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-JAG-

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  1. My earlier comment was unclear. I (mistakingly) referred to a yearly income using a full time hourly wage. This may paint a clearer (or at least more representative) picture: We assume that the standard model of 50 minutes of face-to-face interaction followed by 10 minutes of note taking holds true. Our social worker sees 5 patients a day for a total weekly workload of 25 hours. For this delegated service, you would bill 150$/hour and the patient would bare no expense, which limits no-shows and increases the “supply” of new patients. Yearly billings come out to around 170k.
  2. My reply to ellorie touched on this, but I maintain that the amount that psychologists and social workers bill is in no way representative of their true income. 50$/hr is about 100k/yr. That’s about what most psychologists make (https://www.jobbank.gc.ca/wagereport/occupation/2223) and more than what most social workers make. If they could really bill 200/hr and keep overhead reasonable (say 25%, as is possible for a physician), they would make more than some doctors with significantly less schooling and a much less stressful job, which I doubt is true. If it were, we would see a lot
  3. I think that that’s a tad misleading. I’m not an expert on how much clinical psychologists make, but it was always my understanding that they have high overhead and don’t bill anything close to 40/hrs per week. The average clinical psychologist makes around 100k according to most job sites, which comes out to 50$/hr. The government’s trend analysis of psychologists’ wages seems to corroborate this. (https://www.jobbank.gc.ca/wagereport/occupation/2223) If private practice psychs could really bill 250 an hour, work 40 hours a week and keep overhead at 25%, they would make close to 400
  4. After going through each province’s respective fee schedule, I have found that PEI is the only province that explicitly permits physicians to bill for visits that they delegate to a member of their staff. The most attractive service that is eligible for this seems to be PEI’s counselling (akin to GP psychotherapy) code, which currently pays 182$ per hour, rising to about 200$ per hour in 2023. (code 2501 for those interested) If delegated, the physician may bill 75% of the original amount, so currently 137$ per hour rising to nearly 150$ per hour. Seeing as one could hire a
  5. The 427k gross billings assumes 30% overhead. Even working in someone else's clinic you can go lower than that. In response to your points. a) you can practice good medicine seeing 60 patients a day just as you can practice bad medicine seeing 15. That being said, a lot of achieving high patient volumes comes from cutting out chit-chat, limiting your patients to one issue per visit, charging for forms and not refilling Rx by phone. b) very few family physicians work this much c) the benefits of rural medicine are often overstated on this forum. People act like going rural
  6. By epidurals do you mean steroid injections? That is a big money maker (in some provinces, as long as you're FFS and not hourly pain clinic like Alberta). You may be right for nerve blocks, but I always saw that they were quite à la mode. (Femoral blocks seem to be pretty prevalent but I'm not a pain medicine expert so don't quote me on that.) Nonetheless because pain patient rosters are so small (1000 patients will keep you busy year round) there's quite a bit of room for variation from clinic to clinic and doctor to doctor.
  7. FM overhead is not 45%. Plenty of clinics (and by this I mean for profit enterprises that make money by skimming more of your billings that what overhead actually costs) charge 30% even in expensive cities. If you're willing to go to the suburbs/work in an older building/forgo a medical assistant/shop around a little bit you can easily get to 25% outside of downtown Toronto/Vancouver. Same for endocrinology and rheum. In my province, Endo expenses are very similar to FM with some additional equipment for thyroid biopsies. Rheum is basically the same as FM. Urology here also has low overhead be
  8. I'm sure all the Managing Directors and PE partner only have bachelors. I have family in Private Equity in the States. Are you aware that almost all PE shops are 2 years and out. 3 years in IB, then 2 in PE and then you're asked to leave. You're not going to become a kindergarten teacher, you get an MBA. Now I conveniently forgot to mention that some generous firms pay for your tuition, but most don't. This is the error you would have pointed out if you knew about finance.
  9. Well in my middle of the road province the average specialist including all the part timers, private based and academic based physicians make over 500k before our very generous 1.45x bonus for going to a small town, so I'll have to agree with you.
  10. If by private you mean outside RAMQ, then the answer is no. If you're not charging Medicare, you can do whatever you want (especially with Chaoulli vs Quebec) If you mean private offices that provide insured services, the answer is more complicated. The billing cap for most specialties is different, but is usually between 5-600k. For anything done in a private office (cabinet) only 65 cents of every dollar goes towards this cap. That being said, some specialties, like psych, also have a hard billing cap IN ADDITION to these restrictions. Whichever you hit first applies. For example: the s
  11. Is everyone forgetting the cost of an MBA for banking? That's 100k tuition (UofT) (4x what med school costs in Quebec, 2x in the prairie provinces) and 2 years (the same as FM residency) lost. If you go to an M7 program in the States (as many Canadians do, especially if they want to be competitive for elite PE firms, it's over 200k, not even counting lost income.
