IM Burnout - Ambulatory and Better Lifestyle practice models?

[Bluberblubo]

1 hour ago, RadCdn said:

I work entirely outpatient general IM. I set my own hours, which is a late morning start which is what I prefer. 8 am start?? No way!! I knew early on that I could not work in the hospital. It doesn't suit my introverted personality and the noise in the hospital drives me crazy. In my work, 4 days a week, 300 K net is very reasonable, and I'm a relatively slow paced doctor. Definitely stick it out with IM, as the billings are significantly higher than FM. I do no call whatsoever. Life as an IM Attending is very good. Residency was terrible. 

I guess my main question would be, is it realistic to have a set up like this in or around the GTA?

30 minutes ago, VivaColombia said:

And is there paid vacation/pension/etc. included in this or does that have to be accounted for separately?

No paid vacation/pension if you set up your own outpatient clinic. Even if you work in the hospital, I've rarely heard about that being the case, but if others know differently please chime in

[rmorelan]

39 minutes ago, VivaColombia said:

Based on all this info, is it reasonable to have a take home post-tax income in GIM of 250K provided you gross 400K? And is there paid vacation/pension/etc. included in this or does that have to be accounted for separately?

depends on how you define gross - I mean for one thing if you have a corporation which is the main vehicle for savings for things then you would not really think in terms of the gross being that high. For instance just start up salary tax math - if you pulled all 400K as straight income you would need up with an after tax of about 210K (for most people it would be 220 but I am adding a bit for the fact that we pay both side of the CPP coin - so it is doubled). 

We have no pension except what we create. Your 400K (which is a bit high for GIM in many./most places) would be what you are drawing everything from so there is no vacation plan, or benefits package etc. That comes from what ever you set up. 

 

[ACHQ]

39 minutes ago, skyuppercutt said:

I guess my main question would be, is it realistic to have a set up like this in or around the GTA?

No paid vacation/pension if you set up your own outpatient clinic. Even if you work in the hospital, I've rarely heard about that being the case, but if others know differently please chime in

Its definitely possible anywhere including the GTA. TBH there's enough work that even a GIM (with a focus or not) will get referrals just because sometimes subspecialists referrals can take 2-6 months (whereas GIM you can probably see in like ~ 2 ish weeks at worse), and family doctors maybe too busy to completely be able to work someone up and initiate management. Sometimes they just want an opinion.

The issue with most outpatient practice (regardless of specialty) is that you pay a large overhead (as discussed earlier). Sometimes its worth it if you have a better lifestyle. I've been looking into it myself however the overhead is a killer and without those chronic disease premiums it makes it harder to make as much as like an endo, rheum, resp, etc...

[ACHQ]

2 hours ago, RadCdn said:

I work entirely outpatient general IM. I set my own hours, which is a late morning start which is what I prefer. 8 am start?? No way!! I knew early on that I could not work in the hospital. It doesn't suit my introverted personality and the noise in the hospital drives me crazy. In my work, 4 days a week, 300 K net is very reasonable, and I'm a relatively slow paced doctor. Definitely stick it out with IM, as the billings are significantly higher than FM. I do no call whatsoever. Life as an IM Attending is very good. Residency was terrible. 

I did four years of IM. I saw no point in the fifth year. Always keep in mind opportunity cost for the length of your training. The great thing about general IM is that you can easily focus your career on your particular field of interest. I have a colleague who is general IM, but only does Cardiology, stress tests, Echocardiograms every day. Another colleague of mine focuses on diabetes. Your practice will build quickly and you will have no problem receiving consults. It's better to focus on a few diseases as you'll be quicker and of course volume will be higher. I'm still in the phase where I'm focusing on 5-6 different diseases. Eventually I plan to narrow my focus more. 

IM previously had chronic disease premiums, but unfortunately they were removed in Ontario a couple of years ago. 

Nice! congrats on finding a set up that works for you. I'm looking to outpatient practice myself, but the overhead seems a killer, especially without those chronic disease premium codes. What % of overhead do you pay? How many patients do you see? How many are new consults??

