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jadawo

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  1. Like
    jadawo reacted to bearded frog in What is considered "rural"?   
    There is no standard/legal of definition of rural. For medical school applications for instance they will sometimes ask if you have lived in a "rural" community and define it by number of people or something like that. On the other hand, for return of service requirements in Ontario, "rural" is just not Toronto or Ottawa. What a FM doc does relative to others will be unique to that area, and not necessarily based on population. Thunder Bay generally punches above its weight in terms of services, for example, because it serves a large proportion of northern Ontario. Same with Prince George for BC. And small towns that are 30 mins from major metropolitan centres are not going to be considered as rural. In terms of "rural" for pay bonuses and stipends for FM then it will be defined in each province.
  2. Like
    jadawo reacted to Lock123 in Ask questions about emergency medicine here   
    1. Extremely variable. Ive seen as low as 100/hr to as high as $350. Thats before we get into the intricacies of AFA rates vs ffs and how many patients you see per hour and how savvy you are with billing. Would not say "the most rural emerg department" pays the highest. Oftentimes these very rural Eds see a very low volume of patients per 24 hrs. So you are paid to sit and chit chat with your staff members and hang out and see the occasional patient. And then you sleep at night and they only wake you for high acuity patients (rare). The hourly rate for a 24 hr relaxed shift like this would actually be quite low.
    2. This is mostly correct. Many rural EDs are extremely desperate for coverage and will hire anyone with FM certification. After 4 years, 400 hours/yr and a written and oral exam, you gain EM certification. This is called the "practice-eligible" route. This does not necessarily mean you are on equal ground with physicians who are RC certified or EM certified by residency training when competing for jobs. Other factors will come into play. Also, they are changing the requirements for which sites can be used for the practice eligible pathway although I am not sure about the details there.  And yes, +1 is very competitive and you should absolutely have a backup plan if ER is your goal. 
  3. Like
    jadawo got a reaction from bellejolie in Going into FM without liking the core aspects of the program?   
    Thanks for the reply  yeah I was looking at the Alberta billing codes after I posted that and it’s easy to see how after-hours, call, weekends, etc can start to add up quickly with the modifiers and multipliers in the billing code.
  4. Like
    jadawo reacted to bellejolie in Going into FM without liking the core aspects of the program?   
    its as the other poster said - its mixed and in rural the codes are higher (1.5 depending) because the need is greater, and also often you're on call overnight so there are premiums and everything. but again like the other poster said you can make 400K comfortably as a family doc working in an urban setting too. it's a big misconception that family physicians don't bill much. they tend to make more than both pediatricians and psychiatrists and for hours worked make equal to many specialists. 
  5. Like
    jadawo reacted to JohnGrisham in Going into FM without liking the core aspects of the program?   
    Rural FM docs I know make anywhere from 300-700k in billings.     It is hugely variable.  Again, when you work clinic, in hospital and Emerg with call/overnight shifts, you are naturally working lots of hours..so you make more. And yes often less overhead in hospital, and even clinics can have less overhead due to leasing costs being lower in some rural centres than big urban centres where real estate is expensive.
    I also know urban docs who comfortable bill 400-500k before overhead cuts, doing mostly community medicine(clinics, care homes, methadone/pain etc).  

    Hugely variable depending on province, practice style and of course - time. The ones billing a lot aren't only working 40hrs a week.
  6. Thanks
    jadawo reacted to JohnGrisham in Ask questions about family medicine here   
    Rural in general compensates well, and you will compensated better by virtue of simply working alot in the various scopes(clinic, inpatient/emerg and deliveries). When you are doing all 3(or 4), you aren't only working 40hrs a week, you're doing lots of call coverage, and working lots of hours. Hence you get paid very well.  Many jurisdictions have special call stipend offerings that increase with rurality. So even if nothing comes through the door in your rural hospital on a given night, you're being paid X $s for being available, sleeping in your bed 5 mins away. Its a mixed bag, and you'll have some places where you can easily direct nursing staff over the phone, or t hey handle things overnight with protocols so they don't have to wake up the MD at 3am when they know they also have clinic at 8am etc. Some rural places are run well and have great support staff that make it possible to keep the MDs in town. Rural medicine is nothing without support staff who make it sustainable to practice the rough lifestyle for longer periods of time.

