400k in part time hours - Family Medicine

[windsormd1]

https://www.thespec.com/news-story/9145255-ontario-family-doctors-average-400-000-plus-for-part-time-hours-province-wants-to-claw-back-pay/
 

 

THIS IS WHY FM IS THE BEST!!!!!!! 

[Fortress]

The question is: what are those people doing to make that kind of money? Definitely not sore throats and common colds.

[IMislove]

FHT's are great, except the government has limited now how many new fam docs can enter them in a set amount of time, and only in some select communities, mostly due to this type of thing. Also they're paid based on patient # in their roster, and I think complexity of patients too.

[windsormd1]

It’s a good gig if you can get it, I am based in the US now with a cush gig.  I was FFS in Canada and it was not fun, couldn’t get a FHO spot when I was in Ontario in my desired location. 

[medigeek]

3 hours ago, windsormd1 said:

It’s a good gig if you can get it, I am based in the US now with a cush gig.  I was FFS in Canada and it was not fun, couldn’t get a FHO spot when I was in Ontario in my desired location. 

GTA? lol

[ArchEnemy]

FMs in FHO are definitely making a more comfortable salary compared to FFS FMs, while working less hours. That's why its so difficult to join one. To make matters worse, retiring physicians are selling their FHO positions to recent graduates, which is really unfortunate.

[1D7]

4 hours ago, Fortress said:

The question is: what are those people doing to make that kind of money? Definitely not sore throats and common colds.

The docs I've worked with in FHOs did ordinary family medicine. Work hours 8-4pm/9-5pm. They get paid similar figures to what the article suggests (400-500k).

[member_225]

FHO docs are averaging $406 000 gross income while working 3.5 days a week. That's more than most specialists, no wonder the government is looking to claw back their income. 

[windsormd1]

9 minutes ago, member_225 said:

FHO docs are averaging $406 000 gross income while working 3.5 days a week. That's more than most specialists, no wonder the government is looking to claw back their income. 

Seems like a good deal even after the clawback, if it ever happens.

[gangliocytoma]

14 hours ago, Fortress said:

The question is: what are those people doing to make that kind of money? Definitely not sore throats and common colds.

You get paid for your roster of patients, so you're making income regardless of whether you're in clinic or on a beach. Then you get to bill 15-20% FFS for clinic visits. In addition to that, you get substantial incentives (I think like 20K) if a certain proportion of your diabetics get regular follow-ups, certain proportion of women get regular paps, certain proportion of kids is up to date on immunizations, etc.

They're pretty much making passive income for the most part, and there are definitely ways this system can be abused. You can run 3 half day clinics per week and then spend other days doing Emerg or other stuff, making it hard for your patients to get appointments in a timely manner. I don't expect things continue this way for long.

[LittleDaisy]

4 hours ago, gangliocytoma said:

You get paid for your roster of patients, so you're making income regardless of whether you're in clinic or on a beach. Then you get to bill 15-20% FFS for clinic visits. In addition to that, you get substantial incentives (I think like 20K) if a certain proportion of your diabetics get regular follow-ups, certain proportion of women get regular paps, certain proportion of kids is up to date on immunizations, etc.

They're pretty much making passive income for the most part, and there are definitely ways this system can be abused. You can run 3 half day clinics per week and then spend other days doing Emerg or other stuff, making it hard for your patients to get appointments in a timely manner. I don't expect things continue this way for long.

The government claws back money from your patients' capitation rate if they go to walk in clinic and outside use. There is a hard cap of 55 k per year for FFS, i.e, you really can't abuse it and they certainly discourage you from doing any other clinical work beside inpatient hospitalist, ER and obstetrics. 

The only reason that the government encourages ER/obstetrics is because in rural/suburbia Ontario, the FM  doctor does everything. If they have a hard cap for inpatient hospitalist/ER and obstetrics, then no one will be running the ward. 

I think that you guys forget about 30% overhead which in the end; it will then equal to 280 K pre-taxes.; which after taxes, will leave you around 21 K assuming that you incorporate and spend modestly; with no pension, sick leave, maternity leave and benefits. 

I don't think that anyone else beside Family Physicians can understand the amount of responsibility/paperwork that come with 9-5 pm clinic. You have endless notes to type, phone calls to make, referrals/ and ensure that you follow-up with patients. The specialists see patient once or twice, discharge them if they are being rude/stable/not therapeutic relationship, where you have to deal with a lot of psych/difficult social patients who would have otherwise fallen through the cracks. 

Also, when you are in a FHO, your group has to provide after hour clinic; which means that even though you are working only 3.5 days; you are doing 1-2 evenings per week for FHO walk in patients. 

The current new FHO spots that exist are in areas with higher need and complex patients; where the government actually saves money by paying you a flat capitation rate instead of billing FFS. A lot of FHO doctors working with vulnerable population only have around 1000 for 3.5 days, it really depends on where you end up working!