I tried doing the math and it seems it would only be worth it for me if I saw at least 15 patients/day (all new) with 20% overhead, working 5 days a week (for like 42 weeks though).

[Wachaa]

I'll try to comment a bit here and there

 

9 hours ago, ysera said:

What about 5-6 days a week? Are there any GIM doctors with a narrow focus like yours grossing 400k or more, or is it something only a few superstars are doing? Also whats your overhead?

Of course. The 400k gross is not by any means "outlier". I wouldn't say it's "average", but it's not unreasonable.

Overhead is difficult to estimate. Even those who do a lot of OUTpatient do some of INpatient too. Or, they don't work in one office but several, each with different splits. I suppose 25-30% is reasonable.

 

10 hours ago, RadCdn said:

I work entirely outpatient general IM. I set my own hours, which is a late morning start which is what I prefer. 8 am start?? No way!! I knew early on that I could not work in the hospital. It doesn't suit my introverted personality and the noise in the hospital drives me crazy. In my work, 4 days a week, 300 K net is very reasonable, and I'm a relatively slow paced doctor. Definitely stick it out with IM, as the billings are significantly higher than FM. I do no call whatsoever. Life as an IM Attending is very good. Residency was terrible. 

I did four years of IM. I saw no point in the fifth year. Always keep in mind opportunity cost for the length of your training. The great thing about general IM is that you can easily focus your career on your particular field of interest. I have a colleague who is general IM, but only does Cardiology, stress tests, Echocardiograms every day. Another colleague of mine focuses on diabetes. Your practice will build quickly and you will have no problem receiving consults. It's better to focus on a few diseases as you'll be quicker and of course volume will be higher. I'm still in the phase where I'm focusing on 5-6 different diseases. Eventually I plan to narrow my focus more. 

IM previously had chronic disease premiums, but unfortunately they were removed in Ontario a couple of years ago. 

 

Totally agree. There'll be a niche that you enjoy working in. You get really efficient and your name gets out there. For example, some IMs do mainly DM, so they will be known for seeing gestational DM too. I don't think it can get "boring" because it's what you like. Some people might find it repetitive.

 

13 hours ago, IMislove said:

Does this change when comparing to rural family med, where they may be the majority of docs in a town and very few specialists? Say 1.5 hours away or more to nearest academic center? I know in these cases fam docs do a ton of hospitalist work and very is maybe one GIM in the town. More specifically Ontario if you can speak to that?

 

Definitely. I was specifically talking about urban, where the large majority of GPs don't even have hospital privileges.

[Wachaa]

8 hours ago, ACHQ said:

Nice! congrats on finding a set up that works for you. I'm looking to outpatient practice myself, but the overhead seems a killer, especially without those chronic disease premium codes. What % of overhead do you pay? How many patients do you see? How many are new consults??

I tried doing the math and it seems it would only be worth it for me if I saw at least 15 patients/day (all new) with 20% overhead, working 5 days a week (for like 42 weeks though).

 

What province are you in? (Sorry if you mentioned it earlier)

15 new consults is decent. In reality you'll have a bunch of fast follow ups in the day too. I think the math should work in your favor

[RadCdn]

23 hours ago, ysera said:

What about 5-6 days a week? Are there any GIM doctors with a narrow focus like yours grossing 400k or more, or is it something only a few superstars are doing? Also whats your overhead?

You'll easily take 400K (net before tax) working 6 days a week, but who wants to do that?! That's a lot of work. My colleague in general IM did that for part of the year and took in 500 K last year. I wouldn't focus too much on income. We're taxed like crazy at the upper income tax bracket. Of course incorporation helps, but keep in mind you'll be limited in how you can spend incorporated earnings. 