    In a fee for service model, some provinces will pay premiums for delivering care in rural areas. Others will pay you alternate payment models. You need to look into where you want to work and practice.

     
  7. Like
    jadawo reacted to JohnGrisham in Ask questions about family medicine here   
    Yes, 3 years is longer than 2 - i have colleagues who are FM docs who trained in the US ..it somewhat evens out, and not everyone needs 3 years to become competent for independent practice...and even in Canada, some people feel ready to leave residency halfway through 2nd year too. Value add is very dependent on scope and training programs you participated in. Not all programs are created alike in the US, nor in Canada. Many FM residents in canada will likely never have done extra intubations/lines in residency - because most aren't going to ever do them afterwards anyways.  Even when you're rural, its unlikely you're going to be doing it on a regular basis in some settings - but in some you will do them maybe fairly often for emergency purposes.  Alot of rural places don't have real ICU capabilities, so again, maybe useful training but not always.   There is a fair amount of self-selection in Canada, if you're interested in emerg, or OB care, you seek out more experiences in those fields and do more rotations as electives. This model works quite well on average. Those who are only interested in outpatient clinic care, stop inpatient rotations after the required core rotations, and focus on outpatient medicine, and get complimentary outpatient services(cardio, endo, gastro clinics etc). 

    100 svds is great if you get it, and feel comfortable offering those as services, but again, most FM docs in canada don't do deliveries, and the ones that are interested can always get a few extra rotations after residency if they feel they need more numbers to offer it as a service.

    As a whole, i agree, 3 years of residency prepares people better than 2 years, but many people don't "need" the extra year, depending on their scope and type of training program they completed.   
  8. Like
    jadawo reacted to JohnGrisham in Ask questions about family medicine here   
    Province dependent, but there are many rural communities where you can do all of that you asked for. Some communities you may be able to do all but OB/deliveries - as often you need specific infrastructure(i.e. RNs and backup OBGYN) to do planned maternity care. of course if a low-risk pregnant women ends up in your emerg, you can deliver them, if sending them out wont make logistical sense.

    Most rural communities you can do outpatient clinic, in hospital work, and emerg with zero issues. And many where you can add on OB call coverage - but often very little volume. Bigger less rural but perhaps still remote communities will likely have some more volume for OB and infrastructure to allow planned deliveries/c-sections. You can get additional training in some provinces to do c-sections, but generally you still need to have a OBGYN available in the community for GPs to be allowed to offer this service(i.e. you cant be the only one offering c-section coverage, in case something hits the fan and you need to call in a royal college specialist OBGYN).

    It is almost a necessity due to short staffing in many rural communities where FM docs HAVE to have that full scope coverage - i.e. many communities will mandate that if you want hospital privilege as a FM doc, you have to provide EM shift coverage too or if you want to work at all in that community on an alternate payment plan FM model, you must provide hospital services/coverage (i.e. you can't just work outpatient clinic work 9-5, while your other FM colleagues manage in patient and emerg). Every community is different, and province specific variations happen.
  9. Like
    jadawo reacted to F508 in Ask questions about family medicine here   
    Family medicine is not comprised solely of incremental adjustments of HbA1c and BP...... patients present to you with a multitude of complaints, literally anything and everything. Career satisfaction comes from being a generalist and knowing a little about everything. Throughout my residency, I have counselled parents about newborn problems, delivered babies, inserted IUDs, counselled about diabetes, counselled for depression, performed a multitude of intraarticular injections, accompanied families when their loved ones were losing their autonomy / facing a cancer diagnosis, helped someone quit smoking, diagnosed skin ailments, removed foreign bodies, given patients the knowledge/tools to better their health / to prevent ER visits / reduce their health anxiety, etc. My patients trust me to tell me their secrets and fears. My staff have diagnosed malaria in walk-in, performed abortions, worked in rural Northern Canada, worked for Doctor's Without Borders, worked as hospitalists/in obstetrics/in EM. As a family doctor, you are the first line of contact. You have the flexibility to transform your practice throughout your career.
    Throughout my residency, I saw the value of my generalist training. The staff that performs scopes doesn't remember how to treat HTA, defers to the patient's family doctor, delaying care. The IM subspecialist didn't remember how to treat hyperkalemia. The pediatric subspecialist doesn't remember what is a normal adult HR. The medical team doesn't think of fracture to explain the patient's sudden decrease in mobility. Of course for a lot of these specialties, they don't need to know these particular things to function within their domain. I am a specialist of common diseases in the general population. I don't want to only know one organ system. I don't want to only treat one small subspeciality of medicine. I don't want to know how many different ways we can resect a certain body part. I love working with people of all ages. I derive career satisfaction knowing that I have the knowledge to guide my friends and family through a large range of health issues.
     
