Jump to content
Premed 101 Forums

Recommended Posts

What's the job market like for endo currently? I know it can change 10 years from now, but still would be nice to know. 

Also, would it be wise to do a internal medicine residency solely to match into endo later? How competitive is it? I don't really want to do GIM, but things can change later ofcourse. 

Also, CMG profiles describes 400K payment for endo specialist with 20% overhead? I don't really care about the payment but it would be nice to know that a 5 year residency would pay more than a GP if I were to do it. Are these stats correct?

Link to post
Share on other sites

The Endo job market will always be good, for the sole reason that you can set up a purely outpatient practice (and not be associated with a hospital, which is great because it gets you out of doing call).

It would NOT be wise to do an internal medicine residency to solely match to endo later. Not to say that it is or isn't uber competitive, but what if you don't match to endo... and you don't like GIM then you are totally screwed (not that you won't be a doctor but you'll be stuck in a specialty you don't enjoy), because in the MSM match there are no re-entry's or transfers or do overs (its one shot, can't ever reapply). With all that being said, if you are willing to go ANYWHERE in the country to do endo, then sure you can do Internal medicine and still probably match somewhere (but then you have to be happy with any location).

The pay generally for endo is at the lower end of the spectrum of IM specialties cause it is non-procedural. 300-400k+ is the ball park (large range because it depends on how much you work and how efficient you are) with at least 25-30% overhead. I would be shocked if endo didn't make more then family medicine because new patient/consult for endo is $157/pt, follow ups are usually $70/pt. New consults might take some more time, but endo follow ups take less than 10 min. Combine that with your Diabetes premium and your chronic disease billing premium (which all endo patients are), if you fill your day with patients 8/9-4/5 you can see how the above pay is possible.

Link to post
Share on other sites
4 hours ago, ACHQ said:

The Endo job market will always be good, for the sole reason that you can set up a purely outpatient practice (and not be associated with a hospital, which is great because it gets you out of doing call).

It would NOT be wise to do an internal medicine residency to solely match to endo later. Not to say that it is or isn't uber competitive, but what if you don't match to endo... and you don't like GIM then you are totally screwed (not that you won't be a doctor but you'll be stuck in a specialty you don't enjoy), because in the MSM match there are no re-entry's or transfers or do overs (its one shot, can't ever reapply). With all that being said, if you are willing to go ANYWHERE in the country to do endo, then sure you can do Internal medicine and still probably match somewhere (but then you have to be happy with any location).

The pay generally for endo is at the lower end of the spectrum of IM specialties cause it is non-procedural. 300-400k+ is the ball park (large range because it depends on how much you work and how efficient you are) with at least 25-30% overhead. I would be shocked if endo didn't make more then family medicine because new patient/consult for endo is $157/pt, follow ups are usually $70/pt. New consults might take some more time, but endo follow ups take less than 10 min. Combine that with your Diabetes premium and your chronic disease billing premium (which all endo patients are), if you fill your day with patients 8/9-4/5 you can see how the above pay is possible.

Why does the cmg profile say 407k with 20% overhead? Especially when you consider that the profile includes part time physicians making over 60k, which I assume is a lot of people in a female dominated field like endo.

Link to post
Share on other sites
6 hours ago, ysera said:

Why does the cmg profile say 407k with 20% overhead? Especially when you consider that the profile includes part time physicians making over 60k, which I assume is a lot of people in a female dominated field like endo.

Estimates vary among provinces and work locations (outpatient hospital clinic vs outpatient privately-owned clinic vs inpatient mix). Overall income varies with how much work you do.

It's also personal preference and job market that affect where you'll work. For example, there may not be that many outpatient hospital clinic jobs available. Or, you want more control over your work hours/ work-life balance, or maybe you want to run a clinic as a business, so you choose to work in an outpatient privately-owned clinic instead (either starting your own clinic, or joining an existing one with other endos or IMs/ subspecialists).

Link to post
Share on other sites
1 hour ago, Wachaa said:

Estimates vary among provinces and work locations (outpatient hospital clinic vs outpatient privately-owned clinic vs inpatient mix). Overall income varies with how much work you do. 