Personally, I prefer to make less and have some more time for a balanced life. Everyone has their sweet spot. My sweet spot is four days of work per week. I spend very carefully. I don't care for material things which really helps. Things like fancy cars are not tax deductible, so think twice before you buy the BMW. You may look wealthy, but spending like that actually stalls your wealth growth and slows your ability to become financially independent. The majority of doctors do not have good financial sense and they spend their lives on the "treadmill".

Keep in mind, as you get older, you won't be able to nor desire to work as much. This is why it's important to have good financial habits early. 

As a fee-for-service doctor, if you go on vacation, you won't be paid. 

If money is your goal, get to know other income-focused physicians. Generally you'll earn more as a private practice physician. Only go to academia if you really enjoy it. Otherwise, stick to private practice. 

[rmorelan]

1 hour ago, RadCdn said:

You'll easily take 400K (net before tax) working 6 days a week, but who wants to do that?! That's a lot of work. My colleague in general IM did that for part of the year and took in 500 K last year. I wouldn't focus too much on income. We're taxed like crazy at the upper income tax bracket. Of course incorporation helps, but keep in mind you'll be limited in how you can spend incorporated earnings. 

Personally, I prefer to make less and have some more time for a balanced life. Everyone has their sweet spot. My sweet spot is four days of work per week. I spend very carefully. I don't care for material things which really helps. Things like fancy cars are not tax deductible, so think twice before you buy the BMW. You may look wealthy, but spending like that actually stalls your wealth growth and slows your ability to become financially independent. The majority of doctors do not have good financial sense and they spend their lives on the "treadmill".

Keep in mind, as you get older, you won't be able to nor desire to work as much. This is why it's important to have good financial habits early. 

As a fee-for-service doctor, if you go on vacation, you won't be paid. 

If money is your goal, get to know other income-focused physicians. Generally you'll earn more as a private practice physician. Only go to academia if you really enjoy it. Otherwise, stick to private practice. 

what is particularly annoying is when you don't have a choice - a lot of fields most of the jobs for some reason just come with terrible hours (you do get high pay from working it though). There are a lot of people I know that would love to break that up a bit - 3 people doing 2/3 to equal 2 others for instance. There really really does become a point where the money is no longer the most important thing (speaking as someone up at the cottage as we speak ha - ahhhhh piece and quite). 

[VivaColombia]

So then seeing these numbers with no vacation and pension per say (you make what you want of it). Purely assuming that someone who takes 400k pre tax working 5 days a week for most of the time (say 3 week vacation during the year), you'd have 200-250k post tax take home pay? And from that, you plan for your future pension, etc. 

Trying to figure out if medicine is worth pursuing (especially IM) but if those numbers hold up, would it be wise for someone to study medicine if they currently make low 6 figures, get a pension and have 3 week paid vacation (along with no school debt or mortgage)?

[Wachaa]

37 minutes ago, VivaColombia said:

So then seeing these numbers with no vacation and pension per say (you make what you want of it). Purely assuming that someone who takes 400k pre tax working 5 days a week for most of the time (say 3 week vacation during the year), you'd have 200-250k post tax take home pay? And from that, you plan for your future pension, etc. 

Trying to figure out if medicine is worth pursuing (especially IM) but if those numbers hold up, would it be wise for someone to study medicine if they currently make low 6 figures, get a pension and have 3 week paid vacation (along with no school debt or mortgage)?

Just for the money? I wouldn’t. Think of all the things in life you would otherwise be missing out on. Especially if you’re already in your 30s or near there.

[freewheeler]

53 minutes ago, VivaColombia said:

So then seeing these numbers with no vacation and pension per say (you make what you want of it). Purely assuming that someone who takes 400k pre tax working 5 days a week for most of the time (say 3 week vacation during the year), you'd have 200-250k post tax take home pay? And from that, you plan for your future pension, etc. 

Trying to figure out if medicine is worth pursuing (especially IM) but if those numbers hold up, would it be wise for someone to study medicine if they currently make low 6 figures, get a pension and have 3 week paid vacation (along with no school debt or mortgage)?

Lmao dude if that's the position you're in right now, then you should RUN not walk AWAY from medicine.

