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Canadian Family doctors are overpaid and entitled


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Average net income is at least 50-70% more than US family doctors.

Educational debt is likely 1/3 that of US family doctors.

Yet all I hear are complaints such as:

”We’re underpaid compared to specialists!”

”We can’t bill for writing notes after an appointment!”

”We will quit if the corporate tax loop holes close!”

1. Quit to where may I ask? You’re making more in Canada than you would do anywhere else

2. No other healthcare professional gets paid for writing notes!

3. You don’t have to advertise

4. No worry about not getting paid by patients like there is in other health professions e.g Chiro, Opto

 

Change my mind.

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to add to your argument:

-Family medicine residency is only 2 years in Canada compared to 3 years in the US

-Public perception and perception of family doctors by physicans is better in Canada than the US

-Don't have to worry about insurance bureaucracy in Canada compared to US

-Have the ability to do various +1 fellowships in Canada 

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4 minutes ago, YesIcan55 said:

to add to your argument:

-Family medicine residency is only 2 years in Canada compared to 3 years in the US

-Public perception and perception of family doctors by physicans is better in Canada than the US

-Don't have to worry about insurance bureaucracy in Canada compared to US

-Have the ability to do various +1 fellowships in Canada 

Further points:

- Less threat of lawsuits due to point number 2 and also the absence of a litigation culture in Canada. This likely results in a lower malpractice insurance premium as well

- Less proliferation of NPs and a narrower scope of practice for NPs in Canada compared to the US (MUCH lower NP pay as well)

 

Its always funny listening to the entitlement of FDs in Canada.

“We have more education so we deserve better pay”. How many phDs are payed below 6 figures?

”We made a lot of sacrifices by going to school and delaying an income”. A lot of people make huge sacrifices early in their careee as well, leaving their families and moving to remote regions to get a job,

“In a hospital setting phDs and pharmacists shouldn’t be referred to as Drs.” Basically saying that MDs are superior to phDs and pharmDs.

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1 hour ago, Concernedcitizen said:

Average net income is at least 50-70% more than US family doctors.

Educational debt is likely 1/3 that of US family doctors.

Yet all I hear are complaints such as:

”We’re underpaid compared to specialists!”

”We can’t bill for writing notes after an appointment!”

”We will quit if the corporate tax loop holes close!”

1. Quit to where may I ask? You’re making more in Canada than you would do anywhere else

2. No other healthcare professional gets paid for writing notes!

3. You don’t have to advertise

4. No worry about not getting paid by patients like there is in other health professions e.g Chiro, Opto

 

Change my mind.

There is no question its true, but with that being said, theres no other way to attract people into the specialty, before there were these benefits, people flocked to specialties. Now, they still do but to a lesser extent.

With that being said, I do have an issue with the short training time. I think training is too short. The possibility of doing 3 years of med and 2 years of residency and then staff a clinic or even an emerg all on your own is a bit too little training I think, but that's just me. 

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1 hour ago, Edict said:

There is no question its true, but with that being said, theres no other way to attract people into the specialty, before there were these benefits, people flocked to specialties. Now, they still do but to a lesser extent.

With that being said, I do have an issue with the short training time. I think training is too short. The possibility of doing 3 years of med and 2 years of residency and then staff a clinic or even an emerg all on your own is a bit too little training I think, but that's just me. 

If the gross overpay (relative to other developed nations) of family doctors, short training and guarantee of a full time job (which is not the case with many other specialities) is not enough, then I don’t know what is. Per hour I believe family doctors do compare very well with many specialities.

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1 hour ago, tavenan said:

What is the point of this 

The point is to point out an evidenced based argument which completely contradicts the public perception that Canadian family doctors are overworked, underpaid relative to their US counterparts.

Also in part, trying to figure out what is so difficult in family doctor’s lives that makes them behave this way:

https://www.tbnewswatch.com/local-news/thunder-bay-hospital-er-doctors-threaten-to-leave-720918

Many of us are simply not willing to continue doing our present job if the changes are implemented,"

"We are, with this letter, notifying the government and the hospital administration that...(they) would be wise to have a plan to ensure the health of those in our community is not compromised due to a sudden loss of ER physicians."

