How much do family doctors actually make?

[lowkeyMD]

I'm seeing wildly varying information from actual sources. For example, CMA's specialty profile lists the gross as $253,683, with a 27% overhead. Another source, which broke it down by province, showed $363k gross for Ontario, and between $250-350k in the rest of the country. My friend said his preceptor told him that in a practice with 1000 patients, the earning would be about 250k gross on the capitation model, and 200k on fee-for-service. I don't even know if 1000 patients is above or below average.

I really have no idea what to make of any of this. Obviously money isn't my primary motivating factor, but I'm torn between general internal medicine or family medicine, and money is a consideration. I'd also just like to have realistic expectations of my expected earnings since I'm definitely leaning towards the family side. I'm probably going to be seeing 20-25 patients a day and not more, which from my experiences so far is entirely the norm, so I don't know how much stock I'd put into the estimates that say "if you see 40 patients a day..." when most family doctors don't spend just 5 minutes per patient including all administrative work. Can anyone shed some light?

[tavenan]

It depends on how much you work. With your expectation of 20-25 patients / day, I would say 225-250K gross is not unreasonable. Some of my friends gross 500-600K but they work much harder than that and spend some weekends in rural communities. There are also things like FHOs and FHTs that change things, you can usually earn a bit more if you can join a practice like that.

 

Don't think about the money, in my opinion if the type of work family medicine encompasses is something you enjoy, then you'd have to be crazy not to pursue family medicine. You'll make more than enough no matter what, but family medicine offers you flexibility (both in terms of lifestyle and location) that few other specialties offer. For what it's worth, I know some people in internal med who regret not going into family, but can't say I know anyone who's in the opposite situation.

[lowkeyMD]

Thanks for the reply. I guess my thinking here is that either I work as a hospitalist or in an outpatient clinic. And both options are possible in GIM, which from my understanding makes a lot more than a GP would for doing more or less the same type of work. That's what I've read on here at least, I have no idea about the accuracy of that. But if my take home pay after taxes and overhead is going to be about 100k as a GP, I might be better off in GIM if they make more. I'm now wondering what the benefit is to doing FM if GIM has the same work for higher pay, apart from the residency training. Do you know if hospitalist work is hard to get in FM?

[tavenan]

1 hour ago, lowkeyMD said:

Thanks for the reply. I guess my thinking here is that either I work as a hospitalist or in an outpatient clinic. And both options are possible in GIM, which from my understanding makes a lot more than a GP would for doing more or less the same type of work. That's what I've read on here at least, I have no idea about the accuracy of that. But if my take home pay after taxes and overhead is going to be about 100k as a GP, I might be better off in GIM if they make more. I'm now wondering what the benefit is to doing FM if GIM has the same work for higher pay, apart from the residency training. Do you know if hospitalist work is hard to get in FM?

Hospitalist work is not hard to get if you're not limited to super urban centres like downtown Toronto. In places like London, Hamilton  etc you can pretty much do anything you want as a FM, wheter that's working in a clinic, doing hospitalist or doing a mix. Heck it's not even that hard to work in EM in most places, even without a +1. 

 

The average GIM makes more than the average FM, there's no disputing that. Couple things to keep in mind: Internal medicine residency is no joke, in FM you have a lot of say in how much you will make, and you have to calculate how long it will take you to catch up with the 3 extra years of residency. 

[Wachaa]

3 hours ago, lowkeyMD said:

I'm seeing wildly varying information from actual sources. For example, CMA's specialty profile lists the gross as $253,683, with a 27% overhead. Another source, which broke it down by province, showed $363k gross for Ontario, and between $250-350k in the rest of the country. My friend said his preceptor told him that in a practice with 1000 patients, the earning would be about 250k gross on the capitation model, and 200k on fee-for-service. I don't even know if 1000 patients is above or below average.

I really have no idea what to make of any of this. Obviously money isn't my primary motivating factor, but I'm torn between general internal medicine or family medicine, and money is a consideration. I'd also just like to have realistic expectations of my expected earnings since I'm definitely leaning towards the family side. I'm probably going to be seeing 20-25 patients a day and not more, which from my experiences so far is entirely the norm, so I don't know how much stock I'd put into the estimates that say "if you see 40 patients a day..." when most family doctors don't spend just 5 minutes per patient including all administrative work. Can anyone shed some light?

IMO if you're planning on seeing 20-25 people a day as FM you should go into IM and see 10-12. Pay would be better. It would be more suitable for you if you want to spend that much time per patient. It's not realistic to expect billings over 250k if you see 20-25 people per day working 4-5 days a week. It'll be closer to 200k and after overhead, you might make less than a nurse practitioner.

*The 1000 patient panel is neither large nor small. It depends how sick the patients are and how often they need to come in and see you. Obviously if they have higher needs, then seeing 20-25 a day may not be sufficient.

Hospitalist work is not that difficult to come by. You can locum and try it out.

