Is family medicine really that bad?

[confusedclerk 0]

Hi all,

As a clerk wanting to go into family medicine, I am now having some doubts. I've spoken to several family doctors who complain that they don't get compensated enough/compensated fairly and have read reports online on family doctors having to do much more paperwork at home when compared to other specialities. Some benefits of family medicine I see are the ability to take longer to see your patients (as opposed to certain specialities), the programs being a 2 year residency as opposed to 5, and having a great work-life balance. As much as I like these pros of family medicine, I don't know if I would ultimately regret choosing the speciality. Although making as much money as possible isn't my goal, I don't know if I would want to go into a career that so many people are apparently unsatisfied. 

Just wondering if any family medicine applicants/residents had some insight into family medicine as a career.

 

[JohnGrisham 1,775]

3 hours ago, confusedclerk said:

I see are the ability to take longer to see your patients (as opposed to certain specialities),

Not sure how you have this impression. Other specialties by definition of their fee schedules can much more easily take longer with patients. 150-300$ consult fee, you can take an hour if you want with patients as a specialist.

Often 30-50$ fee to see a clinic patient as a GP, you can't afford to take 20 mins with every patient.

Lots of variables depending on your province, practice style and interests.

Don't think too much of the 2 vs 5 year, think about what you enjoy. Often the 5 year may be 6-7 depending on specialty. 

Psychiatry is 5 years and very employable, and able to spend much longer than FM with patients, and bill considerably higher per patient, so you aren't as stressed to see loads patients a day.

[older 84]

About career prospects: Family Doctors will be the first to be replaced by  "inventive" shortcuts such as eDoctor, or nurses and pharmacists seeing patients and writing prescriptions. Cost of health care is ballooning and in order to cut costs, governments will look at all solutions - even bad ones. They will always try to save on doctors, by reducing pay and number of doctors. It will only get worse.

Regardless, OP should do what is the best for him (her).

[rmorelan 2,615]

interesting - I wonder it is a case of the grass is greener on the other side. I would love to hear everyone's thoughts. 

[Compton 18]

Wouldn't FM docs be the first to face direct impacts from expanded PA/NP roles? I'd imagine in the near future, PAs will be regulated in more provinces and their roles expanded so that they can open up their own practices (similar to the US). I think FM docs will face obstacles in the future from multiple directions since the government wants to save costs. 

[rmorelan 2,615]

On 1/27/2020 at 9:03 PM, Compton said:

Wouldn't FM docs be the first to face direct impacts from expanded PA/NP roles? I'd imagine in the near future, PAs will be regulated in more provinces and their roles expanded so that they can open up their own practices (similar to the US). I think FM docs will face obstacles in the future from multiple directions since the government wants to save costs. 

I mean every doctor is going to face impacts of attempts to reduce costs, and the PA/NPs also aren't all that interested in removing doctors completely either (their argument for increased pay is simply relative to FD. Remove family doctors - and that is HUGE assumption that they can do the same role - just removes the very reason they are entering the system). Of course you can expect a long drawn out fight about truly opening independent practices (family medicine is a complex and challenging job - there is a reason people go to medical school for it ha). 

Edited July 24, 2020 by rmorelan

[medigeek 90]

55 minutes ago, Compton said:

Wouldn't FM docs be the first to face direct impacts from expanded PA/NP roles? I'd imagine in the near future, PAs will be regulated in more provinces and their roles expanded so that they can open up their own practices (similar to the US). I think FM docs will face obstacles in the future from multiple directions since the government wants to save costs. 

In USA, midlevels have really off big time in every little subspecialty. They not only see follow ups but initial consults as well. Quite common for a FM to refer their patient to a GI and the NP or PA sees the patient the first time. 

With that said, FM's job market is still excellent in USA markets despite the midlevel devastation that's occurring. 

[insomnias 133]

5 hours ago, rmorelan said:

interesting - I wonder it is a case of the grass is greener on the other side. I would love to hear everyone's thoughts. 