It's also personal preference and job market that affect where you'll work. For example, there may not be that many outpatient hospital clinic jobs available. Or, you want more control over your work hours/ work-life balance, or maybe you want to run a clinic as a business, so you choose to work in an outpatient privately-owned clinic instead (either starting your own clinic, or joining an existing one with other endos or IMs/ subspecialists).

exactly.

Something else to add that most people don't know. Hospitals rarely if ever give specialists or subspecialist's clinic space + nursing staff + admin staff, without the physician paying substantially more overhead then at a privately owned clinic, or joining a group clinic (with family doctors, and other specialists), with the same amount of resources. There are a few exceptions to this, where the hospital asks you to staff a clinic where you pay minimal/no overhead. The only one I know/can think of is a GIM rapid referral clinic. I'm not too sure about other disciplines.

Link to post
Share on other sites
2 hours ago, Wachaa said:

Estimates vary among provinces and work locations (outpatient hospital clinic vs outpatient privately-owned clinic vs inpatient mix). Overall income varies with how much work you do.

It's also personal preference and job market that affect where you'll work. For example, there may not be that many outpatient hospital clinic jobs available. Or, you want more control over your work hours/ work-life balance, or maybe you want to run a clinic as a business, so you choose to work in an outpatient privately-owned clinic instead (either starting your own clinic, or joining an existing one with other endos or IMs/ subspecialists).

I understand circumstances can be different, but I found it odd that a previous comment mentioned atleast 25-30% overhead when the average was listed at 20% on cmg profiles. Statistically those 2 things are incongruent, so I wanted to know if there was something about the profiles i didnt know, which apparently isnt the case.

Link to post
Share on other sites
9 minutes ago, ysera said:

I understand circumstances can be different, but I found it odd that a previous comment mentioned atleast 25-30% overhead when the average was listed at 20% on cmg profiles. Statistically those 2 things are incongruent, so I wanted to know if there was something about the profiles i didnt know, which apparently isnt the case.

Yeah I’m finding the CMA profiles are different than what I’m hearing anecodotally about various specialities. Like meeting people making way below or above the average, but no one actually at that average hah. I think we just need to ask physicians in practice, both academic and community to get a better idea.

Link to post
Share on other sites
50 minutes ago, ysera said:

I understand circumstances can be different, but I found it odd that a previous comment mentioned atleast 25-30% overhead when the average was listed at 20% on cmg profiles. Statistically those 2 things are incongruent, so I wanted to know if there was something about the profiles i didnt know, which apparently isnt the case.

I can only speak about Ontario, I have no idea about other provinces (although I have read it is approximately the same).

Again a lot of this is anecdotal evidence, (but the CMA are also self reported), but I have never heard of anyone's overhead being as low as 20% even in a large group practice. I'm sure some of the family doctors here can comment. The numbers I hear are 25-30%. Most people I know plan to pay about 1/3 of their billings for overhead, I think if you get lucky and get a practice who offer 20% I would jump on it and never let go ahhaha

Also right now that's what is being debated by the government vs OMA. Whether overhead is actually 20% vs 30%. Obviously the government thinks its 20% and the OMA says its 30%. It's probably somewhere between that.

Link to post
Share on other sites

It seems to me like there is a lot of variation between what people say, what cmg reports and what other sources report.

 

for example according to http://www.canadianhealthcarenetwork.ca/files/2018/03/20-years-compensation-chart.pdf, family physicians make $363k in ontario pre overhead, while cmg reports it as in the low 200k range. But then again fields with a sizeable female population have whacky numbers because of the sheer number of women doctors that work part time. 

I wish we had something like the blue book in bc that we could search by specialty. It seems asinine to do a 5 year IM residency to make the same money as a GP, youd have to really enjoy what youre aiming for to stomach that. With most specialties that require 5 years of residency and maybe a fellowship, you would hope that the extra 3-4 years would result in a significant pay bump compared to a GP, otherwise its really hard to justify the extra training.