  10. Like
    jadawo reacted to yesmedman in Ask questions about family medicine here   
    How much could a family doctor make doing locums in rural areas? For example in one of the rural locum programs in Alberta or BC? What would be the best strategy to maximize earnings in these cases?
  11. Like
    jadawo reacted to magneto in Ask questions about family medicine here   
    It is not only incremental decreases in HbA1c. It is about looking out of your patient.
    A 50 year old male can come to your clinic because he has blood in his stool. You can refer him for colonoscopy and potentially pick up an early cancer.
    Many people don't feel comfortable sharing their embarrassing problems to new people such as a physician at walk-in-clinic or emergency doctor unless they are anxious or super unwell. However, they trust their family doctor because they believe that their family doctor is their quarterback.
    Let's take another example. A patient has a small mole on his skin. He/she is worried that she has cancer. You can do a skin biopsy or small resection under local anesthetic and send it to pathologist for diagnosis. Within a week, you have the ability to potentially diagnose (and even treat) a skin cancer OR give good news that the mole is benign and nothing to worry about. You can possibly pick up an early melanoma and save a patient's life.
    There are not that many things in life where you can play such a crucial role in another person's life.
  12. Like
    jadawo reacted to hking03 in Avg New Fam Grads   
    your numbers are based on either doctors who don't know how to bill... Or they are based on an incorrect assumption that each patient visit is worth the same 30.00...
     
    Either way, both scenarios are incorrect.
     
    I've mentioned it several times all over this forum, but if you learn how to Bill for your patient visits and you engage in a practice of medicine that is actually full scope and utilizing your skills beyond writing prescriptions and doing walk in clinic visits you will make a killing.
     
    For instance, if you were interested in maternity care in BC you can join a call group and work one call shift once a week. For being a part of that call group you get paid 9k over the year through MSP. You also get paid a bonus on 25 deliveries throughout the year that adds 400.00 to the standard delivery fee. If you do prenatals at a clinic you bill 30.00 per prenatal and can crank out dozens in a day.
     
    A family doctor I worked with made ~150k after expenses (the prenatal clinic has overhead, the hospital did not) just from their one call shift a week. On average they would participate in 1-2 deliveries per call shift, which is about 100 deliveries per year.
     
    If you incorporate any sort of complex care into your family practice you can also do quite well... complex care physical exams allow you to Bill ~300-400 for the physical and review session once per year for that patient...
     
    If you work in a smaller community you can qualify for top ups that apply to your billings.
     
    If you are a part of a call group you can also receive top ups every quarter (similar to the maternity call group).
     
    If you have hospital privileges and care for your patients while they are admitted you Bill for those visits and they are usually overhead free. There is also a first patient of the day fee code that helps make it worth while.
     
    If you want to work as a hospitalist once a week you can usually do this for around 1200-1500.00 per shift...
     
    If you want to be a surgical assist you can get paid hundreds of dollars per surgery...
     
    my family doctor works part time, takes 8+ weeks of vacation and is near the end of his career and still makes 250k per year...
     
    The docs I've worked with across BC have all made 300-600k (before overhead). The lower end of the spectrum is usually reserved for docs in urban areas who don't want to do the work that pays.
     
    Hopefully that clears up some misconceptions.
     
