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GP side projects/supplemental income

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Hey I'm an R2 in family.  I'm rolling a few ideas around for something NON R3 that I could do to spice things up when I get practicing and maybe find something extra income without selling my soul (ie. something that actually meets a medical need.  i.e. not cosmetics)  I am sure this has been discussed before but I was hoping to get an updated list of some things you guys have seen and hopefully we can get some ideas that are new. 

 

Add something new or add detail to anything you see on my list that lacks and I will try to update it on my first post.  Specifics are awesome (income numbers or where to get certified for something etc)

 

For the category of pay I have kind of just been arbitrary.  

$ = Roughly regular GP office work

$$ = more but not double

$$$ = A lot

$$$$ = Surgeon money

$$$$$ = ?

$$$$$$ = Rapper

 

 

What: Sports med

Training required: Diploma.  (Minimum number of hours as a GP, then pay a fee and take an OSCE type exam)

Pace: Pretty chill

Pay: $$ 

Other considerations: Work with athletes can be rewarding and frustrating.  Depending on your community, potential for lots of "less than appropriate" referrals (old folks with chronic MSK issues vs actual SPORTS med)

 

What: Cosmetic injections (botox, fillers etc)

Training required:  Pay $ and do a course.  Not sure how much and for how long.  ("Thousands" Source: Silverjelly)

Pace:

Pay: $$$$ (or so I imagine?)

Other considerations:  You are slime and you know it.  jk

 

What: Surgical assistance

Training required: no extra

Pace: Pretty chill 

Pay:$

Other considerations: Pretty obvious.  Nice if you like it and the OR staff are good.  Can wreck your office day/plans if surgery goes longer.

 

What: Prolotherapy (Dextrose trigger point injections)

Training required: 

Pace:

Pay:

Other considerations:  Emerging for chronic pain.  Not sure of the latest research.  

 

What: GP Dermatology

Training required: Diploma.  (A few ways to do it.  Seems most are minimum number of hours as a GP, bunch of online coursework, exams)

Pace: Busy

Pay: $$-$$$ I think?

Other considerations:  No GP knows anything about skin so you are a bit of a pimp.  Lumps and bumps clinics are awesome if you like to keep procedural skills buff.  

 

What: Urgent care center shifts

Training required: no extra (I think)

Pace: Usually very hectic

Pay:$$$ ($800-1000 per 8 hr shift in some places w no overhead)

Other considerations:  No overhead.  ER type excitement with no long term relationship.  Limited by equipment present/level of care/number of beds etc.  Usually no overnight work!  Sessional or FFS.

 

What: Addictions

Training required: Fellowship or nothing.  (St Pauls has a 1 year, I think RCH has one too)

Pace: Slow

Pay: $$

Other considerations: Sessional.  Methadone and suboxone licence can be valuable.  Meets a huge need.  Potential for very personally rewarding work if you are a patient person.  

 

What: GP Oncology

Training required:  CCFP only?  No extra training?  (Source: Real Beef)

Pace: I'm guessing pretty chill

Pay: $$$-$$$$

Other considerations:  See Real Beef's post below.  

 

What: Teaching med students or residents

Training: No extra

Pace: You decide

Pay: Lectures $.  Taking on a student $$-$$$

Other considerations: You can be the preceptor you always hoped for when you were a dirty 3rd year.  Or, on the other hand, you can make the poor young suckers pay for all the shame based learning you got by dishing it out on them.  (Please don't do this) 

 

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1) I met a FP who worked in a Oncology Well Clinic. She told me she is able to bill using specialist codes, no extra training. No idea how she got in on this program and would be limited to areas where the volume was such that oncologists have enough volume to only see the later stage/non-curative patients.

 

"The Model of Care Delivery for cancer patients is evolving, particularly with regard to the follow up of patients who have completed potentially curative therapy for early-stage cancers. It is now well-recognized that the care of these patients can be handled equally well by a Family Physician rather than an Oncologist.

 

Since September 2010, the Regional Cancer Program has been home to a Well Follow-Up Clinic, staffed by Dr. XXXXXX, a Family Physician in Oncology. Dr. XXXX provides follow-up care for patients with early-stage melanoma, breast, colorectal and kidney cancer, who have completed curative therapy. These patients are referred to the Clinic by their Oncologist, who remains available for consultation when needed. Patients have expressed a high level of satisfaction with their care in the Well Follow-Up Clinic, which continues to expand to meet demand." 

 

Pay= $$$-$$$$

Training= ??, MD I know has her CCFP and no other certifications though has a special interest in oncology.

