Dermatology vs. Family Med

[BeentheredonetheDAT]

I know this might be a weird comparison, but what's the difference in renumeration between a dermatologist (in Ontario) and family med or FM+EM? I'm attracted to dermatology in general but lifestyle and pay are very important, and I'm not sure if I want to go down the path of killing myself over trying to get into dermatology. 

[rmorelan]

2 hours ago, BeentheredonetheDAT said:

I know this might be a weird comparison, but what's the difference in renumeration between a dermatologist (in Ontario) and family med or FM+EM? I'm attracted to dermatology in general but lifestyle and pay are very important, and I'm not sure if I want to go down the path of killing myself over trying to get into dermatology. 

roughly I would say a dermatologist would earn at least twice what the standard family doctor would earn. Three times as much is probably not stretching it too much

[indefatigable]

1 hour ago, rmorelan said:

roughly I would say a dermatologist would earn at least twice what the standard family doctor would earn. Three times as much is probably not stretching it too much

In ON (last figure only from 2010 unfortunately):    Derm ~400K (gross, p. 38)        Fam ~300K (gross, FTE, p. 23)

for comparison:

In QC (from 2015-6):  Derm   ~420K    Fam ~280K

Both cases exclude private billings, but also don't compare EM which is much more lucrative.

 

 

[rmorelan]

Just now, marrakech said:

In ON (last figure only from 2010 unfortunately):    Derm ~400K (gross, p. 38)        Fam ~300K (gross, FTE, p. 23)

for comparison:

In QC (from 2015-6):  Derm   ~420K    Fam ~280K

Both cases exclude private billings, but also don't compare EM which is much more lucrative.

 

 

Always a bit of oranges and apples with this this - I was told derm's overhead was less (more streamlined in a sense), and the opportunity for private billings as you mention is relatively higher. 

Isn't EM on that list - at about 250K or so? Not much overhead there of course. 

 

[indefatigable]

7 minutes ago, rmorelan said:

Always a bit of oranges and apples with this this - I was told derm's overhead was less (more streamlined in a sense), and the opportunity for private billings as you mention is relatively higher. 

Isn't EM on that list - at about 250K or so? Not much overhead there of course. 

 

Yeah - EM is there at about ~250K, with pretty much zero overhead.  

From what I've seen, the overheads would be pretty similar.. For extensive private billings, the equipment costs would probably add up.   

[JohnGrisham]

Dont forget about the GP derm certificate. 

[Dermviser]

1 hour ago, JohnGrisham said:

Dont forget about the GP derm certificate. 

Does that help boost someone's salary?

[ZBL]

1 hour ago, JohnGrisham said:

Dont forget about the GP derm certificate. 

Isn’t that pretty much useless though? Normally I’ve seen people have these through random online UK universities. Seems more like a quick way of being able to add the word “dermatology” to ones education section of their website rather than achieve legitimate training in the way that a sports med, low risk OB or EM +1 year is. I’m not sure what sort of patient would actively be referred to someone with a derm certificate for medical derm problems - seems more like a marketing gimmick for non dermatologists who want cosmetic patients. 

 

I dont remember where where I saw it, but I recall seeing that the average dermatologist will have 10-15% of their patients as cosmetics, so presumably all those salary stats account for on average 85% of their patient load. I assume cosmetics pays better than medical billing, so I’d probably add 15-20% to whatever those numbers are, or higher if it’s a derm who focuses on cosmetics or procedures. So I’d say a derm makes AT LEAST 2-3x the average GP, assuming similar hours, with the ceiling for derm obviously being extremely high. 

[la marzocco]

36 minutes ago, ZBL said:

Isn’t that pretty much useless though? Normally I’ve seen people have these through random online UK universities. Seems more like a quick way of being able to add the word “dermatology” to ones education section of their website rather than achieve legitimate training in the way that a sports med, low risk OB or EM +1 year is. I’m not sure what sort of patient would actively be referred to someone with a derm certificate for medical derm problems - seems more like a marketing gimmick for non dermatologists who want cosmetic patients. 

