What do you think about this blog?

[member_225]

https://shawnwhatley.com/doctor-billing/

 

Why does he say family doctors make 100000 after overhead? seems a bit low and not worth it lol 

he mentions how fees are not keeping up with inflation and that you need to see 3 patients an hour just to keep up with overhead. 

Any practising family doctors can chime in? 

 

[hamham]

33 minutes ago, member_225 said:

https://shawnwhatley.com/doctor-billing/

 

Why does he say family doctors make 100000 after overhead? seems a bit low and not worth it lol 

he mentions how fees are not keeping up with inflation and that you need to see 3 patients an hour just to keep up with overhead. 

Any practising family doctors can chime in? 

 

The type of work and work hours a family doctor does is so varied, and hence the pay. 

Most do exclusively office-based work in an urban setting. Some do extra shifts in urgent cares and ED. Some do obstetrics and hospitalist work. Some prefer to do rural where pay is higher. Some work only 3-4 days per week. Others are willing to work up to 6 days per week. Some take up to 3 months of vacation per year. Others don't take more than 2 weeks vacation annually. There are some who make >1 million per annum, while there are also some who make less than $60k per year.

There are definitely ways to increase income as family doctor, but most chose to prioritize other things in life (family, leisure, quality of life etc). The biggest advantage of being a family doctor is that you get to choose the type of work and schedule you like.

[member_225]

1 hour ago, hamham said:

The type of work and work hours a family doctor does is so varied, and hence the pay. 

Most do exclusively office-based work in an urban setting. Some do extra shifts in urgent cares and ED. Some do obstetrics and hospitalist work. Some prefer to do rural where pay is higher. Some work only 3-4 days per week. Others are willing to work up to 6 days per week. Some take up to 3 months of vacation per year. Others don't take more than 2 weeks vacation annually. There are some who make >1 million per annum, while there are also some who make less than $60k per year.

There are definitely ways to increase income as family doctor, but most chose to prioritize other things in life (family, leisure, quality of life etc). The biggest advantage of being a family doctor is that you get to choose the type of work and schedule you like.

I guess how he worded it is just weird. he says "many family doctors make just over 100k", making it seems like the majority of them are making that much. 

[Birdy]

I would expect he’s talking after-tax and after overhead take home, assuming no tax-saving measures are used. 

[rmorelan]

and most family doctors don't bill per visit - they aren't fee for service, but rather are using a capitation model where they get a flat rate per patient per year. Not all mind you, but the government on purpose was pushing people originally towards the new models. 

 

[member_225]

1 hour ago, rmorelan said:

and most family doctors don't bill per visit - they aren't fee for service, but rather are using a capitation model where they get a flat rate per patient per year. Not all mind you, but the government on purpose was pushing people originally towards the new models. 

 

I'm not sure I understand what you mean, don't they bill for things like intermediate assessment and so on?

[rmorelan]

46 minutes ago, member_225 said:

I'm not sure I understand what you mean, don't they bill for things like intermediate assessment and so on?

well not under the capitation model, no they don't. They just get a flat rate per patient per year. 

Not a family doctor so obviously I have some limitations in that area understanding wise - others can comment! but the per year fee is roughly 135 under the newer model, which works out for a roster of 2000 patients to be around 270,000 which is in the ball park we are all hearing about for things. You have a ton of other smaller things thrown in there as well but my point was the government was until rather recently very actively getting rid of the old intermediate assessment model. Most doctors aren't using it now as a result. 

 

[frenchpress]

 

4 hours ago, rmorelan said:

and most family doctors don't bill per visit - they aren't fee for service, but rather are using a capitation model where they get a flat rate per patient per year. Not all mind you, but the government on purpose was pushing people originally towards the new models. 

 

What province are you referring to where most family doctors are on a per-patient model? I can only think of one family doctor I’ve heard of who uses something like this, and it’s specifically an addictions practice. Basically every family doctor I’ve met in BC and Alberta is doing either fee for service or a salary-like model for more specialized services.

I don’t know that it’s actually even an option in BC right now, although they’ve been talking about options. And in Alberta I think there’s only a handful of clinics on the blended model that was developed in 2017.

[rmorelan]

11 minutes ago, frenchpress said:

 

What province are you referring to where most family doctors are on a per-patient model? I can only think of one family doctor I’ve heard of who uses something like this, and it’s specifically an addictions practice. Basically every family doctor I’ve met in BC and Alberta is doing either fee for service or a salary-like model for more specialized services.

I don’t know that it’s actually even an option in BC right now, although they’ve been talking about options. And in Alberta I think there’s only a handful of clinics on the blended model that was developed in 2017.

