Why aren't more GPs making 400k+

[Legume]

Thread removed

[Gametime24]

Just a quick and realistic question for y'all. I see that the average GP income ranges from 210-260k across Canada (220 for BC). Looking at their billing schedule, pace of seeing patients (7-15 minutes each on average), and hours worked, I'm wondering why their average isn't in the 400s.

 

For example, lets say a typical GP spent 10 minutes per patient, worked 40 hours a week, worked no weekends and took the normal statutory holidays off, which comes to :

 

6 (pts per hour) x 8 (hours a day) x 250 (days a year) x $30-35 per pt = 360-420k. That's before any of the chronic disease management incentives ($125 per patient per year), comprehensive physicals, notes, ICBC insurance stuff, and other private billings which could come to at least 50-100k a year.

 

It seems that their income could easily match or overtake most of the internal medicine subspecialties, peds, psyc, path, and even some general surgeons, working way less hours (how many surgeons work 40 hours a week?).

 

So I'm wondering, why do GPs average so much lower than the calculated possibility? And what's preventing them from reaching the calculated potential?

 

I don't know a whole lot (only premed) but one would assume that it is virtually impossible to see patients all day with zero down time between patients, zero time spent writing up their paperwork, zero time doing anything else that isn't seeing a patient.

 

All this time would lower billings I assume.

[rmorelan]

Just a quick and realistic question for y'all. I see that the average GP income ranges from 210-260k across Canada (220 for BC). Looking at their billing schedule, pace of seeing patients (7-15 minutes each on average), and hours worked, I'm wondering why their average isn't in the 400s.

 

For example, lets say a typical GP spent 10 minutes per patient, worked 40 hours a week, worked no weekends and took the normal statutory holidays off, which comes to :

 

6 (pts per hour) x 8 (hours a day) x 250 (days a year) x $30-35 per pt = 360-420k. That's before any of the chronic disease management incentives ($125 per patient per year), comprehensive physicals, notes, ICBC insurance stuff, and other private billings which could come to at least 50-100k a year.

 

It seems that their income could easily match or overtake most of the internal medicine subspecialties, peds, psyc, path, and even some general surgeons, working way less hours (how many surgeons work 40 hours a week?).

 

So I'm wondering, why do GPs average so much lower than the calculated possibility? And what's preventing them from reaching the calculated potential?

 

Are you including overhead in any of these calculations? I mean that runs say 30% etc. As far as I know from looking 400K average billings is not unusual at all

[futureGP]

Just a quick and realistic question for y'all. I see that the average GP income ranges from 210-260k across Canada (220 for BC). Looking at their billing schedule, pace of seeing patients (7-15 minutes each on average), and hours worked, I'm wondering why their average isn't in the 400s.

 

For example, lets say a typical GP spent 10 minutes per patient, worked 40 hours a week, worked no weekends and took the normal statutory holidays off, which comes to :

 

6 (pts per hour) x 8 (hours a day) x 250 (days a year) x $30-35 per pt = 360-420k. That's before any of the chronic disease management incentives ($125 per patient per year), comprehensive physicals, notes, ICBC insurance stuff, and other private billings which could come to at least 50-100k a year.

 

It seems that their income could easily match or overtake most of the internal medicine subspecialties, peds, psyc, path, and even some general surgeons, working way less hours (how many surgeons work 40 hours a week?).

 

So I'm wondering, why do GPs average so much lower than the calculated possibility? And what's preventing them from reaching the calculated potential?

 

part-time working docs (Esp. docs with children)

[da_birdie]

All of the above responses are correct

 

I've been in practice for 4 years and found my pace stabilizing at 6-7 pts/hr (of course this is just an average number. There are longer 20+min visits for counselling and complex issues, and shorter 5-min visits for simple issues).

 

I feel that any more than that increases stress and decreases quality.

(the 6-7 pts/hr pace includes charting,reviewing lab reports,simple paperwork in between patients, plus little breaks here and there surfing web/FB'ing, etc)

 

I generally work 7.5 hours on my clinic days (9-4:30), that's including 30-40 min lunch break. Seeing 35-40 pts/day is routine. I rarely hit the 50 pt/day cap (BC rule), although there are a number of GPs that can hit 50 within 5 hours.

