Family Medicine Income

[windsormd1 11]

Hi Guys, 

 

    Recent graduate; out about 16  months from residency...................working in a FHG in Oakville................here are my numbers:

Most months - Gross $20-25k monthly; have billed up to $32k monthly at my busiest/hardest-working month.   I feel with being the MRP for my patients, actually practicing medicine, spending some time with my patients, and following up; and having time to practice medicine in a meaningful way........................I am comfortably at around 20-25k which is JUST RIGHT.  Working about 20-22 days a month.  My average day is 7-8 hours.

Pay about 30% in overhead; and took home roughly $200k in my first year.  (I TOOK OVER FOR A DOC)

Can others in the GTA chime in with how many hours you are working and what you are grossing?

[JohnGrisham 1,700]

What was your total gross billings for the year -  285k? Minus 30% overhead leading to 200k, then taxes etc. Is this what you're trying to convey?

Seems very good if those are your hours.

[windsormd1 11]

Yes, around that.  Don’t forget licensing fees, malpractice, etc.  overhead doesn’t include this.  Yeah not a bad life, wondering how others are doing.  

[JohnGrisham 1,700]

32 minutes ago, windsormd1 said:

Yes, around that.  Don’t forget licensing fees, malpractice, etc.  overhead doesn’t include this.  Yeah not a bad life, wondering how others are doing.  

Is your 7-8hrs/day inclusive of all clinical and non-clinical work related activities though? 

[windsormd1 11]

Yeah all inclusive, however I chart with patients in the room, and I work in between seeing patients.  I’m one of the more ‘efficient’ docs, also review labs during my lunch break.  

[Aconitase 40]

11 hours ago, windsormd1 said:

Yeah all inclusive, however I chart with patients in the room, and I work in between seeing patients.  I’m one of the more ‘efficient’ docs, also review labs during my lunch break.  

Did you take any vacation time? Or was it basically 5 days a week (or 4?)

[windsormd1 11]

4.5 days a week; 2 weeks vacay.............

 

BUMP! any other practicing docs on this forum!?!?!

[bloh 42]

Good for you!

Your GIM colleagues are pushing 1M though, running the same treadmill/echo +/- MIBI scans on everyone that comes through the door with less hours than you

My first full year was $390k pre-tax. Second year will be $360k. But I work hard, with clinic, walk in, LTC, hospitalist + emerg weekend locums and close to 5.5-6 days a week in Alberta.

 

[VivaColombia 31]

On ‎10‎/‎17‎/‎2018 at 9:34 PM, windsormd1 said:

Yes, around that.  Don’t forget licensing fees, malpractice, etc.  overhead doesn’t include this.  Yeah not a bad life, wondering how others are doing.  

Is that normal for GPs taking home (I'm assuming) 150-160K post-tax and all expenses accounted for in Ontario?

[JohnGrisham 1,700]

7 hours ago, bloh said:

Good for you!

Your GIM colleagues are pushing 1M though, running the same treadmill/echo +/- MIBI scans on everyone that comes through the door with less hours than you

My first full year was $390k pre-tax. Second year will be $360k. But I work hard, with clinic, walk in, LTC, hospitalist + emerg weekend locums and close to 5.5-6 days a week in Alberta.

 

GIM universally are not pushing 1M lol. GIM in my jurisdiction seems to get the bottom of the barrel referrals from the community and is just a dumping ground, at least in the outpatient setting. Obviously depends on how much inpatient and payment structures.  Seems like the culture for most of the internists i know is to avoid GIM like the plague, and usually those that want to work part-time are willing to default to GIM.

[A-Stark 145]

There are a few GIMs pushing up to 7 figures, but they're the ones scoping and/or reading echos in smaller community centres. 

Most of my referrals are cardiology. I had a fairly light clinic day today preceded by stress tests and MIBIs with or without said treadmill all week. And I'm really still just starting so referrals are only just starting to pick up. 

[LittleDaisy 288]

52 minutes ago, A-Stark said:

There are a few GIMs pushing up to 7 figures, but they're the ones scoping and/or reading echos in smaller community centres. 

Most of my referrals are cardiology. I had a fairly light clinic day today preceded by stress tests and MIBIs with or without said treadmill all week. And I'm really still just starting so referrals are only just starting to pick up. 