Ontario specifically - only focused on that province because the fee quoted is from OHIP - it is an Ontario centric article. 

[frenchpress]

11 minutes ago, rmorelan said:

Ontario specifically - only focused on that province because the fee quoted is from OHIP - it is an Ontario centric article. 

Ah, that makes more sense! I just saw your response on the sidebar and hadn’t actually dug into the article yet.

Just goes to show how there’s such huge variability in family doctor incomes across the country though.

[rmorelan]

2 minutes ago, frenchpress said:

Ah, that makes more sense! I just saw your response on the sidebar and hadn’t actually dug into the article yet.

Just goes to show how there’s such huge variability in family doctor incomes across the country though.

true ha - everything is so variable from province to province. 

that article has a lot of useful information although I should say that in Ontario at least the government was trying to push doctors away from the old fee for service model. The only way they can easily do that is change the financing. They didn't want the fee to keep up with inflation, they wanted people to move to the new model. I don't think that defeats the overall point - for a rather long time doctor fees haven't been keeping up with inflation. 

[Birdy]

On 11/29/2018 at 4:41 PM, rmorelan said:

well not under the capitation model, no they don't. They just get a flat rate per patient per year. 

Not a family doctor so obviously I have some limitations in that area understanding wise - others can comment! but the per year fee is roughly 135 under the newer model, which works out for a roster of 2000 patients to be around 270,000 which is in the ball park we are all hearing about for things. You have a ton of other smaller things thrown in there as well but my point was the government was until rather recently very actively getting rid of the old intermediate assessment model. Most doctors aren't using it now as a result. 

 

Capitation models (there are several different kinds) are common in Ontario but not so much elsewhere. Average per patient annual rostering fee is $144 last I recall. 

But they still bill per visit. There are “in-basket” services - things that are expected to be part of the basic services a family doc should offer - for which they receive usually 15% of the standard fee on top of the rostering fee, and then they have “out of basket” services that they receive the full fee for. Those are usually things that are being incentivized or are specialized FM services. 

And that’s just touching on the basics of it in Ontario. A straight up salary from the province isn’t an option here for community practice but it is elsewhere. 

Family docs often have multiple revenue streams; it’s not just their capitation payments or just FFS. 

[rmorelan]

4 minutes ago, Birdy said:

Capitation models (there are several different kinds) are common in Ontario but not so much elsewhere. Average per patient annual rostering fee is $144 last I recall. 

But they still bill per visit. There are “in-basket” services - things that are expected to be part of the basic services a family doc should offer - for which they receive usually 15% of the standard fee on top of the rostering fee, and then they have “out of basket” services that they receive the full fee for. Those are usually things that are being incentivized or are specialized FM services. 

And that’s just touching on the basics of it in Ontario. A straight up salary from the province isn’t an option here for community practice but it is elsewhere. 

Family docs often have multiple revenue streams; it’s not just their capitation payments or just FFS. 

I guess I would lumping most of the fees billed as a relatively small aspect of it. Ha, in the "ton of smaller things" group etc. 

You would know this much better than I - what fracture of a typical family doctor in Ontario would fall into each category of payment do you estimate? Obviously varies by place etc 

 

 

[Birdy]

5 hours ago, rmorelan said:

I guess I would lumping most of the fees billed as a relatively small aspect of it. Ha, in the "ton of smaller things" group etc. 

You would know this much better than I - what fracture of a typical family doctor in Ontario would fall into each category of payment do you estimate? Obviously varies by place etc 

 

 

Honestly I don’t know the averages off the top of my head. I don’t imagine they’d represent more than 30% or so of their overall revenue, but that’s just a very rough estimate. We’re talking $5-ish for the majority of visits (intermediate visit) with a few additions like smoking cessation, psych work, or diabetes visits thrown in there. But I’m estimating based only on a very incomplete understanding myself.

Back home, as a contrast, family docs have the option of being straight FFS or having a salary plus 31% of shadow billings. To be eligible for a salary, you have to shadow bill at least 85% of your salary’s equivalent, so the minimum earnings for a salaried doc is actually 1.26x the salary (most make more. They don’t pay overhead when they’re salaried, and there is paid vacation and defined benefit retirement, so it’s equivalent to a lot more than it looks at first glance.) NS offers a straight salary option (no one has been able to actually clarify for me whether they have shadow billings on top of that) which they call their “alternative payment plan” since it’s an alternative to FFS. There are a couple setups for academic docs too that are slightly different. 

Making heads or tails of FM income is... not a straightforward proposition. 

