Salaries of specialists adjusted for overhead expenses

[DermJuly2018PGY1]

2 hours ago, snapmoster82 said:

I will say that in Canada there is no pattern of "smartest" medical students going into the ROAD specialtiies. The smartest people from my class went into FM or more commontly IM. To get into a ROAD, you need to gun from day 1 really. Canadian medical school training favors gunning vs book smarts. 

I definitely agree with this, contrarily to the US.

[Aconitase]

Perhaps the rads can comment but something like a knee MRI seems like a quick read that pays a lot for time spent

 

Every speciality has these Overpaid for time spent analmoies 

 

-optho has catarcats

-cardio has reading nucs and echos 

-ICU has hypothermia and anesthesia for procedures 

-GIM has the special visit codes at night and ‘Tylenol rounds’

-GI has poly removal

Unfair to label rads as being only offender here but it exists pretty globally

[DermJuly2018PGY1]

18 minutes ago, Aconitase said:

Perhaps the rads can comment but something like a knee MRI seems like a quick read that pays a lot for time spent

 

Every speciality has these Overpaid for time spent analmoies 

 

-optho has catarcats

-cardio has reading nucs and echos 

-ICU has hypothermia and anesthesia for procedures 

-GIM has the special visit codes at night and ‘Tylenol rounds’

-GI has poly removal

Unfair to label rads as being only offender here but it exists pretty globally

What do derms have?

[Aconitase]

Just now, DermJuly2018PGY1 said:

What do derms have?

Lol. Not as aware of seem but I imagine some off OHIP stuff and freezing and removals but not sure 

[rmorelan]

2 hours ago, Aconitase said:

Perhaps the rads can comment but something like a knee MRI seems like a quick read that pays a lot for time spent

 

Every speciality has these Overpaid for time spent analmoies 

 

-optho has catarcats

-cardio has reading nucs and echos 

-ICU has hypothermia and anesthesia for procedures 

-GIM has the special visit codes at night and ‘Tylenol rounds’

-GI has poly removal

Unfair to label rads as being only offender here but it exists pretty globally

I think a knee bills for about 100 dollars. I have seen staff ready one comfortably in less than 15 mins routinely - but that is assuming it is routine or something relatively easy. Of course with MRI in particular it seems it comes in fest and famine mode. You can get 10 follow that pancreatic cyst MRIs and they don't take that long. You can get an involved complex cancer and you are at it for ages - every time you think you are done you are hit with another thing you have to look at over 10 sequences. ha annoying - they can take forever to read, and so can almost any MRI study. It's easier when it is easier and extremely hard the other times. I really  enjoy MRI days because it is a problem solving tool mostly so you are looking at interesting pathology much more often. 

[ZBL]

12 minutes ago, DermJuly2018PGY1 said:

What do derms have?

From what I’ve heard, they don’t really have one. The pay for a new patient or follow up is not that large, and the fee for skin biopsies and excisions is also not out of proportion large for the time it takes. Derm is a volume business, which is why many can see 50-70 patients per day. 

[Aconitase]

7 minutes ago, ZBL said:

From what I’ve heard, they don’t really have one. The pay for a new patient or follow up is not that large, and the fee for skin biopsies and excisions is also not out of proportion large for the time it takes. Derm is a volume business, which is why many can see 50-70 patients per day. 

Yeah I agree. I doubt it has a glaring one like the GIM shifts and ICU stuff does For instance 

[1D7]

3 hours ago, snapmoster82 said:

It's fascinating how politics, and payment fees can lead to such different perceptions of specialties. Pathology in my view is largely under-appreciated and dismissed. It's too bad there's a seeming issue with training of pathology. It's also very very under-reprented in medical school. At my medical school, we aren't taught histology at all. Any discussion of its relevance is usually dismissed. However, I have been pimped 7000x times on the JVP. 

I will say that in Canada there is no pattern of "smartest" medical students going into the ROAD specialtiies. The smartest people from my class went into FM or more commontly IM. To get into a ROAD, you need to gun from day 1 really. Canadian medical school training favors gunning vs book smarts. 

