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So are family doctors making more by the hour than a lot of specialists/surgeons?


medigeek

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This thread is getting off-topic. A reminder, the topic is, "So are family doctors making more by the hour than a lot of specialists/surgeons?".

 

I'd be interested in hearing more from Physicians practicing FM in rural communities. Also, I think it's important to consider the cost-of-living when looking at these numbers. I know that the home I'd like in a rural community will cost significantly less than the same home in or near a city.

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FM is extremely versatile. That does not mean family docs practice that way. I'm an IM resident, I'm married to a family physician and neither she nor very few of her colleagues do anything outside of the office. As you get into more rural areas that changes completely. My rural family med rotation at UBC was with a doc who did ER, nursiing + housecalls, and some did inpatient stuff. There was a family doc from Peace River who just gave a talk at a conference who does his own scopes. Again, I think you misinterpreted my post, as I agree with you 100% that family med is very versatile. Cheers.

 

No your post was clear

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Then your answer makes no sense. Saying family med is versatile doesn't mean people actually work in that way. All the power to you if that's what you'd like to do though.

 

You seem to be basing your argument on your wife's experience and on family physicians in Vancouver. This is an honest question: can you extrapolate this to the rest of Canada? Over 50% of the family physicians in Canada only work in an office based setting?

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You seem to be basing your argument on your wife's experience and on family physicians in Vancouver. This is an honest question: can you extrapolate this to the rest of Canada? Over 50% of the family physicians in Canada only work in an office based setting?

I would assume that the medical system in Vancouver is not unique, and it's the same if you're in Toronto, Ottawa, Hamilton, Regina, Montreal etc. Even if you wanted to, you couldn't work outside of an office in Vancouver. There are a few GP hospitalists in the suburbs, but most hospitals only hire GIM docs. You could work in the ER, but those guys/gals are CCFP-EM. Also basically 100% of them only work in the ER, so I'd consider them more of emerg docs than family docs.

 

Since most doctors work in urban environments (there is a huge shortage in rural towns, after all), I don't think that's a stretch to say at least half of them work only in offices. You sound offended by what I'm saying and I apologize for that, but I have to admit I'm not sure what exactly it is that's so offensive. Family med is an awesome career because of its diversity and I almost ranked it above IM for that reason, but that doesn't mean many family docs want that diversity.

 

Then again...Vancouver has a huge abundance of specialists because so many people want to live here, so maybe it is different elsewhere. Are you aware of any urban cities where family docs are doing more than office work?

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Agree with leviathan. Some posters here seem to focus on the outliers. Lots of things are within a family doc's scope of practice, but opportunities to practice this way are not common. Yes, there are family docs doing hospitalist work, ER, and other non-primary care work, but in major urban centres these are increasingly less common, and are unlikely to be a viable option for most new graduates in urban centres (with an exception for CCFP-EM). Likewise, a new general surgeon without additional training should not expect to be performing Whipples or other complicated cancer surgeries these days, except in very rare circumstances.

 

Similarly, and back OT, there are family docs making more than the average specialist per hour, but again these are outliers.

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GP-hospitalists practice in Halifax at the QEII (on psych units and the Community Health Unit on 8.4) and at Dartmouth General where they cover most inpatients. Outside of the city most GPs do inpatient coverage and some element of emerg and/or walk-ins and long-term care. I've never actually worked with a family doctor who did 100% office practice, but I'll grant that Lunenburg and Berwick are not typical of the urban experience. On the other hand, the staff at the North End Clinic typically do addictions and/or methadone-clinic work alongside an office practice, though my preceptor there also did emerg and surgical assist, the latter of which seems pretty common outside of academic centres.

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I would assume that the medical system in Vancouver is not unique, and it's the same if you're in Toronto, Ottawa, Hamilton, Regina, Montreal etc. Even if you wanted to, you couldn't work outside of an office in Vancouver. There are a few GP hospitalists in the suburbs, but most hospitals only hire GIM docs. You could work in the ER, but those guys/gals are CCFP-EM. Also basically 100% of them only work in the ER, so I'd consider them more of emerg docs than family docs.

 

Since most doctors work in urban environments (there is a huge shortage in rural towns, after all), I don't think that's a stretch to say at least half of them work only in offices. You sound offended by what I'm saying and I apologize for that, but I have to admit I'm not sure what exactly it is that's so offensive. Family med is an awesome career because of its diversity and I almost ranked it above IM for that reason, but that doesn't mean many family docs want that diversity.

