Ask questions about family medicine here

[magneto]

On 3/6/2020 at 1:55 PM, cotecc said:

How do you see the impact of nurse practicionners in the future. Will they take a big chunk of work off the GPs?

I am not sure how to answer this question.

I will try to be positive and others can take on the other side of the debate.

In my opinion, many Canadians do not have easy accessible access to health care outside of going to ED/urgent care center. Unfortunately, finances play a big role in running family physician clinics and walk-in-clinics. Sometimes patients may not be able to see their doctor right away. I know that's a problem for me. My own family doctor usually has a wait time of roughly 2-3 weeks. There are good reasons. My family doctor is trying his best but unfortunately he cannot work 24/7/365. There are just not enough family physicians in the area.

Complexity of medicine is increasing. Mental health is on the rise. Government is cutting funding. I don't want to paint any more negatives but they exist and they are making healthcare difficult to provide in Canada.

This is sometimes leading people to turn away from medicine and turn towards alternative medicine which often does not have good evidence for their diagnosis/treatment. Sometimes it can be even dangerous. Methyl salicylate (wintergreen oil) is found in many essential oils and other herbal products - people don't know that. It can lead to dangerous salicylate poisoning.

In my not-so-expert opinion, we need more health care workers with proper training. I also think there should be some clear differences in scope between nurse practitioners and GPs.

Overall, I think for the near future, family physicians will stay to be in high demand regardless of other professions who will have overlapping scope (NPs, PAs, Pharmacists etc). We need to figure out how to work in harmony and be on the same team at the end.

[magneto]

On 3/8/2020 at 11:49 AM, medisforme said:

Just a word of advice for everyone asking about billing. You should indicate what province you are in/want to practice in so appropriate advice can be given, as billing info is DRASTICALLY different from province to province (ie. 1) there are no time codes for billing in BC,  2) in response to a previous poster who indicated that mental health visits pay more, mental health visits in BC (termed counselling appointments) pay less per 10min then a typical office appointment )

Thanks for clarifying.

[Egg_McMuffin]

Has anyone done a fly in fly out locum at a remote community? Wondering what your experience is like. How do you know you are ready to do that sort of work, with little resources and no backup (I imagine)? How common is it for docs to do that right out of residency?

[magneto]

21 minutes ago, Egg_McMuffin said:

Has anyone done a fly in fly out locum at a remote community? Wondering what your experience is like. How do you know you are ready to do that sort of work, with little resources and no backup (I imagine)? How common is it for docs to do that right out of residency?

Many people do it.

There is a lot of need in remote communities.

Only you can know whether you are ready or not. Medicine is medicine. It does not matter whether you are practicing in city vs remote community. If you don't have resources then you make the best out of the situation. If you think patient needs more resources, you call someone where the resources are available. Let's do an extreme example - take a cardiac arrest patient. If you don't have AED or monitor/defibrillation - you can still do CPR. Yes, it is not the best situation. But you have to make do with the resources that you got.

I don't have the numbers of how common it is. But I think only a few new residents go to locum at remote communities.

 

[Oliveoil]

On 3/10/2020 at 10:36 PM, magneto said:

Yes, it is realistically possible to have an exclusive mental health practice as a GP. I believe that mental health is rising and there are not enough psychiatrist/mental health allied care professionals. The more people who are genuinely interested in mental health are needed to help the community. Try to get some extra training. There are some +1 programs out there I believe. If not +1 then do extra electives in psychiatry or try to arrange a 3-6 month informal training with a psychiatrist. If you feel comfortable diagnosing/managing mental health then extra training might not be needed. You need to send out a letter to all the GPs in the area that you are working expressing your interesting in helping diagnose/manage mental health patients etc. Hopefully, you can get referrals that way. And after that do a good job. And word gets around fast in the community and on internet. Just make sure to get psychiatrist/psychologist/social worker/mental health nurse/mental health specialist help when needed. Develop good contacts with other mental health care professionals.

I am not aware about GP psychotherapy pathway. But I know it exists. I am not sure about the billing but my guess is that they have their own codes with ministry. And some also bill privately.

Thank you so so much for this  

appreciate!!!

[Fortress]

On 2/6/2020 at 8:46 PM, magneto said:

I am a recent graduate of family medicine residency and would like to help forum members by answering any questions about family medicine residency or family medicine as a career.

Are you aware how do some family physicians become competent in interventional pain management (e.g ultrasound-guided nerve blocks, bursa injections etc.)? Also have you ever heard of a family physician running an infertility clinic as a focused scope of practice?