 

- Overhead is on average 25%-35% (20% if you're lucky, skilled at negotiating, or works further away from city core).

- un-insured services generally add another 5-10% to billings (for regular GP practice)

- sessional fees for GP who works in community clinics runs at ~$115/hr. (no overhead)

- hospitalists in Vancouver gets ~$120-140/hr (no overhead) (needs confirmation)

[Wachaa]

How come you don't hit the cap of 50 patients? Is it because the day would run longer?

Also, how can those GPs see 50 in 5 hours?? Won't they get sued?

[rmorelan]

How come you don't hit the cap of 50 patients? Is it because the day would run longer?

Also, how can those GPs see 50 in 5 hours?? Won't they get sued?

 

provincial cap. In BC you just cannot see more than that - or rather you can but you cannot bill beyond 50 a day.

 

As for the getting sued that is only if they are providing substandard care, and that I guess would depend on the nature of the visit and the patient.

[Wachaa]

Let me rephrase: why is it that you don't book 50 patients a day to maximize your income?

[jerkoutnow2]

Let me rephrase: why is it that you don't book 50 patients a day to maximize your income?

 

you do,

 

da_birdie just doesn't because he only works 7.5 hrs

[rmorelan]

Let me rephrase: why is it that you don't book 50 patients a day to maximize your income?

 

well you do need to maintain quality of care I guess and that can take more time - a lot of doctors average 4-6 patients an hour and may not want to work 10 hour days. Not everyone wants to work so hard as the maximize their ultimate income (I mean really, at some point that next chunk of income is far less important than the loss of free time. Where that point is is a personal choice - but at some point it just isn't worth it for most people.)

[Gametime24]

well you do need to maintain quality of care I guess and that can take more time - a lot of doctors average 4-6 patients an hour and may not want to work 10 hour days. Not everyone wants to work so hard as the maximize their ultimate income (I mean really, at some point that next chunk of income is far less important than the loss of free time. Where that point is is a personal choice - but at some point it just isn't worth it for most people.)

 

Economics talk! It's all about where the point of diminishing marginal returns is for you personally. When the opportunity cost of losing time to do things other than work (friends, family, etc) is more to you than the marginal income for those extra hours, you stop booking people. Profit is always at a maximum with the marginal revenue is equal to the marginal cost, you just need to take everything into account when thinking of the revenue and costs, so social life, etc plays into it, not just the pure money. At least for some people, for others they consider only the financial aspect, to each his own.

[rmorelan]

Economics talk! It's all about where the point of diminishing marginal returns is for you personally. When the opportunity cost of losing time to do things other than work (friends, family, etc) is more to you than the marginal income for those extra hours, you stop booking people. Profit is always at a maximum with the marginal revenue is equal to the marginal cost, you just need to take everything into account when thinking of the revenue and costs, so social life, etc plays into it, not just the pure money. At least for some people, for others they consider only the financial aspect, to each his own.

 

ha - a fellow economist Preference curves, and Pareto efficiency for the win.

 

I think a lot of people on the forum over value the money aspect - probably because we aren't sitting on piles of money etc. Natural probably, but ultimately I haven't run into many doctors that think that way. Sure they are all concerned at least to some degree about maximizing their income for the time the do spend , but not ridiculously obsessed with squeezing every last nickle out of the system. That just sounds exhausting

[jerkoutnow2]

ha - a fellow economist Preference curves, and Pareto efficiency for the win.

 

I think a lot of people on the forum over value the money aspect - probably because we aren't sitting on piles of money etc. Natural probably, but ultimately I haven't run into many doctors that think that way. Sure they are all concerned at least to some degree about maximizing their income for the time the do spend , but not ridiculously obsessed with squeezing every last nickle out of the system. That just sounds exhausting

 

maximizing utility?

[Legume]

provincial cap. In BC you just cannot see more than that - or rather you can but you cannot bill beyond 50 a day.