Example 1: my family doctor went into it because it was a 2 year program. He's been in practice for >20 yrs. He takes his time with patients, all his patients love him, etc. He hates being a family doctor. He continues to urge me not to do it.

Example 2: a family doctor I shadowed works ~3 days/week, still makes 6 figures, and is maybe 4 years out of residency. Loves it.

Imo, FM is like every other specialty in that you can find a way to love it or you can find a way to hate it. Uniquely, there's so many potential niches that if you literally have no clue what you want to do, you have the ability to find that thing that you'd enjoy doing, and do it.

As for midlevel incursion into FM in Canada: I don't see it as being as big of a concern. The entire purpose of FM being gatekeepers to specialists is to keep system costs down. NP/PAs send more referrals than FM does for the same patient complexity level. As a result, an expansion of their scope of practice would result in increased healthcare costs in the long run, which would be great for anyone working in the MoH who then runs the stats on why that happened. The more imminent possibility is that IMGs get the ability to practice at the same scope an NP/PA has today, or at a more expanded scope compared to midlevels. Unlike in the US, IMGs (especially CSAs) are viewed pretty favourably by the public here.

[a1b1 38]

Ultimately it comes down to what your long term goals are.

I went into family medicine for multiple reasons, some very similar to the ones you mentioned. 2 years of residency. The ability to do a +1 if i was interested. The ability to work in multiple area's (hospital, palliative care, rehab, walk in clinics, CHSLD e.t.c). I personally like having a "office job" type work environment, where i show up at 8:30 and am done by 5pm without too much stress. Another important point is the physical aspect of being a doctor. This probably doesn't apply to everyone but as someone who has a physical disability, i could not see myself working in surgery for example where i would have to be on my feet for hours. The salary in family medicine is not bad either (especially in qc compared to some other provinces), you will live a very comfortable life, you may not be as rich as a radiologist/cardiologist/ophthalmologist for example but it's still a good salary.

As a recent residency grad currently working as a family doctor, I have to say i am pretty satisfied with my decision and could not see myself doing any other part of medicine. It's easy to get lost in all the downsides of family medicines (i.e PREM, media e.t.c) but it's important to keep in mind that family medicine still has a lot of very attractive points.

[1D7 173]

The 'younger' family docs (20s-40s) I've worked with have all been happy with their lives. There's stuff they don't like (mostly paperwork, admin, and certain patients) but none of them would prefer to sacrifice lifestyle for it (location, hours, call, additional painful years in residency). My own family doc encouraged me to pursue family medicine for whatever that's worth.

I don't think pay should be a big factor in your decision since family medicine does out earn some 4-5 year specialty residencies (e.g . neuro, paeds, etc.) and has options to literally be some of the highest earners. Additionally the fact that you start earning some real money 3-5 years earlier than many other specialties puts you ahead in terms of life and investments, which is worth quite a bit with our decade-long bull market. It's not all sunshine and roses but people tend to overemphasize the downsides of family medicine.

As for what you read on the Internet and hear from vocal physicians, there is a lot of 'grass is greener' phenomenon. In general all of us are expected to work and do more despite fewer resources and down trending pay. Complex psychosocial issues are now increasingly being encountered and affecting our ability to provide care in non-psychiatric specialties like emergency medicine, internal medicine, even radiology. The respect for being a physician has diminished with the rise of the Internet, hostile media, pseudo-medical organizations (e.g. NDs gaining prescribing rights), anti-science movements (e.g. anti-vaxxers). This is also exacerbated by American sentiments regarding primary care, where not only does family medicine experience the same issues with greater severity, but also face openly hostile midlevel organizations. If you enjoyed your family med rotation, I would not let these things dissuade you—these are challenges that we will face in one way or another across all specialties.

[medisforme 62]

I am 1.5 years out of residency and don't understand all the doom and gloom around family medicine. As a disclaimer, I neither love nor hate family medicine.  It provides a great income so I can provide for my family and enjoy the time I spend with them.  The other disclaimer, is that I quickly gave up on trying to be an agent for change in our health care system, it is too inefficient and bureaucratic and not amenable to change.  I am much happier just putting my head down and working within the parameters we have.