[JohnGrisham]

3 hours ago, Fortress said:

Are you aware how do some family physicians become competent in interventional pain management (e.g ultrasound-guided nerve blocks, bursa injections etc.)? Also have you ever heard of a family physician running an infertility clinic as a focused scope of practice?

You get good at procedures...by doing procedures! No magic to it. Get exposure as much as you can doing residency, and taking the steps to keep doing it during practice. Focused hands on CME seminars and sessions where you can get a bunch in help.

Sure you could run an infertility clinic - but with the billing fee codes, doesn't really seem like it would make sense at all financially. Takes time to build relationships and counsel on infertility, can't see doing it all day long an not sure who would refer to you as a FM doc, when there's OBGYNs who would also take them on, and actually have interventions to also offer.

[sangria]

Do you see telemedicine getting incorporated into FM practice after COVID-19 is behind us? 

[magneto]

On 4/5/2020 at 6:52 PM, Fortress said:

Are you aware how do some family physicians become competent in interventional pain management (e.g ultrasound-guided nerve blocks, bursa injections etc.)? Also have you ever heard of a family physician running an infertility clinic as a focused scope of practice?

Interventional pain management - My guess is through extra-training or apprenticeship or PGY-3 with a pain clinic or MSK clinic. I did not look into it too much so my knowledge is very limited. I hope another member can provide a bit more insight.

Infertility clinic - again my knowledge is limited but I am sure family physicians are involved along with OB-Gyne specialists.

I don't have much knowledge on both subjects.

My advice is to reach out to people who practice in these areas and set up a meeting. You will be surprised how sometimes people are willing to help others. Let me know how it goes.

[magneto]

On 4/6/2020 at 9:11 PM, sangria said:

Do you see telemedicine getting incorporated into FM practice after COVID-19 is behind us? 

Yes. I think telemedicine will play a larger role than before for both good and bad reasons.

I really hope that COVID-19 situation improves soon. Because it is really affecting the quality and accessibility to health care. I cannot get an appointment with my doctor at all for simple things. Not my family physician fault. It is just a challenging time for everyone.

Telemedicine is great but it has limitations. And some patients really need a in-person visit with their family physicians.

[magneto]

I have a feeling that current and incoming medical students may view the funding and billing cuts that are happening across Canada (but in some provinces more than others) as a threat to future of family medicine due to possible negative financial implications. This may cause some genuine medical students interested in family medicine to look elsewhere. In addition, there are other challenges (most of them passionately discussed by members on this forum).

I want to acknowledge that things might not look promising. However, I want to appeal to anyone who is genuinely interested in family medicine to continue their path towards it. You will be providing great help and service to Canadians and the community. And I hope what looks like challenges today will either go away or will not a matter at the end. Family medicine is a great specialty - it is the backbone and quarterback of medicine in Canada.

If you feel that the challenges will be too much for your personal situation then don't feel guilty. Look into other specialties for sure and at the end of the day, go for what you would like to do.

[MDinCanada]

2 hours ago, magneto said:

I have a feeling that current and incoming medical students may view the funding and billing cuts that are happening across Canada (but in some provinces more than others) as a threat to future of family medicine due to possible negative financial implications. This may cause some genuine medical students interested in family medicine to look elsewhere. In addition, there are other challenges (most of them passionately discussed by members on this forum).

I want to acknowledge that things might not look promising. However, I want to appeal to anyone who is genuinely interested in family medicine to continue their path towards it. You will be providing great help and service to Canadians and the community. And I hope what looks like challenges today will either go away or will not a matter at the end. Family medicine is a great specialty - it is the backbone and quarterback of medicine in Canada.

If you feel that the challenges will be too much for your personal situation then don't feel guilty. Look into other specialties for sure and at the end of the day, go for what you would like to do.

Do you have a source for the funding/billing cuts?

[Wachaa]

27 minutes ago, MDinCanada said:

Do you have a source for the funding/billing cuts?

Too many to list.

For a very broad overview (and very recent), just google "health funding cut [insert province name]". Most notably Alberta and Ontario.

[Canadian MED]

On 2/6/2020 at 8:46 PM, magneto said:

I am a recent graduate of family medicine residency and would like to help forum members by answering any questions about family medicine residency or family medicine as a career.

How challenging is it as a family medicine physician to relocate across provinces in Canada and find employment? Are there additional licensing requirements for positions outside the province you completed your residency? 