 

Do they not realize that, given their qualifications, they’re being paid more than any of their counterparts worldwide?

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2 hours ago, Concernedcitizen said:

“In a hospital setting phDs and pharmacists shouldn’t be referred to as Drs.” Basically saying that MDs are superior to phDs and pharmDs.

In a clinical setting it confusing for patients if PharmDs and PhDs are referred to as Dr. (not that PhDs walk around rounding on patients anyway). Nothing to do with superiority.

Yes FM is a very attractive specialty and it is likely better to be a family doctor here than anywhere else in the entire world, but it is designed to be that way. There is an overemphasis on specialization in America and in part it is caused by the incredible disparity between the highest earning specialists and FM (i.e. neurosurg/ortho making 800k-1+ mill/yr vs family doctor making 225k/yr). I do think that we have a better overall system so many of these comparisons are not particularly relevant; it's not like we should strive towards creating billing insurance nightmares. Comparisons with PhDs are also not relevant since a MD is a professional degree for physicians, while a PhD is an academic degree with highly heterogenous vocational applications (e.g. PhD in English vs petroleum chemical engineering vs mathematics).

Anyway while I don't think family physicians are overpaid on average, there are a lot of unwarranted complaints about income disparity. During these arguments for some reason the highest earners of other specialties are cherry picked to compare vs the average family physician when we know that family medicine is #3 on the top 100 earners list and the average family doc does reasonably well, especially considering the intangible benefits of pursuing FM as a career.

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26 minutes ago, 1D7 said:

In a clinical setting it confusing for patients if PharmDs and PhDs are referred to as Dr. (not that PhDs walk around rounding on patients anyway). Nothing to do with superiority.

This confusion can be cleared up by introducing yourself/job title to the patient instead of taking away an earned title of another profession. And this confusion does not affect patient outcomes if the non-physician is staying within their scope of practice. All pharmacists in US hospitals are referred to as “Dr”. This issue of “confusion” seems to only be a worry in Canada. Should podiatrists and hospital dentists also have that title stripped because of a potential confusion?

 

26 minutes ago, 1D7 said:

There is an overemphasis on specialization in America and in part it is caused by the incredible disparity between the highest earning specialists and FM (i.e. neurosurg/ortho making 800k-1+ mill/yr vs family doctor making 225k/yr).

Overemphasis on specialization? Any evidence for this? Last time I checked, it was Canada that was severely lacking family doctors, not the US.

 

26 minutes ago, 1D7 said:

 Comparisons with PhDs are also not relevant since a MD is a professional degree for physicians, while a PhD is an academic degree with highly heterogenous vocational applications (e.g. PhD in English vs petroleum chemical engineering vs mathematics).

Comparisons are relevant when PhDs are only allowed to use their earned title in the absence of MDs.

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27 minutes ago, Concernedcitizen said:

This confusion can be cleared up by introducing yourself/job title to the patient instead of taking away an earned title of another profession. And this confusion does not affect patient outcomes if the non-physician is staying within their scope of practice. All pharmacists in US hospitals are referred to as “Dr”. This issue of “confusion” seems to only be a worry in Canada. Should podiatrists and hospital dentists also have that title stripped because of a potential confusion?

 

Quote

Comparisons are relevant when PhDs are only allowed to use their earned title in the absence of MDs.

If a pharmacist wants to be called Dr. X I have no problem using that title—I have yet to encounter any pharmacist who introduced him/herself with that title so I default to their first name. Additionally I have never had to use a pharmacist's name in a clinical context to a patient so I don't see it as any form of disrespect.

For defaults it just comes down to tradition. Residents are often referred to by their first name even though they have a MD. Dentists, optometrists, and podiatrists are usually referred to as Dr. X because they are usually the primary clinician in their respective clinical settings. Several of my old classmates had PhDs prior to entering medical and dental school but avoided the title because it would create confusion. Same with my pharmacy friends. This tradition exists to reduce confusion, but if someone introduced themselves as such I'm sure most people would be fine using it.

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On 9/30/2019 at 12:52 PM, Concernedcitizen said:

Could you point the posts you’re referring to?

Basically every post you've made in this topic. You clearly have a bone to pick with family physicians for the numerous poorly informed points listed above. What level of medical training are you at, and what experience with family physicians have you had?

