GPs have super low income

[Legume]

Thread removed

[justletmein]

I'm not sure that you can call 175-200K gross a "super low income".

 

You are not saying anything new by pointing out that GP's have lower income than specialists.

 

If you want to compare with surgeons, though, then I would ask the question: How much $$$ is your quality of life worth to you?

 

P.S. Surgeons are, like most doctors, not "employees" of the hospital. They do not get benefits, paid vacation, etc. Not sure who is feeding you that info.

[A-Stark]

The only physicians who receive pensions, paid vacation, or other benefits are salaried employees in public health, government, and some laboratory specialties (pathology, med micro, etc.). Everyone else is an "independent contractor" regardless of whether they are paid classical fee-for-service or some kind of AFP.

[thebouque]

I wish pathology had those benefits A stark. Maybe they do in a few places but clearly not everywhere

[A-Stark]

Well I stand corrected. I know in Ontario (everywhere?) they're considered employees so they end up on the "sunshine list".

[thebouque]

Does the L4e system ring a bell?

[A-Stark]

Nope - what is it?

[rmorelan]

I feel like doing a thought experiment

 

Using the same article

 

Specialists in B.C. have gross, average, fee for service billings of $308,061, compared to the national average of $311,171. Which by their math is about 80K more than a family doctor. Often the overheads are very similar (there is a recent thread about that out there actually )

 

Let's look at everything - specialists work more hours than a FD - that is isn't just something we can guess about - the CMA career page states the hour ranges. Usually it is at least 10 more hours a week over a FD.

 

Next a FD requires 2 years of residency training vs at least 5 years for specialist - now I am going out on a limb here and point out that many of these specialists require a fellowship - I don't know the exact number but tones of internal docs, the vast majority of surgeons, and so on do. Some do more than one or the fellowship is more than a year as well. I am just going with 4 years of additional training over a FD.

 

we have to bring in those extra hours into the picture - to get them prorated back to the same wage per work hour you have to effectively drop most specialists pay by about 10-20%. You can argue that point of course - but I would point out as FD there is NOTHING stopping you in particular from working more (in fact if you do your overhead as a % would fall) - I just want to compare apples to apples - two different types of docs working the same amount of hours per year post training. If you do that we would either increase the effective FD salary by 10-20% or drop the specialist down by about around the same. I will go with about 15% and just up the FD salary to equate the two. That actual ups effectively FD salaries to about about 260K gross. I am doing this because if you primary motivation is money then you would be exactly the sort of person that would work those extra hours. The true difference is gross billings is about 50K a year then for equal work. I also should say that often as a specialty you cannot "work more" in many fields - OR time is capped, the hospital clinics only run for so long.....

 

I am ignoring in all of these the bonuses some provinces give doctors for meeting specific heath targets or upgrading their systems (like an EMR). That is not covered in gross billings and pretty much is only a FD thing. I probably shouldn't- there is good money in all of that, they have NO overload associated with them really - but they are less predictable. I am also ignoring all the things a FD could bill for that is not directly to the government and thus not gross billings either - most other docs (with some very important exceptions) cannot do that. I really should be careful about that though because that 50K gross billings isn't much of a gap to overcome and if I even knock 20K out of that something interesting happens. I am also ignoring that a lot of people went into FD knowing there was a lower income because they wanted some of the benefits - point being their are different characteristics between the two groups - if you are going purely for money you are an outlier in the FD group so the raw stats apply to you less. All of this underestimates the income of a FD potentially if that is your main concern.

 

In my vanilla example of 50K prorated per hour work gross billing difference. This means that for each year of that extra training means the specialist has to work about 5-6 years to make up the money the FD made (that 50K a year thing again and they make about 300K a year) ignoring overhead for just a bit (if you look at this you will see why - overhead is not that much different overall and if you know what these people do you will understand way). Those four years cost them about 20-24 working years to catch up (I am ignoring the residency wage for all of this over those extra 4 years as yes you make 50-70K but you are killing yourself so much and often going further into debit during this time. Plus you have to move to do the fellowship usually - it is just messy)

 

You are about 31 as a specialist if you are quick - 17 university - 21 med school 25 residency - 30 fellow - 31 done. I am ignoring grad school completely in this. 20+ years later or so you are into your fifties. Then you enjoy 15-20 years surplus income at again prorated 50K a year - it is a good chunk of money no doubt but there is a price to pay for it -

 

There is no guarantee you can get a particular specialty. It is great to say be a plastic surgeon but with an average of 50% success rate of people really, really training to get it (smart motivated people) you cannot ignore the risk.