I might be wrong. I thought that reading echos are usually reserved for cardiologists? Scoping for GI or general surgeons? One of the GIM academic staff was saying that he could read echos and bill for them, but it's typically reserved for cardiologists in academic hospitals & large community hospital. 

Perhaps in smaller community, ,if the general internists feel comfortable and received extra training, they would read echos and do scopes? 

I won't say that the culture is to avoid GIM as plague, it's one of the few fields in internal medicine that actually have a good job market, very flexible working hours: work part-time, locum, or do night- shifts in ED. 

[A-Stark 145]

It depends on the hospital. You won't say many if any GIMs who have anything like Level III echo training but Level II (e.g. about 6 months and mainly TTE) is feasible. We have radiologists reading echos currently...

GIMs scoping is a thing in smaller hospitals - mine has actual GI specialists and surgeons who compete for scope time. 

I don't get any of the urban "academic" GIM consults with the non-specific aches and pains and feelings of ennui (and many iterations of ANA/ENA investigations). And I have yet to get an outpatient diabetes consult. I don't expect I'll really have time for any of that. There's just so much chest pain...

[insomnias 130]

The impression I get from GIM staff here is that they basically do what's necessary within the IM specialties. So in places where there's a long wait for cardiologists, they'll do echos/stress tests/etc. In places with a long wait for nephro, they'll do dialysis. In places with equal waits in everything, they... do GIM stuff, I guess

44 minutes ago, LittleDaisy said:

I won't say that the culture is to avoid GIM as plague, it's one of the few fields in internal medicine that actually have a good job market, very flexible working hours: work part-time, locum, or do night- shifts in ED. 

It seems that the job market very much depends on whether you want a hospitalist job or a community job. One GIM staff I know has to move from one major city to another and is finding it difficult to get a hospitalist job. It's possible to take a community position, but then you're stuck in a contract for a minimum of x months -- which is an issue if a hospital job opens up -- and it's difficult to move from a community clinic back to an academic hospital.

[LittleDaisy 288]

54 minutes ago, insomnias said:

The impression I get from GIM staff here is that they basically do what's necessary within the IM specialties. So in places where there's a long wait for cardiologists, they'll do echos/stress tests/etc. In places with a long wait for nephro, they'll do dialysis. In places with equal waits in everything, they... do GIM stuff, I guess

It seems that the job market very much depends on whether you want a hospitalist job or a community job. One GIM staff I know has to move from one major city to another and is finding it difficult to get a hospitalist job. It's possible to take a community position, but then you're stuck in a contract for a minimum of x months -- which is an issue if a hospital job opens up -- and it's difficult to move from a community clinic back to an academic hospital.

By hospitalist jobs, do you mean academic medicine jobs? Those jobs are hard to get by, not just in internal medicine, but in all specialties. Even though you get 30-40% pay cut, it is actually very pleasant to have residents, medical students working with you (save much time for paperwork, coordinating imaging, calling consultants, d-c summaries, calling families up) , while you make the important medical decisions and sleep through the nights, while your residents admit overnight patients under your name.

I believe that the community job market for GIM is actually excellent, somebody corrects me if I am wrong

[bloh 42]

20 hours ago, JohnGrisham said:

GIM universally are not pushing 1M lol. GIM in my jurisdiction seems to get the bottom of the barrel referrals from the community and is just a dumping ground, at least in the outpatient setting. Obviously depends on how much inpatient and payment structures.  Seems like the culture for most of the internists i know is to avoid GIM like the plague, and usually those that want to work part-time are willing to default to GIM.

Sure, they're not universally pushing it. In alberta, 8% of GIM bills more than 1M while 39% of cardiologists bill more than that. The ones that are doing it are the interventional ones but a good chunk of those are also people running cookie-cutter risk-stratification clinics that order the same work-up for absolutely everyone.

[Aconitase 40]

In general GIMs don’t tip a million unless they do lots of cardio or they do tons of nights. 

 

A busy GIM night can net 3500-5000. There are guys I know doing 20-30 a month of these and easily surpass a million. But it’s a hard way to do it working 20-30 nights a month 

 

the best  part of medicine is the unlimited overtime. Literally no other profession let’s you kill your self if you want to make more money. We can work all the time if we like and some do. Most dont. 

[LittleDaisy 288]

2 hours ago, Aconitase said:

In general GIMs don’t tip a million unless they do lots of cardio or they do tons of nights. 