[rmorelan]

6 hours ago, Birdy said:

Honestly I don’t know the averages off the top of my head. I don’t imagine they’d represent more than 30% or so of their overall revenue, but that’s just a very rough estimate. We’re talking $5-ish for the majority of visits (intermediate visit) with a few additions like smoking cessation, psych work, or diabetes visits thrown in there. But I’m estimating based only on a very incomplete understanding myself.

Back home, as a contrast, family docs have the option of being straight FFS or having a salary plus 31% of shadow billings. To be eligible for a salary, you have to shadow bill at least 85% of your salary’s equivalent, so the minimum earnings for a salaried doc is actually 1.26x the salary (most make more. They don’t pay overhead when they’re salaried, and there is paid vacation and defined benefit retirement, so it’s equivalent to a lot more than it looks at first glance.) NS offers a straight salary option (no one has been able to actually clarify for me whether they have shadow billings on top of that) which they call their “alternative payment plan” since it’s an alternative to FFS. There are a couple setups for academic docs too that are slightly different. 

Making heads or tails of FM income is... not a straightforward proposition. 

hey thanks - it isn't all that straightforward for a lot of fields but family medicine in particular has extra complications it seems. 

[NutritionRunner]

Also don’t forget that family physicians working at Community Health Centres in Ontario are on salary. Pure salary.  The only exceptions are the doctors who also work opioid replacement clinics as part of their CHC work or who do low-risk OBS as part of their family practice. Physicians who just do regular family practice in CHCs are on salary. The ones I’ve worked with are very happy with that model, but you have to enjoy the work environment, which is quite different from FHT or FFS family practice.

[member_225]

21 hours ago, NutritionRunner said:

Also don’t forget that family physicians working at Community Health Centres in Ontario are on salary. Pure salary.  The only exceptions are the doctors who also work opioid replacement clinics as part of their CHC work or who do low-risk OBS as part of their family practice. Physicians who just do regular family practice in CHCs are on salary. The ones I’ve worked with are very happy with that model, but you have to enjoy the work environment, which is quite different from FHT or FFS family practice.

what's their salary?

[medigeek]

6 hours ago, member_225 said:

what's their salary?

Low 200 range is what I've seen. Ideal for someone who wants a more relaxed job, with 0 business aspects tied to their work. Show up, see your 3 patients per hour, chat about life with each one for 10 minutes, and go home. 

[member_225]

10 hours ago, medigeek said:

Low 200 range is what I've seen. Ideal for someone who wants a more relaxed job, with 0 business aspects tied to their work. Show up, see your 3 patients per hour, chat about life with each one for 10 minutes, and go home. 

sounds like a good gig, avg family docs are billing 300k and they keep ~70%, leaving them with a low 200 range income as well 

[IMislove]

1 hour ago, member_225 said:

sounds like a good gig, avg family docs are billing 300k and they keep ~70%, leaving them with a low 200 range income as well 

Forgetting taxes ;). 30% overhead and tax. But still very comfortable relative to the average Canadian for sure.

[Snowmen]

2 hours ago, member_225 said:

sounds like a good gig, avg family docs are billing 300k and they keep ~70%, leaving them with a low 200 range income as well 

Don't forget the juicy pension plan that comes with the salary jobs.

[JohnGrisham]

14 hours ago, medigeek said:

Low 200 range is what I've seen. Ideal for someone who wants a more relaxed job, with 0 business aspects tied to their work. Show up, see your 3 patients per hour, chat about life with each one for 10 minutes, and go home. 

Are they actually only seeing 3 patients an hour though?

[member_225]

3 hours ago, IMislove said:

Forgetting taxes ;). 30% overhead and tax. But still very comfortable relative to the average Canadian for sure.

True, but aren't the family doctors who are not salaried capable of incorporating their practise? 

So they don't get the juicy pension but they do get a tax break...each one has it's benefits but I'm sure it comes down to roughly the same post tax income 

[JohnGrisham]

28 minutes ago, member_225 said:

True, but aren't the family doctors who are not salaried capable of incorporating their practise? 

So they don't get the juicy pension but they do get a tax break...each one has it's benefits but I'm sure it comes down to roughly the same post tax income 

I find that most people don't actually understand how incorporation works and automatically assume that its a tax break by default. This isn't universally the case depending on your financial needs and how much you draw from your corporation.   

Hands down, i would take a pension over incorporation in most scenarios of equivalency. 

[blah1234]

I have friends that work or have worked in CHC. Although the pace is slow the patients can often be complex and difficult to deal with. Also, I believe that because of your salary you can't bill extra for things like paperwork, but I don't think that's a huge deal breaker. 

I think they get the HOOPP pension but I'm not sure of all the details. It should be something where the longer you work in that role the better your pension situation is. However, I don't think any of my friends have survived in the CHC system for long.