1) My personal opinion is that the NP/PA encroachment is almost irrelevant (at least in BC).  There is such a dire lack of primary care that there will always be work for family doctors (outside of large cities at least).  The city I work in, has at least 3 new NP's to help ease the fact that there is a 5 year wait to obtain a family doctor (i do have a problem with how much NP's earn per patient seen, which is a bit of a separate argument).  

2) I also don't understand the paperwork argument

- don't refill Rx by fax

- charge patients for all private forms

- you bill for all simple communications with nursing homes, home health etc...

It's a non-issue if you follow the above 3 rules

3) Memorize your province's billing codes to help you maximize your income (I already outearn most of my colleagues who have no idea about all the billing codes available to them.)  I earned >350K last year, with zero hospital work, zero evening work, and a minutiae of weekend work.  I typically see about 30 patients on a full office day.

ie. psychosocial issues can easily be converted to counselling and mental health planning appointments, filter charts to see who qualifies for chronic disease management codes (ie. anyone who has ever had an Ha1c of 6.5 or above qualifies for CC diabetes codes regardless of their complexity) etc...

 

Negatives would be:

that certainly, there is a lot of frustration with certain patients who are demanding, neurotic etc... It doesn't provide a lot of job satisfaction.  

A lot of the office based work involves listening and counselling on mental health issues (the medicine is just validating their feelings and providing simple advice, which is actually often quite helpful).  That is not for everyone

Dealing with chronic pain (especially chronic back pain).  Very difficult to convince patients there is little indication for medications, procedures etc... vs physio, tai chi, weight loss, stretches (as an aside see February 18 issue of the economist for a crazy story on how much is spent treating back pain in the US, it is nearly 80% of what is spend on all cancer treatments).  This also doesn't lead to much job satisfaction.

 

I would just say speak to a variety of family docs about their experiences before making a decision as you will find a wide variety of opinions.

[Lesigh2 24]

On 2/8/2020 at 9:48 AM, medisforme said:

I am 1.5 years out of residency and don't understand all the doom and gloom around family medicine. As a disclaimer, I neither love nor hate family medicine.  It provides a great income so I can provide for my family and enjoy the time I spend with them.  The other disclaimer, is that I quickly gave up on trying to be an agent for change in our health care system, it is too inefficient and bureaucratic and not amenable to change.  I am much happier just putting my head down and working within the parameters we have.

1) My personal opinion is that the NP/PA encroachment is almost irrelevant (at least in BC).  There is such a dire lack of primary care that there will always be work for family doctors (outside of large cities at least).  The city I work in, has at least 3 new NP's to help ease the fact that there is a 5 year wait to obtain a family doctor (i do have a problem with how much NP's earn per patient seen, which is a bit of a separate argument).  

2) I also don't understand the paperwork argument

- don't refill Rx by fax

- charge patients for all private forms

- you bill for all simple communications with nursing homes, home health etc...

It's a non-issue if you follow the above 3 rules

3) Memorize your province's billing codes to help you maximize your income (I already outearn most of my colleagues who have no idea about all the billing codes available to them.)  I earned >350K last year, with zero hospital work, zero evening work, and a minutiae of weekend work.  I typically see about 30 patients on a full office day.

ie. psychosocial issues can easily be converted to counselling and mental health planning appointments, filter charts to see who qualifies for chronic disease management codes (ie. anyone who has ever had an Ha1c of 6.5 or above qualifies for CC diabetes codes regardless of their complexity) etc...

 

Negatives would be:

that certainly, there is a lot of frustration with certain patients who are demanding, neurotic etc... It doesn't provide a lot of job satisfaction.  

