Anatomical Pathology vs Family Med

[seeking1]

I've been reading through the boards, and I realize I've thought of something that I don't think is well covered here. If one were looking at picking between doing AP and doing FM, which one would you choose and why?

 

Both specialties are schedule friendly and pay pretty well compared to some of the IM specialties, psych and peds, especially if one is not predisposed towards the surgeries or the ROAD specialties.

 

I know there are several differences which may make AP or FM better than the other in someone's eyes. AP is salaried, whereas FM still does FFS and allows you to incorporate, allowing for some tax fun. However, AP gets paid more on average (~300-350k) compared to FM (~200k gross billings). Also, AP has no overhead and little insurance costs, where FM has anywhere from 20-30% overhead and much higher insurance costs. AP is very science and diagnostic oriented, whereas FM is very communication and clinic oriented. There are more comparisons to be made, I won't go overkill here.

 

What are people's thoughts on choosing between the two?

[Lactic Folly]

This question probably doesn't arise much because the type of work in AP and FM is so different. Have you had firsthand exposure to both fields? Could you genuinely see yourself happy in either field, doing its bread and butter day in day out for the rest of your career? Remember that the main goal is happiness, to which job satisfaction and remuneration both contribute; money cannot buy job satisfaction in a field one is not well suited for, so the fine points of insurance or billing should not really be one's deciding factor here.

[seeking1]

This question probably doesn't arise much because the type of work in AP and FM is so different. Have you had firsthand exposure to both fields? Could you genuinely see yourself happy in either field, doing its bread and butter day in day out for the rest of your career? Remember that the main goal is happiness, to which job satisfaction and remuneration both contribute; money cannot buy job satisfaction in a field one is not well suited for, so the fine points of insurance or billing should not really be one's deciding factor here.

 

Completely fair point. Truth be told, I am still pre-med, haven't really experienced either yet. I'm just interested in getting insight ahead of time. I am in the position where I might not be able to handle the intense hours of some specialties, and so I want to get other people to chime in before I get into all of this (if I do lol ). LF, I know you're in AP, did you ever consider FM?

[Lactic Folly]

Hi seeking1; well, I agree it is good to ask these types of questions comparing different specialties, as you can often obtain valuable insights this way.

 

I'm not in AP, but did strongly consider it, and likely would have been happy doing it as well. From your mention of lifestyle, I assume you are thinking of urban FM, which I did not consider because

1) I wanted to be a specialist rather than a generalist

2) I am happy with meaningful short-term patient interactions, and it is not important for me to get to know entire families over a period of time

3) I prefer the higher acuity hospital environment to the clinic environment

4) The type of work I did on my urban FM rotation (refilling prescriptions, physical examinations on healthy people, treating coughs/colds/STIs, filling out paperwork/referrals, psych/relationship issues that cannot really be dealt with in a short time slot) didn't really energize me, compared to what I do now.

 

For a post explaining the appeal of FM from the perspective of someone who has chosen it, see HycrestJIT's excellent post here:

http://www.premed101.com/forums/showthread.php?t=84453

 

Ultimately, AP is more about the disease than the patient; FM is more about the patient than the disease. Both will go through some busy rotations in clerkship and internship; if lifestyle after residency is a main consideration, there are other fields to consider (IM subspecialties, PM&R, etc.) that are not so much at opposite ends of the patient contact spectrum.

[thebouque]

In a nutshell, you have to enjoy looking at slides (and I'm talking about SLIDES, ie diagnosing diseases and cancer while looking at slides, not looking at meaningless slides in your biology class). If so, you could consider path as a career. If not, steer clear from path. It's as simple as that. Also, while it's good to have a headstart, it's way to early to think about it in premed.

 

Edit: most people can stand family medicine even if it's not their passion. Most people can't stand looking at slides and find it boring as hell (but those who like slides have the time of their life at the scope). You have to try it to see if it's for you or not. It shouldn't take more than 10 minutes.

[Lactic Folly]

not looking at meaningless slides in your biology class

 

Most people can't stand looking at slides and find it boring as hell (but those who like slides have the time of their life at the scope). You have to try it to see if it's for you or not. It shouldn't take more than 10 minutes.

Well, this is an interesting point. At the time, I wouldn't have known enough about what I was seeing under the microscope to be able to tell if the slides were boring or not! But I enjoyed the people, the working environment, and the role of the pathologist.