 

As for the getting sued that is only if they are providing substandard care, and that I guess would depend on the nature of the visit and the patient.

 

You can actually bill up to 65 patients a day by the way http://www.health.gov.bc.ca/msp/infoprac/physbilling/payschedule/pdf/7-general-practice.pdf, just that patients 51-65 pays at 50% rate.

 

da_birdie, if you don't mind me asking, what's the ballpark range that you bill annually? And also, how much stress is there in seeing 35-40pts a day (how many of those 40 patients are there for simple things like Rx refill, acne, cough&cold, migranes, etc and how many are complex problems that you actually need to think about?). How does it compare to a day's work as an internal medicine subsubspecialist?

 

And if GPs can theoretically hit 400-500K on 40 hour work weeks, I want to put forth the question of why would one -ever- want to specialize?

 

GPs:

1) Jobs anywhere in Canada, any time

2) Set your own working hours/days

3) Short training vs hellish 5-7 years of sleep deprivation/moral degradation in peds/IM/surgery/radiology/obs/you name it

4) No research or any bullsh*t interfering with your life

 

People in GI and cardio, sure they can make 600-900k but those people work like dogs (excuse the language), take 1 in 3-4 call, do consults at 2, 3, 4, 5am in the morning on people that can't even answer your questions, up in your scoping suite 645am sharp daily. Other IM subspecialties have a hard time even matching the theoretical GP income.

 

Things like peds/path/psyc/med onc pay half to two-thirds of what GPs can theoretically make.

 

Anesthesia/radiology are on par with the theoretical income but they work 60-70 hours a week (and that's after the 5 year residency + fellowship(s) + crappy job situation, ugh)

 

Gen surg can make 500-700 but the guys are spending the majority of their remaining life up in the OR. Ditto Obs/gyn. ENT and uro make slightly more and work slightly less but you are still looking at 6am mornings and 6-8pm evenings.

 

The only things I can reason to place in front of family medicine would then be Optho (gonna be cut back down to gen surg income any time), and Derm/Plastics (only if you can get out of academia/hospital work and start your own private beauty clinic, at which point you aren't even a doctor anymore).

 

-Realistic 4th year medical student

[rmorelan]

maximizing utility?

 

exactly - even though economists use income as a proxy for utility (or happiness I guess - always thought we should use that term) we shouldn't make that mistake in the real world.

[jerkoutnow2]

You can actually bill up to 65 patients a day by the way http://www.health.gov.bc.ca/msp/infoprac/physbilling/payschedule/pdf/7-general-practice.pdf, just that patients 51-65 pays at 50% rate.

 

da_birdie, if you don't mind me asking, what's the ballpark range that you bill annually? And also, how much stress is there in seeing 35-40pts a day (how many of those 40 patients are there for simple things like Rx refill, acne, cough&cold, migranes, etc and how many are complex problems that you actually need to think about?). How does it compare to a day's work as an internal medicine subsubspecialist?

 

And if GPs can theoretically hit 400-500K on 40 hour work weeks, I want to put forth the question of why would one -ever- want to specialize?

 

GPs:

1) Jobs anywhere in Canada, any time

2) Set your own working hours/days

3) Short training vs hellish 5-7 years of sleep deprivation/moral degradation in peds/IM/surgery/radiology/obs/you name it

4) No research or any bullsh*t interfering with your life

 

People in GI and cardio, sure they can make 600-900k but those people work like dogs (excuse the language), take 1 in 3-4 call, do consults at 2, 3, 4, 5am in the morning on people that can't even answer your questions, up in your scoping suite 645am sharp daily.

 

Things like peds/path/psyc/med onc pay half to two-thirds of what GPs can theoretically make.

 

Anesthesia/radiology are on par of the theoretical income but they work 60-70 hours a week (and that's after the 5 year residency + fellowship(s) + crappy job situation, ugh)

 

Gen surg can make 500-700 but the guys are spending the majority of their remaining life up in the OR.

