Realignment of Doctor's Income 2

[1D7]

40 minutes ago, -JAG- said:

Is everyone forgetting the cost of an MBA for banking? That's 100k tuition (UofT) (4x what med school costs in Quebec, 2x in the prairie provinces) and 2 years (the same as FM residency) lost. If you go to an M7 program in the States (as many Canadians do, especially if they want to be competitive for elite PE firms, it's over 200k, not even counting lost income. 

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We are aware of that...that's one of many things buddy conveniently forgot to mention, let him be, let him think that if you work hard a business grad will be VP of a large company and make millions but only the top 1% of doctors make high very incomes lmao

FYI enter it from undergrad or close to it from undergrad without MBA. MBA is only needed if making a career switch. If you are not knowledgeable about this career path, just stop posting about it.

All of you seem desperate to prove a point without having any knowledge of these careers whatsoever.

[-JAG-]

31 minutes ago, YesIcan55 said:

We are aware of that...that's one of many things buddy conveniently forgot to mention, let him be, let him think that if you work hard a business grad will be VP of a large company and make millions but only the top 1% of doctors make high very incomes lmao

Well in my middle of the road province the average specialist including all the part timers, private based and academic based physicians make over 500k before our very generous 1.45x bonus for going to a small town, so I'll have to agree with you.

[-JAG-]

29 minutes ago, 1D7 said:

FYI enter it from undergrad or close to it from undergrad without MBA. MBA is only needed if making a career switch. If you are not knowledgeable about this career path, just stop posting about it.

All of you seem desperate to prove a point without having any knowledge of these careers whatsoever.

I'm sure all the Managing Directors and PE partner only have bachelors. I have family in Private Equity in the States. Are you aware that almost all PE shops are 2 years and out. 3 years in IB, then 2 in PE and then you're asked to leave. You're not going to become a kindergarten teacher, you get an MBA. Now I conveniently forgot to mention that some generous firms pay for your tuition, but most don't. This is the error you would have pointed out if you knew about finance.

[ArchEnemy]

13 hours ago, procrastinating said:

My understanding is that ophthalmology practice is significantly different in the US - and the pay is proportionally the same. The work is chiller, less hours, more control over your life. These are things people really want. Also, ophtho has huge overhead (60-70%) so take-home pay is really not what it seems.

With pay as it is now in Canada, Canadian doctors don't have a big enough reason to uproot their lives and make the big move down south. But compounding already tight job prospects and difficulty securing OR time with reduced pay? New grads will inevitably leave the country. Especially if the choice comes down to moving to some faraway rural Canadian city (where there will be more work, more call, less support) vs. an urban American city that's just south of the border (where you can call all the shots, albeit for slightly less pay ... but that's where the private procedures come in). It's what happened to ortho, ENT, neurosurgery. What that means is that the Cdn govt is paying hundreds of thousands of dollars subsidizing our education only for them to lose us to the states. That's why it'll hurt the retention and recruitment of these specific physicians. 

I'm not defending the obscenely high pay, but rather trying to add some element of nuance to this discussion. It's not as straightforward as it seems.

I will respond to the points that I have bolded & underlined above.

According to the Alberta Medical Associations' report, the average Ophthalmology's overhead is around 45%. From speaking to Staff Ophthalmologists, the "60-70%" overhead that is often thrown around is for those running private ORs for LASIK or Blephs, not the average Medical or Surgical Ophthalmologist. 

The tight job market and difficulty securing OR time is a complex problem that plagues all surgical specialties, not unique to Ophthalmology. Arguably, Ophthalmology is one of the fortunate specialties where the practitioner can choose to lean towards the Medical side if OR time is unavailable. Even without OR time, Medical Ophthalmologists make a very decent living with their intravitreal injections. Can't say the same for Neurosurgeons or Orthopedic surgeons who do not share the same alternative without inevitably crossing into Neurology or Physiatry/Rheumatology's turf.