[rask]

Great that as a pre-med you are even aware of AP as a potential specialty as many med students aren't even familiar with what it entails. Lactic Folly and thebouque have done an excellent job of outlining some of the key features that appeal to those in pathology. In my mind, comparing AP and FM is like comparing apples and oranges. 'Lifestyle' may be a similarity but there are numerous differences that should be considered as others have brought up. Those who truly like pathology tend to like it a lot and are in their element looking at slides and grossing specimens. But it is not for everyone.

 

Since you're a pre-med and it is still quite early in the game, when you get into med school do an elective in pathology outside of your core rotations and see if you think it's for you.

[seeking1]

These are all excellent posts, I really appreciate the insight you are all giving me, and I know I am being a little precocious asking as a premed. I was kind of hoping brooksbane would come swooping in to go crazy on this thread. As a salaried AP, say in Ontario, is it true that the government would just take 50% of what they paid you in taxes right away?

[thebouque]

These are all excellent posts, I really appreciate the insight you are all giving me, and I know I am being a little precocious asking as a premed. I was kind of hoping brooksbane would come swooping in to go crazy on this thread. As a salaried AP, say in Ontario, is it true that the government would just take 50% of what they paid you in taxes right away?

 

That's not how taxes work

[seeking1]

That's not how taxes work

 

Hahaha! Well thats reassuring! I had seen brooksbane mention elsewhere that this is the case, due to the whole "pathologists can't incorporate" thing, but I likely misunderstood. I'm sorry to be so focused on this, but I want to know more about how pathologists are paid and how it plays out tax-wise.

[astudentis]

re taxes

it depends on what tax bracket you fall under and which province you are from.

also, you maybe able to bring your self to lower bracket depending what you can write off as overhead expenses

 

handy calculator

http://www.ey.com/CA/en/Services/Tax/Tax-Calculators-2012-Personal-Tax

[seeking1]

re taxes

it depends on what tax bracket you fall under and which province you are from.

also, you maybe able to bring your self to lower bracket depending what you can write off as overhead expenses

 

handy calculator

http://www.ey.com/CA/en/Services/Tax/Tax-Calculators-2012-Personal-Tax

 

Thanks for that. So if I'm a pathologist in Ontario making $330,000/year, I'm paying about $130,000 in taxes and taking home about $190,000? Seems pretty good to me. How would incorporation affect this? Can pathologists incorporate like FM?

[Laika]

Can pathologists incorporate like FM?

 

Some can and some can't. It depends if you're a hospital employee or on contract. It's usually hospital-specific and pathologists at a given hospital aren't given a choice.

[seeking1]

Some can and some can't. It depends if you're a hospital employee or on contract. It's usually hospital-specific and pathologists at a given hospital aren't given a choice.

 

Oh...I didn't realize that. Are most of the hospitals in Ontario expecting their pathologists to be a hospital employee? Thats sort of rough, but also a little understandable.

[rmorelan]

Oh...I didn't realize that. Are most of the hospitals in Ontario expecting their pathologists to be a hospital employee? Thats sort of rough, but also a little understandable.

 

Most are but not all, and in some centers it is changing. I can see why they are salaried - almost no one is more pure service than path. I mean rads even can do procedures (well has to actually) and heaven forbid say no to a imaging test - path is even more directly supporting another team.

[thebouque]

Oh...I didn't realize that. Are most of the hospitals in Ontario expecting their pathologists to be a hospital employee? Thats sort of rough, but also a little understandable.

 

As a salaried employee you have many advantages, including retirement/pension and social benefits. Incorporation isn't always beneficial. You more or less split your income (for eg you give a salary to your wife), so you divide the tax brackets, and pay less tax. It's very expensive, and sometimes income splitting is not possible in your situation. Nothing is black or white and there is no clear advantage between having a good salary and incorporation.

 

If you speak some french you could come work in Quebec, 100% of the pathologists are ffs (fee for service) here and they can incorporate.

[Laika]

Unless one plans on spending all of one's income without saving a dime, being an employee is always a fiscally worse decision than incorporation.

 

Not true in all situations. I know a pathology fellow who was comparing two job offers: one where they could incorporate, and the other where they were an employee. In this person's situation, they ended up being financially equivalent. If you can't income split (either because you have no dependents or because your spouse is already incorporated) and you want the benefits provided as an employee, the benefits of incorporation are significantly reduced.

 

Having said that, incorporating is generally the better choice, and a few hospitals are switching how pathologists are paid.