 

I dont remember where where I saw it, but I recall seeing that the average dermatologist will have 10-15% of their patients as cosmetics, so presumably all those salary stats account for on average 85% of their patient load. I assume cosmetics pays better than medical billing, so I’d probably add 15-20% to whatever those numbers are, or higher if it’s a derm who focuses on cosmetics or procedures. So I’d say a derm makes AT LEAST 2-3x the average GP, assuming similar hours, with the ceiling for derm obviously being extremely high. 

This is consistent with my personal experience. I was once referred by my FP to a dermatology centre and the physician who saw me was IM + a UK derm certificate. Not really sure how that works lol 

[indefatigable]

Some FPs do the cosmetic part of dermatology like botox injections - I know some dermatologists don't do those.    

Something else to note is that the median=mean=300K for FM, but not for derm.  The difference between higher and lower earning dermatologists is much higher - median is 300K vs mean 400K (p. 37-8).  Even bigger spread in ophth.    

[Mithril]

4 hours ago, rmorelan said:

Always a bit of oranges and apples with this this - I was told derm's overhead was less (more streamlined in a sense), and the opportunity for private billings as you mention is relatively higher. 

Isn't EM on that list - at about 250K or so? Not much overhead there of course. 

 

According to the CMA, average overhead for derm is 20% at a gross income of $420k at 48.3 hours per week.

For FM, average overhead is 28% at a gross income of $258k at 47 hours per week. To me this seems to be low because I work 48 hours a week and my gross is much higher.

There's definitely ample private billing for both specialties.

[indefatigable]

17 minutes ago, Mithril said:

According to the CMA, average overhead for derm is 20% at a gross income of $420k at 48.3 hours per week.

For FM, average overhead is 28% at a gross income of $258k at 47 hours per week. To me this seems to be low because I work 48 hours a week and my gross is much higher.

There's definitely ample private billing for both specialties.

Yeah - those numbers are skewed provincially and don't account for full-time status.  FM is higher in pretty much every province now except the maritimes.  Also derm in AB is much higher than other provinces (almost factor of 2).  The ON link, even though dated gives a much better breakdown of income percentiles (although ON physicians had wage freezes).  

[DermJuly2018PGY1]

I wouldn't chase derm if you are interested in the $$$. FM = derm in terms of money and FM has more flexibility in terms of hours.

Derm can make $$$ if you do cosmetics, but that means finding the clientele and setting your practice up like a business, something an FM can easily do if you are business savvy. Also, cosmetics has even higher overhead, especially with lasers, and there are newer ones coming out every 1-2 years.

Unless you truly like dermatology (very hard residency ~5 years with lots of studying), I wouldn't recommend it. I expect FM to be much more competitive in the years to come with the 2-year residency and the high $$ potential with great quality of life.

[hamham]

44 minutes ago, DermJuly2018PGY1 said:

I wouldn't chase derm if you are interested in the $$$. FM = derm in terms of money and FM has more flexibility in terms of hours.

I am not so sure about that.

[ZBL]

I dunno.... it’s no secret that derm is routinely one of the most competitive specialties in the match in Canada and the US, and it’s not just the hours/flexibility as that can be had in FM or many other specialties. The $ potential is probably way higher in derm than what those income reports let on. Same for plastics. On the surface, they are the lowest paid surgical specialty but everyone knows they can make a lot more than that through other means. While not every dermatologist or plastic surgeon will pursue those other means, those other means are probably a lot easier to come by in derm or plastics compared to FM. Maybe some provinces don’t pay as well, like Quebec/BC, but I think on balance it’s a no brainer that the average derm is making more money per hour (as many may also be working just part time) than the average FM per hour. 

[DermJuly2018PGY1]

25 minutes ago, hamham said:

I am not so sure about that.

For example: http://www.cbc.ca/news/canada/british-columbia/dermatologists-avoid-work-in-b-c-over-low-pay-1.1267024

21 minutes ago, ZBL said:

But I think on balance it’s a no brainer that the average derm is making more money per hour (as many may also be working just part time) than the average FM per hour. 

Lots of FM docs are working part-time as well.