Not worth the toil of the application process + medical school/clerkship especially + CaRMS + residency +/- fellowship(s) to maybe land a job and for it to be somewhere that you might not want to be.

Low 6 figures + pension + 3 wk paid vacation + no debt = No brainer.

Enjoy your hopefully humane hours, evenings/weekends off, spend time with your friends/family/SO and stay connected to your personal interests/hobbies.

[RadCdn]

1 hour ago, VivaColombia said:

So then seeing these numbers with no vacation and pension per say (you make what you want of it). Purely assuming that someone who takes 400k pre tax working 5 days a week for most of the time (say 3 week vacation during the year), you'd have 200-250k post tax take home pay? And from that, you plan for your future pension, etc. 

Trying to figure out if medicine is worth pursuing (especially IM) but if those numbers hold up, would it be wise for someone to study medicine if they currently make low 6 figures, get a pension and have 3 week paid vacation (along with no school debt or mortgage)?

You're in a very good position right now. Keep in mind, the IM route is an 8 year investment (if everything goes according to plan and things rarely do!) and many of those years are not fun years. Residency is quite brutal actually. I started med school in my mid-20's and I was working a minimum wage job after my undergrad. Going to med school made financial sense and it was my passion (and still is). But even though I love it, I'd like to minimize my hours working. With good planning I think I will eventually be able to work 3 days a week. Many of my colleagues do that and they do quite well financially. 

 

[NLengr]

1 hour ago, VivaColombia said:

 

Trying to figure out if medicine is worth pursuing (especially IM) but if those numbers hold up, would it be wise for someone to study medicine if they currently make low 6 figures, get a pension and have 3 week paid vacation (along with no school debt or mortgage)?

Don't bother with medicine. You are in too good of a position now. 

[anonymouspls]

4 hours ago, RadCdn said:

You'll easily take 400K (net before tax) working 6 days a week, but who wants to do that?! That's a lot of work. My colleague in general IM did that for part of the year and took in 500 K last year. I wouldn't focus too much on income. We're taxed like crazy at the upper income tax bracket. Of course incorporation helps, but keep in mind you'll be limited in how you can spend incorporated earnings. 

Personally, I prefer to make less and have some more time for a balanced life. Everyone has their sweet spot. My sweet spot is four days of work per week. I spend very carefully. I don't care for material things which really helps. Things like fancy cars are not tax deductible, so think twice before you buy the BMW. You may look wealthy, but spending like that actually stalls your wealth growth and slows your ability to become financially independent. The majority of doctors do not have good financial sense and they spend their lives on the "treadmill".

Keep in mind, as you get older, you won't be able to nor desire to work as much. This is why it's important to have good financial habits early. 

As a fee-for-service doctor, if you go on vacation, you won't be paid. 

If money is your goal, get to know other income-focused physicians. Generally you'll earn more as a private practice physician. Only go to academia if you really enjoy it. Otherwise, stick to private practice. 

The plan as of now (realize plans change 10+ years down the line) is to work longer hours and more days for the first half of my career, not to buy luxuries but to pay down the LOC and buy a house. Thus the reason I was interested in the numbers.

This is something that a bit frustrating when we’re reading about the numbers - for instance cmg profiles report physician incomes over 60k, but part time physicians would still be above that line, which skews the numbers for the whole specialty. Ive noticed to my surprise that there are a considerable number of part time doctors, more-so in certain specialties than others.

[LittleDaisy]

4 hours ago, VivaColombia said:

So then seeing these numbers with no vacation and pension per say (you make what you want of it). Purely assuming that someone who takes 400k pre tax working 5 days a week for most of the time (say 3 week vacation during the year), you'd have 200-250k post tax take home pay? And from that, you plan for your future pension, etc. 

Trying to figure out if medicine is worth pursuing (especially IM) but if those numbers hold up, would it be wise for someone to study medicine if they currently make low 6 figures, get a pension and have 3 week paid vacation (along with no school debt or mortgage)?