 

Cheers

[Blackbelt1998]

Just wondering if anyone can speak to how the 1 year palliative care fellowship after completion of a family medicine residency works? If so, what are some positives and negatives of becoming a palliative care physician or working in a palliative care setting as a family med physician? Just an interested 4th year BSc student that would like to know more about the palliative care field  Any insight would be greatly appreciated! 

[LittleDaisy]

On 4/9/2020 at 2:20 AM, Wachaa said:

Too many to list.

For a very broad overview (and very recent), just google "health funding cut [insert province name]". Most notably Alberta and Ontario.

I believe that the OMA in Ontario has been able to negotiate a pay increase for physicians, the pay increase has been the most beneficial for family physicians and ID. Amid the pandemic, I would be surprised that Ontario government will decrease physicians' pay.

For Alberta, their economy has been crashing due to oil crisis, I hope that the pipeline can be approved sooner than later to help the Alberta's economy. The Alberta Physicians Association has decided to take the Ministry of Health to court for their arbitrarily decision to cut physician salary, which is supported by CMA.  

[LittleDaisy]

3 hours ago, Canadian MED said:

How challenging is it as a family medicine physician to relocate across provinces in Canada and find employment? Are there additional licensing requirements for positions outside the province you completed your residency? 

 

Cheers

If you do your medical school/residency all in Canada, you won't face any licensing issues. The licensing fees are ranging from 1 k- 3k per province, and can take 1-3 months to get approved. I really hope that the FMRAC can come up with a national license, if you are licensed in one province, I don't see why the other province will have reserves about licensing you independently. 

For employment, the job aspects for family medicine are excellent. Same thing can be said about psychiatry, pediatrics and GIM. Just my two cents

[schpurp88]

Thanks for starting this thread, I have been waiting for something like this for a long time.

imo, i think family medicine is becoming more popular even with the cuts. It seems people are moving away from competitive specialties that have to do with the OR and are moving towards more outpatient friendly specialties (due to the job market) and a lot of people are backing up with FM, thus match rates are increasing. I think this leaves few options in terms of what specialties to pursue.

I am interested in family because of the stability, lifestyle and freedom it provides. I understand that its hard to predict what your net income is going to be because of all the variables involved and I think more and more people who pursue family will try to get creative and diversify their practice. But my main question was to ask what is a reasonable net income i can expect in the following scenario  where I can control for the variables:

1.  100% fee for service

2. 5 days a week, 8 hours a day so 40 hours per week, no weekends or evenings, no call, 50 weeks in the year 

3. clinic practice, outpatient, about 35 patients a day (or the max reasonable amount you can see without compromising care)

4. located in Ontario, near greater Toronto Hamilton area, so anywhere from oshawa, greater Toronto area,  hamilton, st. catherines, cambridge, kitchener, waterloo, london,  and maybe even barrie

 

[Wachaa]

12 hours ago, schpurp88 said:

Thanks for starting this thread, I have been waiting for something like this for a long time.

imo, i think family medicine is becoming more popular even with the cuts. It seems people are moving away from competitive specialties that have to do with the OR and are moving towards more outpatient friendly specialties (due to the job market) and a lot of people are backing up with FM, thus match rates are increasing. I think this leaves few options in terms of what specialties to pursue.

I am interested in family because of the stability, lifestyle and freedom it provides. I understand that its hard to predict what your net income is going to be because of all the variables involved and I think more and more people who pursue family will try to get creative and diversify their practice. But my main question was to ask what is a reasonable net income i can expect in the following scenario  where I can control for the variables:

1.  100% fee for service

2. 5 days a week, 8 hours a day so 40 hours per week, no weekends or evenings, no call, 50 weeks in the year 

3. clinic practice, outpatient, about 35 patients a day (or the max reasonable amount you can see without compromising care)

4. located in Ontario, near greater Toronto Hamilton area, so anywhere from oshawa, greater Toronto area,  hamilton, st. catherines, cambridge, kitchener, waterloo, london,  and maybe even barrie

 

I'm looking at my own practice profile, published in *BC*, which provides data on the overall physician pool. I'm extrapolating and making some assumptions, but I think it is reasonable for a FFS estimate.

Those are some above-average work hours in my opinion. A lot of people who are reported as "average income" are working 3.5 days a week, 35 patients/day. As a result you're likely going to bill around 30% above the average; therefore $400+ before overhead is very reasonable in my opinion.

Most people who work 100% FFS will see about 5-7 patients per hour. That fact is not purely a matter of wanting to generate more income. It's just the reality of patients wanting to fit in for urgent requests and is beyond your control.