 

2) Teaching at medical school. My understanding is our school pays MDs $500 for half day for certain sessions and $200/hr for lecturing. Other schools are similar likely.

 

Pay = $$

Edited by Real Beef

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1) I met a FP who worked in a Oncology Well Clinic. She told me she is able to bill using specialist codes, no extra training. No idea how she got in on this program and would be limited to areas where the volume was such that oncologists have enough volume to only see the later stage/non-curative patients.

 

"The Model of Care Delivery for cancer patients is evolving, particularly with regard to the follow up of patients who have completed potentially curative therapy for early-stage cancers. It is now well-recognized that the care of these patients can be handled equally well by a Family Physician rather than an Oncologist.

 

Since September 2010, the Regional Cancer Program has been home to a Well Follow-Up Clinic, staffed by Dr. XXXXXX, a Family Physician in Oncology. Dr. XXXX provides follow-up care for patients with early-stage melanoma, breast, colorectal and kidney cancer, who have completed curative therapy. These patients are referred to the Clinic by their Oncologist, who remains available for consultation when needed. Patients have expressed a high level of satisfaction with their care in the Well Follow-Up Clinic, which continues to expand to meet demand." 

 

Pay= $$$-$$$$

Training= ??, MD I know has her CCFP and no other certifications though has a special interest in oncology.

 

2) Teaching at medical school. My understanding is our school pays MDs $500 for half day for certain sessions and $200/hr for lecturing. Other schools are similar likely.

 

Pay = $$

 

Nice additions to the list.  

 

1)I know some docs do GP onc.  Don't know the training.  I think GP oncology would be pretty cool.  Its a pretty intense relationship.  Many of your patients would swiftly die.  Others may be cured from a scary diagnosis.  You would learn lots about humanity.  It could also wear you down or get boring if you weren't in it for good reasons.  

2) Teaching lectures at my residency program does not pay all that well.  Its not terrible; I think its 90$ per hour.  But thats per lecture hour.  It takes time to prepare, travel to and from the lecture site etc.  Compare that to seeing 5 patients in the office for that hour...

Teaching med students is different.  You can usually have a med student along and have your normal office day, or just a touch lighter if you are a good preceptor and like to teach.  That pays $2000 per week (I think.  Source ?) for 3rd or 4th year med students at UBC.  Can a anyone confirm? 

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How hard is it for family phyisicians or physicians in general to become preceptors for medical schools to vary up their practice? Do you have to have an academic appointment to be a small group preceptor or something? :)

My school was always clamouring for more family docs to take on students.  Not sure if this is the same across Canada.  Its a pretty big country.  

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List updated.  Some great additions, thanks guys and gals.  

 

Anyone know more about Prolotherapy?

 

I've seen physiatrists do it, dry needling and PRP injections. The needling is in the trigger points and the prolo is for long-term injuries like tendinosis where it's thought that the healing process has stopped and needs something to get it going again. I've heard that some physios do dry needling as well. I doubt it takes too much extra training. Have no idea how much it bills for though.

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You kind of made up values for how much those fields get paid eh? Really nothing to back any of it up other than a few stories. I will add some more!

 

Teaching medical students or residents is generally considered a negative on your income at an office.  Sure, running a CTU gets you a fleet of junior staff to see 35 inpatients but at the clinic or ED level it slows most of the staff down. They like teaching and find it rewarding for other reasons, but money is not one of them.

 

Lots of sports med docs that I know actually make less money than if they just worked in a clinic or walk-in. Most of team stuff or big events is also semi-volunteering. They generally won't pay for expenses but they don't paid like in a clinic.

 

GP Derm doesn't NEED extra training.

 

The hardest part about carving out a niche, like derm or 'lumps and bumps', or anything, is getting a steady stream of referrals.  Like all areas of medicine, there are docs that can do it very efficiently (from a money point of view) and others that don't despite how much they try.

 

My advice, you can make a ton of money doing anything, you might as well just find the area you like.  If you want to cut out skin cancer and toenails all day, do lumps and bumps. If you like rashes and acne and skin cancer, try derm. Like cancer stuff, get a job at a cancer centre.  Then do it faster and better than the other docs. Be nice to your patients (so that they tell their own doctor about how "great" you are). Then ???. And finally $$$$$$$$.