As sketchy as looking at the JVP is for fluid assessment, it's 7000x as useful as knowing whatever histology bullcrap they used to teach.

[NeuroD]

 

11 hours ago, marrakech said:

The most competitive residencies in the US are surgeries - ortho, neuro, plastics, ophth, ENT,..  Rads is definitely less competitive these days and IM isn't nearly as competitive.  Derm is also very competitive.  Basically - one can't match into surgeries or derm without attending a US med school.  Cardiology matching is through performance during IM residency.

A great example of difference between US & Canada is neurology (besides standardized tests) - it's quite competitive here, but not in the US (even though outside Québec it doesn't pay that well). 

Drives me crazy that neuro continues to be so low on the pay scale, and the gap between neuro and similar other fields is growing. Hard to see why its competitive when fellowships are becoming the norm and relative pay seems to be getting worse. (Obviously I'm biased because I like neuro :))

2 hours ago, Aconitase said:

Perhaps the rads can comment but something like a knee MRI seems like a quick read that pays a lot for time spent

 

Every speciality has these Overpaid for time spent analmoies 

 

-optho has catarcats

-cardio has reading nucs and echos 

-ICU has hypothermia and anesthesia for procedures 

-GIM has the special visit codes at night and ‘Tylenol rounds’

-GI has poly removal

Unfair to label rads as being only offender here but it exists pretty globally

And Neuro has LPs, which pays $65 for 1 hour (some times more) of a sterile procedure

Edit: to be fair, we can also share EMGs with PMR...but it's no cataract or stent

[indefatigable]

47 minutes ago, PhD2MD said:

 

Drives me crazy that neuro continues to be so low on the pay scale, and the gap between neuro and similar other fields is growing. Hard to see why its competitive when fellowships are becoming the norm and relative pay seems to be getting worse. (Obviously I'm biased because I like neuro :))

 

I think many people understandably find the physiology very interesting.  Haha you can always set your sights on Montreal and Mcgill - some history there with Penfield and neurologists are paid much better (assuming there aren’t pay cuts).  I doubt it would be easy to get job though - would probably need at least one fellowship.  

[A-Stark]

On 2018-03-09 at 1:31 AM, Aconitase said:

Putting in IHD lines pays nothing. It’s all chronic dialysis fees. Once you roster a patient for dialysis then you are paid a set amount by the government each year for that patient. That covers their chronic IHD management for the year. 

Putting in temporary dialysis lines nets about $150. Chronic fees aren't actually that great; it's just that patients all go three or more times a week!! Given that chronic orders mainly amount to "take fluid off until you reach dry weight", I'd say they're grossly overpaid. 

On 2018-03-09 at 9:46 PM, Aconitase said:

Perhaps the rads can comment but something like a knee MRI seems like a quick read that pays a lot for time spent

 

Every speciality has these Overpaid for time spent analmoies 

 

-optho has catarcats

-cardio has reading nucs and echos 

-ICU has hypothermia and anesthesia for procedures 

-GIM has the special visit codes at night and ‘Tylenol rounds’

-GI has poly removal

Unfair to label rads as being only offender here but it exists pretty globally

Most closed ICUs operate on an AFP basis so staff aren't billing as such. 

On 2018-03-10 at 0:08 AM, PhD2MD said:

 

Drives me crazy that neuro continues to be so low on the pay scale, and the gap between neuro and similar other fields is growing. Hard to see why its competitive when fellowships are becoming the norm and relative pay seems to be getting worse. (Obviously I'm biased because I like neuro :))

And Neuro has LPs, which pays $65 for 1 hour (some times more) of a sterile procedure

Edit: to be fair, we can also share EMGs with PMR...but it's no cataract or stent

An hour for an LP? 