[schpurp88]

15 hours ago, Wachaa said:

I'm looking at my own practice profile, published in *BC*, which provides data on the overall physician pool. I'm extrapolating and making some assumptions, but I think it is reasonable for a FFS estimate.

Those are some above-average work hours in my opinion. A lot of people who are reported as "average income" are working 3.5 days a week, 35 patients/day. As a result you're likely going to bill around 30% above the average; therefore $400+ before overhead is very reasonable in my opinion.

Most people who work 100% FFS will see about 5-7 patients per hour. That fact is not purely a matter of wanting to generate more income. It's just the reality of patients wanting to fit in for urgent requests and is beyond your control.

400k+?......after giving 30% to overhead, that means the net gross will be 280k+. This seems a little high, I was thinking that I would be making somewhere between 200k to 250k net income but closer to the 250k end. Can anyone else confirm this.

I see what you see about fitting in patients, but I was throwing out 35 patients as a round number which I felt was reasonable.

 

Also I would like to ask how likely is it to work 100% ffs in the greater toronto hamilton area and surrounding parts (london, waterloo, st.catherines, geulph)?

 

[MDinCanada]

8 hours ago, schpurp88 said:

400k+?......after giving 30% to overhead, that means the net gross will be 280k+. This seems a little high, I was thinking that I would be making somewhere between 200k to 250k net income but closer to the 250k end. Can anyone else confirm this.

I see what you see about fitting in patients, but I was throwing out 35 patients as a round number which I felt was reasonable.

 

Also I would like to ask how likely is it to work 100% ffs in the greater toronto hamilton area and surrounding parts (london, waterloo, st.catherines, geulph)?

 

30% overhead seems high. Shouldn't overhead be a somewhat fixed number (i.e. not dependent on how many hours your work)?

Also, why are you prioritizing purely ffs? Wouldnt it be beneficial to have a model where you're payed a certain amount per patient, and then also renumerated per visit?

[Wachaa]

9 hours ago, schpurp88 said:

400k+?......after giving 30% to overhead, that means the net gross will be 280k+. This seems a little high, I was thinking that I would be making somewhere between 200k to 250k net income but closer to the 250k end. Can anyone else confirm this.

I see what you see about fitting in patients, but I was throwing out 35 patients as a round number which I felt was reasonable.

 

Also I would like to ask how likely is it to work 100% ffs in the greater toronto hamilton area and surrounding parts (london, waterloo, st.catherines, geulph)?

 

I think that's really splitting hairs. Don't factor that into the decision whether you go into a specialty. The 30k difference is not significant in the grand scheme. Year to year your income can fluctuate 2-3 times that amount. For FFS specialists that number can fluctuate even more year to year.

 

If you go into FM expecting 200-250k net after overhead, I think you'll be pleasantly surprised that you can net more.

[schpurp88]

6 hours ago, Wachaa said:

I think that's really splitting hairs. Don't factor that into the decision whether you go into a specialty. The 30k difference is not significant in the grand scheme. Year to year your income can fluctuate 2-3 times that amount. For FFS specialists that number can fluctuate even more year to year.

 

If you go into FM expecting 200-250k net after overhead, I think you'll be pleasantly surprised that you can net more.

I mean you can always net more, but i was looking for an average number for 50 weeks in the year, 5 days a week, 35 patients a day (which is still a solid amount of work). I could always do more and diversify my practice or get more efficient with my billing but I am looking for an average number.

7 hours ago, MDinCanada said:

30% overhead seems high. Shouldn't overhead be a somewhat fixed number (i.e. not dependent on how many hours your work)?

Also, why are you prioritizing purely ffs? Wouldnt it be beneficial to have a model where you're payed a certain amount per patient, and then also renumerated per visit?

I heard 30% is an average number for overhead costs, I think it would be closer to 30% rather than 20%, especially when it comes to the GTHA area which is where I want to work.

I agree with your second statement, I might make more in a capitation model + ffs, versus ffs alone. I would like to ask (especially in this area) how are family physicians most likely to be numerated straight out of residency and further down the line. I also do not expect to work in FHT/FHO setting, since I heard its competitive to get a chance to work in these settings. 

 

[omentum]

Hey, do you recommend any good FM resources for clerkship?

[asd873]

For anyone currently practicing family medicine, or in residency, I am wondering what would be the top 5 most common types of visits you see? For example, I have heard some say it's largely mental health, MSK, and derm. Wonder if that holds up in practice?