[windsormd1]

4 hours ago, LittleDaisy said:

The government claws back money from your patients' capitation rate if they go to walk in clinic and outside use. There is a hard cap of 55 k per year for FFS, i.e, you really can't abuse it and they certainly discourage you from doing any other clinical work beside inpatient hospitalist, ER and obstetrics. 

The only reason that the government encourages ER/obstetrics is because in rural/suburbia Ontario, the FM  doctor does everything. If they have a hard cap for inpatient hospitalist/ER and obstetrics, then no one will be running the ward. 

I think that you guys forget about 30% overhead which in the end; it will then equal to 280 K pre-taxes.; which after taxes, will leave you around 21 K assuming that you incorporate and spend modestly; with no pension, sick leave, maternity leave and benefits. 

I don't think that anyone else beside Family Physicians can understand the amount of responsibility/paperwork that come with 9-5 pm clinic. You have endless notes to type, phone calls to make, referrals/ and ensure that you follow-up with patients. The specialists see patient once or twice, discharge them if they are being rude/stable/not therapeutic relationship, where you have to deal with a lot of psych/difficult social patients who would have otherwise fallen through the cracks. 

Also, when you are in a FHO, your group has to provide after hour clinic; which means that even though you are working only 3.5 days; you are doing 1-2 evenings per week for FHO walk in patients. 

The current new FHO spots that exist are in areas with higher need and complex patients; where the government actually saves money by paying you a flat capitation rate instead of billing FFS. A lot of FHO doctors working with vulnerable population only have around 1000 for 3.5 days, it really depends on where you end up working!

That’s still an amazing gig compared to FFS setups.  Are you really going to whine about 280k plus CAD income on part time hours? Seriously? 

[gangliocytoma]

5 hours ago, LittleDaisy said:

The government claws back money from your patients' capitation rate if they go to walk in clinic and outside use. There is a hard cap of 55 k per year for FFS, i.e, you really can't abuse it and they certainly discourage you from doing any other clinical work beside inpatient hospitalist, ER and obstetrics. 

The only reason that the government encourages ER/obstetrics is because in rural/suburbia Ontario, the FM  doctor does everything. If they have a hard cap for inpatient hospitalist/ER and obstetrics, then no one will be running the ward. 

I think that you guys forget about 30% overhead which in the end; it will then equal to 280 K pre-taxes.; which after taxes, will leave you around 21 K assuming that you incorporate and spend modestly; with no pension, sick leave, maternity leave and benefits. 

I don't think that anyone else beside Family Physicians can understand the amount of responsibility/paperwork that come with 9-5 pm clinic. You have endless notes to type, phone calls to make, referrals/ and ensure that you follow-up with patients. The specialists see patient once or twice, discharge them if they are being rude/stable/not therapeutic relationship, where you have to deal with a lot of psych/difficult social patients who would have otherwise fallen through the cracks. 

Also, when you are in a FHO, your group has to provide after hour clinic; which means that even though you are working only 3.5 days; you are doing 1-2 evenings per week for FHO walk in patients. 

The current new FHO spots that exist are in areas with higher need and complex patients; where the government actually saves money by paying you a flat capitation rate instead of billing FFS. A lot of FHO doctors working with vulnerable population only have around 1000 for 3.5 days, it really depends on where you end up working!

I am currently doing a rotation in a FHO. I know there are physicians that run 2 half day FM clinics per week and spend the rest of the time picking up ER shifts. Patients can't get appointments with them in clinic, so they end up going to the ER to be seen by them instead. All the ER physicians are all part of the FHT, and there is no walk-in clinic in town. I've been here for 2 months and as far as I know all after-hours patients are seen in the ER. Either my preceptor isn't involved in the after-hours clinic, or it doesn't exist here.

 

[Wachaa]

1 hour ago, windsormd1 said:

That’s still an amazing gig compared to FFS setups.  Are you really going to whine about 280k plus CAD income on part time hours? Seriously? 

Depends how hard you are willing to work. In FFS, if I only wanted 280k I could stop working in May lol.

[windsormd1]

11 minutes ago, Wachaa said:

Depends how hard you are willing to work. In FFS, if I only wanted 280k I could stop working in May lol.

You gross 400k in 5 months? Do tell us how you would do that in FFS.........we are all waiting..........

[daleader]

let me add one other perspective on it as well, because you also have to remember that a FM training vs. lets say internal med specialist is at least ~3 years shorter. If you are making 350K as a family doc (working resident hours ~80hrs/week), that's still ~250K/year of income MORE than how much internal resident makes in PGY3, 4, and 5 EACH YEAR. Times 3, by the time a specialist graduates, you are 750K ahead of them in terms of investment. Let's say you don't want to put that 750K in appreciating assets, and assuming an internal med specialist makes ~100-150K more than FM / year , it means that the average specialist has to work another 6-7 years (after 5 years of training) to get to the same financial level of a family doc. point being, I think with 2 years of training, considering all the other factors such as flexibility (which imo is huge), a 250-300K income is amazing for a family doctor. 