Link to post
Share on other sites

There are a few 5yr+ specialties that make less-per-dat than thanily. Neurology, peds, PMR, psych. Although psych has improved a lot I don't think they are in this list anymore.

And that's despite the fact that family has lots of flexibility in terms of how you spend your time and the level of income you chase.

Link to post
Share on other sites
27 minutes ago, ysera said:

 

It seems asinine to do a 5 year IM residency to make the same money as a GP, youd have to really enjoy what youre aiming for to stomach that. With most specialties that require 5 years of residency and maybe a fellowship, you would hope that the extra 3-4 years would result in a significant pay bump compared to a GP, otherwise its really hard to justify the extra training.

Perhaps people do it because they don't want to commit the next 30-40 years of their lives to something they personally find dull and unstimulating? If money were to be the sole factor to take into account when deciding on a career that will last for decades, then medicine might not be the best choice to begin with. 

 

Link to post
Share on other sites
14 minutes ago, lurker25 said:

Perhaps people do it because they don't want to commit the next 30-40 years of their lives to something they personally find dull and unstimulating? If money were to be the sole factor to take into account when deciding on a career that will last for decades, then medicine might not be the best choice to begin with. 

 

Like I said, you would justify it if its something you would really enjoy. But dont be naive, if there wasnt a financial incentive family medicine would be the most competitive specialty because of the training time and flexibility. Homo economicus etc etc.

 

Do you think dermatology and ophthalmology are so competitive because lots of people are really into the eye and skin?

Link to post
Share on other sites
2 hours ago, ysera said:

Like I said, you would justify it if its something you would really enjoy. But dont be naive, if there wasnt a financial incentive family medicine would be the most competitive specialty because of the training time and flexibility. Homo economicus etc etc.

 

Do you think dermatology and ophthalmology are so competitive because lots of people are really into the eye and skin?

Back off man, I ju$t reall¥ lov£ $kin ₱athology :D

Link to post
Share on other sites

CMA profiles are terrible for salary. If you're a part of the OMA search "selected billings" on the site for hard data about ohip billings. Keep in mind this doesn't include 3rd party billings, makes no mention of hours worked to achieve that salary, and has self-reported overhead numbers from a separate survey that changes wildly based on setting. For example, family is listed as around 30% overhead which is accurate in most cases, but if you're deciding on a job you have a lot of leeway in what you'll accept. As a family resident I had job offers with 0% overhead in the middle of nowhere and passing 40% for a new clinic starting up in an urban area. 

Last thing to keep in mind is that each of those numbers represents a person with their own goals. You'll see family as the second lowest median salary, yet of the top 100 billers in Ontario the second most represented specialty was family medicine. I, and a ton of other recent grads, can without question be making more than we are right now, but there's a deliberate choice to value life over evening walk-in and weekend ER shifts.

Endocrinology should be fine as long as there are family doctors who consult out at an a1c of 7, but when you look at a job with a limited job market, that doesn't just mean it may take a while to find a job. It could mean that choice between life and work gets made for you when you're competing with 10 other people for one position and the person who covers call and takes all the terrible consults gets the job. Focus on a specialty's fit with your personality and it's job market/flexibility; you won't be starving no matter what you do and there's always going to be opportunities to make more money. 

Link to post
Share on other sites
7 hours ago, ysera said:

Like I said, you would justify it if its something you would really enjoy. But dont be naive, if there wasnt a financial incentive family medicine would be the most competitive specialty because of the training time and flexibility. Homo economicus etc etc.

 

Do you think dermatology and ophthalmology are so competitive because lots of people are really into the eye and skin?

Certainly money is part of it. But you’re forgetting about what the work is actually like, and that’s huge.

Many people dislike family because it tends to involve shorter appointments, a lot more of things people often find repetitive or boring (like prescription refills, htn, etc etc etc) and less complex problem solving, and more overhead (if you’re running a big office). Certainly there are other options out there (locuming or walk ins can decrease your overhead for example, or you can do hospitalist if you like no overhead and the hospital environment), but the bread and butter and style of family drives people away from it as much or more so than the money.

