Internal vs Family - need advice

[Belle_MD]

Hi everyone!

i know this topic has been debated before, I'm just looking for advice from people who have gone through the same struggle of choosing internal vs family. I am interested in pursuing geriatrics and/or palliative and I know both routes will take me there. I'm not interested in an academic career necessarily, I would be more interested in working at a community hospital vs doing research. I'm in my 30s and I'm a little worried about the intensity of the IM program/lifestyle vs family...But income is also important to me and I know if I go through IM I can potentially make more money (I know you're not supposed to say that but hey it's the truth). 

 

Can anyone offer advice? If you went through this debate how did you choose? 

[goleafsgochris]

Geriatrics and palliative are actually quite different. Also for palliative, you don't need to go through internal, but for geriatrics you do (unless there has been a major change recently).

Do some electives in each- this is the best way to decide.  I recommend doing geri in an inpatient consulting service, as well as a clinic (as they are quite different).  Do some palliative as well.  Again they really are different fields, so if you haven't done this yet, it can pretty much make the family vs IM decision for you.

[Belle_MD]

15 minutes ago, goleafsgochris said:

Geriatrics and palliative are actually quite different. Also for palliative, you don't need to go through internal, but for geriatrics you do (unless there has been a major change recently).

Do some electives in each- this is the best way to decide.  I recommend doing geri in an inpatient consulting service, as well as a clinic (as they are quite different).  Do some palliative as well.  Again they really are different fields, so if you haven't done this yet, it can pretty much make the family vs IM decision for you.

Thanks! You can actually do a +1 in care of the elderly through Family, hence my dilemma. I have done electives in Geri, palliative and care of elderly and enjoyed them all so far. It's more the family vs internal routes that is my dilemma... just looking for advice from people who have had this debate themselves.

[#YOLO]

geriatricians i've worked with told me they woulda done family and +1 care of the elderly if they coulda done it again. 

based on what u've laid out, and say go for fam. 

[estairella]

I think there are three major factors:

1) If you were not able to become a geriatrician or palliative care doctor, would you prefer to practice as a family doctor or internist?

2) Financially speaking, going through the internal route probably means more yearly income at the risk of loss of 2 years of income (coming out early with a 2+1). Depending on when you plan to retire, it may all be a wash. For example, let's say $300k vs $350k. 2 extra years of income = $600k more which will take 12 years to beat. I suspect though that the differential is bigger esp. if you are doing more inpatient consults.

3) What the job market will be like when you graduate. I think it will always be easier to go the internal route if job security is a factor, because both geriatrician and palliative care have in-hospital components and most hospitals suffer from credential-creep (expecting more and more subspecialization).

So I can't answer the question for you. I think #1 is most important.

[freewheeler]

6 hours ago, Belle_MD said:

Hi everyone!

i know this topic has been debated before, I'm just looking for advice from people who have gone through the same struggle of choosing internal vs family. I am interested in pursuing geriatrics and/or palliative and I know both routes will take me there. I'm not interested in an academic career necessarily, I would be more interested in working at a community hospital vs doing research. I'm in my 30s and I'm a little worried about the intensity of the IM program/lifestyle vs family...But income is also important to me and I know if I go through IM I can potentially make more money (I know you're not supposed to say that but hey it's the truth). 

 

Can anyone offer advice? If you went through this debate how did you choose? 

I see all of the bolded points in your post as you totally leaning towards the FM route.

The only thing I really see in your post leaning towards IM is the possibility for a higher income. Perhaps spend some time investigating what that potential difference would be if any.

Also consider whether you want to work with more complex patients (IM route) or relatively less complex (FM route).

What kind of size of community or hospital do you want to practice in as well and are the geriatricians working there preferentially IM or FM docs?

If you really want to immerse yourself into geriatrics, then the IM route may be preferable in terms of really solidifying your knowledge base and spending a ton of time in the hospital. 

The FM route on the other hand will provide you with the opportunity for a lot more flexibility in your practice and will likely have you spend more time in an outpatient setting.

Are there any preceptors you have had that you can speak with about this? It would perhaps be especially valuable if you could connect with any recent grads. 