 

Then again...Vancouver has a huge abundance of specialists because so many people want to live here, so maybe it is different elsewhere. Are you aware of any urban cities where family docs are doing more than office work?

 

In Montreal and Ottawa they do more than office work (as you pointed out earlier Mtl is in quebec so things might be different, in Mtl a family doc has to do 12-16 hours per week of non office hours if he's been working for less than 20 years or so). I am not trying to defend anything here, I'm a resident in another specialty and I never had an interest in primary care.

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How is the 95k/year salary for the Toronto school board in that document for a less populated area? The difference between there and the most remote areas is at most 5k/year.

 

How old are the teachers making 95k? (which in net income, is equal to a 2nd year resident's net income basically)

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You seem to be basing your argument on your wife's experience and on family physicians in Vancouver. This is an honest question: can you extrapolate this to the rest of Canada? Over 50% of the family physicians in Canada only work in an office based setting?

 

Unless you're an old timer, you won't be working in the hospital as a family doctor.

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Honestly, you are underestimating how much teachers & RNs make. If you take a look at the links that Wachaa posted (which is by far more credible than the #s you are quoting), it's obvious that the highest payment bracket in Ontario for teachers is basically $100k. This is not considering teachers who have worked for a significantly longer period of time, and ones who teach at summer school, grade EQAOs, etc. etc.

 

What do you consider a long time? Teachers will have worked for almost 10 years by the time one finishes a 5-year residency program. By that time many of them are at the max payment bracket. It's a $95K salary + benefits with 3+ months of vacation a year. I could go on about how much RNs make as well. Don't be so certain about claims you make about professions that you clearly don't know very well, listen to the other folks in this thread who's actually providing proof for their statements.

 

http://www.fin.gov.on.ca/en/publications/salarydisclosure/pssd/

 

No sorry you're wrong. Given the extremely minimal number of teachers on that list, I'm inclined to say that the vast majority of teachers do not make close to 100k/year. Otherwise, most night school/summer school ones would be over 100k. Which isn't even the case.

 

Last I checked by the way, schools out in july and most of august for teachers. You can't really count winter break/march break given vacation time in other careers as well.

 

Comparing a family doctor to a teacher. Well one, good luck even getting a job as a teacher nowadays... chances are you'll be 25 after you're done your masters. Compared to a 28-29 year old family doctor... I don't think there's much debate over who's gonna be doing better.

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There are quite a few family docs working as hospitalists/clinical associates on the specialty wards at the University of Alberta hospital. They're usually somewhat more advanced in their careers (aged 35-45, on average, I would guess, but not old-timey), and have left their previous office practices. Because the clinical associates often bill FFS while the specialists are on salary, I've heard that some CAs actually make close to (and sometimes more than) the specialists on their units.

 

Same for Montreal. Even big university hospitals like the jewish general have family med wards.

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Yeah, maybe not in a huge city like Toronto or Vancouver, but in any of the mid-sized cities, FMs are the hospitalists.

 

Even in Toronto, there are a fair number of family docs who work as hospitalists in the large downtown hospitals...

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Even in Toronto, there are a fair number of family docs who work as hospitalists in the large downtown hospitals...

 

you sure they didn't get those jobs like 15 years ago? and are just continuing on with it? It's not like they're gonna fire a family doc hospitalist with experience in favour of a newly graduated internal med guy.

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you sure they didn't get those jobs like 15 years ago? and are just continuing on with it? It's not like they're gonna fire a family doc hospitalist with experience in favour of a newly graduated internal med guy.

 

No, that's not how it works. The majority of the time, and from my experience going to different institutions, the hospitalist is part of the hospitalist service. They admit patients that need to be admitted (single smile organ disease, failure to cope/social issues/placement issues) but are not acute enough for Medicine or were on medicine, and their active issues have been addressed and are on course to discharge, or they may have a disposition issue and need a few more days but not necessarily stay under medicine. I've seen them admit simple pneumonias, pancreatitis that has a ransom score of <3, take our patients with multiple issues that have been addressed and are on their way to complete recovery, etc.

 

So it's an entirely different service. From my understanding, IM guys are not going for hospitalist positions. It's different than ER 2+1s competing with 5 years for the same positions.

 

Toronto Western has a strong hospitalist program (I think one of 2, the other being in Windsor, unless others have popped up recently), and they certainly have hospitalists there. Needless to say its in a big metropolitan city.