[daleader]

2 minutes ago, Wachaa said:

IMO if you're planning on seeing 20-25 people a day as FM you should go into IM and see 10-12. Pay would be better. It would be more suitable for you if you want to spend that much time per patient. It's not realistic to expect billings over 250k if you see 20-25 people per day working 4-5 days a week. It'll be closer to 200k and after overhead, you might make less than a nurse practitioner.

Hospitalist work is not that difficult to come by. You can locum and try it out.

Even with 250K billing, minus over head and income tax, you are looking at 100-110K, meaning you'd be looking at 9-10K. 

[brady23]

Internal Medicine is not just an extra 3 years in residency, it is a grueling 3 years and with the stress (maybe a bit less) of matching to a subspecialty for CARMS 

[Mephistopheles]

I work in rural MB, 1 year out after finishing residency. Currently my gross is 550k, with ~30% overhead. This includes working ER sporadically and doing call 1 in 7 and seeing my own inpatients. My clinic days are 9:30-16:30.

[LittleDaisy]

On 9/29/2019 at 8:35 PM, Wachaa said:

IMO if you're planning on seeing 20-25 people a day as FM you should go into IM and see 10-12. Pay would be better. It would be more suitable for you if you want to spend that much time per patient. It's not realistic to expect billings over 250k if you see 20-25 people per day working 4-5 days a week. It'll be closer to 200k and after overhead, you might make less than a nurse practitioner.

*The 1000 patient panel is neither large nor small. It depends how sick the patients are and how often they need to come in and see you. Obviously if they have higher needs, then seeing 20-25 a day may not be sufficient.

Hospitalist work is not that difficult to come by. You can locum and try it out.

I think in Ontario, the FHO/FHT's pay model end up attracting complex patients being registered to a Family Health team with all allied health and community resources. Those patients tend to be higher needs and come back more frequently than q 6-12 months. So physicians in academic FHT end up seeing 20-25 patients per day (9-4 pm; with q 15 minutes per patient). Given they are paid per rostered patient with preventative bonuses; having a roster of 1000 patients pay around 300 K; after overhead it should be around 210 K (30% in Toronto, might be less somewhere else given the rent will significantly decrease). 

The caveat is that the government is restricting FHO/FHT spots. For FFS, the doctors usually see a patient < 10 minutes; so hence 40-50 patients per day; but the continuity of care and patient dissatisfaction is poor; to a point where the College in Ontario starts to have higher expectations for walk in physicians.  

[Compton]

12 hours ago, Mephistopheles said:

I work in rural MB, 1 year out after finishing residency. Currently my gross is 550k, with ~30% overhead. This includes working ER sporadically and doing call 1 in 7 and seeing my own inpatients. My clinic days are 9:30-16:30.

Met someone from Manitoba recently that was a PA (internal/family medicine) in Winnipeg + rural Manitoba making 130k working 37 hours/week (no call) with full benefits and 3.5 weeks vacation. Is that common out there because that seems too good to be true...

[Mephistopheles]

2 hours ago, Compton said:

Met someone from Manitoba recently that was a PA (internal/family medicine) in Winnipeg + rural Manitoba making 130k working 37 hours/week (no call) with full benefits and 3.5 weeks vacation. Is that common out there because that seems too good to be true...

That is a bit higher than I would expect but working 9-5 as a PA near our centre without call would net approx 110k. The further rural you are the better you are compensated. 

[tavenan]

25 minutes ago, Mephistopheles said:

That is a bit higher than I would expect but working 9-5 as a PA near our centre without call would net approx 110k. The further rural you are the better you are compensated. 

I should have become a PA...

[MomInMed]

I'm posting this link from a previous thread that I found really helpful

How much you make as a GP also depends on what you do, some friends doing GP-derm and private procedures that make a lot

[LittleDaisy]

4 hours ago, MomInMed said:

I'm posting this link from a previous thread that I found really helpful

How much you make as a GP also depends on what you do, some friends doing GP-derm and private procedures that make a lot

I think for GP derm private procedures like botox and fillers, the challenge is that patient shops around and can be challenging in term of their expectations. If they can afford to see a dermatologist, they would go see a cosmetic dermatologist. You end up with patients who are well-educated and would prefer a MD to inject botox and fillers; but sometimes want unrealistic results. 

You also have to get your name out there for patients to pick you. There is no referral needed, as it's not covered by the government.

The lack of regulation around cosmetic dermatology, allows any allied health to inject botox: i.e: cosmetician, nurse; etc; which is worrisome as botox does have side effects and can cause damages. 

[MDStudenthappy]

Is there a difference between rural and urban FM. Like hospitalist?