 

The only things I can reason to place in front of family medicine would then be Optho/Derm/Plastic (and only if you can get out of academia/hospital work for the latter 2 and start your own private beauty clinic, at which point you aren't even a doctor anymore)

 

-Realistic 4th year medical student

 

i think 400~500k is a bit of a stretch, 300~mid300s is probably reasonable,

 

but still, it's good lifestyle + good income

 

i'm pretty sure you're asking a rhetorical question regarding why would anyone want to specialize? but i think one of the reasons is 'prestige', especially with the typical ugrad medical education being taught by specialists who bring up clinical mistakes FPs make to illustrate a point that you should know this...

 

plus most med students just want to be an 'expert' in one thing, and the typical FM stereotype doesn't help the situation

 

it is the ideal job, but i guess med students are a different crowd (typical type A)

[Legume]

i think 400~500k is a bit of a stretch, 300~mid300s is probably reasonable,

 

but still, it's good lifestyle + good income

 

i'm pretty sure you're asking a rhetorical question regarding why would anyone want to specialize? but i think one of the reasons is 'prestige', especially with the typical ugrad medical education being taught by specialists who bring up clinical mistakes FPs make to illustrate a point that you should know this...

 

plus most med students just want to be an 'expert' in one thing, and the typical FM stereotype doesn't help the situation

 

it is the ideal job, but i guess med students are a different crowd (typical type A)

 

Thanks for your thoughtful reply. If you see the first post in this thread, the calculations come out to be 360-420k + 50-100k. What are some reasons that GPs aren't hitting this theoretical income? (40 hours a week and 6 patients an hour are quite reasonable..). And if one chose to work 56-60 hours a week as a GP (clinics 7 days a week), can they be looking at 600-650k?

 

And in terms of 'prestige', there isn't much of that on my mind when I'm on a 27-30 hour shift on a freaking Sunday, knowing that I go home for a few hours and have to come right back 7am tomorrow. There are better things I'd like to do with my life.

[Lactic Folly]

Well, one could as easily ask why family medicine vs dentistry/NP/other careers with shorter training periods (multiple past threads come to mind). Your analysis has not accounted for intrinsic motivators (job satisfaction) that also play a large role in work-related happiness, once a certain level of income has been met.

 

It's great that you enjoy FP, but despite working 9-3:30 on my urban family medicine rotation with a 5 minute commute, it wasn't an ideal fit for me, and I now arrive at and leave the hospital considerably more energized because I really enjoy what I do - it has never been hellish, not for a second.

 

It's really all in one's individual perspective. Some enjoy learning and research (enough to go for the MD/PhD even), and in that respect I view my time in residency as a singular opportunity to devote oneself to learning one's craft, with backup always available if needed, and minus the extra responsibility and duties of staff.. will miss it when it ends.

 

And in terms of 'prestige', there isn't much of that on my mind when I'm on a 27-30 hour shift on a freaking Sunday, knowing that I go home for a few hours and have to come right back 7am tomorrow. There are better things I'd like to do with my life.

 

Medical student or residency hours =/= staff lifestyle

[bloh]

All of the above responses are correct

 

I've been in practice for 4 years and found my pace stabilizing at 6-7 pts/hr (of course this is just an average number. There are longer 20+min visits for counselling and complex issues, and shorter 5-min visits for simple issues).

 

I feel that any more than that increases stress and decreases quality.

(the 6-7 pts/hr pace includes charting,reviewing lab reports,simple paperwork in between patients, plus little breaks here and there surfing web/FB'ing, etc)

 

I generally work 7.5 hours on my clinic days (9-4:30), that's including 30-40 min lunch break. Seeing 35-40 pts/day is routine. I rarely hit the 50 pt/day cap (BC rule), although there are a number of GPs that can hit 50 within 5 hours.

 

- Overhead is on average 25%-35% (20% if you're lucky, skilled at negotiating, or works further away from city core).

- un-insured services generally add another 5-10% to billings (for regular GP practice)

- sessional fees for GP who works in community clinics runs at ~$115/hr. (no overhead)

- hospitalists in Vancouver gets ~$120-140/hr (no overhead) (needs confirmation)

 

Da birdie would you be comfortable giving us an idea what you take home after expenses? And how many weeks of vacation do you take each year?