Your last point on Canadian Govt spending hundreds of thousands training specialists only to lose them to the US is a frequently brought up argument. However, it vastly underestimates the cost savings from a senior resident. Many senior residents are quite capable of functioning almost independently by PGY-4, so the Govt is actually benefiting from 2 years of decreased labour cost (70k vs 400k), and potentially more if they choose pursue a fellowship.

Back to my original point, Dr. Rocha claimed that fee cuts will hurt recruitment and retention of Ophthalmologists. He is right in that any fee cuts in general will hurt any recruitment or retention efforts. However, I stand by my point that the 10-25% cut will not be a significant factor in driving Ophthalmologists to emigrate South, since Canadian Ophthalmologists vastly outearn their American counterparts. On the other hand, Neurosurgeons & Orthopedic surgeons in Canada are under-compensated compared to their American counterparts, so this will be another impetus for them to emigrate South.

I have to admit that a bigger problem in our system seems to be that older physicians are delaying retirement and hanging onto the better paid procedures, which may require OR time, while leaving the lower paid procedures to the newer graduates. 

[ChemPetE]

Not to mention incomes not keeping up with inflation...

[-JAG-]

On 4/24/2020 at 1:39 AM, ArchEnemy said:

I will respond to the points that I have bolded & underlined above.

According to the Alberta Medical Associations' report, the average Ophthalmology's overhead is around 45%. From speaking to Staff Ophthalmologists, the "60-70%" overhead that is often thrown around is for those running private ORs for LASIK or Blephs, not the average Medical or Surgical Ophthalmologist. 

The tight job market and difficulty securing OR time is a complex problem that plagues all surgical specialties, not unique to Ophthalmology. Arguably, Ophthalmology is one of the fortunate specialties where the practitioner can choose to lean towards the Medical side if OR time is unavailable. Even without OR time, Medical Ophthalmologists make a very decent living with their intravitreal injections. Can't say the same for Neurosurgeons or Orthopedic surgeons who do not share the same alternative without inevitably crossing into Neurology or Physiatry/Rheumatology's turf.

Your last point on Canadian Govt spending hundreds of thousands training specialists only to lose them to the US is a frequently brought up argument. However, it vastly underestimates the cost savings from a senior resident. Many senior residents are quite capable of functioning almost independently by PGY-4, so the Govt is actually benefiting from 2 years of decreased labour cost (70k vs 400k), and potentially more if they choose pursue a fellowship.

Back to my original point, Dr. Rocha claimed that fee cuts will hurt recruitment and retention of Ophthalmologists. He is right in that any fee cuts in general will hurt any recruitment or retention efforts. However, I stand by my point that the 10-25% cut will not be a significant factor in driving Ophthalmologists to emigrate South, since Canadian Ophthalmologists vastly outearn their American counterparts. On the other hand, Neurosurgeons & Orthopedic surgeons in Canada are under-compensated compared to their American counterparts, so this will be another impetus for them to emigrate South.

I have to admit that a bigger problem in our system seems to be that older physicians are delaying retirement and hanging onto the better paid procedures, which may require OR time, while leaving the lower paid procedures to the newer graduates. 

FM overhead is not 45%. Plenty of clinics (and by this I mean for profit enterprises that make money by skimming more of your billings that what overhead actually costs) charge 30% even in expensive cities. If you're willing to go to the suburbs/work in an older building/forgo a medical assistant/shop around a little bit you can easily get to 25% outside of downtown Toronto/Vancouver. Same for endocrinology and rheum. In my province, Endo expenses are very similar to FM with some additional equipment for thyroid biopsies. Rheum is basically the same as FM. Urology here also has low overhead because they do all their cystoscopies and other costly procedures in the hospital. Most hospitals have a group that leases an office space and has some secretaries to do elective stuff, but very little equipment. Lots of gloves though... but 10-15 overhead is possible. IN regards to this table, it probably has a very small sample size which is skewing the numbers. Assuming endo/rheum really had 50% overhead, they would all just do GIM work instead or go to a salaried position in the US.