Fam Med Pay + Future

[SKM]

Theoretically, shouldnt family medicine have one of the highest $/hr in medicine? and control over lifestyle in medicine as well (besides maybe ophtho and derm).

 

Ex) A family doc who works 9hr days 6days a week in a walk in clinic with a conservative estimate of 4pts/hr at somewhere from $35-$50 per patient, can make ~400k after overhead with a month off (very conservative estimate).

 

Why isnt this more common?

 

Where do you guys see the future of FM heading? Especially with NPs and other healthcare workers encroaching on the role of a general GP. Economically, I feel there will be huge pressure to cut FM as it takes up the biggest % of healthcare dollars. I also think in comparison to markets elsewhere (US UK), family physicians here earn more, allowing for less "brain drain" in case of reasonable cuts.

[Birdy]

I think you've missed some very important parts of FM... Phone calls, lots of phone calls, forms, billing, reviewing labs, lunch breaks, CME time, etc. I also think you haven't really considered how much is actually used on overhead. I've seen numbers in the vicinity of 30% but I'm not sure how accurate that is in the real world. There are lots of things a family physician does besides just seeing patients in their clinic. And, frankly, I have no intention of working 9 hours a day 6 days a week for the rest of my life.

 

There absolutely are FMs who make that much, but there's plenty who don't and I suspect it's because they probably want some degree of work/life balance.

[ralk]

If your numbers don't match reality, it's time to re-examine your assumptions. I think first and foremost would be that FM docs are spending approximately 54 hours a week in direct contact with patients. As Birdy says, the average FM doc isn't working that many hours period and those that do are spending only a fraction of it on billable patient care. The National Physician Survey put the average total work time at 47 hours with 30 hours of direct patient contact. Taking that average 30 hours by your frequency of seeing patients (say, 4 patients per hour at ~$40 per patient) plus 4 weeks off in the year and you get about $230k gross income, which is about what I've seen reported for typical FM docs (perhaps a bit on the low side).

 

As for where the profession is headed, the outlook is pretty good. NPs aren't really encroaching on the role of a GP in Canada. Mostly they're complimenting GP practices or filling needs in areas without enough GPs in the first place. In many cases, they're serving in hospital roles, so if they are encroaching on physicians, it's not concentrated on GPs in particular. If they ever do start to encroach, two things have to happen first: one, there'd need to be more of them, because while their numbers are increasing, it's happening slowly; and two, they'd need viable funding models for independent practice. Right now, a lot of NPs get paid through physician billings - hard for them to be a threat when they're relying on physicians for income.

 

As for cuts to FM income, it's certainly a target given FM's relative size and some cuts are possible (or happening), but it's hard to see their incomes falling off a cliff, say, as is currently being seen in Radiology in Ontario. FM is by far the largest specialty, one that's well regarded by patients of all health states, and one that's still in high-demand by patients. Basically, they have a lot of political power relative to other groups of physicians. You're right that a drop in income wouldn't lead to a mass exodus to the US or UK, but it could easily cause FM docs to change provinces, scale back their practice, or simply retire if they feel the pay isn't worth their time. With the relative shortage of FM docs, a small drop in their numbers would be noticed and could provoke political backlash, something not necessarily seen in other specialties with an overabundance of workers.

[rmorelan]

yeah that scenario is implausible unfortunately - you could use similar sounding numbers with any other field and get equally unrealistic numbers as well. If radiologist read a msk/chest X ray every 2 mins (which if completely left alone they could typically do) for around 10 dollars and did that for 9 straight hours, 6 days a week they would earn much more than the FM in your scenario. Plus that is just for the x rays as opposed to higher paying CTs etc.

 

Trouble is no one can read 300 x rays a day, every day,  6 days a week - not to say they wouldn't be available read in some places - because there is a lot more to do than just that aspect. Community rads seem to be able to do about 200 a day on a good day - which is a very busy day.

[SKM]

yeah that scenario is implausible unfortunately - you could use similar sounding numbers with any other field and get equally unrealistic numbers as well. If radiologist read a msk/chest X ray every 2 mins (which if completely left alone they could typically do) for around 10 dollars and did that for 9 straight hours, 6 days a week they would earn much more than the FM in your scenario. Plus that is just for the x rays as opposed to higher paying CTs etc.

 

Trouble is no one can read 300 x rays a day, every day, 6 days a week - not to say they wouldn't be available read in some places - because there is a lot more to do than just that aspect. Community rads seem to be able to do about 200 a day on a good day - which is a very busy day.

I agree that the average dr is not going to want to work thise hours.