The job market - particular for the higher paying ones - is not great, getting worse.

The government is looking at cutting fees in the higher paying ones - it has already begun doing so.

You may not get to live where you want and have less flexibility in your practise. To be fair FD is becoming like at to a point as well but just not as extreme.

You have to put up with a mountain of politics and administration at the hospitals you work.

Let's talk about call and how most people don't consider it a plus

 

Is it worth it? Maybe! But there is a reason 40+% of my class is going for family medicine. It isn't because they are lazy or insensitive to income - three people I know going into family medicine this year have an MBA, finance degree and another a phd in math. These are the sort of people that know how to play with the numbers (way better than me with my lonely economics degree )

 

Now I during all of these was just using the average cases - you can pull up the high end specialty and say if you could get that I would be doing amazingly well. You are right! - and you may be able to do that. The point is just that it is not a sure thing, the job market often not good and not going to improve in a big hurry (in the analysis above you lose even one or two years due to under employment and the numbers line up even). People like to say some of that is because the old docs didn't retire due to the stock market crash in 2008 - we guess what? The stock market has completely recovered since then, and those docs now need even 5 years less retirement income because they just worked five more years. Yet there doesn't seem to be mass retiring happening everywhere. I cannot say why for sure except that doctors often don't like to retire - their self worth is tied up in their jobs where they are kings in the sandboxes, the work is interesting to them, and well they are getting paid

 

---------------------

 

Also I should say again - surgeons don't get "paid vacations, health insurance, liability insurance, retirement funds, all that jazz". Actually they get none of that at all unless they pay for it themselves.

[rmorelan]

I must be trying to tie with muse on the length of a post

[NLengr]

The only physicians who receive pensions, paid vacation, or other benefits are salaried employees in public health, government, and some laboratory specialties (pathology, med micro, etc.). Everyone else is an "independent contractor" regardless of whether they are paid classical fee-for-service or some kind of AFP.

 

You can elect to be salaried in other specialties, but most do not since the difference in pay is not worth the gain in benefits.

 

At medium centers, many Peds sub specialists may be salaried if there is not enough volume to be FFS.

[Legume]

The only physicians who receive pensions, paid vacation, or other benefits are salaried employees in public health, government, and some laboratory specialties (pathology, med micro, etc.). Everyone else is an "independent contractor" regardless of whether they are paid classical fee-for-service or some kind of AFP.

 

Hmm it seems to me a lot of surgeons are paid like a 150-200k salary to be affiliated with the hospital/university, and then they can bill FFS on top of that for the work they do. And with that university affiliation comes vacation time, health benefits, retirement benefits, etc. At any rate, things like medical oncology, radiation oncology, path, hospitalist, etc, etc and many other specialties do have full salary and full benefits while having 0 overhead, no?

[Legume]

rmorlean brings up a lot of good points. But if you look at it from the other perspective, specializing is only 2-4 more years compared to family medicine. What's 2-4 more years when most of us (?everybody) have been in school for 22-28 years (K-12 + bachelors + ?MSc/PhD + 4 years med school + 2 years residency minimum)? Plus, residency pays quite well anyways. 5 years of residency can easily add up to 300 grand of income. If you aren't wasteful (renting in expensive places, eating out 3 meals a day, etc, etc), you don't necessarily have to come out of residency with any debts.

 

Plus, many GPs these days are doing 6-18 months of extra fellowship training in palliative, emerg, obstetrics, anesthesia, etc etc. That'd bring their residency total to 3.5 years. Pretty close to a true specialization already.

[NLengr]

Plus, residency pays quite well anyways.

 

I would say it pays. Not pays quite well.

 

Given the hours and the level of responsibility it actually pays terribly. Plus you get nickel and dimed to death by everyone.

 

I agree that for a single person with no kids and manageable debt you can probably come out with no extra debt. Of course, this is probably site specific to a degree.

[rmorelan]

I would say it pays. Not pays quite well.