  12. In 2015, over 500 doctors in Ontario billed OHIP more than 1 million dollars. Let’s compare that to some other professionals 1. Lawyers. Here’s a study of self employed lawyers’ incomes from 2012. [https://www.thestar.com/news/canada/2012/03/30/the_verdict_lawyer_well_paid_at_8_million.html] Only 8 self employed lawyers in the entire country made over seven figures. Sure, that ignores employed lawyers such as partners in large law firms, but hitting a million a year there isn’t a guarantee either. While profits per partner aren’t an exact portrait of salaries, it’s still pretty telling
  13. TL:DR: Why do primary care clinics in the US have overheads in the 50-60% range while Canadian ones pay less that half that. Do malpractice insurance premiums and billing agents really make up the difference? Some back of the napkin math below: Let’s start by citing some commonly thrown around percentages. The CMA states that family physicians in Canada pay, on average, 27% overhead. The large GMF’s here in Montreal all charge around that rate, usually between 23 and 31% from what I’ve personally seen. While I can’t confirm it, I’ve also heard from a few family physicians that even at
  14. I wonder if it would be too intrusive to ask if the fact that they can only bill 12k worth of excisions of benign or pre-cancerous tumours every 6 months is what’s holding them down. At the very least, it would make a great conversation starter.
  15. [1] Leaked report from AMA showing that average daily billings for derm in Alberta are nearly 5k (doesn’t include cosmetics). These overhead numbers are way out of whack for all specialties, but even if we assume that these numbers are true (which they aren’t, derm overhead is manageable unless you own lasers and other equipment used in cosmetics), the average derm is still taking home 800k after practice expenses in the worst case scenario. Source - https://c2-preview.prosites.com/213099/wy/docs/Attachment 01 - Fee and Income Relativity 101 for Spring 2017 RF FINAL 2017-02-10.pdf [2
  16. Experimental Surgery at Mcgill is the program I’m most familiar with. It can lead to either a Masters or PhD. Other universities in Quebec also offer it, sometimes under the surgeon scientist name. It’s usually done during residency, but I’ve heard of fellows doing it as well in some circumstances. CIP is another alternative, but that’s already been explained in detail here.
  17. This varies by university. I don’t know about McGill, but they’re usually the strictest about these things. For the university of montreal, if you have less than 12 university level credits you are considered a cegep student for admission purposes. Afterwards you will have to finish your bachelors to be admired. Sherbrooke has a similar requirement, but you do not need to finish your bachelors. This means that if you mess up on your first try, it may not be in your interest to attend university. For example, let’s say you have an r score of 36.xxx in Cegep. Very good but ce
  18. Fellow Quebecer here, these are my two cents. 1. What do you think about this change? The Casper has always been a bit controversial. I don’t think anyone truly believes that it is the perfect tool for considering applicants, but there has been data that suggests a strong correlation between Casper scores and performance during clerkship. I’ve never taken the Casper, but to me it is something that you must first study for and understand, no matter what those who think that life experience is the only studying needed say. In regards to Laval, I don’t know what to think. It was f
  19. Sorry for the double post. Any idea if the Ontario Ministry would issue new licenses for underserved regions (Sudbury, for example), especially for a facility willing to work on less funding than a public hospital. Also, do you know how this works in Alberta? There seems to be a number of private clinics offering publicly covered MRI and CT? (BGSA, EFW, for instance) What abut Quebec, it was one of Barrette's (a radiologist) main promises as Minister to cover these but nothing has happened since. The radiologists' association refused, but I don't see how this would have hurt them, especially i
  20. There are, as with MRI, a small number of independent CT providers in Ontario, as shown on the last page of this document (http://www.auditor.on.ca/en/content/annualreports/arreports/en18/v1_308en18.pdf) However, I can’t see how this is financially viable with the apparent lack of technical/facility fees for both CT’s and MRI’s in Ontario. A basic 64 slice CT machine can easily cost 500k CAD for even a used example, add to that qualified techs and special installations, I don’t see how it could be financially viable to run such a practice seeing as how you could make the exact same thing
  21. Posted this elsewhere but thought I may get more answers here. Are there any clinics in Canada that offer MRI’s covered by Medicare? Can radiologists bill for these services? I couldn’t find anything in any provincial fee schedule on fees for the technical component of MRI’s, only interpretation. The only leads I could uncover were that the Quebec government was negotiating with the Fédération des Médecins Spécialistes du Québec on covering MRI and CT outside hospitals as early as 2016 yet even the 2019 fee schedule clearly states that radiologists cannot bill for these service
  22. Are there any clinics in Canada that offer MRI’s covered by Medicare? Can radiologists bill for these services? I couldn’t find anything in any provincial fee schedule on fees for the technical component of MRI’s, only interpretation. The only leads I could uncover were that the Quebec government was negotiating with the Fédération des Médecins Spécialistes du Québec on covering MRI and CT outside hospitals as early as 2016 yet even the 2019 fee schedule clearly states that radiologists cannot bill for these services outside a hospital, which leads me to think that negotiations have
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