[Economist]

On 3/9/2018 at 5:16 PM, Aconitase said:

Perhaps the rads can comment but something like a knee MRI seems like a quick read that pays a lot for time spent

 

Every speciality has these Overpaid for time spent analmoies 

 

-optho has catarcats

-cardio has reading nucs and echos 

-ICU has hypothermia and anesthesia for procedures 

-GIM has the special visit codes at night and ‘Tylenol rounds’

-GI has poly removal

Unfair to label rads as being only offender here but it exists pretty globally

What's this special visit codes at night? 

[NLengr]

7 hours ago, Economist said:

What's this special visit codes at night? 

Province dependent I would imagine

[Let'sGo1990]

On 3/11/2018 at 11:21 PM, A-Stark said:

Putting in temporary dialysis lines nets about $150. Chronic fees aren't actually that great; it's just that patients all go three or more times a week!! Given that chronic orders mainly amount to "take fluid off until you reach dry weight", I'd say they're grossly overpaid. 

Most closed ICUs operate on an AFP basis so staff aren't billing as such. 

An hour for an LP? 

Probably not the norm to spend an hour on an LP. I could maybe see it once in a blue moon - if the CSF is hard to get and it's dripping painfully slowly. 

But even if you do do two in an hour, the return on time isn't as fruitful as it would be doing other things.

 

[rmorelan]

7 hours ago, Let'sGo1990 said:

Probably not the norm to spend an hour on an LP. I could maybe see it once in a blue moon - if the CSF is hard to get and it's dripping painfully slowly. 

But even if you do do two in an hour, the return on time isn't as fruitful as it would be doing other things.

 

even under flouro those things are variable - rare but the longest I had was 1.5 hour "gotta have it" LP. It was coming, but coming at a snail's pace and they needed 13 CCs. 

[goleafsgochris]

1 hour ago, rmorelan said:

even under flouro those things are variable - rare but the longest I had was 1.5 hour "gotta have it" LP. It was coming, but coming at a snail's pace and they needed 13 CCs. 

Hah, for sure, obvious the average is much quicker (20 mins with set up?), but especially with slower staff or with learners I have seen them go over an hour.  Medicine can be painful/boring sometimes haha

[rmorelan]

Just now, goleafsgochris said:

Hah, for sure, obvious the average is much quicker (20 mins with set up?), but especially with slower staff or with learners I have seen them go over an hour.  Medicine can be painful/boring sometimes haha

something like that - when it works it goes super smooth my part is about 10 mins. But like most things it doesn't always go super smooth

[uwopremed]

I've been off the boards for a bit of time (nothing like 3rd year western clerkship to take the piss out of you).  But I did want to comment to this board.

Take the numbers in the original chart with a major grain of salt.

Some specialties have significant NON-OHIP sources of income.  I'm talking Ophthalmology, Plastic Surgery, ENT, Physiatry, Dermatology and even Radiology (quite a few Radiologists here do outsourcing CT reading for the USA during evenings - and add an extra 100K+ to their earnings from US HMOS).   Many of the specialties with 'high overheads' are exaggerated (cardiology, gastroenterology, etc- they include fancy dinners that are meetings, conferences in Hawaii that also are vacations for family, a portion of the payment of nice cars, computers that are often more personal use than work related, etc.  Even GP

Other specialties, like Anesthesia and Oncology are bang on - they have few things that one can write off (though they do), and there are no sources of non OHIP money.

The work/hour is also hard to really calculate.  In the end, all doctors work hard, and have trained a long time to make their income.  Some doctors could not work outside regular hours anyways; not sure they should be punished selecting such a specialty with more pay cuts.

The top earning specialties generally correlate with competitiveness.  If you are willing to work 50=60 hours a week - the below is pretty accurate AFTER expenses.

1 million plus:  ophthalmology, plastic surgery (many make 2-3 million+ - often within a year or two of developing a cosmetic practice in an under serviced region), cardiology

600K plus:  gastroentrology, anesthesia, ENT, neurosurgery, orthopedics, vascular, nuclear medicine, emergency

450L plus:  most other specialties

<300K:  the underpaid - Neurology, Peds, Psychiatry

 

GP income varies so much, it's very difficult to give an accurate assessment.  It depends on where you live, if you can get onto a family health team, and how smart your business sense is.