 

But doesn't family offer one the flexibility of being able to work harder for more $. Especially with Rural Locums, obs, cosmetics, walk ins etc. I feel that while the average earnings might be low, the earning potential if wanted is much higher... whereas a lot of specialties that are tied to hospitals do not have that same opportunity.

 

Realistically, It doesn't seem implausible for a fam doc to see 35 patients a day working in a walk in clinic for 6 days a week. Thats 1 patient every 15 minutes with maybe a 15 min break for lunch. Hard work? Definitely. But very realistic i would assume.

[Beacon]

For arguments sake, if the aforementioned practitioner did see 35 patients a day working for 6 days a week, that would amount to around 9 hours a day. 

 

In the short term, it may seem plausible, however, as the years count by, the mental strain would take its toll. I would believe that if someone did work those hours (with only a 15 min lunch break..), that person may have to take 12 weeks off every year to recuperate. That or retire at the age of 40. Strenuous work, more like it. Besides, there are other things FPs do other than seeing patients such as going through lab work and such.

 

My 2 cents..

[W0lfgang]

FM is low income.  From what I've learned, to make 400k+, the FM would have to work very hard hours.

 

Choose another specialty if money matters to you.

[rmorelan]

FM is low income.  From what I've learned, to make 400k+, the FM would have to work very hard hours.

 

Choose another specialty if money matters to you.

 

low being a relative term

 

I mean they do have a often 5 year head start on everyone else. If you do it right you could be very well set prior to other specialties even getting their first paycheck ha .It takes a lot of years for the specialists to catch up.

[Lactic Folly]

Besides, there are other things FPs do other than seeing patients such as going through lab work and such.

Not a FP, but I often hear about FPs taking paperwork home, and I imagine there is a ton of lab / diagnostic test reports to review and referral letters to write (and consultations to review once patients have been seen by specialists), not to mention aspects of running a business (and if working at a walk-in clinic owned by someone else, well you are not getting the full FFS amount).

 

Follow up of test results and proper communication with other health care providers involved in a patient's care (e.g. what meds have been started/stopped, who is responsible for arranging a needed test) is particularly important, and a high risk area for errors should something fall through the cracks, with potentially disastrous results. Not something I'd want to rush.

[Beacon]

Not a FP, but I often hear about FPs taking paperwork home, and I imagine there is a ton of lab / diagnostic test reports to review and referral letters to write (and consultations to review once patients have been seen by specialists), not to mention aspects of running a business (and if working at a walk-in clinic owned by someone else, well you are not getting the full FFS amount).

 

Follow up of test results and proper communication with other health care providers involved in a patient's care (e.g. what meds have been started/stopped, who is responsible for arranging a needed test) is particularly important, and a high risk area for errors should something fall through the cracks, with potentially disastrous results. Not something I'd want to rush.

 

Not a FP either, but that is what I meant. 

 

Putting all aspects of the business aside, there is also self-care, family time, and other matters that are important to an individual, that should get a share of time. I mean, leaving 1 day a week to do all of that for the rest of one's career is a daunting thought. 

[ralk]

I agree that the average dr is not going to want to work thise hours.

 

But doesn't family offer one the flexibility of being able to work harder for more $. Especially with Rural Locums, obs, cosmetics, walk ins etc. I feel that while the average earnings might be low, the earning potential if wanted is much higher... whereas a lot of specialties that are tied to hospitals do not have that same opportunity.

 

Realistically, It doesn't seem implausible for a fam doc to see 35 patients a day working in a walk in clinic for 6 days a week. Thats 1 patient every 15 minutes with maybe a 15 min break for lunch. Hard work? Definitely. But very realistic i would assume.

 

To see patients in clinic for 9 hours a day, 6 days a week, that family physician would probably have to work at least 12 hours a day, 6 days a week. Even for a relatively money-driven person, that's a lot of work (and probably not the best care).

 

Family does offer some ability to work longer for more money, but there are some limits. Lots of services are tied to hospitals, even for FM docs, especially some of the more lucrative ones. Increasing clinic practice can come with diminishing returns once overhead is factored in - infrastructure costs stay constant with higher earnings, but supply and personnel costs increase.

 

For FM physicians really looking to earn more money, the biggest factor is location - most high-income FM docs I've met were rural practitioners covering services that would traditionally managed by specialists in other settings. Those areas are typically hurting for physicians and do work somewhat longer hours than their urban counterparts, so there is some truth to working longer for more money, but it's not a simple "just work more" path forward to getting, say, surgeon-level compensation.

[ellorie]

Plus from my own medical school experiences with FM - some patients are just not going to be 15 minute patients.