For the money part, definitely no!

I am obviously surprised that NPs in BC are paid that much with all their pension and benefits, what an insult to GP in BC who have no benefits, sick leave nor maternity leave, and who take home post-tax the same amount of money as an NP (without having to undergo medical school+ clerkship+ residency). 

The governmental officials have no idea what a family doctor can do, and how we are different from a NP, and obviously, no doctors are ever consulted on the reasonable scope of practice for NP, PA and rising mid-level providers.  For example, the mid-wives are becoming your new friendly "Obs-gyne" paid by the government without learning and getting first-hand experience on how delivery can get complicated--> i.e: having a code pink and an obs code at the same time. 

If you really love medicine, I still think that it is a great profession, where you can find a specialty that you would enjoy, with great stability and overall good income, and generally speaking, respect from the general public (although be aware you will have to deal with extremely difficult patients and be cautious of potential lawsuits given you have a lot of responsibility). 

At the end of day, you will have to love learning throughout your whole life, the management keeps changing and the new guidelines keep coming at you. Be okay with delayed gratification, once you get paid at a staff salary---> you have to pay back your LOC first, save for that 20% down payment, save for your future pension + maternity leave; unless you are a workaholic who only retire when you can't work anymore. You will leave a good lifestyle, but you should not spend all your money lavishly unless you plan never to retire and keep up the patient volume past age 65. 

No matter what specialty you end up picking, the lifestyle in medicine is never great, because clerkship is grueling, residency is tough. Being a staff gives you more autonomy over your schedule, but medicine is not a 9-5 job. Even in family medicine, after you see your last patient, you have to document all your encounters, call your patients for follow-up and follow-up with lab results, you never finish at 5 pm. 

[blah1234]

I was a professional before medicine and I can say that it's not worth it for the money. Yes, I make a comfortable living and do well but if I wanted to optimize for money I would've been much further ahead at my old job. People underestimate the value of investing 10+ years into education not to mention the debt load. I think my hours are fine now but residency was brutal and I think I sacrificed a lot in my personal life to make this dream of mine happen.

I don't think that there is only one path to success and happiness, and medicine definitely isn't the only one. It is an amazing job for some people and it is a terrible job for others. Unfortunately, the system is designed so that most students don't find out until it's too late to leave. 

[Internalmed1234]

Thanks for the helpful replies, I am an IM resident and was hoping to have a mix of hospital and outpatient as a future GIM. How many weeks do GIMs normally do in hospital and is it possible to get with just 4 years of GIM in the GTA area (Markham, richmond-hill, barrie, newmarket)? Are the weeks on service flexible based on how much a GIM wants to do inpatient medicine? And also, right now I'm in a program,where  we see quite complex patients on CTU, I am wondering if that is the case in the areas mentioned above as well or do they just take these patients down to a major centre hospital in Toronto? Thank you!  

[ACHQ]

3 hours ago, Internalmed1234 said:

Thanks for the helpful replies, I am an IM resident and was hoping to have a mix of hospital and outpatient as a future GIM. How many weeks do GIMs normally do in hospital and is it possible to get with just 4 years of GIM in the GTA area (Markham, richmond-hill, barrie, newmarket)? Are the weeks on service flexible based on how much a GIM wants to do inpatient medicine? And also, right now I'm in a program,where  we see quite complex patients on CTU, I am wondering if that is the case in the areas mentioned above as well or do they just take these patients down to a major centre hospital in Toronto? Thank you!  

4 years of GIM can easily find work anywhere NON-academic in the GTA. By non-academic I mean UHN (TGH, TWH), Mount Sinai, Sunnybrook, St. Mikes and Women's college. Outside of those select few hospitals, 4 year GIMs are the ones that get hired in the community (Including Markham, Richmond Hill, Barrie and Newmarket).

Weeks on service and the mix of type of work differ between different sites so can't say 100% its always flexible (very few things in medicine are).