 

Given the hours and the level of responsibility it actually pays terribly. Plus you get nickel and dimed to death by everyone.

 

I agree that for a single person with no kids and manageable debt you can probably come out with no extra debt. Of course, this is probably site specific to a degree.

 

absolutely true I think - I mean often life does happen in residency (marriage, children with all that expense, whatever car you had probably will die) so many do have problems keeping debit under control etc. Plus there is a lot of temptation - you know you will be making a good income very soon, the banks will give you more money, and you are surrounded by other people living quite well. Plus friends etc who are not doctors are now well into their productive careers. Plus stressed out people often spend a bit more on things to enjoy whatever they can.

 

You can save but I can see why that would be relatively rare.

[rmorelan]

rmorlean brings up a lot of good points. But if you look at it from the other perspective, specializing is only 2-4 more years compared to family medicine. What's 2-4 more years when most of us (?everybody) have been in school for 22-28 years (K-12 + bachelors + ?MSc/PhD + 4 years med school + 2 years residency minimum)? Plus, residency pays quite well anyways. 5 years of residency can easily add up to 300 grand of income. If you aren't wasteful (renting in expensive places, eating out 3 meals a day, etc, etc), you don't necessarily have to come out of residency with any debts.

 

Plus, many GPs these days are doing 6-18 months of extra fellowship training in palliative, emerg, obstetrics, anesthesia, etc etc. That'd bring their residency total to 3.5 years. Pretty close to a true specialization already.

 

 

Oh it wasn't the time I was worried about - I wasn't trying to make an economic argument that way. It was more that simply factoring everything FD is more attractive than it first seems. I won't mind living as a resident a few years longer, but I would be foolish to ignore that there is am opportunity cost for doing so.

 

In Ontario five years of residency earns you 313,410.00 more or less, not including income from call etc. Not that bad at all if you are careful (with taxes, deductions, etc by my math that is about 250K after tax thanks to that huge tuition tax credit most of us will have).

[The Journey Man]

From my recent research I see that GPs average between 200-250k across Canada (http://blogs.vancouversun.com/2009/12/01/what-doctors-in-b-c-and-canada-earn/, http://blogs.vancouversun.com/2013/01/22/what-doctors-in-b-c-and-canada-earn-what-your-doctor-makes/, and many other sources. I'm sure you can find a bunch if you just Google up average Canadian physician income). Conservatively speaking, with a 30% overhead (which is on the lower end), GPs only make 140-175k. I don't even want to calculate their post-tax income, too depressing. I personally know a handful of pharmacists that make that amount.

 

Surgeons reportedly average between 400-500k, double the GPs. If you discount the overhead (hospital employees pay none), they easily triple the GPs. Plus they get paid vacations, health insurance, liability insurance, retirement funds, all that jazz.

 

I think the straight multiplication math in my previous thread can't be applied to real world situations, or else GPs would be making way more than the concrete, recorded numbers. For example, paediatrics is well known to be one of the lower paying specialties. If we did straight math on paediatricians: if one just saw 6 consults and 12 follow ups per day, they'd make (6 x $220 + 12 x $35) x (250 work days) = $435,000 per year. No calls, no overtime, no working holidays/weekends. That sounds pretty sweet if you ask me. But that's not what happens in reality with paediatricians, not by a long shot. So perhaps we can't just calculate potential physician incomes with straight math.

 

GPs seem to be the lowest end of the spectrum. An ophthalmologist/plastic surgeon can make 10 years of GP's income in 1 year.

 

Any thoughts?

 

You can make a lot as a GP. It depends on how efficient you are and how many extra services you do. It's just so happens that many GPs work part time, only do office practice so that skews the averages by a lot.

 

Furthermore, many are inefficient at billing and with their office visits. Many are not willing to take on more lucrative things because of lifestyle issues.

 

GPs have some of the lowest stress and best lifestyles comparable to Derm. Its a pretty sweet deal actually for a pretty lower stress 2 year residency. If you work hard like many other specialists, you can make specialist money without too much issues without the same specialist problems (job outlook etc..)

 

A lot more people are considering family med because of lifestyle if uscale ack on work hours with potential to make a lot if u want if you work a lot. 30% overhead is average or high end not conservative.