 

From my experience in clerkship, it's a completely different mindset working in a clinic (where time is money) and the wards (where it usually isn't). And I find there's a lot of pussyfooting with wardteams where someone that's determined to get things done could really be a lot more efficient at it.

[NLengr]

You can actually bill up to 65 patients a day by the way http://www.health.gov.bc.ca/msp/infoprac/physbilling/payschedule/pdf/7-general-practice.pdf, just that patients 51-65 pays at 50% rate.

 

da_birdie, if you don't mind me asking, what's the ballpark range that you bill annually? And also, how much stress is there in seeing 35-40pts a day (how many of those 40 patients are there for simple things like Rx refill, acne, cough&cold, migranes, etc and how many are complex problems that you actually need to think about?). How does it compare to a day's work as an internal medicine subsubspecialist?

 

And if GPs can theoretically hit 400-500K on 40 hour work weeks, I want to put forth the question of why would one -ever- want to specialize?

 

GPs:

1) Jobs anywhere in Canada, any time

2) Set your own working hours/days

3) Short training vs hellish 5-7 years of sleep deprivation/moral degradation in peds/IM/surgery/radiology/obs/you name it

4) No research or any bullsh*t interfering with your life

 

People in GI and cardio, sure they can make 600-900k but those people work like dogs (excuse the language), take 1 in 3-4 call, do consults at 2, 3, 4, 5am in the morning on people that can't even answer your questions, up in your scoping suite 645am sharp daily. Other IM subspecialties have a hard time even matching the theoretical GP income.

 

Things like peds/path/psyc/med onc pay half to two-thirds of what GPs can theoretically make.

 

Anesthesia/radiology are on par with the theoretical income but they work 60-70 hours a week (and that's after the 5 year residency + fellowship(s) + crappy job situation, ugh)

 

Gen surg can make 500-700 but the guys are spending the majority of their remaining life up in the OR. Ditto Obs/gyn. ENT and uro make slightly more and work slightly less but you are still looking at 6am mornings and 6-8pm evenings.

 

The only things I can reason to place in front of family medicine would then be Optho (gonna be cut back down to gen surg income any time), and Derm/Plastics (only if you can get out of academia/hospital work and start your own private beauty clinic, at which point you aren't even a doctor anymore).

 

-Realistic 4th year medical student

 

You must be at Western.

 

In the normal world(Western excluded due to the love of working yourself to death) I don't know any Uro or ENT staff starting at 6 and working 12-14 hour days on a regular basis. Hell, I can't even think of many GSx or Ortho staff pulling those hours regularly.

[NLengr]

You can actually bill up to 65 patients a day by the way http://www.health.gov.bc.ca/msp/infoprac/physbilling/payschedule/pdf/7-general-practice.pdf, just that patients 51-65 pays at 50% rate.

 

da_birdie, if you don't mind me asking, what's the ballpark range that you bill annually? And also, how much stress is there in seeing 35-40pts a day (how many of those 40 patients are there for simple things like Rx refill, acne, cough&cold, migranes, etc and how many are complex problems that you actually need to think about?). How does it compare to a day's work as an internal medicine subsubspecialist?

 

And if GPs can theoretically hit 400-500K on 40 hour work weeks, I want to put forth the question of why would one -ever- want to specialize?

 

GPs:

1) Jobs anywhere in Canada, any time

2) Set your own working hours/days

3) Short training vs hellish 5-7 years of sleep deprivation/moral degradation in peds/IM/surgery/radiology/obs/you name it

4) No research or any bullsh*t interfering with your life

 

People in GI and cardio, sure they can make 600-900k but those people work like dogs (excuse the language), take 1 in 3-4 call, do consults at 2, 3, 4, 5am in the morning on people that can't even answer your questions, up in your scoping suite 645am sharp daily. Other IM subspecialties have a hard time even matching the theoretical GP income.

 

Things like peds/path/psyc/med onc pay half to two-thirds of what GPs can theoretically make.