Are you at UofT? That's the BS they try to sell to everyone on CTU. Most inpatient units across the country will have their share of complex patients, mixed in with the simple patients and the ever so boring ALC patients. As you go through your career your going to want to deal with simpler cases as oppose to the complex ones as they eat away at your soul. But getting back to your question, no a place will only transfer patients to a centre/hospital that is able to do things (of offer things) that the other hospital can't. Most of all the hospitals in the GTA (includoing the ones you listed) have the full spectrum of medicine AND surgical subspecialties. The only thing they don't have (usually) is neuro and cardiac surgery, transplant and trauma, which (if you haven't noticed) IM doesn't normally need on a day to day basis. Even most transplant and cancer patients can be managed at peripheral sites unless they are extremely complex or on experimental Rx. Plus lets be honest, most times on CTU at academic sites, if a patients gets slightly more complicated than a staff would like to admit, they will consult the F out the subspecialists.

[Internalmed1234]

Thanks for your super helpful response ACHQ! That's great to hear. In term of flexibility, I tend to mean, if i want to do more inpatient weeks than say for example the minimum of 8 that they require you to do, is there flexibility for that? Say for example I want to do 16-20? Also, what about sub specialists like endo /rheum, can they also find inpatient GIM type of work on top of their outpatient work? And just to confirm, the hospitals you mentioned above are academic?

[ACHQ]

56 minutes ago, Internalmed1234 said:

Thanks for your super helpful response ACHQ! That's great to hear. In term of flexibility, I tend to mean, if i want to do more inpatient weeks than say for example the minimum of 8 that they require you to do, is there flexibility for that? Say for example I want to do 16-20? Also, what about sub specialists like endo /rheum, can they also find inpatient GIM type of work on top of their outpatient work? And just to confirm, the hospitals you mentioned above are academic?

Again it would depend on the hospital and their needs. At community hospitals the minimum I've seen is 12 weeks/yr (~1 week a month). Others require 16-20 weeks/yr. It also depends on whether you're part time or full time. For example full time 12 weeks is not bad, but for part time that might be a lot.  Groups usually are flexible on people doing MORE work (meaning very few people will turn that down, they always need to cover vacations etc...), where as they will be much less flexible on you doing LESS work (cause they have to cover there services).

For me personally 16-20 weeks of MRP/inpatient work is a lot. Ideally I want to work between 32-42 weeks a year total (probably more earlier on and then dial back), but definitely not more than 42. Of those 42 I want to minimize inpatient/hospitalist work as much as possible ahahahha. But to each their own.

Very few Endo and Rheum will do GIM type work in the community. Mainly cause a) they don't want to/they don't have to so they choose a better lifestyle or b) their too busy with their subspecialty practice. I'm sure people find weeks here and there of GIM (whether its ER or wards) with whatever subspecialty, but for the clinic based ones, they would have to have their clinic closed for the time they are on service for GIM (it would be impossible in the community to do an outpatient busy endo/rheum/whatever clinic and do GIM wards or ER).

Yes sorry those above (UHN (TGH, TWH), Mount Sinai, Sunnybrook, St. Mikes and Women's college) are academic sites in Toronto. Anything else is considered community in Toronto (or hybrid).

Also be weary of using Academic sites as a model for practice. They are NOT how a community based clinician operates (in terms of number of weeks worked, inpatient vs outpatient mix etc...) or pay

[Bluberblubo]

On 8/13/2019 at 10:13 PM, ACHQ said:

 Also be weary of using Academic sites as a model for practice. They are NOT how a community based clinician operates (in terms of number of weeks worked, inpatient vs outpatient mix etc...) or pay

In terms of the pay, I consistently hear people say that in the community you would make significantly more than at an academic centre. I'm having some difficulty understanding that, because at an academic centre you always have a handful of residents seeing your patients and I imagine that because of this you're able to see and bill for more patients on a daily basis? I heard that in a community the MRP would have a team of 10-15 patients, while at an average academic centre it would be anywhere from 20-30. The attendings also get to bill premiums for all the overnight admissions codes and all those things.