[older]

_{God save patients  from doctors who see 35 patients per day for 15 minutes each, in clinic for 9 hours a day, 6 days a week. Aren't  we nuts discussing such scenario in  pure monetary terms? What about quality of patient care, nobody has a comment?  The only concern seems to be that the poor greedy doctor will get overworked. And that sounds almost like some kind of a virtue. Hard working, eh?}

 

_{That's one of the things that is wrong with the current system of payment for service - encouraging money-makers to assemble patient production lines.}

 

_{OP, what about becoming investment broker instead of FM doc. At least they do no harm.}

[JohnGrisham]

_{God save patients  from doctors who see 35 patients per day for 15 minutes each, in clinic for 9 hours a day, 6 days a week. Aren't  we nuts discussing such scenario in  pure monetary terms? What about quality of patient care, nobody has a comment?  The only concern seems to be that the poor greedy doctor will get overworked. And that sounds almost like some kind of a virtue. Hard working, eh?}

 

_{That's one of the things that is wrong with the current system of payment for service - encouraging money-makers to assemble patient production lines.}

 

_{OP, what about becoming investment broker instead of FM doc. At least they do no harm.}

I'd argue that investment bankers as a whole...do a lot more big picture harm than doctors...

[Beacon]

It actually has been mentioned a couple of times. Plus, the basis of this discussion was mostly considering this as a hypothetical case, not very feasible realistically speaking.

 

Besides, quality of patient care suffers as a result of this hypothetical physician overworking, and the ever-increasing mental strain. Physician self-care is important to both physician and patient.

[rmorelan]

I think the reason people are focussed on the money aspect is a) that was the OPs original focus and b ) it seems so implausible to people that it could even be done realistically that there is little point talking about the impact broadly c) 15 min per patient under normal conditions is actually slower than many family doctors work and d) we actually trying to force back in all the missing aspects of care (hence all the extra care etc

[rmorelan]

I'd argue that investment bankers as a whole...do a lot more big picture harm than doctors...

 

heheheh good thing we are holding ourselves up to that standard

 

trouble about investment bankers is any good they do you will never hear about (the hard work done to secure the money to build the factory to employ 100s and evaluate the business plan to make sure it will work? You won't here a word about that).

 

Kind of like lawyers - no one seems to really express any joy with respect to them until you actually need one.

[Beacon]

heheheh good thing we are holding ourselves up to that standard

 

trouble about investment bankers is any good they do you will never hear about (the hard work done to secure the money to build the factory to employ 100s and evaluate the business plan to make sure it will work? You won't here a word about that).

 

Kind of like lawyers - no one seems to really express any joy with respect to them until you actually need one.

 

Well, anything that involves deception, lying, misrepresentation, and manipulation of evidence, is generally cast under a negative light. There are lawyers, for example, who actively engage in this, which puts the whole profession under a 'bad umbrella'. 

 

If not for these 'negative qualities', I believe lawyers would be held in a higher regard. 

[rmorelan]

Well, anything that involves deception, lying, misrepresentation, and manipulation of evidence, is generally cast under a negative light. There are lawyers, for example, who actively engage in this, which puts the whole profession under a 'bad umbrella'. 

 

If not for these 'negative qualities', I believe lawyers would be held in a higher regard. 

 

I wonder how often that actually happens in the real world - to the extremes we see on TV etc. 

 

This isn't to say there wasn't a relatively recent event that investment bankers weren't acting like greedy morons - it is amazing we can all get in risky investment practises (ahem subprime mortgages - ???NINJA loans - really?).

 

anyway I think the idea that anyone that could be a doctor could also be a good investment banker has a lot of assumptions - I mean to be blunt the average doctor simply isn't all that good at math, which is kind of a key skill in investment banking. Not a lot of premeds are taking degrees in economics or getting an MBA. With enough time they probably could develop those skills - I am just saying you cannot make it sound like it is an instantaneous process.

[amichel]

I wonder how often that actually happens in the real world - to the extremes we see on TV etc.

 

This isn't to say there wasn't a relatively recent event that investment bankers weren't acting like greedy morons - it is amazing we can all get in risky investment practises (ahem subprime mortgages - ???NINJA loans - really?).

 

anyway I think the idea that anyone that could be a doctor could also be a good investment banker has a lot of assumptions - I mean to be blunt the average doctor simply isn't all that good at math, which is kind of a key skill in investment banking. Not a lot of premeds are taking degrees in economics or getting an MBA. With enough time they probably could develop those skills - I am just saying you cannot make it sound like it is an instantaneous process.

Not to get too philosophical here, but I think a very large portion of the "math divide" between the two groups is how we deal with math culturally.

 

We decide if kids are good at math super early on and then continually tell them whether they are or aren't good at it. Then we talk about how hard it is and portray it not as a challenge to be mastered but as a innate character trait. Self fufilling prophecy really. It doesn't work this way else where in the world.