[rmorelan]

Not true in all situations. I know a pathology fellow who was comparing two job offers: one where they could incorporate, and the other where they were an employee. In this person's situation, they ended up being financially equivalent. If you can't income split (either because you have no dependents or because your spouse is already incorporated) and you want the benefits provided as an employee, the benefits of incorporation are significantly reduced.

 

Having said that, incorporating is generally the better choice, and a few hospitals are switching how pathologists are paid.

 

must have had an amazing pension as the tax deferring properties alone are huge (income splitting is not the most important part of it - it is holding investments in the corp and investing them instead of immediately paying 50% tax on all earnings)

[ploughboy]

If you can't income split (either because you have no dependents or because your spouse is already incorporated) and you want the benefits provided as an employee, the benefits of incorporation are significantly reduced.

 

It's not just the income splitting, though. Assuming that you're not a complete spendthrift you ought to be retaining a lot of your income within your professional corporation where it's taxed at approx 20% (versus 40+% for salaried income).

 

Now of course that money has to eventually come out of the professional corporation for your use, but deferring that tax burden for decades gives you the opportunity to make that money grow. As well, my accountant tells me there are tax-efficient ways to liberate the value of what's in your corporation. Don't know any more details than that, as we've only been talking generalities thus far. I won't actually be incorporating until sometime next year, rcpsc willing...

[thebouque]

The FFs system of which you speak in Quebec is not truly FFs. It's this thing called l4e that operates essentially like capitation. Am I misunderstanding that?

 

The L4E is just a mean to calculate how much work you've done, since every case is not equal (there are very subtle variations such as the use of IHC, number of blocks, and even differences between organ systems). It's not capitation, where a fixed amount is paid.

 

What happens in the L4e system is the following: you plan to get 1 L4E at the beginning of the year, which amounts to 300k. At the end of the year, if you've worked more than 1 L4E, you get more money. If you've worked less, you have to reimburse some of the money (a very rare occurrence). Therefore, if a pathologist in Quebec has done 1.5 L4E, he'll get 450k. If he has worked 0.8 L4E, I'll let you do the math. What's the difference between this system and FFS? It's supposed to be capitation, but in fact it's FFS in disguise, since the amount of money given to pathologists is VARIABLE, is directly proportional to their workload, and pathologists make 0 if they don't see cases. The gvnt thought that by setting 1L4E = 300k, the various groups would hire more pathologists. Instead, they're all trying real hard to get that 1.5 L4E (which amounts to almost 3x the average workload of a canadian non quebecer pathologist).

 

Honestly I'm not sure I would mind having a salary. Keep in mind that the 35% difference in tax only applies to the amount you put in your ''corporation'' and not your whole income.

 

EDIT: I agree that incorporation is more interesting most of the time, but I think it's important that our premed friend realizes that everything is not black or white, especially since he has a lot to learn about our tax system

[Mourning Cloak]

(which amounts to almost 3x the average workload of a canadian non quebecer pathologist).

 

Wow! Remind me NOT to have my biopsy read in Quebec!

[thebouque]

Wow! Remind me NOT to have my biopsy read in Quebec!

 

Yet we get consults from everywhere in Canada. Don't worry, despite the workload the quality control measures are there.

[seeking1]

I seemed to have stirred the hornet's nest with my question. I know a little about the L4e system, is that an attempt to introduce more FFS for path in Canada? How much of a bite out of renumeration would self-planning for pension and benefits take out of a family doc's take-home pay? I know on the Primary Care subforum that they pointed out average take-home for an FM is about $120k w/o factoring in pension, other everyday expenses, etc.

 

I'm still get used to the tax system here, sorry.

[rmorelan]

I seemed to have stirred the hornet's nest with my question. I know a little about the L4e system, is that an attempt to introduce more FFS for path in Canada? How much of a bite out of renumeration would self-planning for pension and benefits take out of a family doc's take-home pay? I know on the Primary Care subforum that they pointed out average take-home for an FM is about $120k w/o factoring in pension, other everyday expenses, etc.

 

I'm still get used to the tax system here, sorry.

 

well you won't take the pension or benefits out of the take home pay if you were doing it correctly. That would be paid directly out of your corporation. Actually the main point of the corporation is to set up a retirement vehicle for yourself

 

I suspect the 120K number would be post pension in other words (even the term pension bugs me a bit there actually - you don't really get a pension in the proper sense of the word - you just have investments that generate a return in the corporation).