Ask questions about family medicine here

[medical_grad]

Do residents have a say in how to rank applicants during match week?

What exactly are FM programs looking for in a residency applicant?

[CrispyF]

How to prepare yourself during residency to work as a hospitalist beside office work. (choice of electives for example) ? 

[magneto]

On 4/8/2020 at 11:52 PM, MDinCanada said:

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

Google "Alberta billing cuts" and you will get a lot of articles about how the provincial government ended the physician's agreement and cutting some billing codes etc. Then COVID19 happen but so far there is no indication that government will reverse its decision. Similar thing happened before in Ontario but they were able to have a compromise through arbitration.

[magneto]

On 4/13/2020 at 2:37 PM, 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 brand new out of residency then it is not a problem. There is a separate licensing application for each province.

If you are already in practice then it can be potentially challenging if you had your own practice because you will have to find someone to takeover care of your patients, find a way to securely store charts etc. However, most things in life bring a challenge or two. So I think it is quite doable for family physicians to move across provinces.

[magneto]

On 4/13/2020 at 2:59 PM, Blackbelt1998 said:

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! 

There is a growing need for palliative care in Canada. Every family physician should feel comfortable with community palliative care of their own patients and they can always consult a palliative care expert if there are any issues or help required.

In the past, most palliative care physicians had 2 years of family medicine training and started doing palliative care either after developing an interest in the field and learning as they go; OR doing some electives during the two years of family medicine.

However, like most things in medicine, everything is becoming more and more sub specialized. This led to the start of palliative care fellowship. At the start, most physicians could still get a job in palliative care without doing a fellowship. Then College made an exam that you needed to pass to get a certificate in palliative care (like you can get EM certificate). Therefore, more hospitals in theory started wanting applicants to have both palliative care fellowship and the new certificate (this is all relatively new).

But as I said earlier, there is a large need for palliative care physicians. Two of my colleagues were offered a job in palliative care right out of 2 years of family medicine at a medium-large size (almost tertiary care) hospital. Things will change in future but for now still some jobs available in palliative care without doing a fellowship.

[magneto]

On 4/17/2020 at 6:27 AM, 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

 

Approximately $250,000 to $400,000 (this is before overhead). Overhead is 20% (if you are lucky and find a good group) to 30% (for most new grads) but can be even higher.

[magneto]

On 4/18/2020 at 10:19 AM, 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)?

 

Most new grads in GTA and hamilton area work 100% FFS. The reason is that government is not opening up more FHO positions in urban and large cities. Therefore, the doctors are holding on to FHO positions even when they are pass their retirement age because it guarantees great income from rostering patients.

The other forum member has provided good estimate. Again, net income will be highly variable. But if you are working above average work hours, efficient in seeing patients and running your practice, and keep expenses to low side, it is definitely doable to bill in $400,000 before overhead.

[magneto]

On 4/18/2020 at 7:00 PM, 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?

30% overhead is quite common in certain parts of the country (e.g., Greater Toronto Area). Overhead varies from 20-30% for most clinics (some are obviously a bit lower, or higher).

In many place, purely FFS is the only option for billing. In Ontario, FHO positions (and other related plans) where you roster patients are limited because government is not opening new spots. So the only way to get one of those positions is to find a retiring physician and took over his or her practice.

[magneto]

On 4/19/2020 at 2:41 AM, schpurp88 said:

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.

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. 

 

It is difficult to get a FHT/FHO or salaried position. So most likely it will be 100% FFS.

[magneto]

On 4/22/2020 at 1:38 PM, omentum said:

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

If you are 100% going for family medicine, the two textbooks for exam preparation in family medicine are: (1) "Family Medicine Notes" by Dr. O'Toole and (2) "Guide to the Canadian Family Medicine Examination, Second Edition" by Angela Arnold and Megan Dash.

O'Toole book is quite detailed and dense to read but it has almost everything you need to pass the exam.