A lot of the office based work involves listening and counselling on mental health issues (the medicine is just validating their feelings and providing simple advice, which is actually often quite helpful).  That is not for everyone

Dealing with chronic pain (especially chronic back pain).  Very difficult to convince patients there is little indication for medications, procedures etc... vs physio, tai chi, weight loss, stretches (as an aside see February 18 issue of the economist for a crazy story on how much is spent treating back pain in the US, it is nearly 80% of what is spend on all cancer treatments).  This also doesn't lead to much job satisfaction.

 

I would just say speak to a variety of family docs about their experiences before making a decision as you will find a wide variety of opinions.

Just wondering, where did you learn all the practical/business side of family practice? Was this just through experience or did you access some more formal education regarding this topic? 
 

I feel like the numbers you are quoting in terms of billing and hours worked seem out of the ordinary.

[NeuroD 297]

On 2/8/2020 at 12:19 PM, 1D7 said:

 

I don't think pay should be a big factor in your decision since family medicine does out earn some 4-5 year specialty residencies (e.g . neuro, paeds, etc.) and has options to literally be some of the highest earners. Additionally the fact that you start earning some real money 3-5 years earlier than many other specialties puts you ahead in terms of life and investments, which is worth quite a bit with our decade-long bull market.

This should not be underestimated.

[rmorelan 2,615]

1 hour ago, PhD2MD said:

This should not be underestimated.

No it shouldn't - and if you objectively do the math it would take a couple of decades for most specialists to "catch up" - I really think that point is not stressed enough with the entire money side of medicine is talked about. Comparing apples to apples the say 3-5 years (or more) head start is really powerful. Factor in the fact that many of those specialists have no choice but to work more hours than a typical family doctors so to truly compare things you also have to equate that as well  (and of course extra hours often at worse times) .

Some of the smartest BUSINESS minded doctors from my class objectively compared things and just went to family. It is actually hard to argue with their logic when you really look at things. 

and even now ha - there is part of myself that thinks it would have been really nice if I just personally liked the field as a profession as there is so much going for it. I don't think I would, which is why I did something else but I am on that 5 extra year pathway, so I can really see the effects at this point (4 months to go ha!).  Five years of 80+ hour work weeks ha...and over 200 all nighters extra over FM, 12 months of every waking moment preparing for a crushing exam, and really not a ton of control over your schedule or major aspects of your life. 

 

Edited February 10, 2020 by rmorelan

[MedZZZ 16]

I have read this forum and want to thank everyone in advance for all the helpful information. I am currently in third year, in the process of choosing my electives and cannot make up my mind between IM and FM.

The 2 year residency is attractive considering that I am an older/non-trad applicant and also the flexibility and job prospect is very appealing. I feel like the breadth of FM is too broad for me as you have to be able to deal with pediatrics issues, OB/GYN issues, mental health, and etc. I have also heard from various family doctors complaining about how they are not compensated enough and one told me he makes only slightly more than what he made during residency. Regardless, there flexibility, job prospect, and the 2 year residency is very appealing.

I enjoyed my CTU rotation and although the hours are long, the depth and the detailed-ness of the consult and problem solving aspect was enjoyable. I've heard from multiple residents that the job prospects for some IM sub specialties (GI, Cardio, resp, nephro) is not good so if I pursue IM, I'm interested in either GIM at a community hospital or endo/rheum sub specialty.

I am wondering if I can get insight about people who were kinda in the same position and if they can elaborate more on how they chose between the two. Some info about the lifestyle/job prospect/ and income of FM and GIM/Rheum/Endo would be very helpful. Sorry for the long post and thank you in advance.

[rmorelan 2,615]

I would love to see the math on how he is only earning a bit more than residency considering residency for for the two year program is about 60K in year one and 65K in year two. This isn't at all just about finance - but we should at least correct that statement right away. The ranges of what FM makes are pretty well know, and so are the average number of hours worked for both FM and a range of other specialties. The data is out there for a complete objective comparison. 

You are asking the tough and important questions - hopefully we can get a nice discussion going on it. 