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3 hours ago, ameltingbanana said:

Basically every post you've made in this topic. You clearly have a bone to pick with family physicians for the numerous poorly informed points listed above. What level of medical training are you at, and what experience with family physicians have you had?

Congratulations, you’ve written the longest paragraph without adding anything to the discussion. Zip, Zero, Nothing.

Why don’t you actually post something intellectual against the points I made instead of trying to attack me?

Let’s try again. Which points do you disagree with:

Average net income is at least 50-70% more than US family doctors.

Educational debt is likely 1/3 that of US family doctors.

Don't have to worry about insurance bureaucracy in Canada compared to US

Have the ability to do various +1 fellowships in Canada 

Less threat of lawsuits due to point number 2 and also the absence of a litigation culture in Canada. This likely results in a lower malpractice insurance premium as well

- Less proliferation of NPs and a narrower scope of practice for NPs in Canada compared to the US (MUCH lower NP pay as well)

 

With all those points, would you argue that GPs are underpaid like a significant amount of them are arguing?

Do you disagree that this behaviour shows a sense of entitlement?:

https://www.tbnewswatch.com/local-news/thunder-bay-hospital-er-doctors-threaten-to-leave-720918

“Many of us are simply not willing to continue doing our present job if the changes are implemented,"

"We are, with this letter, notifying the government and the hospital administration that...(they) would be wise to have a plan to ensure the health of those in our community is not compromised due to a sudden loss of ER physicians."

I’m not saying they don’t have the right to quit, of course not. But their entitlement has caused them to loose touch with the reality that they simply, on average, make more in almost any other location on earth.

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34 minutes ago, Concernedcitizen said:

Congratulations, you’ve written the longest paragraph without adding anything to the discussion. Zip, Zero, Nothing.

Why don’t you actually post something intellectual against the points I made instead of trying to attack me?

Let’s try again. Which points do you disagree with:

Average net income is at least 50-70% more than US family doctors.

Educational debt is likely 1/3 that of US family doctors.

Don't have to worry about insurance bureaucracy in Canada compared to US

Have the ability to do various +1 fellowships in Canada 

Less threat of lawsuits due to point number 2 and also the absence of a litigation culture in Canada. This likely results in a lower malpractice insurance premium as well

- Less proliferation of NPs and a narrower scope of practice for NPs in Canada compared to the US (MUCH lower NP pay as well)

 

With all those points, would you argue that GPs are underpaid like a significant amount of them are arguing?

Do you disagree that this behaviour shows a sense of entitlement?:

https://www.tbnewswatch.com/local-news/thunder-bay-hospital-er-doctors-threaten-to-leave-720918

“Many of us are simply not willing to continue doing our present job if the changes are implemented,"

"We are, with this letter, notifying the government and the hospital administration that...(they) would be wise to have a plan to ensure the health of those in our community is not compromised due to a sudden loss of ER physicians."

I’m not saying they don’t have the right to quit, of course not. But their entitlement has caused them to loose touch with the reality that they simply, on average, make more in almost any other location on earth.

Well I have to admit that having treated patients from the U.S in the Canadian health system, they straight come to my clinic for the first time and asking to see specialists for medical conditions that can be well-managed by a first year FM resident. My U.S patients told me that they can directly go to the specialists without any referrals, which undermines the role of the Family Physician in the United States.

We have to understand that U.S is mostly private-funded health care system. It may seem much that the system is efficient, however only for people who are generally well,  and who can afford to have private insurance. You tend to neglect the marginalized and vulnerable patients with multiple medical comorbidities; and who can't afford to pay the medications nor access specialized care because they can't AFFORD.

I don't know why the U.S sets up their healthcare system this way. Regardless,  there is already a huge economic disparity between the U.S citizens, same as for physicians in the States, where people pick specialties because it's much more well -respected and pays much better.

I am not sure if you are a Canadian family physician. I want you to be aware that most Family Physicians pay 30% overhead, and spend countless hours DOING UNPAID WORK by filling out insurance forms, writing advocacy letters, doing social advocacy by being a social worker & psychotherapist & dietitian etc, filling out governmental forms for their patients; calling specialists so they can see a concerning patient sooner; and not counting being held always LIABLE for all their patients. 