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Anyway, I think given the versatility in family medicine, I think how much you make is dependent on your competence, efficiency, and your will (one person might wanna see 5 patients an hour while an other will rush to get 8, it varies on the person).

 

But family med has potential for other stuff too, like cosmetics. One "acne specialist" doctor who lives near me, this guy had a huge patient load (and assuming he still does). Every seat in the office was always taken. But the guy was blazing through patients in like 3 minutes each it seemed. He told me he works 55 hours a week... and not to mention he did dry ice for 10$ per patient (in cash) which would be on top of his OHIP billings. One secretary and a fairly small/below average office.

 

Taking a low estimate... lets round down to 30$ billing per patient... 10 patients an hour. 300 dollars per hour, 16,500$/week... close to 700k/year if he's working 48 weeks a year. Then add on 100k to the net income (cash).

 

Anyway just an example of how if you're seeking the money in medicine, there's alternative ways.

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No, that's not how it works. The majority of the time, and from my experience going to different institutions, the hospitalist is part of the hospitalist service. They admit patients that need to be admitted (single smile organ disease, failure to cope/social issues/placement issues) but are not acute enough for Medicine or were on medicine, and their active issues have been addressed and are on course to discharge, or they may have a disposition issue and need a few more days but not necessarily stay under medicine. I've seen them admit simple pneumonias, pancreatitis that has a ransom score of <3, take our patients with multiple issues that have been addressed and are on their way to complete recovery, etc.

 

So it's an entirely different service. From my understanding, IM guys are not going for hospitalist positions. It's different than ER 2+1s competing with 5 years for the same positions.

 

Toronto Western has a strong hospitalist program (I think one of 2, the other being in Windsor, unless others have popped up recently), and they certainly have hospitalists there. Needless to say its in a big metropolitan city.

 

i was under the impression taht hospitalist wards are actually increasing in #. It's a way to lighten the load for emergency/internal medicine. esp for patients who don't really need significant internal medicine care but still can't stay outside the hospital.

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Anyway, I think given the versatility in family medicine, I think how much you make is dependent on your competence, efficiency, and your will (one person might wanna see 5 patients an hour while an other will rush to get 8, it varies on the person).

 

But family med has potential for other stuff too, like cosmetics. One "acne specialist" doctor who lives near me, this guy had a huge patient load (and assuming he still does). Every seat in the office was always taken. But the guy was blazing through patients in like 3 minutes each it seemed. He told me he works 55 hours a week... and not to mention he did dry ice for 10$ per patient (in cash) which would be on top of his OHIP billings. One secretary and a fairly small/below average office.

 

Taking a low estimate... lets round down to 30$ billing per patient... 10 patients an hour. 300 dollars per hour, 16,500$/week... close to 700k/year if he's working 48 weeks a year. Then add on 100k to the net income (cash).

 

Anyway just an example of how if you're seeking the money in medicine, there's alternative ways.

 

there are daily limits on billing in most provinces...

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Anyway, I think given the versatility in family medicine, I think how much you make is dependent on your competence, efficiency, and your will (one person might wanna see 5 patients an hour while an other will rush to get 8, it varies on the person).

 

But family med has potential for other stuff too, like cosmetics. One "acne specialist" doctor who lives near me, this guy had a huge patient load (and assuming he still does). Every seat in the office was always taken. But the guy was blazing through patients in like 3 minutes each it seemed. He told me he works 55 hours a week... and not to mention he did dry ice for 10$ per patient (in cash) which would be on top of his OHIP billings. One secretary and a fairly small/below average office.

 

Taking a low estimate... lets round down to 30$ billing per patient... 10 patients an hour. 300 dollars per hour, 16,500$/week... close to 700k/year if he's working 48 weeks a year. Then add on 100k to the net income (cash).

 

Anyway just an example of how if you're seeking the money in medicine, there's alternative ways.

 

You are not even in med school yet you talk as if everyone is oblivious. The #5 top billing GP in BC billed 990K. Your "low estimate" yields about 800k. Yes you wilk make that much if you are one of top ten GPs in rural area in your province but then again, top 10 in any specialty will make a lot...

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All this talk about money is making me sick. Don't get me wrong, money is important, but FAR from being the most important aspect of choosing a specialty. In my opinion, it's better to be a GP and maybe earn a little bit less than a specialist and love your job than be a specialist billing more money and hating his job!

 

My radiology rotation was the most boring rotation of my clerkship, I wouldn't do it even if it payed 2 million bucks per year.

 

Just my 2 c

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