Arnold's book has many errors (which you will need to pick it up and correct yourself) and not as detailed but it is much easier to read (technically possible to read the entire thing in 2-3 days if you have a good baseline knowledge).

[magneto]

On 5/4/2020 at 4:41 PM, asd873 said:

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?

Not in any particular order:

- Depression and anxiety (other mental health)

- Check up for hypertension, cholesterol, diabetes

- Cancer screening (+/- physical exam), cancer patient follow-up, palliative care

- Neck pain/Back pain/Shoulder Pain/Headaches/Abdominal Pain/Pelvic Pain etc

- Lumps and bumps, rashes, moles, acne etc

- Disability and occupation work forms

- Writing referrals, reading consult notes, reviewing labs & x-rays

- Minor procedures (skin biopsies etc.)

I hope that helps.

[magneto]

On 5/6/2020 at 2:21 PM, medical_grad said:

Do residents have a say in how to rank applicants during match week?

What exactly are FM programs looking for in a residency applicant?

Residents help with file reviews for interviews. They are given a criteria on how to rank the application.

Residents help out with interviews. They help with assigning interview scores.

FM programs are looking for:

- Candidates interested in FM (electives in FM and related fields etc.)

- Candidates interested in their program (whether you did an elective in their city or not)

- Overall interests and hobbies (extra-curricular activities, research etc.)

- Overall personable and good human being (reference letters, how you present yourself at the interview).

Things that look for bad for you are:

1. Bad reference letters

2. Not speaking at the interview

3. Asking about how much time you can take off in the interview

4. Asking about family medicine salary in the interview

In summary, most reasonable medical students who show some interest in family medicine should be able to secure an interview and position in family medicine. However, it is all about supply and demand and due to large number of applicants, unfortunately sometimes good applicants are lost in numbers. It is not perfect but it is what it is.

[magneto]

18 hours ago, CrispyF said:

How to prepare yourself during residency to work as a hospitalist beside office work. (choice of electives for example) ? 

If you are interested in being a hospitalist:

1. Do electives with FM hospitalist service

2. Do electives with Internal Medicine hospital service

3. Do electives in palliative care

4. Think about applying to PGY3 hospitalist programs

5. Network with hiring people and chiefs of the program

Hope that helps.

[medisforme]

On 5/6/2020 at 1:21 PM, medical_grad said:

What exactly are FM programs looking for in a residency applicant?

One other note, that doesn't reflect my personal opinion but I noted from a couple of local site leads whom I interviewed beside.  Applicants were docked points if they solely expressed interest in a niche/subspecialty area of family medicine (sports med, ER, hospitalist, obstetrics are the 4 that come to mind) during the interview without discussing concurrent interest in longitudinal care (though given the enormous number of applicants, I really don't think this would make or break your application).

[Fortress]

In an urban family medicine program, how many times per month do you have to stay in the hospital for an overnight shift? Are there times when you are allowed to go home but you are on-call and can get called in in the middle of the night? If so, how frequent does this happen?

Just trying to get a sense of the impact of an urban family medicine program on sleep.

[JohnGrisham]

7 minutes ago, Fortress said:

In an urban family medicine program, how many times per month do you have to stay in the hospital for an overnight shift? Are there times when you are allowed to go home but you are on-call and can get called in in the middle of the night? If so, how frequent does this happen?

Just trying to get a sense of the impact of an urban family medicine program on sleep.

It depends on what rotation you are on, and what hospital. No 2 programs are the same. But overall, expect some rotations where in-hospital call will be required (often general surgery, internal medicine, OBGYN etc).  FM is going to be the least impactful on your sleep, simply because its the shortest program so less chance of having too many rotations that require in-hospital call.  There is also home-call for some rotations,  where you can go home after a certain time but can be called back in if needed. 

You'll get a sense of this in your clerkship years.