Worst case scenario, apply for IM and FM, rank IM first and see if you get it or not. If you do and then hate it, switch in to FM.

[ralk]

In terms of income, while IM generally outearns FM, I'm not sure that holds true with Geriatrics. It's one of the lower-earning subspecialties, and largely comparable to FM. With the reduced years of training, I'd argue FM probably comes out ahead, though not by much. Not sure how working in the hospital as an FM doc with a Care of the Elderly focus changes things financially, but I imagine not by much.

[RadCdn]

I'm IM trained with a Geriatrics fellowship. All done in the US. I did IM because the choices of fellowship were numerous. Also, I like the consultant role of an IM doc in Canada. The billing is higher, less factory-type work (5 mins per patient which I can't stand in FM), allows me to focus and be really good in a particular niche too. 

[LittleDaisy]

On 9/21/2017 at 7:09 PM, ralk said:

In terms of income, while IM generally outearns FM, I'm not sure that holds true with Geriatrics. It's one of the lower-earning subspecialties, and largely comparable to FM. With the reduced years of training, I'd argue FM probably comes out ahead, though not by much. Not sure how working in the hospital as an FM doc with a Care of the Elderly focus changes things financially, but I imagine not by much.

I think that you get paid more as an internist doing an inpatient geriatrician consult than a FM with + 1.  Again, a complete geriatrics consult requires 2-3 hours, compared to 45 min-1 hour for GIM consult. I don't think that a billing for a complete geri consult is much more lucrative than a GIM consult (400 $ for a comprehensive geri consult which takes 2-3 hours vs Comprehensive GIM consult 300 $ which takes 1-1.5 hours)

A lot of geriatricians doing in patient consults could only do maximum 2-4 inpatient comprehensive geriatrics consults per day, so it is less lucrative than doing 10-12 GIM & cardio & GI consults. That's why geriatrics is one of the lowest paid IM sub-specialty. People definitely don't go into geriatrics for money, if money is important to you, I definitely won't go into geri

At the end of day, it is up to you!

[Belle_MD]

Thanks everyone for your perspectives! So what would be a geriatrician salary vs Family Med typically? 

[Snowmen]

In Quebec, we're talking about 284,000$ for a GP vs 460,000 for a geriatrician. That's the average, before overhead, straight from the governments budget date for the 2015-2016 year. The numbers are probably different in other provinces since, from my experience looking at the data, Quebec seems to have less disparity between specialties. As mentioned, geriatrics are a fairly low paying specialty in most provinces but that obviously isn't the case in Quebec (average for a specialist is 474,000$).

[Edict]

4 hours ago, Snowmen said:

In Quebec, we're talking about 284,000$ for a GP vs 460,000 for a geriatrician. That's the average, before overhead, straight from the governments budget date for the 2015-2016 year. The numbers are probably different in other provinces since, from my experience looking at the data, Quebec seems to have less disparity between specialties. As mentioned, geriatrics are a fairly low paying specialty in most provinces but that obviously isn't the case in Quebec (average for a specialist is 443,000$).

The issue with that income is they don't tell you the number of hours worked. A lot of GPs do not work full-time, whereas likely a higher percentage of internists do. 

[JohnGrisham]

1 hour ago, Edict said:

The issue with that income is they don't tell you the number of hours worked. A lot of GPs do not work full-time, whereas likely a higher percentage of internists do. 

A gp who is working part-time, is not billing 284,000 haha. 

[Edict]

12 hours ago, JohnGrisham said:

A gp who is working part-time, is not billing 284,000 haha. 

What I was saying was that GPs who work part time will drag down the average income earned of a GP. On a per hour basis, a GP's salary may be a lot higher. If you look at the BC Blue book you will see there are a significant number of doctors who don't work full time and as a result make significantly less than their counterparts. 

 

I don't think that kind of data can allow us to confidently say that a GP would make less than an internist if they work the same number of hours. 

[Snowmen]

The data already excludes physicians who have not billed for at least 117,000$ for that year so there already are some measures to clear out data that could skew the average. On the other hand, it includes hospitalists who can often make up to 500,000$ a year in distant regions so that would probably more than balance out the part time GPs that have been included and make significantly less than 284,000$.