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From Wachaa

 

"It's lower than you cited for teaching FYI

http://med.ubc.ca/fi...oved-by-FEX.pdf

FP onc training programs are often advertised in the BCMJ. It's also a +6 month R3 at some schools. And again probably not paid as well as 6-7 pts/hr office work. BC hospitalist work tends to pay around $130/hr only. It's possibly different if you were in a smaller GP-run cancer agency. However, BC Cancer only pays their oncologists/ radiation oncologists ~230-330k/year so it's unlikely you'll top that as a GP oncologist. (source: Vancouver Sun public sector salaries) And also, since it's usually a full-time day job, you won't be doing it to "supplement" an office practice unless you like to be really busy."

http://postgrad.familymed.ubc.ca/e3-enhanced-skills-programs/category-2/#Onc

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From Wachaa

 

"It's lower than you cited for teaching FYI

 

http://med.ubc.ca/fi...oved-by-FEX.pdf

 

FP onc training programs are often advertised in the BCMJ. It's also a +6 month R3 at some schools. And again probably not paid as well as 6-7 pts/hr office work. BC hospitalist work tends to pay around $130/hr only. It's possibly different if you were in a smaller GP-run cancer agency. However, BC Cancer only pays their oncologists/ radiation oncologists ~230-330k/year so it's unlikely you'll top that as a GP oncologist. (source: Vancouver Sun public sector salaries) And also, since it's usually a full-time day job, you won't be doing it to "supplement" an office practice unless you like to be really busy."

 

http://postgrad.familymed.ubc.ca/e3-enhanced-skills-programs/category-2/#Onc

 

I would suppose an effective salary about 250K without the stresses of running an office isn't something terrible of course (assuming 8 hour days at that rate - which again is actually a low amount of work for a doctor).

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Just saw this thread. In St John's the GP oncologists do pretty well. They do clinics and cover the inpatients (all 4 or 5 of them) on different weeks. And they have nice offices. 

 

My experience with addictions is that it is actually pretty fast paced. Methadone clinics don't entail a great deal of casual socialization but there is a lot of volume. Takes a very particular sort of personality, though, I think. 

 

Another track would be work as a GP hospitalist. 

 

Surgical assist looks pretty boring. They don't even get to close most of the time. 

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What about GP psychotherapy? Is that a viable avenue?

I've hear of some docs doing this.  You could do a day/half day of it in your office (I doubt you would have more need to do more).  Or do a few appts at the end of the day.  Not sure if this is an insured service or not.  I will look it up.  

This actually has me curious.  I will see what I can find. 

 

I also want to mention that this thread is not about money for me.  Its about opportunities and about variety and about time.  Money is an important factor.  I have a certain standard of living (not extravagant) that I want to achieve plus charitable donations plus save for retirement etc and I have a rough number I need to take home to have that.  I want to work hard, but I don't need more than that figure and I won't work to the bone to go past that.  If there is something that gives my career variety and pays awesome then I have just bought myself TIME.  Time to book lighter, time to take completely off, time to stay fresh and focused on giving good care to my patients for a long while.  End rant.

 

Time = money = time = freedom = happiness =  :)

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I am a family doc who does a bunch of stuff on the side.  Here's my take on the components of my practice:

 

- Housecalls: $ - slow paced and rewarding because patient's are so grateful.  Pays reasonably, but balances out in that you have to do all your paperwork/notes/scripts/referrals later, rather than as you go like is done in the office.

- Palliative Care: $.5 to $$ - very rewarding if you can handle the emotional side.  Pays well, though tough cases can be time consuming.

- ER: $$ to $$$ - great money, fast pace, at times crappy hours, but at least when you're done, you're done...no paperwork following you home most of the time.  Many people can't handle the stress or the shift work or both.

- OB: $$ - pros/cons very similar to ER.

- Surgical assisting: 0.5$ - very boring for the most part. Money pretty crappy.  You don't get paid for downtime between cases (assuming you're working fee per service).  The only surgeries I really like to assist on are C-sections for my own ob patients :)

- Hospital inpatients: 0.5$ to $ - complicated patients can eat up a lot of time both on medical and administrative issues (i.e. trying to organize a discharge plan).  Very rewarding to look after my own family med patients - makes for awesome continuity and much better patient care.

- Teaching: 0.5$ - I definitely make less per hour of work when I have students.  They slow me down a LOT, so I'll usually end up spending an hour extra at work every day.  The renumeration no where pays the amount per hour for that extra time that I would get in any other area of my work.  Plus there is the extra work of evals, ref letters, etc.  I do it because I like it.  Teaching residents ends up being more equal for pay, and once in awhile with a good resident, I might make a little more than without them, but not a lot.