 

 

[NeuroD 297]

48 minutes ago, rmorelan said:

No it shouldn't - and if you objectively do the math it would take a couple of decades for most specialists to "catch up" - I really think that point is not stressed enough with the entire money side of medicine is talked about. Comparing apples to apples the say 3-5 years (or more) head start is really powerful. Factor in the fact that many of those specialists have no choice but to work more hours than a typical family doctors so to truly compare things you also have to equate that as well  (and of course extra hours often at worse times) .

Some of the smartest BUSINESS minded doctors from my class objectively compared things and just went to family. It is actually hard to argue with their logic when you really look at things. 

and even now ha - there is part of myself that thinks it would have been really nice if I just personally liked the field as a profession as there is so much going for it. I don't think I would, which is why I did something else but I am on that 5 extra year pathway, so I can really see the effects at this point (4 months to go ha!).  Five years of 80+ hour work weeks ha...and over 200 all nighters extra over FM, 12 months of every waking moment preparing for a crushing exam, and really not a ton of control over your schedule or major aspects of your life. 

 

That's assuming the specialists catch up at all. Bunch of us (including mine) never do/makee than FM, and have less flexibility for changing our practice focus or revenue source.

If you enjoy clinic/family, take it VERY seriously.

[MedZZZ 16]

2 minutes ago, PhD2MD said:

That's assuming the specialists catch up at all. Bunch of us (including mine) never do/makee than FM, and have less flexibility for changing our practice focus or revenue source.

If you enjoy clinic/family, take it VERY seriously.

Thanks for the info. Would you mind sharing if you are in an MI-related specialty?

[rmorelan 2,615]

1 minute ago, PhD2MD said:

That's assuming the specialists catch up at all. Bunch of us (including mine) never do/makee than FM, and have less flexibility for changing our practice focus or revenue source.

If you enjoy clinic/family, take it VERY seriously.

yeah there is such a wide range here - nothing else has the range, flexibility, and well freedom that family medicine has. 

there are also a lot of doctors earning more than family medicine that would love to exchange money for time. After a point the money is just not important - hard to get that message across as well sometimes ha. There are very few things in life that you would want to do that you cannot do on a FM income (particularly if you optimize that), and getting to the next level may cost you the time to do many of the things you want to do as well.  It is not a bad idea if you are exploring the finance side to think about what you really want to do with it - instead of just more money is good in all cases way of thinking. 

[JohnGrisham 1,775]

23 minutes ago, rmorelan said:

I would love to see the math on how he is only earning a bit more than residency considering residency for for the two year program is about 60K in year one and 65K in year two. This isn't at all just about finance - but we should at least correct that statement right away. The ranges of what FM makes are pretty well know, and so are the average number of hours worked for both FM and a range of other specialties. The data is out there for a complete objective comparison. 

You are asking the tough and important questions - hopefully we can get a nice discussion going on it. 

 

 

Actually, I could see this scenario happening if you are a junior staff who doesn't understand numbers:

With tax credits and getting 65k fully as an R2, you would maybe see a similar amount into your bank account(not actually due to deductions, but lets go with it)

Now you're a fresh staff, tax credits run out. You work pretty hard, and have a complex patient panel, lots of mental health, marginalized populations, etc that you cant whip out in 10mins, maybe seeing a bit more per day then you were during your residency - a residency that didn't prepare you that well for billing, for managing longer patients more quickly etc, maybe coddled you as some do with # of patients to see per day....maybe you're locuming for clinics where you're not fully booked.... so you bill 180k for that year.  At 30% overhead-split, your gross-take home is 126k. Then you pay taxes and you're left with 87k.    

87k versus seeing that 65k-ish.   "Only slightly more than residency"

Only way i can rationalize it, if you're actually working decently busy like you would in an ambulatory clinic-only setting like you would in R2. 

verses making 120k gross and then having taxes taken, could be plausible if you misunderstand how numbers work..and only look at what $$ is in your account.

Realistically, many people finishing FM will barely break 100k in their first year in their bank account after overhead, taxes and licensing fees, because they haven't adapted the business aspects to their clinical practice etc. 

