Why aren't more GPs making 400k+

[NLengr]

42% is the average tax rate for that salary in Ontario, 46% is the marginal tax rate. His taxation losses were correct.

 

Throw the value of $480 000 into here and look at the column for Ontario and you'll see a take-home income of roughly $278 000.

 

http://lsminsurance.ca/calculators/canada/income-tax/taxes-2012

 

I stand corrected.

 

Hopefully though, you are incorporated, or at least get some write offs.

[Laika]

Emerg seems to make little but their hours are really cupcake too. Many of them work 10-15 eight-hour shifts a month, which comes out to 80-120hrs a month.

 

Have you ever done shift-work? Personally, I found working 40 hours/wk felt like I was working 60. I think this is part of the reason the average practice-lifespan for an emerg doc is only 10 yrs.

[Alastriss]

Have you ever done shift-work? Personally, I found working 40 hours/wk felt like I was working 60. I think this is part of the reason the average practice-lifespan for an emerg doc is only 10 yrs.

 

+100000000

 

I remember looking at my clerkship schedule for emerg and thinking 8 shifts over 2 weeks would be amazing. I hated it. Shift work is a different beast altogether - you have to experience it to know. You either love it or hate it.

[futureGP]

+100000000

 

I remember looking at my clerkship schedule for emerg and thinking 8 shifts over 2 weeks would be amazing. I hated it. Shift work is a different beast altogether - you have to experience it to know. You either love it or hate it.

 

12hr? 8hr shifts?

[NLengr]

I also found working four to five 8 hour shifts a week as a PGY1 was just as bad as an 80 hour gen Surg week.

 

Most people don't adapt well to a sporadic sleeping schedule.

[rmorelan]

+100000000

 

I remember looking at my clerkship schedule for emerg and thinking 8 shifts over 2 weeks would be amazing. I hated it. Shift work is a different beast altogether - you have to experience it to know. You either love it or hate it.

 

Yeah not a big fan and I also was only doing it for a few weeks. The problems with scheduling your entire life crop up - never a fixed time you are free, sometimes days would go by and you were just hanging on (shifts like 4pm-12, next day 10am-6pm, next day 6am to 3pm...It just felt like although you are only working 8 hours at a time all you were doing was working, eating and sleeping.)

[Legume]

Hmmm.. I've heard that many emerg docs are doing bolus-type work up front and taking the rest of the month off (i.e. 120 hours in a span of 7-10 days, then having 3 whole weeks off). That can't possibly be worse than doing 1 in 4-5 call in IM/Surgery/rad all year round and having that #$*@ with your sleep?

[Legume]

nephro/GI/cardiology/resp all work pretty long hours and share call (unless they're in a private clinic) as attendings,

GIM is pretty bad too - long work-hours + call cover

Endo/rheum are much better and call is pretty light

Med onc = probably similar to rad onc? 9-5

Rad onc = 9-5, no call

 

Ophthal probably have pretty good lifestyle -- private clinics are usually day-time hours (lots of clinics with ophthal sharing office with optometrists -- clinic hours are pretty light), idk about call and if it's busy or not.

-- but wow their overhead is HIGH 600k --> 350k

 

Obs/gyn isn't bad either, i shadowed an obs/gyn once and they start at ~9 end at ~5. They cover off-shift deliveries for each other in the clinic (So if 9 ppl, it's 1/9 call).

 

Derm is probably 9-5 (private clinic... idk what skin emergencies are there :s), but i'm surprised that derm net income is similar to FM/emerg

 

Good analysis, right on. What are the rough hours for ENT/uro/gen surg/rad/anesthesia?

 

And looking at the specialties payments again, it seems like 100k per 10 hours worked a week is a good number. GPs work 30-35 hours a week for 300k. If you were more efficient like da_birdie, and are good with computers, you can most likely bang off 450k on 36-40 hour weeks.

 

Many surgeries and IM subspecialties and anes, etc can't match the 100k per 10 hours ratio, even after they finish their trek to Mordor and back (5-7 years of residency + fellowship(s)). So my original question still remain unanswered -- why would anybody want to do those things instead of family medicine? Like other than interest, ego, willingness for personal sacrifice, and for some (?many), pipe-dreams of reaching a mountain of gold in the end, what else is there? (Alastriss is going to jump all over me again )

[rmorelan]

Hmmm.. I've heard that many emerg docs are doing bolus-type work up front and taking the rest of the month off (i.e. 120 hours in a span of 7-10 days, then having 3 whole weeks off). That can't possibly be worse than doing 1 in 4 call in IM/Surgery all year round and having that #$*@ up your sleep?

 

but in internal medicine does 1 in 4 call all the time is really rare as well - that just isn't how it is structured at a major centre.

 

I have seen some pretty extreme call schedules for surgery but that doesn't mean they were called in all the time either.

[ploughboy]

Edit: Emerg seems to make little but their hours are really cupcake too.

 

 

Yup, if there's a word that describes my life it's "cupcake"

[Gametime24]

Good analysis, right on. What are the rough hours for ENT/uro/gen surg/rad/anesthesia?