In Canada, most patients NEED to go through a GP to get triaged to see a specialist; and we are trained to manage most pathology comfortably on our own from a new-born baby, to a schizophrenic patient, to a pregnant lady in labour, to a dying patient in palliative care, to a fairly complex patient with COPD, and to a frail elderly. In fact, patients trust their GP the most, and we save the health system money by triaging if patient needs specialist care, where in U.S, patient shops around for a tertiary care specialist for simple complaint like warts. 

Family Physicians ACT as the front gatekeeper of Canadian healthcare system, we KNOW patients the best, and ADVOCATE FOR them the most. If a specialist does not figure out what our patient has or dismisses our patients, we don't STOP trying and say too bad, see you in follow up PRN if you want to. 

U.S health system underpays family physician, as their healthcare is PRIVATE, and given patient can SHOP around specialists; what's the point of increasing financial incentives for GP?

Your posts of NP and PA taking over Family Physicians show how little you KNOW about what Canadian Family Physicians do! I work closely with NPs and PAs, and honestly, they see a patient q 30 minutes to 1 hour for simple minor complaints; and will end up consulting MD for any complex presentation; they end up seeing 5-6 patients per day; and paid by the government with a salary over 130,000$ with all the benefits and no overhead; which is almost comparable to a GP working 60-70% full time who has to pay overhead. I find it personally insulting that the Canadian government tries to "sell" to the general population that a NP and PA are as "good" as a family physician who did 4 years of undergrad, 3-4 years of medical school, and 2 years of residency to still feel unsure of what patient comes in with; and where one constantly reads up all the guidelines and having full responsibility of all the patients under their name with higher standards of medical ethics and professionalism; IT'S NOT THE SAME.

To @edict who said: "With that being said, I do have an issue with the short training time. I think training is too short. The possibility of doing 3 years of med and 2 years of residency and then staff a clinic or even an emerg all on your own is a bit too little training I think, but that's just me. "

To be completely honest, I think you learn the most as being a young staff when you have the FULL RESPONSIBILITY. When you are a resident, you don't think as a staff and being the final person making the final decision. As for the ER work, most family doctors who just graduate is backed up by older colleagues during first year of ER work. Having done my residency in an academic center, with a few of ER electives and great exposure to acute care medicine,  I myself feel that I am ready to work in an ER setting. It's up to the FM resident on how to bests advocate for their residency training. I am certain that my colleagues doing rural Family Medicine residency are fully competent as ER doctors by end of their training. And you HAVE TO remember that  You just have to know your limits and WHEN to call for help. 

The majority of Canadian ER chiefs (> 75%)  are CCFP-trained, https://canadiem.org/routes-to-emergency-medicine-practice-following-a-family-medicine-residency/

You have to remember that FRCPC- EM do not work in rural areas, they are trained to work in tertiary centers. So for the undeserved rural population, the family physicians fill in the gap and serve the communities that needs the care the most. Some family physicians work in urban ERs but mostly in community hospitals; or in academic hospitals after CCFP-EM fellowship. 

To be honest, having worked with CCFP-EM and FRCPC EM, except for trauma cases, I don't personally see much difference. I don't want to start an eternal debate for CCFP vs FRCPC EM; but I personally feel that if you advocate for your family medicine residency, and have a good exposure to acute care medicine, you are ready to work in an ER setting if that's your inner calling. 

To @OP, please remain respectful to the other members. You certainly don't behave as a professional MD, if you are one!

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4 hours ago, Ian Wong said:

This thread has run its course, and is going to be locked. 
 

Ian

PS:  Canadian family physicians are most definitely NOT overpaid, and are critical to a well-functioning Canadian healthcare system. Change my mind. 

Ha beat me to the punch - 

I have to say I found the arguments. The over pay issue seems to crop up from time to time - yes they get paid more than the US counterparts but as someone practising in the US right now I can say that is because the US is clearly underpaid. We all get paid for documenting our findings, unless the implication is that FM provide no value which is something I would strongly argue against. No doctors really has to truly advertise in Canada, and FM and other doctors actually have cases where they are not paid for a variety of reasons - although it is less than other fields. 

The medical field in Canada has enough to worry about without attacking itself ha. 

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