Same reason you see some FM residents on off-service rotations like IM and Psych, taking ages to do a consult out of their depth, but then see some who are able to get down to the pertinent issues quicker, write up a SOAP faster, and get to their clinical decisions. 

[rmorelan 2,615]

39 minutes ago, JohnGrisham said:

Actually, I could see this scenario happening if you are a junior staff who doesn't understand numbers:

With tax credits and getting 65k fully as an R2, you would maybe see a similar amount into your bank account(not actually due to deductions, but lets go with it)

Now you're a fresh staff, tax credits run out. You work pretty hard, and have a complex patient panel, lots of mental health, marginalized populations, etc that you cant whip out in 10mins, maybe seeing a bit more per day then you were during your residency - a residency that didn't prepare you that well for billing, for managing longer patients more quickly etc, maybe coddled you as some do with # of patients to see per day....maybe you're locuming for clinics where you're not fully booked.... so you bill 180k for that year.  At 30% overhead-split, your gross-take home is 126k. Then you pay taxes and you're left with 87k.    

87k versus seeing that 65k-ish.   "Only slightly more than residency"

Only way i can rationalize it, if you're actually working decently busy like you would in an ambulatory clinic-only setting like you would in R2. 

verses making 120k gross and then having taxes taken, could be plausible if you misunderstand how numbers work..and only look at what $$ is in your account.

Realistically, many people finishing FM will barely break 100k in their first year in their bank account after overhead, taxes and licensing fees, because they haven't adapted the business aspects to their clinical practice etc. 

Same reason you see some FM residents on off-service rotations like IM and Psych, taking ages to do a consult out of their depth, but then see some who are able to get down to the pertinent issues quicker, write up a SOAP faster, and get to their clinical decisions. 

ok I can buy some of that - but that just reinforces the idea that you need to prepare and explore the business side. Plus those effects are no different than many other specialists as well that start up a clinic - they to will need to ramp up and ha they aren't getting any better training in how to do that than FM are (huge weakness in our training programs is the don't teach us how to actually RUN a practice. I am a board certified in two countries radiologist that still has ZERO training in how to run anything in EITHER of them after 7 years of training post med school ha - anything I know is because I had to take time away from something else they wanted me to do to learn it). Everyone running a clinic has the same initial problem. 

and of course using those tax credits is a form of "cheating" with respect to the math, 30% overhead is on the high side (granted many places are not cheap but going there as a family doctor was a choice in some fashion)...... barely clearing 100K after all costs would require a standard job salary of 160K - a bit more than the 65K senior FM resident. 

but maybe it isn't about the math, it is about the feeling at that point. They were somehow expecting some big pay off right away, and the tax credits were helping mask their real salary - managing expectations is so important. Maybe because they were expecting instant high income they also didn't get the training, or worry as much about the costs of a particular location/practice etc because they thought the income would overwhelm any issue. We all have to pay just a bit of attention to that area of medicine, because doing poorly in that area can bleed over into doing poorer in other areas (no one feeling they are being ripped off would then turn around and do 100% - and our patients deserve top notch care). 

 

 

Edited February 10, 2020 by rmorelan

[blah1234 155]

On 2/9/2020 at 10:48 PM, JohnGrisham said:

Actually, I could see this scenario happening if you are a junior staff who doesn't understand numbers:

With tax credits and getting 65k fully as an R2, you would maybe see a similar amount into your bank account(not actually due to deductions, but lets go with it)

Now you're a fresh staff, tax credits run out. You work pretty hard, and have a complex patient panel, lots of mental health, marginalized populations, etc that you cant whip out in 10mins, maybe seeing a bit more per day then you were during your residency - a residency that didn't prepare you that well for billing, for managing longer patients more quickly etc, maybe coddled you as some do with # of patients to see per day....maybe you're locuming for clinics where you're not fully booked.... so you bill 180k for that year.  At 30% overhead-split, your gross-take home is 126k. Then you pay taxes and you're left with 87k.    