 

And looking at the specialties payments again, it seems like 100k per 10 hours worked a week is a good number. GPs work 30-35 hours a week for 300k. If you were more efficient like da_birdie, and are good with computers, you can most likely bang off 450k on 36-40 hour weeks.

 

Many surgeries and IM subspecialties and anes, etc can't match the 100k per 10 hours ratio, even after they finish their trek to Mordor and back (5-7 years of residency + fellowship(s)). So my original question still remain unanswered -- why would anybody want to do those things instead of family medicine? Like other than interest, ego, willingness for personal sacrifice, and for some (?many), pipe-dreams of reaching a mountain of gold in the end, what else is there? (Alastriss is going to jump all over me again )

 

This has been answered SO much already. In this thread and in others. Read what people post and actually think about it sometime.

[Alastriss]

See, right now, I don't blame you anymore. I blame all the other sensible people like ploughboy and rmorelan who have fed into your ignorance.

 

your brain -use it. You will need it for your apparently budding medical career.

 

It's a pretty simple answer.

 

Oh and, plastics, ophthalmology can bury anything a family dr makes. It's called running a private OR doing plastics and LASIK.

[apache]

honestly (lol, and it's obvious since i always post at night, lol) im a huge nightowl... i did 25 emerg shaddow shifts and was in love, middle of the night rocks... but i know i have a weird brain

 

psych could be insane too, if u bring in qeeg, work on even home design for adhd... bit of cbt, oh gosh, i could go on forever... and this generation of crao meds are finally outgrowing the profitability... and the next 7 years will bring smiles to patients faces... there's other things too... like, blue light glasses to filter for sleep... man o man... but i can't imagine practicing without psychopharm... ****... new mexico anyone?

[apache]

i remember my first talk about money was in second two with a clinical psych prof... he told me how to make 250 k easy... ironically, the hours aren't even close to linearly paid... you make half in 15 hours a week, the other in another 30... i love people who find tax law boring too... i used to, until well i started making boatloads from just taking percentage refunds retroactive on things no one knows about... lol, when i eventually do medicine, whether now or later... those 8 months a year will not ever give the government 40 percent... i can't believe people are complacent about such an outrageous wage... so many ways out of it,,,

 

See, right now, I don't blame you anymore. I blame all the other sensible people like ploughboy and rmorelan who have fed into your ignorance.

 

your brain -use it. You will need it for your apparently budding medical career.

 

It's a pretty simple answer.

 

Oh and, plastics, ophthalmology can bury anything a family dr makes. It's called running a private OR doing plastics and LASIK.

[Legume]

honestly (lol, and it's obvious since i always post at night, lol) im a huge nightowl... i did 25 emerg shaddow shifts and was in love, middle of the night rocks... but i know i have a weird brain

 

psych could be insane too, if u bring in qeeg, work on even home design for adhd... bit of cbt, oh gosh, i could go on forever... and this generation of crao meds are finally outgrowing the profitability... and the next 7 years will bring smiles to patients faces... there's other things too... like, blue light glasses to filter for sleep... man o man... but i can't imagine practicing without psychopharm... ****... new mexico anyone?

 

Dude what the %(#$ are you saying lol? You on drugs or something? Are you saying that psyc can make a lot of money too or..

[Alastriss]

Dude what the %(#$ are you saying lol? You on drugs or something? Are you saying that psyc can make a lot of money too or..

 

Yeah bro, psych is the new family Med. Make mad cash, work part time, and have super chill life.

 

I have no idea why anyone would huff and puff through a family med residency when all that matters is making money and having a good life like those psychiatrists. Those aspiring GP types have some messed up ego complex to choose the field.

 

The fools.

[Legume]

Haha nice one. Psyc residency is still 5 years though. I could've made 1.5 million bricks with that time if I did a family med residency.

 

Huff and puff would be an understatement for some of the IM/surgery/rad residents. They look like they rather be dead than alive and it's just painful to see. They work SO hard all year round, year after year after year. I have great respect for them though, but personally I wouldn't subject myself to that amount of workload.

[Legume]

Optho seems like they can make 1.2-1.5 per year off cataracts and LASIK, but after their obscene overhead (most likely 60% if you ran a private OR), they get to keep like 480-600k. If a GP stretched really hard billing 600-700 per year with 80-110k overhead, he can almost match these cowboys.

 

Guess what I'm trying to say is that it would be great if you can find something you love and devote to it, like Alastriss said. If you can contribute back to society and make the world a better place, even better. But a lot of kids specializing these days have $$ first and foremost on their minds too. From all the numbers I've been seeing, if $$ and lifestyle was the primary objective, family medicine is a relatively quick, efficient, and painless route.

[Alastriss]

Optho seems like they can make 1.2-1.5 per year off cataracts and LASIK, but after their obscene overhead (most likely 60% if you ran a private OR), they get to keep like 480-600k. If a GP stretched really hard billing 600-700 per year with 80-110k overhead, he can almost match these cowboys.