I actually like family. But the 10 min appointments often make me nuts. And every time I get to spend an hour on something complex in IM or Psych I rethink my plans.

Link to post
Share on other sites
1 hour ago, frenchpress said:

Certainly money is part of it. But you’re forgetting about what the work is actually like, and that’s huge.

Many people dislike family because it tends to involve shorter appointments, a lot more of things people often find repetitive or boring (like prescription refills, htn, etc etc etc) and less complex problem solving, and more overhead (if you’re running a big office). Certainly there are other options out there (locuming or walk ins can decrease your overhead for example, or you can do hospitalist if you like no overhead and the hospital environment), but the bread and butter and style of family drives people away from it as much or more so than the money.

I actually like family. But the 10 min appointments often make me nuts. And every time I get to spend an hour on something complex in IM or Psych I rethink my plans.

 

I agree that is one reason why most people don't want to go into family. Many people enjoy the complexity and want to delve into the details, therefore they choose specialty. Family medicine isn't supposed to get into the details. That's why the government pays that small amount. That's why 10 minutes is actually a really long time for many cases. If I can see 6-8 people in the same time it takes a specialist to see 1 person, then the income difference is reduced.

But........ not many IM/ psych specialists can take 1 hour to see people either. It's not uncommon that IM/ psych specialists working fee-for-service are doing new consults in 15-30 minutes, and follow up appointments in 10-15 minutes. It's not just the desire for money that drives the "rush", but also the waiting lists. You honestly can't expect things to grind that slowly if you have a 6+ month waiting list of new consults, and a ton of follow ups to see. You also can't expect to solve every single problem, so you only focus on one or a few problems per visit. In my office, GPs see 40-50 people/ 7 hours while IM sees 15-25 in the same time depending on the ratio of new consults to follow ups. Billings in office are roughly the same, but IMs go do hospital work/ call on top of that.

 

8 hours ago, lurker25 said:

Perhaps people do it because they don't want to commit the next 30-40 years of their lives to something they personally find dull and unstimulating? If money were to be the sole factor to take into account when deciding on a career that will last for decades, then medicine might not be the best choice to begin with. 

 

 

I only partly agree with this. Granted, you shouldn't hate/ despise your job. But most people in today's world also don't love their jobs. If you paid me $500k a year to answer telephones I'd gladly switch my from MD job due to the lesser pressures and liability. I probably wouldn't need to work that many hours a week nor that many years of my life and can retire sooner.

Link to post
Share on other sites
6 minutes ago, Wachaa said:

It's not just the desire for money that drives the "rush", but also the waiting lists. You honestly can't expect things to grind that slowly if you have a 6+ month waiting list of new consults, and a ton of follow ups to see.

This is an important point.

6 minutes ago, Wachaa said:

But most people in today's world also don't love their jobs. If you paid me $500k a year to answer telephones I'd gladly switch my from MD job due to the lesser pressures and liability. I probably wouldn't need to work that many hours a week nor that many years of my life and can retire sooner.

But.. no one is going to pay someone more for a job with *less* responsibility and pressure. There's the rub.

Link to post
Share on other sites
13 minutes ago, Lactic Folly said:

This is an important point.

But.. no one is going to pay someone more for a job with *less* responsibility and pressure. There's the rub.

I know, haha, I only meant just because it is dull doesn't mean we can't choose it as a career. Because like it or not, most of what an MD does is going to be dull + unstimulating because it's mostly repetitive. I'm pretty sure when the surgeon is dictating his 5th cholecystectomy report of the day, happy hormone rushes aren't going off in his brain. Or the OB doing the C-section at 3 AM in the morning on back to back calls. Or the radiologist reading 50 mammograms. Etc.

Link to post
Share on other sites
1 hour ago, frenchpress said:

Certainly money is part of it. But you’re forgetting about what the work is actually like, and that’s huge.

