a relatively new specialty, so most of the intensivists practising are young, and most of the ICUs that were large enough to warrant intensivist staffing have already become closed units. Job prospects are slim and likely to remain that way for a few years.

 

ouch...Hopefully this will change in 10 years

 

Going back to the ER coverage, is this typical for a general internist to do or something that's hard to find?

 

Thanks for the info.!

[cheech10]

Easy. Although call shifts are lucrative, they are tiring, and especially older docs try to give them away to locuming docs.

[itimebomb2]

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...

 

youve gotta be kidding me... 200-250 and 250-300 is NOT a significant difference! These are averages, man - averages comprised of literally thousands of doctors. There are obviously a lot of doctors (old ones) who don't work as much, and some young guns who make a lot more. It's been made clear that if you're willing to work - you can make far above the average.

 

You're obviously a very "ambitious" person - I wouldn't worry about earning on the high end of numbers - stop fretting about these minor differences.

[medenv]

youve gotta be kidding me... 200-250 and 250-300 is NOT a significant difference! These are averages, man - averages comprised of literally thousands of doctors. There are obviously a lot of doctors (old ones) who don't work as much, and some young guns who make a lot more. It's been made clear that if you're willing to work - you can make far above the average.

 

You're obviously a very "ambitious" person - I wouldn't worry about earning on the high end of numbers - stop fretting about these minor differences.

 

The difference between 200k and a 300k is a 50% increase in salary. I don't know about you but in my book that is a significant difference. But you are right, these are just averages, you could end up making more or less.

 

So if you can work for 35 hours and make 300k+ (with 0 overhead) as an Emergency doctor with lots of time off and no call, why would you go for 55 hours with call and make 250-300k (minus overhead) as an IM? Not trying to start a flame war, just want to hear from people who chose the GIM route. What was your reason?

[cheech10]

A few reasons, although there are more:

- fewer calls in GIM than EM

- disliking shift work, which has both evening and overnight calls that are disruptive to one's social life

- probably most importantly, the type of work is totally different. On a GIM call, you see ~1-2 patients per hour (as new consults). In EM, more like ~5. It's a vastly different experience.

[Guest copacetic]

mednev, you need to relax man. you're getting flustered.

[Guest copacetic]

The difference between 200k and a 300k is a 50% increase in salary. I don't know about you but in my book that is a significant difference. But you are right, these are just averages, you could end up making more or less.

 

So if you can work for 35 hours and make 300k+ (with 0 overhead) as an Emergency doctor with lots of time off and no call, why would you go for 55 hours with call and make 250-300k (minus overhead) as an IM? Not trying to start a flame war, just want to hear from people who chose the GIM route. What was your reason?

 

every specialty has its pros and cons. EM isnt for everybody, sure they get shift work. but when their working its go go go, theres no telling whats gonna come through the door. EM can be very acutely stressful. There is more that goes into what people choose to do than just how much they will work and how much they will be compensated for it.

[medenv]

At least as an EM you can be compensated enough for your hard work. IM is only getting lower and lower compensation for more and more work.

 

No one answered my question about overhead for IM. Also can they "incorporate" for taxes like FM?

[A-Stark]

Any physician can incorporate. I'm not clear why you think that IM is only getting lower. Especially outside a tertiary centre, GIM provides ample opportunity for procedures and internists will gross considerably more than ERPs.

[Guest copacetic]

from my understanding you cant incorporate if you are salaried. so if you or FFS you can incorporate, but otherwise now. someone correct me if im wrong.

[medenv]

from my understanding you cant incorporate if you are salaried. so if you or FFS you can incorporate, but otherwise now. someone correct me if im wrong.

 

That's what I thought. You have to have your own practice right? Where as an EM can't because they're salaried? I guess then for GIM it depends on how they set up practice (hospitalist vs acedemic)? However it all balances out because salaried doctors generally have no overhead?

 

Is overhead for a GIM somewhere around 25%?

[cheech10]

That's what I thought. You have to have your own practice right? Where as an EM can't because they're salaried? I guess then for GIM it depends on how they set up practice (hospitalist vs acedemic)? However it all balances out because salaried doctors generally have no overhead?

 

Is overhead for a GIM somewhere around 25%?