87k versus seeing that 65k-ish.   "Only slightly more than residency"

Only way i can rationalize it, if you're actually working decently busy like you would in an ambulatory clinic-only setting like you would in R2. 

verses making 120k gross and then having taxes taken, could be plausible if you misunderstand how numbers work..and only look at what $$ is in your account.

Realistically, many people finishing FM will barely break 100k in their first year in their bank account after overhead, taxes and licensing fees, because they haven't adapted the business aspects to their clinical practice etc. 

Same reason you see some FM residents on off-service rotations like IM and Psych, taking ages to do a consult out of their depth, but then see some who are able to get down to the pertinent issues quicker, write up a SOAP faster, and get to their clinical decisions. 

I think this is a good rationalization of how people feel. I think it boils down to the "grass is greener" situation where people feel that they're not getting paid that much more than others working "easier jobs". I think that's just a natural consequence of tax brackets and being independent contractors with no ability to control our fees. The other side of that coin is possibly seeing our peers in other "prestige professions" make more for working similarly long hours. I think this is also a rosy view as I think physicians do very well given our monopoly of the market but I will concede that our regulated fees make us noncompetitive compared to the higher end of the private sector.

[magneto 49]

Family medicine is a great career for people who really genuinely want to be a family doctor.

Every single specialty has its own advantages/disadvantages. Nothing is perfect.

Many provinces are cutting down on fees for all specialties.

Technology is affecting all specialties.

Family medicine is NOT becoming obsolete.

NPs, PAs, RNs, are not making family medicine obsolete. They are part of a team.

You will make a great income as a family doctor.

My advice: become a family doctor if you really want to. Otherwise, choose something that will make you happy. Don't worry about the money. There is no guarantee about anything in life (quantity of life, quality of life, income etc.). 3 residents in different specialties have passed away that started the same time as me. Life is too short to worry about "what ifs".

 

[medisforme 62]

On 2/9/2020 at 2:57 PM, Lesigh2 said:

Just wondering, where did you learn all the practical/business side of family practice? Was this just through experience or did you access some more formal education regarding this topic? 
 

I feel like the numbers you are quoting in terms of billing and hours worked seem out of the ordinary.

The income number i quoted is gross (not net) billings, but is after overhead.

1) I attended a couple day workshops and taught myself.  I also do %100 my own billings so I know how to maximize them, the only billings the MOA's do for me is billing chronic care fees on due dates.  

2) I only pay 20% overhead (vs 30-40% in big cities).

3) I charge for all forms (ie. every patient over 80 needs drivers physicals every 2 years, I charge $150/form)

4) I spent countless hours (and was paid by GPSC for a big portion of it) reviewing my charts to maximize who qualifies for chronic care and complex care billings

5) Nursing home "call" ($250 from 0800-1700) - and is as chill as you can get (ie. maybe 1 non-urgent phone/call a day)

6) addictions medicine (ie. panel of 10 OAT patients nets around $10,000 extra/year)

7) I am one of 2 physicians in our town who does out of office clinics at the local semi assistant care living retirement homes (higher visit fees and virtually every patient there qualifies for complex care billings.

8) I don't work in the hospital (covering inpatients as a non-hospitalist pay relatively poorly in BC).

#2 would be the biggest factor though.

 For new FM docs, i would just say a lot of new clinics are so desperate to attract docs you can have a little bit of say in your overhead (of course, the trade off is that you are guaranteeing to see x amount of patients/day etc.. that pressure isn't for everyone.

[Medapp2017 14]

On 2/9/2020 at 9:47 PM, rmorelan said:

Five years of 80+ hour work weeks

I'm curious, is 80+ hrs/week a reality even for ROAD specialties? I've heard from O&D residents that their days are mostly 8-9am to 5-6pm excluding call, and they would be on call, as junior residents, once per week or even less frequently. Senior residents would usually be back-up call for juniors so the hours are even better.