Many people dislike family because it tends to involve shorter appointments, a lot more of things people often find repetitive or boring (like prescription refills, htn, etc etc etc) and less complex problem solving, and more overhead (if you’re running a big office). Certainly there are other options out there (locuming or walk ins can decrease your overhead for example, or you can do hospitalist if you like no overhead and the hospital environment), but the bread and butter and style of family drives people away from it as much or more so than the money.

I actually like family. But the 10 min appointments often make me nuts. And every time I get to spend an hour on something complex in IM or Psych I rethink my plans.

 Yeah the 10- 15 minutes appointments are short, where you get to address only 1-3 main issues, and then you have to book patients for follow-up appointments. Some patients are unrealistic and demand all their issues to be dealt within at a walk in clinic with a MD whom they have never met before. 

The main thing about family medicine is that you are always the MRP, you always end up dealing with all of your patient's issues even though you may have referred to specialists. You end up with the most responsibility, because the patients are rostered to you in a FHO/FHT. 

You have to be comfortable knowing a bit of everything, constantly reading up all guidelines. Where a specialist can focus on a limited number of pathology, and be an expert on a specific disease and looking smart  in front of the patients. As a GP, you will have to be comfortable saying: " I am not sure what you have right now, but it's not concerning and we will continue to monitor. " " I will refer you to a specialist as I am not sure with the management and hoping Dr X could help to further take care of you. 

Link to post
Share on other sites
30 minutes ago, Wachaa said:

I know, haha, I only meant just because it is dull + well paying doesn't mean we can't choose it as a career. Because like it or not, most of what an MD does is going to be dull + unstimulating because it's mostly repetitive. I'm pretty sure when the surgeon is dictating his 5th cholecystectomy report of the day, happy hormone rushes aren't going off in his brain. Or the OB doing the C-section at 3 AM in the morning on back to back calls. Or the radiologist reading 50 mammograms. Etc.

I dunno, having worked in an in-hospital setting for several years, I have yet to experience this at all. It's actually a relief to have a straightforward case once in a while - it seems there are so many diagnostic and management dilemmas, and unexpected complications that can occur in the acute setting. Shades of grey everywhere - someone might have some signs for, but other signs against cholecystitis. Could have an ill unstable patient but the intervention is risky - how to proceed? (hindsight is 20/20 of course). Daily multidisciplinary cancer rounds debating extent of disease and management (is it posttreatment change or recurrence? Chemo/rad/surg or monitor?) Even the "routine"  mammo/CXR is often an exercise in judgment - is that contour or asymmetry within the range of normal? Should we call the patient back (anxiety/radiation/biopsy) or dismiss it (could we be missing some pathology)?

Very different from my experience as a student in urban family medicine. Despite the much more controllable/favourable hours, given the higher proportion of prescription refills and well checkups as above, and psychosocial/life issues not possible to adequately address in a standard appointment slot, it wasn't for me. Also, the challenge of sorting out the worried well from someone who has something sinister brewing was daunting.

Link to post
Share on other sites
22 hours ago, PhD2MD said:

There are a few 5yr+ specialties that make less-per-dat than thanily. Neurology, peds, PMR, psych. Although psych has improved a lot I don't think they are in this list anymore.

And that's despite the fact that family has lots of flexibility in terms of how you spend your time and the level of income you chase.

I did notice that too which was fairly shocking to see. For something like Neuro, which is competitive and also requires one or more fellowships, its confusing that they get paid so little comparatively. I dont think I could do the 5+ years of training if I knew in the end I wouldnt be compensated for the extra training, no matter how much I like the field. 

Link to post
Share on other sites
1 hour ago, ysera said:

I did notice that too which was fairly shocking to see. For something like Neuro, which is competitive and also requires one or more fellowships, its confusing that they get paid so little comparatively. I dont think I could do the 5+ years of training if I knew in the end I wouldnt be compensated for the extra training, no matter how much I like the field. 

the government has this funny bias in billing I think towards someone doing something measurable or permanent. They really have problems paying for specialities that don't do that or do less of if (peds patients are complex and take more time so you end up with less, psych/neuro often can only manage a problem and cannot "fix it" and so on). This is not exactly fair. 

Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...
×
×
  • Create New...