 

Anesthesia/radiology are on par with the theoretical income but they work 60-70 hours a week (and that's after the 5 year residency + fellowship(s) + crappy job situation, ugh)

 

Gen surg can make 500-700 but the guys are spending the majority of their remaining life up in the OR. Ditto Obs/gyn. ENT and uro make slightly more and work slightly less but you are still looking at 6am mornings and 6-8pm evenings.

 

The only things I can reason to place in front of family medicine would then be Optho (gonna be cut back down to gen surg income any time), and Derm/Plastics (only if you can get out of academia/hospital work and start your own private beauty clinic, at which point you aren't even a doctor anymore).

 

-Realistic 4th year medical student

 

You must be at Western.

 

In the normal world(Western excluded since they tend to work way crazier hours than other places) I don't know any Uro or ENT staff starting at 6 and working 12-14 hour days on a regular basis. Hell, I can't even think of many GSx or Ortho staff pulling those hours regularly.

 

That being said, if I had my time back I'd give dentistry a long, hard look.

 

Also are many 40 hr/wk GP's making 500k? I would imagine the 500k ones work more hours.

[Legume]

Also are many 40 hr/wk GP's making 500k? I would imagine the 500k ones work more hours.

 

Hmm.. how much do you think 40hr/wk GPs can make and which province are you in?

[Legume]

You must be at Western.

 

In the normal world(Western excluded since they tend to work way crazier hours than other places) I don't know any Uro or ENT staff starting at 6 and working 12-14 hour days on a regular basis. Hell, I can't even think of many GSx or Ortho staff pulling those hours regularly.

 

I don't know man. I'm in western Canada actually. Many gen surg teams start rounding at 545am in this city and OR can go till 11pm quite often. Call teams go straight through to the AM and have a normal work day (till 6pm) after. One in 2-4 call.

 

I said that gen surg 'can' make 500-700 but that's on 70-80 hour weeks (11-14 hour days a day, 7 days a week). They average more like 450 because they tap out at lower hours (10-11hrs a day x 5-6 days a week?). And if they average 450, I question why don't one just be nice to himself and his family and just work 40 hr/wk as a GP?

 

My main question and main point of making this thread is to ask the you other smart beings out there why GPs only average in the low 200s, when the billing schedule clearly allows them to make much more than that?

[Legume]

Are you including overhead in any of these calculations? I mean that runs say 30% etc. As far as I know from looking 400K average billings is not unusual at all

 

I think the overhead is not a fixed % but a fixed number. It's gonna be 70-100k whether you made 150 or you made 550 (probably 5-7k higher if you made 550 for more equipment used, staff overtime, etc. The monthly rent, water, property tax (if you bought your office) is the same whether you saw 1 pt a day or 100 a day). People always talk about 25-30% and that sounds really scary, but I think it only apply to GPs that made 250k-ish. When you start billing 400-500k it's more like 15-20% imo.

 

Which begs the question.. why aren't more GPs billing 400k+? (their average is in the low 200s in most provinces) Are they just lazier than other specialists or..

[da_birdie]

Let's start with the key reasons I chose Family Med

- portability/mobility: being a big-city type, while gf also resided in Vancouver, I preferred a specialty which allows me to work & "grow root" at any city of my choice immediately after residency.

 

- flexibility of schedule: can work as much/little as I like. Don't have day-night reversal. Being a habitual night-owl, I needed a job where I can start my day relatively later (9-10AM). Vacation as much as I like (especially for locums/group practice).

 

- flexibility/variety of practice style/niche: clinic / hospital / mixed. Regular GP work, OB, hospitalist, GP-anes, CCFP-EM, sports med, palliative care, refugee clinic, community clinic, Nursing home MD, cosmetic practice, etc.

 

- low acuity/risk: I can get my adrenaline rush from my other hobbies. I preferred a low risk/stress job. Always having ER/referral as one management option is reassuring to some, including me.

 

- continuity of care / patient rapport

 

- breadth of skills: versatile, well connected with specialists and community resources (so can be a good resource for friends and family).