 

I'm not in Family med and sometimes jealous of their lifestyle and ability to finish quickly but think that in the long run will be happier as a specialist despite the greater sacrifice.

[tooty]

i think you should give up this crusade Legume. those averages say nothing about how much each individual works.

 

have you spoken with any family physicians directly about these figures or do you rely on newspaper articles for your research?

[Legume]

I think the average means -everything-. How else do you gauge how much a profession makes? You can't expect everybody to be a statistical outlier. Ya I've worked with a whole bunch of family physicians and their pay ranges from 140k-350k. I've also worked with a bunch of surgeons and their pay ranges from 300-800k. I've looked up 30 ophthalmologists and their pay ranges from 900k - 2.2 mil.

[tooty]

how did those family docs make 350k?

[Jochi1543]

how did those family docs make 350k?

 

You can bill that if you're a rural GP with ER/inpatient coverage.

[ubcredfox]

If you are billing FFS, then working as a GP pretty much sucks -- I would say that if you are doing only office then you are looking at roughly $240K / year minus approx. 20% overhead if you work 5 days a week and bill approx. $1000/day (that's about 30 patients / day). The working day is usually 6 hours long in terms of seeing patients, with another two tacked on for dealing with paperwork labs etc.

 

ER usually pays approx. $2000/shift (8 hours) depending on where you are, so you can make quite a bit more if you are willing to do ER. In terms of bang for the buck, ER is where it is at (IMO).

 

Now having said the above, I'd really caution people into interpreting salaries strictly at face value.

 

On call time (i.e. being in a state of permanent crisis) is rarely worth what you are paid to do it, and as a specialist you are certainly going to be doing much more call then a GP. There is no hospital that I know that will hire you without on-call coverage requirements.

 

Further, and this is especially true for surgical or procedural specialties, the amount you make is proportionate to how much OR time you have. This is under the direct control of the RN-cum-MBA high school dropouts whos only real prerogative is making sure health care austerity looks good on a spreadsheet. If this can be done by cutting OR times, why not?

 

So ya, while you are making more in the end, think of how much time you are investing to make that amount of money and work it out on a per hour basis. The eye docs have it nailed -- sure, but the surgeons? I don't think so. Not for the hours they are putting in.

 

And to finish - I knew a surgeon in a small community who was making $700K / year. Single. With cat. And pretty miserable to boot. I'd rather make a third of that, and do whatever the hell I feel like.

 

That's the beauty of family medicine. If you don't like what you are doing, and where you are doing it, then quit and find something better. There are few specialists that can just drop their jobs and walk. And if you can't do that, then you've lost quite a bit of control over your own existence.

 

And lastly, yes, you make total crap billing FFS as a GP. Sure. But, there's always ways to branch out and do different stuff: cosmetics, derm, minor procedures, travel consulting. Things that are ridiculously easy, varied, and usually well paid b/c you can bill privately. I think there are few specialties in medicine like fam where in Canada (as of now) you can bill privately for a LOT of stuff. Especially in Ontario where OHIP is insuring less and less it seems.

[tooty]

thanks jochi i'm well aware. the rural docs i worked with bill well beyond that actually.

 

i'm curious about what legume found.

[Legume]

how did those family docs make 350k?

 

Hmm my 350k preceptor worked 9-5 Mon-Fri with 1-3 hours of paperwork after office closing everyday.

[tooty]

what kind of hours did your 300k surgeons work?

[Legume]

The 300k surgeon worked like 3 days a week with one of them being an OR day.

 

The 700k surgeon had 2 OR days a week, 7-5pm. On non-OR days he has clinic days where he starts at 930am and finishes at 3pm. Consults take like 5 minutes and he bills $200-250 for each one. "Ok you have a hernia (Dx already stated on the GP referral letter). Cough cough palpate cough stand up lie down ok we are done! Surgery in 6 weeks sounds good? K bye!" Or like, "Oh you got perianal pain. Let's take a look (no history at all). Looks like pilonidal abscess. Surgery 6 weeks K? Ok bye!"

 

He has like one in 7 call but there's 2 residents (1 Sr 1 Jr) on call with him every shift so he never gets called during his shifts -- residents handle all the business and put the consults under his name.

 

He also has a clinical associate professor position with the university, with which comes a 120-130 grand salary from them (I looked him up on the university payroll).