    Granted, this may not be the type of medicine you
    Or others want to practice and these numbers
    May not apply to different provinces...
  13. Like
    jadawo reacted to jnuts in Orthopedic Surgery   
    Ok.  Lots of wrong information here. The below applies specifically to ortho.  I'm a Canadian trained Ortho staff in the US. I'm a permanent resident in the US by marriage.
    This refers to setting up an independent practice in the US, not fellowship.
    The job market for general ortho is very good in the US right now.  It is also easy to find a job for most subspecialties but expect to do some general to get started.  But you have to be qualified to work here.  In general, all of my peers who have immigration rights in the US left Canada after residency. Those who do not are still in Canada with a few exceptions who are often struggling with visa issues.  In short, there are reasons that the backlog of underemployed orthopaedic surgeons in Canada just don't all leave for the USA.
    The biggest barrier is immigration. You cannot work outside of academic centers with a J-1 or H1b (or any visa).  If you have US citizenship or a green card, expect to have many more options.  Very very broadly and with exceptions, the US job market is very different from Canada.  Starting academic jobs are more work, lower remuneration, higher obligation. They tend to be in places where the pay:cost of living ratio is less desirable. Most people who end up in them are research keeners trying to get to a senior position, IMGs, or just can't live without teaching.  The vast majority of new grads down here avoid academic jobs.  The only consistent positive to academic positions is that they tend to be more prevalent in geographically desirable areas.
    The next two barriers I'll mention are softer and likely more variable.  I'm sure there exceptions and workarounds that are possible but I'm going to discuss them with the assumption that the person considering a move down to the US would like to maintain the widest array of options and minimize future administrative snags.
    You must (most likely) write the USMLEs.  Some border States might give you a license for a fellowship with just the MCC or some such but the US regulatory structure is multilayered and the State license is not a big barrier to practice.  At some point for the hospital to credential you, or to enroll to bill one of the insurance plans, or to get malpractice insurance, or to get a visa, you will need to have the USMLEs.  Even if there are examples of people getting around this requirement, why would you shoot yourself in the foot and limit your options? My advice to anyone considering the US route to practice is to get all the Steps done during or as close to medical school as possible. As a motivating cautionary tale, I know people who would prefer to be under-employed in Canada than to face these exams in their early career -- so again, get them done early.  
    Similarly, one of the layers of barriers to independent practice outlined above will (most likely) require that you complete the ABOS (orthopaedic board) exams.  You can do them after the RCPSC exams but there is a year lag before you can take the first step (usually during fellowship).  The ABOS exam is divided into two Steps. For the first ABOS Step, the written exam, the material is not the same as the RC material but review questions are much easier to access--it's on orthobullets. The first step of the board exam itself is just MCQs at a prometric center.  In that sense, it's easier than the RC exam. Expect to spend some time studying during your fellowship.  After completing the first step you become Board Eligible (BE), which is the same status American graduates have for their first few years of practice -- in other words, you're in the normal stream after the first Step of the ABOS from the American perspective. The second ABOS Step exam comes after a couple of years of being in practice and involves collecting your own cases over your first year of practice and sitting an oral exam where a selection of your own cases that you must defend form the basis of the exam material.  The ABOS Step 2 is the same whether you're Canadian or American and isn't relevant to relocating other than to say that, to stay employed, some hospitals will require you to complete it within a certain number of years from finishing residency as part of their by-laws.  After you complete the second ABOS Step you're Board Certified (BC) in the US.
    Of note, I was able to work as a locum tenens with just my RC board certification.  However, the visa problem with working outside academic centers above would still apply if you're not a permanent resident. 
  14. Like
    jadawo reacted to bearded frog in USMG in CMG or IMG stream?   
    Correct, USMD = CMG, USDO = IMG for CaRMS. USMD will need to take the same exams that CMGs take, ie MCCQE1 and MCCQE2, if they do residency in Canada.
  15. Like
    jadawo reacted to skyuppercutt in USMG in CMG or IMG stream?   
    US grads count as CMG. I called CaRMS to confirm when I was a pre-med applying to med school
     
    EDIT: That was back in 2013, but I doubt they would've made a drastic change
  16. Thanks
    jadawo reacted to JohnGrisham in Ask questions about emergency medicine here   
    Varies by province and by region, especially if its hourly or FFS. At a minimum if its a dedicated EM shift for 8hrs you could expect at least 1000$ bare minimum.   

    Rural can sometimes pay more, but not always. Semi-rural can pay more but not always. 

    The point is, there are way too many variables to answer questions like this unless you narrow down some demographics.  You'll be well compensated regardless of region and rurality. 
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