[medisforme]

I am a family doc in BC, one year out of residency, working about 1 hour from Vancouver.  I do office FM, residential care, OAT and  youth clinic sessionals (no hospital, no evenings and about 3-4 weekend hours every 5 weeks at nursing home "on call") and will make well over 300k this year post overhead but before taxes and I am still learning the ropes about maximizing my billings etc.. I work in my primary office on average 3.5 days week and will see about 30 patients per full day.  You can make a lot more money in BC if you are willing to work outside of Vancouver.  

[MDStudenthappy]

Is the billing different because you are 1 hour away?

[LittleDaisy]

5 hours ago, MDStudenthappy said:

Is the billing different because you are 1 hour away?

No, because the overhead is lower. The rental cost pushes higher overhead, and I assume that employees in Vancouver expect to get higher pay given the insane cost of rent in downtown. The same thing applies to other major urban cities. 

Of note, B.C is one of the lower paying provinces after Quebec for family medicine. In other provinces, if you are efficient and do some inpatient or find a clinic with lower overhead, you can make 300 K easily as well. A lot of GP work part time: i.e 3-4 days per week with no evening/overnight and weekend duties; and hence the overall CMA lower GP pay. Overall, people choose family medicine for the flexibility, lifestyle and great job market that other specialties don't offer. So overall, my FM colleagues are not very "keen" on making more money rather than living comfortably.

If you are an efficient physician seeing > 30 patients per day, and doing some other side inpatient work, you will get very well remunerated as a Family Physician. 

[windsormd1]

If you can; try to go to the states.  The numeration and model there is changing.  Lots of job options; lots of choices in terms of where to live.  Most jobs there paying (220-250k USD NET, meaning after overhead. That's 292-345k CAD!) You also get benefits, time off, vacation, CME money, health/vision/dental insurance etc. Cost of living probably better as well; depends on the area; but not everywhere.  I'm looking into it myself.  

[Compton]

19 hours ago, windsormd1 said:

If you can; try to go to the states.  The numeration and model there is changing.  Lots of job options; lots of choices in terms of where to live.  Most jobs there paying (220-250k USD NET, meaning after overhead. That's 292-345k CAD!) You also get benefits, time off, vacation, CME money, health/vision/dental insurance etc. Cost of living probably better as well; depends on the area; but not everywhere.  I'm looking into it myself.  

Practicing conditions I've heard aren't that great compared to Canada though when dealing with insurance. But the pay with the cost of living is definitely lower in the states since they have less taxes and business loopholes. Even allied professions are killing it in the US compared to Canada but the most stress comes from dealing with insurance.

[windsormd1]

3 hours ago, Compton said:

Practicing conditions I've heard aren't that great compared to Canada though when dealing with insurance. But the pay with the cost of living is definitely lower in the states since they have less taxes and business loopholes. Even allied professions are killing it in the US compared to Canada but the most stress comes from dealing with insurance.

Yea that's true; funny thing is, most family doctors there are 'employed' and they are still collecting ~$200-250k salaries plus benefits, all in USD.  The really entrepreneurial ones who actually own their own clinics in the USA are still way better off with earnings of 300K plus in USD.  But the insurance hassles are definitely there.  The thing is, these are all 'net' income; after overhead.  I'm contemplating an offer in the Philadelphia region; but the VISA issue is a drag at this point......we'll see.........comfortable either way; but actually feel the tax situation here will get worse after October 21..........

[windsormd1]

I'm not sure why the consensus among some family doctors here is that we make more than down south.  Even if you compare the 'average' salary in the USA of 225k USD(which is 300K CAD!!!) NET for an 'employed USA physician' with 'above average canadian billings of 375k CAD minus a generous 25% overhead which equals 262.5k CAD NET', the USA family doctor still wins out.  And they get reimbursed for licenses, have time off, benefits, etc.  The difference is that we are 'independent'; for whatever that's worth.  IMHO, I still don't see how we win out in any other sense aside from independence and 'lack of insurance hassles.'  

Out of my residency class, 4 out of the 8 graduates went down South.

[MDStudenthappy]

On 10/8/2019 at 8:30 PM, windsormd1 said:

I'm not sure why the consensus among some family doctors here is that we make more than down south.  Even if you compare the 'average' salary in the USA of 225k USD(which is 300K CAD!!!) NET for an 'employed USA physician' with 'above average canadian billings of 375k CAD minus a generous 25% overhead which equals 262.5k CAD NET', the USA family doctor still wins out.  And they get reimbursed for licenses, have time off, benefits, etc.  The difference is that we are 'independent'; for whatever that's worth.  IMHO, I still don't see how we win out in any other sense aside from independence and 'lack of insurance hassles.'  

Out of my residency class, 4 out of the 8 graduates went down South.

FM is a 4 year residency in USA so that is another issue. Thoughts windsormd1?

[BernieMac]

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[rmorelan]

39 minutes ago, YesIcan55 said:

no, it's not. It's 3 years. 

side note: There is a lot of interest by many to move to a 4 year program (and there are 4 year programs out there for family medicine in the US).