[Let'sGo1990]

Source for those numbers?

[indefatigable]

The CMA numbers exclude billers under 60K - the Quebec numbers may be different.  The CMA numbers are a bit lower - about 250K for FM.  There are more women in FM than in GIM from what I saw - it could be they are more likely to be part time on average.

[Snowmen]

41 minutes ago, Let'sGo1990 said:

Source for those numbers?

Quebec's budget review for the previous year. I've linked the document. It's in french but you should be able to figure out which specialties are which. What you are interested in is the "Revenus moyens bruts" column which is the average billing before overhead. The other columns relate to overhead but as the small characters at the bottom mention, their calculation is crap and unreliable while the pre-overhead numbers should be the most reliable ones available.

Rémunération.pdf

[samy]

In Quebec, geriatrics has an extremely favorable job market at the current time.

http://www.msss.gouv.qc.ca/sujets/organisation/medecine-au-quebec/medecine-specialisee/prem/documents/toutes_specialites_2017-08-09.pdf

There are many prems available thoughout the province, even in Montreal, Quebec, Laval....

[NLengr]

On September 23, 2017 at 9:39 PM, Snowmen said:

In Quebec, we're talking about 284,000$ for a GP vs 460,000 for a geriatrician. That's the average, before overhead, straight from the governments budget date for the 2015-2016 year. The numbers are probably different in other provinces since, from my experience looking at the data, Quebec seems to have less disparity between specialties. As mentioned, geriatrics are a fairly low paying specialty in most provinces but that obviously isn't the case in Quebec (average for a specialist is 474,000$).

460k for a geriatrician? That seems incredibly high. Especially since its quebec who pay the least of any province. 

 

Not saying your wrong, I'm just shocked. That's more than many surgeons I know. 

[Snowmen]

3 hours ago, NLengr said:

460k for a geriatrician? That seems incredibly high. Especially since its quebec who pay the least of any province. 

 

Not saying your wrong, I'm just shocked. That's more than many surgeons I know. 

We've had huge pay increases in the last 10 years or so to catch up with the rest of Canada and a few more to come. Average in Quebec for surgical specialties is 520,000$ (again, before overhead).

[indefatigable]

As Snowmen mentioned, the Quebec specialties are also much less disparate.  Comparing the numbers in his link vs newly released pan-Canadian numbers, shows a lot of specialties like psych (420 vs 270K), neuro (380 vs 300), peds (400 vs 290), etc..  are much better compensated than across Canada (QC figures are strongly corrected for part-time though).  The Quebec figures could even be bringing up national averages up a little.  The rest of Canada seems to follow US compensation average with some well known disparities like surgery.  

QC government heavily regulates health care jobs and getting through formal French accreditation isn't easy - 

I'm not sure why QC is bringing in a number of anesthesiolgists from France - it has to be one of the highest renumerated specialties when accounting for very low overhead (~500K gross).  

[drbenoitchen]

I am a FM geriatrician (CCFP(COE)) working in an academic hospital in Montreal. I can attest that the gross pay of $460000 for IM geriatricians is accurate. Due to the clinical volume, FM geriatricians make similar amounts, with almost no overhead.

I do also other hospitalist work, which increases my income by another $100K or so. 

I cannot say if my situation represents the norm though.

[JohnGrisham]

On 4/15/2018 at 8:51 AM, drbenoitchen said:

I am a FM geriatrician (CCFP(COE)) working in an academic hospital in Montreal. I can attest that the gross pay of $460000 for IM geriatricians is accurate. Due to the clinical volume, FM geriatricians make similar amounts, with almost no overhead.

I do also other hospitalist work, which increases my income by another $100K or so. 

I cannot say if my situation represents the norm though.

wow. Coupled with relatively lower cost of living, that is astronomical.

[brady23]

Do geriatricians make more than family doctors after overhead and income tax?

I thought geriatricians made about 300k pre-tax and overhead, while family docs tend to make about $350k before tax and overhead.