 

Guess what I'm trying to say is that it would be great if you can find something you love and devote to it, like Alastriss said. If you can contribute back to society and make the world a better place, even better. But a lot of kids specializing these days have $$ first and foremost on their minds too. From all the numbers I've been seeing, if $$ and lifestyle was the primary objective, family medicine is a relatively quick, efficient, and painless route.

 

I know a ophthalmologist who does 50 cataracts a day 2 x a week with a day for LASIK. Ill let you crunch the numbers.

[rmorelan]

I know a ophthalmologist who does 50 cataracts a day 2 x a week with a day for LASIK. Ill let you crunch the numbers.

 

that is exactly why we have to correct that billing schedule

[Legume]

What 'should' happen is different from what 'will' happen. What you say makes sense but I just can't see it happening to family docs, not in Canada, not in our working lifetime. Other specialties are gonna feel the axe before GPs get it and that's the reality of things.

[rmorelan]

What 'should' happen is different from what 'will' happen. What you say makes sense but I just can't see it happening to family docs, not in Canada, not in our working lifetime. Other specialties are gonna feel the axe before GPs get it and that's the reality of things.

 

well what was described isn't actually that far off some of the new funding models adopted in ontario over the past 5 years

[Wachaa]

Don't most family doctors have over 2000 patients on their roster, among those are people they rarely see? How will the $$/patient model be worse for family doctors? What will limit family doctors from enlisting 2000 patients and then cutting back their hours knowing they're already getting paid? Sorry I don't understand that method very well.

[jerkoutnow2]

Disagree with you here bro.

 

Due to the family doctors' relative ubiquity, coupled with the recent lower-level encroachment de-valuing the worth of the family doctor, their bargaining power is limited. Since they are hoi polloi of the medical profession any cut to them will have a larger net savings than cuts to smaller subspecialties like ophthalmology.

 

I tell the students I teach that family medicine will be in for a future that's more challenging than ever before. Not only will the "not-so-hidden curriculum" paint every patient and specialist encounter with the brush of regret as it does now, but the ability to work and be remunerated fairly will be compromised by pharmacists, NPs and naturopaths doing the duties that used to be those of doctors.

 

Family med has a dark future. There will be cuts. The government will drink the milkshake of the family doc.

 

What I tell my students is that if income is a factor in specialty selection, I'd stick with imaging. It's interesting, intellectual work, and even with cuts, the relative lack of overhead and fee-for-service billing model is the most financially rewarding in medicine. Lots of students understand matching to imaging is difficult, so they ask about pathology too. I tell them that pathology, imaging's ugly cousin, is no less intellectual and is a similar job but the salary model eliminates any incentives to work more and provide higher quality service, and also limits one's autonomy.

 

well that sucks,

 

40% of med students have a dark future

[da_birdie]

As it stands, family doctors are rewarded on a "fee-for-service" basis, in which they are paid for "doing" rather than for "thinking" or "being there".

 

The unfortunate consequence of this payment structure is that the modus operandi of the family doctor - the physician who cares for the whole patient and their life situation - runs counter to it. To do true family medicine, one must take time with their patients and be thoughtful of how to approach each encounter. To make money, one must have a roster of 5000 patients, see 10 patients in 30 minutes and limit patients to one problem per visit, while ordering too many tests and requesting too many consults. The dissonance is huge.

 

Family doctors should instead be paid on a roster model - namely, they are paid per patient in their roster up to a point. So, if the governmental plan funds family doctors $500 per patient in the roster and the family doc has 500 patients, this is $250,000. To make that as a family doctor today, one needs to have a roster of far more than that and see patients at a breakneck pace.

 

But what about complex patients? Perhaps the model could be based on the patient's age, their "diagnosis list" and other factors. For instance, a healthy 20 year old male is seen for $350 a year, a middle-aged man with cardiovascular risk factors is $500, and an elderly person with multiple comorbidities, or a young person with a complex medical history, is $800 or thereabouts. These numbers are ballpark and take nothing concrete into account.

 

Agreed re: FFS model rewarding speed over quality.

I see 40 patients in my 7-hour clinic day, but I know many older docs (and also some younger GP's who's out of residency for < 3 years) who see 50 pts in <5 hours. Granted many of them work in Walk-in clinics which often deal with minor issues/ Rx refills, while sending the patients back to their regular GPs for f/up of more complex problems.

 

However, WICs certainly plays an important role to provide service when the patient's regular GP is away or too fully-booked. WICs also commonly provide after-hours service which most family docs don't, offering convenience for patients and relief for ER.

 

I'm not sure how patient-rostering works in Ontario (extra lump-sum/pt/year?). As many (if not most) patients are "double-/triple-doctoring" (either via having >1 GPs concurrently or via visiting walk-ins), it might be difficult to work out a fair fee for the non-primary physician. That would also discourage GPs from working in walk-in clinics (some may say it's a good thing), which as mentioned above, do play an important role in primary care.