 

So yah, I think most people who could be doctors have at least the academic potential to be investment bankers, somewhere in there.

[rmorelan]

Not to get too philosophical here, but I think a very large portion of the "math divide" between the two groups is how we deal with math culturally.

 

We decide if kids are good at math super early on and then continually tell them whether they are or aren't good at it. Then we talk about how hard it is and portray it not as a challenge to be mastered but as a innate character trait. Self fufilling prophecy really. It doesn't work this way else where in the world.

 

So yah, I think most people who could be doctors have at least the academic potential to be investment bankers, somewhere in there.

 

Oh I agree completely - we also have this annoying tendency to forgive bad math skills (you see that in medicine from time to time - I actually had one staff doc tell me once 'of course I am bad at math, I am a doctor!' - ha, I was quite annoyed by that.

 

my point is more the turn around time - you have these people that have been ignoring math and related skills for many years and are now mid way or beyond their degree in life sciences. Now they need to jump into economics, heavy statistics, and business planning - can you do it? absolutely of course.  I am a huge believer in that ability  having multiple unrelated undergraduate degrees myself. I am just saying in part from experience I guess doing it that doing it take some time/effort and it is not seamless (well wasn't for me). Critically interest is required (just because you like money being in your bank account doesn't necessarily mean you like the idea of investment banking as a career)

[amichel]

Oh I agree completely - we also have this annoying tendency to forgive bad math skills (you see that in medicine from time to time - I actually had one staff doc tell me once 'of course I am bad at math, I am a doctor!' - ha, I was quite annoyed by that.

 

my point is more the turn around time - you have these people that have been ignoring math and related skills for many years and are now mid way or beyond their degree in life sciences. Now they need to jump into economics, heavy statistics, and business planning - can you do it? absolutely of course. I am a huge believer in that ability having multiple unrelated undergraduate degrees myself. I am just saying in part from experience I guess doing it that doing it take some time/effort and it is not seamless (well wasn't for me). Critically interest is required (just because you like money being in your bank account doesn't necessarily mean you like the idea of investment banking as a career)

I fully get what you're saying, it's just a favourite soapbox of mine I couldn't resist hopping on for a bit, haha.

[Beacon]

I wonder how often that actually happens in the real world - to the extremes we see on TV etc. 

 

This isn't to say there wasn't a relatively recent event that investment bankers weren't acting like greedy morons - it is amazing we can all get in risky investment practises (ahem subprime mortgages - ???NINJA loans - really?).

 

anyway I think the idea that anyone that could be a doctor could also be a good investment banker has a lot of assumptions - I mean to be blunt the average doctor simply isn't all that good at math, which is kind of a key skill in investment banking. Not a lot of premeds are taking degrees in economics or getting an MBA. With enough time they probably could develop those skills - I am just saying you cannot make it sound like it is an instantaneous process.

 

Agreed - I did not mean that at all. It is not an instantaneous process.. at all.

 

Put aside the technical skills required for a banking career for a moment. How many premeds would even be remotely interested in a banking career? I think that what keeps people in the health/science fields away from business in general, is habituation to the sciences. I don't think the issue is a lack of ability to learn the required skills, but more like a lack of interest in the first place. 

[NLengr]

anyway I think the idea that anyone that could be a doctor could also be a good investment banker has a lot of assumptions - I mean to be blunt the average doctor simply isn't all that good at math, which is kind of a key skill in investment banking. Not a lot of premeds are taking degrees in economics or getting an MBA. With enough time they probably could develop those skills - I am just saying you cannot make it sound like it is an instantaneous process.

Couple of my friends are investment bankers. One with a major US firm. Neither are math whizzes. What they are good at is salesmanship.

[rmorelan]

Couple of my friends are investment bankers. One with a major US firm. Neither are math whizzes. What they are good at is salesmanship.

 

valid point sure they aren't idiots at it either. What was their background prior to going into it?

 

My uncle is an investment banker (?was, I don't know it is a tough market - he seems to do more of the educational side of things now. It is hard to be a front line investment banker for a long time - long hours, big stress etc). Chartered accountant, MBA - you know the usual stuff it seems you need. Guess it depends on what type of banker you are at as well because he didn't do too much selling - just management large corporate accounts (someone has to manage those 100+million loans big, big corporations ask for).  

 

There was actually a point when I was finishing my economics degree and applying to medicine where there was recruitment for banking zipping around the campus at Waterloo meeting with all the students that won some sort of award in the program that year (if you are getting the GPA for medical school you probably are getting the sort of grades that would attract attention). There was a surreal day when I realized I could if I wanted to go down that route despite not aiming for it at all. I wonder how that would have turned out ha!