 

[uwopremed]

On 3/9/2018 at 7:59 PM, DermJuly2018PGY1 said:

I definitely agree with this, contrarily to the US.

Because our transcripts are absolutely useless - getting into competitive specialties is not actually as reflective of how smart students are (in relative to the USA - where grades are on transcripts, and board exams results are required (Step 1 at least).  

There are a few dummies in my class that are gunning for some high paying specialties - and because they can present themselves reasonably well for short periods of time on a focused subject , and have some research, they will have a great shot of matching next year.  I'm talking plastics and ENT and urology as specialties.

Oh well...

[Aconitase]

On 2018-03-12 at 2:29 AM, Economist said:

What's this special visit codes at night? 

In Ontario you get 100 bucks per patient seen after midnight bonus. No maximum  

 

 

[NeuroD]

On 3/13/2018 at 10:55 AM, goleafsgochris said:

Hah, for sure, obvious the average is much quicker (20 mins with set up?), but especially with slower staff or with learners I have seen them go over an hour.  Medicine can be painful/boring sometimes haha

20 min LPs with setup? Geez its either me or my patient pop...I had 6 in the last few days, they all took 45min+, except for one which had an opening pressure of 20....might be because my senior likes collecting excess CSF for weird and wacky studies.

[Aconitase]

22 minutes ago, PhD2MD said:

20 min LPs with setup? Geez its either me or my patient pop...I had 6 in the last few days, they all took 45min+, except for one which had an opening pressure of 20....might be because my senior likes collecting excess CSF for weird and wacky studies.

This is because you are a resident. In the community the nurses setup and clean up everything. It’s not like in residency where you have to do it 

[Aconitase]

20 hours ago, uwopremed said:

I've been off the boards for a bit of time (nothing like 3rd year western clerkship to take the piss out of you).  But I did want to comment to this board.

Take the numbers in the original chart with a major grain of salt.

Some specialties have significant NON-OHIP sources of income.  I'm talking Ophthalmology, Plastic Surgery, ENT, Physiatry, Dermatology and even Radiology (quite a few Radiologists here do outsourcing CT reading for the USA during evenings - and add an extra 100K+ to their earnings from US HMOS).   Many of the specialties with 'high overheads' are exaggerated (cardiology, gastroenterology, etc- they include fancy dinners that are meetings, conferences in Hawaii that also are vacations for family, a portion of the payment of nice cars, computers that are often more personal use than work related, etc.  Even GP

Other specialties, like Anesthesia and Oncology are bang on - they have few things that one can write off (though they do), and there are no sources of non OHIP money.

The work/hour is also hard to really calculate.  In the end, all doctors work hard, and have trained a long time to make their income.  Some doctors could not work outside regular hours anyways; not sure they should be punished selecting such a specialty with more pay cuts.

The top earning specialties generally correlate with competitiveness.  If you are willing to work 50=60 hours a week - the below is pretty accurate AFTER expenses.

1 million plus:  ophthalmology, plastic surgery (many make 2-3 million+ - often within a year or two of developing a cosmetic practice in an under serviced region), cardiology

600K plus:  gastroentrology, anesthesia, ENT, neurosurgery, orthopedics, vascular, nuclear medicine, emergency

450L plus:  most other specialties

<300K:  the underpaid - Neurology, Peds, Psychiatry

 

GP income varies so much, it's very difficult to give an accurate assessment.  It depends on where you live, if you can get onto a family health team, and how smart your business sense is.

 

I think most of higher paying g medical specialists (ICU/cardio/nephro) are closer to 600k-1mill as well. Also rads is 750-1mill

[DermJuly2018PGY1]

8 hours ago, Aconitase said:

I think most of higher paying g medical specialists (ICU/cardio/nephro) are closer to 600k-1mill as well. Also rads is 750-1mill

Why is rads 750-1mill... and there are available second iteration spots...?

[Lactic Folly]

If it sounds too good to be true...