 

Anyone on FFS can incorporate, and many ER docs are still FFS billing. Overhead depends on many things: solo/group/academic, your contract with the institution you have privileges at, whether or not you have an office outside the hospital. 25% is about right for an internist with an office component to their practice, but the variation is large.

[hp18]

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).

 

If EM docs are paid hourly salary, they must be employees of the hospital and should be covered with usual benefits like healthcare, dental, pension etc. Am I right?

[Handsome88]

Which specialty is more procedure oriented (use of technology/gadgets...etc)? I know GIM can do procedures but only outside tertiary centres and in rural areas. What about in big cities?

[A-Stark]

There are lots of community hospitals in big cities too. I wouldn't say that emerg is especially technologically oriented. There's some minor suturing, some fairly minor procedures like casting and splinting, and diagnostics like LPs. You can do a lot in IM for sure and it really comes down to the type of practice you want.

[xkittens]

how much income tax do doctors pay?

[rmorelan]

how much income tax do doctors pay?

 

complex question actually But let's say a doctor does the simplest thing and draws all earnings as income in the current year after all overhead/expenses are covered. The bunk of their income then would taxed at the highest tax rate which is roughly speaking 50%. That would be all income earned above again roughly speaking 130,000 dollars.

 

So basically in the default state they pay a lot of tax

[hking03]

how much income tax do doctors pay?

 

http://www.cra-arc.gc.ca/tx/ndvdls/fq/txrts-eng.html

 

that site should answer the most basic way of looking at tax rates for canadians.

 

if you live in BC and make 300k after overhead you'll be taxed:

 

provincially:

~7.81% first 100787.00

+

14.7% over 100787.00

 

+

federally:

27256.00 + 29% of income over 128800

 

so, if you take the above and use 300k you'll be taxed a total of:

114059.18 of your income... not including CPP/EI/Pension/RRSP contributions. I'm also not sure how overhead factors in as I'm not sure if it's realistic to gross 300k after overhead and whether or not overhead is included in your taxable income. I would think that it isn't included in your income, but rather considered a write off and could help lower your bracket a bit...

 

Anyways, the above calculations leave you with 185940.82 or about 15495.07/month... not too shabby when all's said and done.

 

I think there are ways of changing this around buy incorporating and paying dividends to family and paying yourself a lower salary, but I have no idea how it all works... I'm primarily basing that information off of what others have indicated on this site. I'd also assume that dumping money back into your "company" would lower the taxable income rate and give you some money back as well as things like RRSP contributions tax free savings accounts and the like...

 

I'll leave it to the experts, but I thought it would be fun to tackle the basic tax info to see what it worked out to.

[cheech10]

Income minus expenses equals taxable income, which is then taxed at various marginal rates. So it's in your best interest to claim as many of your expenses as you can as being business related.

 

If you are not incorporated, you owe tax on the entire profit every year. If you are incorporated, the tax rate is only ~15% for the money that stays in the business, and you pay the rest of the tax when taking the money out of the corporation. This is the big benefit of incorporating: leave the money in the corporation, deferring income tax, and allowing you to invest it while paying a low tax rate. There are also other ways to get money out of the corporation while paying little/no tax: paying dividends or salaries to shareholders is the most common.

[gb35]

So I know that it is possible to do FM, with a 1 year fellowship in EM, but can you enter that one year EM fellowship from any other discipline, like IM for instance? I am guessing the answer is no, since I have never heard of it, but I just figured I'd ask.

 

EDIT: after poking around the CaRMS website, it appears that this is not possible.

[justletmein]

So I know that it is possible to do FM, with a 1 year fellowship in EM, but can you enter that one year EM fellowship from any other discipline, like IM for instance? I am guessing the answer is no, since I have never heard of it, but I just figured I'd ask.

 

EDIT: after poking around the CaRMS website, it appears that this is not possible.

 

No, the 1 year add-on is only available in FM (be it emerg, geriatrics, obstetrics, surgery etc.....)

[gb35]

This is true. Otherwise we'd see far few people going into FM.

 

I think its funny that FM needs to have all of these add-ons to entice people to go into it.

 

How competitive is the +1 in ER? It would be a little devastating to me to match to FM, but not to ER afterwards.

 

edit: I guess I should be calling it EM and not ER. Sorry, bad habit.