 

Other things that some of my family doctor colleagues do:

- Nursing home: 0.5$ to $ - I personally just can't work through these complicated patients fast enough to earn decent money doing it but others who are more experienced/efficient can probably make good money doing it. Slow pace is quite enjoyable.

- Anesthesia: $$ to $$$ - pros/cons very similar to ER.  Lots of calls for epidurals at night, so when on call, sleep is very broken up.

- Walk-in clinic: $$ - great money and generally good hours - usually fairly easy cases (strep throat, UTI, etc.) but some difficult patients (i.e. opioid seekers) and care is generally sub-par due to poor continuity and difficulty following up on diagnostic tests.

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I know in Newfoundland the surgical specialty assist fee is outstanding (0.75 of the primary surgeon billing last I heard). I wonder if the family doc assist fee is as lucrative.

 

Most provinces, the assist fees suck.

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I have been in office practice now for about 9 mo.

You gotta mix it up.

I do some urgent care centre shifts (its like emerg light, just a step up from WIC)

Its great.  I do 2-3 shifts per month.  I see lots of acute medicine.  The shifts are 8 hours and pay a bit less than an office day but no overhead, so really its a bit more than the office.  The variety is nice and keeps my skills up a bit.

I work hard when I'm there but honestly it feels like a day off sometimes...

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I have been in office practice now for about 9 mo.

You gotta mix it up.

I do some urgent care centre shifts (its like emerg light, just a step up from WIC)

Its great.  I do 2-3 shifts per month.  I see lots of acute medicine.  The shifts are 8 hours and pay a bit less than an office day but no overhead, so really its a bit more than the office.  The variety is nice and keeps my skills up a bit.

I work hard when I'm there but honestly it feels like a day off sometimes...

 

 

What do you think your annual billing projection will be?  How many patients do you see a day?  What's your typical day like?  Do you work weekends? 

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I work Mon to Thursday in the office.  See about 25-30 pts per day on Mon/Tues/Wed, and about 15 per Thursday with the afternoon for paperwork (disability pension applications, lawyer requests, workplace forms etc.- you get paid for these!)  I have 1 hour booked off for lunch but I use most of that to catch up from the morning notes and errands.   That leaves about 20 mins of relaxing, eating and socializing with other docs in my clinic which is just right. 

I'm a new grad so it has taken quite some time to get more efficient.  I am doing now in 8.5 hours of work what took me 12-15 hours of work for the first 4 months.  (Expect late nights doing labs and notes!)  I probably should have just taken less pts and less money...

No hospital work.  Every 7th week I do a Friday and Saturday "doctor of the day" walk in clinic for patients of our group. Same day appts only.  I see maybe 15-20 pts over 3-4 hours those days, typically quick and easy appts with less "baggage".  No Sundays.  The week that I do the Friday Saturday clinic I am "on call" for the group which really only means I have to take calls for urgent labs that come in for our group after hours.  I have been on call a few times now and have only been called once and it was for a high INR that came in at 7pm.  Cake.

2-3 Fridays per month I work at an urgent care centre.

The other Fridays I either take off, get caught up on admin stuff (banking, paperwork etc).

This is enough for me.  I have kids and I am very busy in my church community volunteering.  I am spent by the end of most work days and weeks.  A bad day can run you over, a bad week can really run you over.  But I am finding as time passes I am getting much more efficient and sane at the end of the day.  The other thing I have noticed is that if I take a few less patients per day I am more efficient and accurate with my billing and my bottom line does not suffer at all.

I estimate I will bill around 240,000 from the office over 12 months, with an additional 8000-12000 in private fees for paperwork and 18,000-24000 in urgent care shifts.

But remember its not what you bill, its what you take home...

 

Example 1:

Doc 1 loves his life, works 40 hrs per week and bills 250,000.  He pays 20% overhead, so = 200,000 pretax income

Doc 2 works his bag off and his wife leaves him, bills 350,000.  He pays 40% overhead, so = 210,000 pretax income  oops

 

Example 2:

Doc 1 checks out 2 clinics knowing he will bill 250,000 in a year

Clinic 1 has 25% overhead so 187,500 pretax income

Clinic 2 has 30% overhead so 175,000 pretax income

A 5% difference in overhead might not sound like a lot, but I bet 12,500 does.  (Over 1000 bucks a month!)

Same work, more pay.

 

Overhead is a big deal and it doesn't stop when you take a vacation... Find a clinic that is well managed.  Look for under 30% overhead.

 

PS. Incorporate.

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