22 minutes ago, ZBL said:

The $ potential is probably way higher in derm than what those income reports let on. 

I agree. Mainly because of cosmetics, but that becomes a business thing. Good luck competing in Vancouver or Toronto with all the cosmetic derm practices there.

 

I'll add Canada vs US is a different beast. US derms are paid much more than Canadian derms and US FM docs are paid much less than Canadian FMs.

[ZBL]

You have cherry picked the worst-paying province for derm. But I'll bite anyway. 

See this report from BC:

https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/medical-services-plan/irm_complete.pdf

 

This doesn't account for who's working full time and who's not, but this alone would not explain the differences above. 

[indefatigable]

4 hours ago, DermJuly2018PGY1 said:

For example: http://www.cbc.ca/news/canada/british-columbia/dermatologists-avoid-work-in-b-c-over-low-pay-1.1267024

Lots of FM docs are working part-time as well.

I agree. Mainly because of cosmetics, but that becomes a business thing. Good luck competing in Vancouver or Toronto with all the cosmetic derm practices there.

 

I'll add Canada vs US is a different beast. US derms are paid much more than Canadian derms and US FM docs are paid much less than Canadian FMs.

 The earnings difference between Canada and US FM isn't as large as people think: US FPs are mostly employees and so 200K reported income is basically a salary and also includes pension plan, etc..  Canadian FPs have much higher individual gross earnings but have to pay overhead and don't get benefits, unless they specifically set aside money.  25-30% of 300K is 75-90K without benefits.  Still, the single-payer model also has a lot of benefits (source).   There was a forum post comparing US vs Canada FM

 

[ArchEnemy]

On 2018-03-03 at 10:46 AM, Dermviser said:

Does that help boost someone's salary?

From my understanding, it will boost someone's salary but not to the level of a dermatologist of course. 

Did you match to Derm?

[JohnGrisham]

On 3/3/2018 at 8:15 AM, ZBL said:

Isn’t that pretty much useless though? Normally I’ve seen people have these through random online UK universities. Seems more like a quick way of being able to add the word “dermatology” to ones education section of their website rather than achieve legitimate training in the way that a sports med, low risk OB or EM +1 year is. I’m not sure what sort of patient would actively be referred to someone with a derm certificate for medical derm problems - seems more like a marketing gimmick for non dermatologists who want cosmetic patients. 

 

I dont remember where where I saw it, but I recall seeing that the average dermatologist will have 10-15% of their patients as cosmetics, so presumably all those salary stats account for on average 85% of their patient load. I assume cosmetics pays better than medical billing, so I’d probably add 15-20% to whatever those numbers are, or higher if it’s a derm who focuses on cosmetics or procedures. So I’d say a derm makes AT LEAST 2-3x the average GP, assuming similar hours, with the ceiling for derm obviously being extremely high. 

My understanding was that you had to have the UK Derm certificate in order to do the GP-Derm Billing codes? Maybe i am completely off base though!  

I know of one local GP-Derm doc, makes a killing but does mostly the cosmetic stuff(and they did the UK derm certificate) and medical MSP related stuff..probably 50:50.

[JohnGrisham]

Unrelated:http://www.doctorskinlaser.com/last-dermatologist-leave-bc-please-turn-lights/

The woe is me in dermatology.

[goleafsgochris]

The posters equating derm and GP pay in this thread are being extremely misleading.  There is really no financial comparison between the average GP and average derm.  Of course you can cherry pick a GP making bank or a derm doing poorly.  But look at OHIP averages--derm is higher even without non-OHIP billings, which is an extremely high part of the average derms billings.  Knowing new docs in both derm and family in the GTA, here is a rule of thumb: a GP will make 250k take home working hard and putting a lot of effort in.  A community derm could make that working 2 days per week, without doing anything out of the ordinary

[indefatigable]

The net-earnings per specialty per full-time physician in Ontario derived from the ICES report are mentioned in another thread (besides DermJuly2018PGY1 remarks above).  

 

[ZBL]

Honestly I don't even know why we are having this discussion. 

 

[indefatigable]

3 hours ago, ZBL said:

 

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