Is the %amount that the medicine departments take from the MRP's billing so much that they end up making less money than they would in the community or am I missing something here?

Is it reasonable as an MRP in the community to see and manage a ward of 30 patients without residents? (Maybe it's because I just started R2 that I'm finding it a bit difficult, but it'll be easier as an attending?)

[rmorelan]

11 minutes ago, skyuppercutt said:

In terms of the pay, I consistently hear people say that in the community you would make significantly more than at an academic centre. I'm having some difficulty understanding that, because at an academic centre you always have a handful of residents seeing your patients and I imagine that because of this you're able to see and bill for more patients on a daily basis? I heard that in a community the MRP would have a team of 10-15 patients, while at an average academic centre it would be anywhere from 20-30. The attendings also get to bill premiums for all the overnight admissions codes and all those things.

Is the %amount that the medicine departments take from the MRP's billing so much that they end up making less money than they would in the community or am I missing something here?

Is it reasonable as an MRP in the community to see and manage a ward of 30 patients without residents? (Maybe it's because I just started R2 that I'm finding it a bit difficult, but it'll be easier as an attending?)

to quote and paraphrase the house of god -

"Show me a resident who only triples my work and I will kiss his feet."

checking people's work (because you are responsible) takes way longer than just doing it yourself in most cases. 

cases are often usually more simple (and leave faster as a result - you don't get paid much if the person is just "there" for weeks on end compared to getting a fresh patient), often people often mix doing ward work in with also doing their clinic work, there is no teaching time/responsibilities, and the entire hospital just seems better configured to getting things done faster....

as I understand it even at an academic centre you can only bill for the overnight stuff if you actually sign off on the work during that night. Thus the annoying attending that would want to round on his patients I had to work with at 4am.

[ACHQ]

3 hours ago, skyuppercutt said:

In terms of the pay, I consistently hear people say that in the community you would make significantly more than at an academic centre. I'm having some difficulty understanding that, because at an academic centre you always have a handful of residents seeing your patients and I imagine that because of this you're able to see and bill for more patients on a daily basis? I heard that in a community the MRP would have a team of 10-15 patients, while at an average academic centre it would be anywhere from 20-30. The attendings also get to bill premiums for all the overnight admissions codes and all those things.

I don't know where you heard that, but its not correct. All the community sites I've rotated through and staff I've talked to for job opportunities, routinely are as busy, if not busier than academic sites. The list is variable depending on the time of year and of course the hospital (as some are busier than others, and some have caps on number of patients per team, or ALC floors, or more than just 4-5 GIM MRPs on at a time), but generally between 18-30. I'm not going to dive into whether having a handful of residents do the actual work and staff just supervise is more efficient (its usually not), I guess if you had 2-3 seasoned senior residents (i.e. PGY3+), then it could be... but that's never the case. As a PGY4 at a community site, I can round on 8-12 patients by noon. Things are more efficient and I don't do any scut, there is no teaching or other time sucks which all helps.

Also most academic staff aren't good billers and don't bill aggressively enough, as they belong to some communistic style practice plans (all billings and stipends and awards etc... go to a communal pot and it gets distributed to each physician). I would NEVER EVER EVER learn billing from an academic physician.

Quote

Is the %amount that the medicine departments take from the MRP's billing so much that they end up making less money than they would in the community or am I missing something here?

Is it reasonable as an MRP in the community to see and manage a ward of 30 patients without residents? (Maybe it's because I just started R2 that I'm finding it a bit difficult, but it'll be easier as an attending?)

I don't know about other universities, but at UofT department of medicine (as I mentioned above) ALL of the physicians billings go into a "pot". Its a bit complicated but at the end they "give back" a certain amount.

Community GIM's are doing it routinely. Once you've been through enough you manage (you'll see once you finish)

[notagunner]

.

[grapz]

If you are in a community hospital In the gta as a GIM, how is the split of nights and day shifts?