 

A busy GIM night can net 3500-5000. There are guys I know doing 20-30 a month of these and easily surpass a million. But it’s a hard way to do it working 20-30 nights a month 

 

the best  part of medicine is the unlimited overtime. Literally no other profession let’s you kill your self if you want to make more money. We can work all the time if we like and some do. Most dont. 

Lolll I like your analogy aconitase. I guess that residents are just more grumpy with unlimited overtime and on-call stipends (less than minimum wage lol), because we are not paid FFS lol 

I think that working overtime and at insane hours (night, early morning) is an unspoken rule in medicine. 

I agree with GIM salary, in academic hospitals or urban community hospitals (where you have cardio for echos, GI for scopes, nephro for dialysis lines), a GIM doesn't make near 1 million, mostly around 300 k ( academic hospitals with higher overheads) - 500 k (that's the maximum usually ). 

[deathvvv 54]

Yes it really depends.

In BC physicians salaries are published in the bluebook. The GIM docs I know work in Vancouver pull 350 k minimum (this is public msp billings only). The specialists I know usually average around 600-700 k with a respirologist pulling 1 mil +. It really depends on how much you work like others have said. However, from personal observation they live pretty chill lives

[windsormd1 11]

On 10/25/2018 at 2:53 PM, VivaColombia said:

Is that normal for GPs taking home (I'm assuming) 150-160K post-tax and all expenses accounted for in Ontario?

That's 'normal' for GP's throughout Canada..............not just Ontario; with maybe 5-10% differences in other provinces.  Say you billed $350k in whatever billing model you are in; take off 25-30% in overhead plus fees/malpractice/etc.   You are down to roughly 250-260k pre-tax; take off tax; assuming no RRSP deduction; you are at 150-160k post-tax.....................everybody pays tax; you cannot look at income 'post-tax.'  

[rmorelan 2,561]

On 10/25/2018 at 10:43 PM, A-Stark said:

It depends on the hospital. You won't say many if any GIMs who have anything like Level III echo training but Level II (e.g. about 6 months and mainly TTE) is feasible. We have radiologists reading echos currently...

GIMs scoping is a thing in smaller hospitals - mine has actual GI specialists and surgeons who compete for scope time. 

I don't get any of the urban "academic" GIM consults with the non-specific aches and pains and feelings of ennui (and many iterations of ANA/ENA investigations). And I have yet to get an outpatient diabetes consult. I don't expect I'll really have time for any of that. There's just so much chest pain...

ha total side note - but we (radiologists) have been reading echo cardiograms forever. It is an ultrasound of the heart, and originally we didn't view it as that much different than ultrasound of anything else (why would it be after all - it is good marketing on the cardiologists part to make it seem like there is something special there and that is an important lesson). That has changed a bit but there are still quite a few radiologists that read them still. 

[brady23 77]

How much of your income gets taxed after overhead? I'm assuming it's not the marginal tax rate (i.e. ~50%)

[shematoma 89]

26 minutes ago, brady23 said:

How much of your income gets taxed after overhead? I'm assuming it's not the marginal tax rate (i.e. ~50%)

https://www.taxtips.ca/calculators/basic/basic-tax-calculator.htm

This calculator will give you a rough idea of taxes payable on personal income

[A-Stark 145]

On 10/28/2018 at 12:22 PM, rmorelan said:

ha total side note - but we (radiologists) have been reading echo cardiograms forever. It is an ultrasound of the heart, and originally we didn't view it as that much different than ultrasound of anything else (why would it be after all - it is good marketing on the cardiologists part to make it seem like there is something special there and that is an important lesson). That has changed a bit but there are still quite a few radiologists that read them still. 

It's not really the same as looking at renal cysts or the liver's "echotexture". 

[rmorelan 2,561]

2 hours ago, A-Stark said:

It's not really the same as looking at renal cysts or the liver's "echotexture". 

ha sure - that being said it isn't any worse in terms of complexity than many other US scans we do ( I mean you just picked the two simplest of all possible US findings) - and again we have been doing them for a long time as well. I would take a echocardiogram over those darn pediatric cardiac US we still do and are supposed to be able to diagnose all the congenital heart defects etc that way. 

It is just something you are trained to do. It isn't all that special compared to any other imaging really in my mind.  They just take time and practice like everything else. 

Edited October 30, 2018 by rmorelan