[magneto]

On 5/18/2020 at 10:14 AM, medisforme said:

One other note, that doesn't reflect my personal opinion but I noted from a couple of local site leads whom I interviewed beside.  Applicants were docked points if they solely expressed interest in a niche/subspecialty area of family medicine (sports med, ER, hospitalist, obstetrics are the 4 that come to mind) during the interview without discussing concurrent interest in longitudinal care (though given the enormous number of applicants, I really don't think this would make or break your application).

I agree with this. Don't talk about that you want to do EM in FM interview.

[magneto]

On 5/18/2020 at 2:21 PM, Fortress said:

In an urban family medicine program, how many times per month do you have to stay in the hospital for an overnight shift? Are there times when you are allowed to go home but you are on-call and can get called in in the middle of the night? If so, how frequent does this happen?

Just trying to get a sense of the impact of an urban family medicine program on sleep.

Depends on the rotation and which program/university you are at. I had all in-house calls and was up for most of my calls during family medicine training. Calls are usually 1 in 4 to 1 in 6 depending on the rotation.

[Fortress]

1 hour ago, magneto said:

Depends on the rotation and which program/university you are at. I had all in-house calls and was up for most of my calls during family medicine training. Calls are usually 1 in 4 to 1 in 6 depending on the rotation.

And, in general, are those calls usually evening shifts or overnight shifts? What is the proportion between them?

[MedZZZ]

Can you comment on the lifestyle/hours/call and income of a family physician working as a hospitalist at a community centre? Are they mainly on salary or is it FFS? do they get benefits like extended health benefits and dental benefits? Thank you

[magneto]

1 hour ago, Fortress said:

And, in general, are those calls usually evening shifts or overnight shifts? What is the proportion between them?

In my program, all calls were 24 hour shifts except family medicine where it was just carrying the pager from home and showing up on extra-hours clinics and weekend clinics.

[magneto]

41 minutes ago, MedZZZ said:

Can you comment on the lifestyle/hours/call and income of a family physician working as a hospitalist at a community centre? Are they mainly on salary or is it FFS? do they get benefits like extended health benefits and dental benefits? Thank you

Family physician:

- Lifestyle is what you want to be

- Lifestyle depends on solo practice vs group practice (small group vs large group)

- The large the call group, the lower the frequency of call

- Most call in family medicine is home call unless your group is associated with inpatient hospital admission, follow-up your own patients in hospital, long-term care, palliative care etc.

- Hours are what you want to be. In large urban cities, most people work from 4-5 work per days and typically 5-7 hours per days. There are some people who work 6 days per week and 10 hours daily. So it is up to you what you want your practice to be.

 

Hospitalist:

- Lifestyle depends on arrangement with rest of the group. Most hospitals have 10 days on, 10 days off schedule.

- Call depends on how large the group is.

- Call is usually busy at most hospitals. Most groups have divided call from 24 hour shifts into 12 hour shifts.

- Hospitalist are either FFS or salary depending on city and hospital. Salary is $300,000-$450,000 (little to no overhead). FFS can be higher at busier hospitals.

- Extended health benefits only are offered when you are a hospital employee on salary. No benefits for FFS physicians.

[FrannieLydon]

On 2/10/2020 at 10:42 PM, magneto said:

Rural areas in all provinces pay well.

I see this mentioned a lot and I am wondering how rural is defined? Let's say you were working in a town with around 20,000 total population – would that qualify as rural? 

[MDinCanada]

On 5/20/2020 at 12:14 AM, magneto said:

- Hospitalist are either FFS or salary depending on city and hospital. Salary is $300,000-$450,000 (little to no overhead). FFS can be higher at busier hospitals.

So the salary for a hospitalist is comparable to that of a GIM doctor?

[MedZZZ]

1 hour ago, MDinCanada said:

So the salary for a hospitalist is comparable to that of a GIM doctor?

If that's the case, wouldn't it be more reasonable to go into FM route and save yourself another 2-3 years of brutal residency to be a GIM doc since you are doing what a GIM does basically with a lot less complexity ... That's my internal dilemma for pursuing FM versus IM ...