[rmorelan]

8 minutes ago, daleader said:

let me add one other perspective on it as well, because you also have to remember that a FM training vs. lets say internal med specialist is at least ~3 years shorter. If you are making 350K as a family doc (working resident hours ~80hrs/week), that's still ~250K/year of income MORE than how much internal resident makes in PGY3, 4, and 5 EACH YEAR. Times 3, by the time a specialist graduates, you are 750K ahead of them in terms of investment. Let's say you don't want to put that 750K in appreciating assets, and assuming an internal med specialist makes ~100-150K more than FM / year , it means that the average specialist has to work another 6-7 years (after 5 years of training) to get to the same financial level of a family doc. point being, I think with 2 years of training, considering all the other factors such as flexibility (which imo is huge), a 250-300K income is amazing for a family doctor. 

I have done the math with this a few times - it takes quite a while to catch actually (usually somewhere in people's 50s) if you hold all things equal (assume a 100K difference in billings, and the same overhead percentage, assume you earn the same salary as the IM colleagues over the same time period...). You should also factor in that many of those 5 year jobs often require fellowships on top of that as well. 

People REALLY underestimate the power often of those missing 3-5 years of income etc in a relatively tax sheltered corporation. 

[Wachaa]

1 hour ago, windsormd1 said:

You gross 400k in 5 months? Do tell us how you would do that in FFS.........we are all waiting..........

The situation I was describing above was only to show how FFS still is better if you're willing to work harder.

 

I work in BC in the lower mainland in a community office practice. No evenings/ call/ hospital/ long term care. I start off the year usually working pretty hard about 50 hours a week. For January and February I grossed around 68k a month. Overhead is fixed, approximately 20%. If I bill higher the percentage is lower. I slow down as the year goes on, but if I kept up the same pace, it's do-able what I mentioned above. Actually 50 hour weeks is not that hard compared to many jobs but it's not the lifestyle I want.

[Wachaa]

3 hours ago, windsormd1 said:

That’s still an amazing gig compared to FFS setups.  Are you really going to whine about 280k plus CAD income on part time hours? Seriously? 

Just also want to add I wasn't saying that it's not a good gig.

Just unfortunately in BC the pay for salaried positions is not as good.

For example, a GP with a minimum requirement of 1250 patient panel, 1680 hours, 220 days a year, is paid at most 280k. Overhead is subtracted from this. So maybe 30% overhead = $196k take home

In comparison, for funded nurse practitioners, with a minimum requirement of only 1000 patients, is paid up to 160k. But they keep all 160k because they get an allocated fund of additional $85k for overhead = $160k take home

 

Feel free to PM me for the references.

[LittleDaisy]

54 minutes ago, Wachaa said:

Just also want to add I wasn't saying that it's not a good gig.

Just unfortunately in BC the pay for salaried positions is not as good.

For example, a GP with a minimum requirement of 1250 patient panel, 1680 hours, 220 days a year, is paid at most 280k. Overhead is subtracted from this. So maybe 30% overhead = $196k take home

In comparison, for funded nurse practitioners, with a minimum requirement of only 1000 patients, is paid up to 160k. But they keep all 160k because they get an allocated fund of additional $85k for overhead = $160k take home

 

Feel free to PM me for the references.

Yeah I have heard about this, it's outrageous how BC pays GP compared to NP!

I am frustrated that cfpc is not doing much to those increasing number of NP who act as a GP now there are so many spots for NP students in Ontario it will soon be a power struggle and money claw back from the government who don't appreciate our extensive training.

280 K pre taxes is good income, but I encourage you to do one day of family medicine clinic you will understand that it comes with challenge. A lot of specialists work in hospitals , and there are no overhead, a lot of community specialists are making around 500 K and up with hospital stipend and based salary. 

To the OP about FHO/Er the government only takes outside use for walk in clinic not for ER visits because it's usually urgent acute matters. 

[MDinCanada]

14 hours ago, rmorelan said:

I have done the math with this a few times - it takes quite a while to catch actually (usually somewhere in people's 50s) if you hold all things equal (assume a 100K difference in billings, and the same overhead percentage, assume you earn the same salary as the IM colleagues over the same time period...). You should also factor in that many of those 5 year jobs often require fellowships on top of that as well. 

People REALLY underestimate the power often of those missing 3-5 years of income etc in a relatively tax sheltered corporation. 

lets not forget the trauma that comes with the additional years of residency + fellowships.

 

[rmorelan]

15 hours ago, rmorelan said:

I have done the math with this a few times - it takes quite a while to catch actually (usually somewhere in people's 50s) if you hold all things equal (assume a 100K difference in billings, and the same overhead percentage, assume you earn the same salary as the IM colleagues over the same time period...). You should also factor in that many of those 5 year jobs often require fellowships on top of that as well. 

People REALLY underestimate the power often of those missing 3-5 years of income etc in a relatively tax sheltered corporation. 

oh I should add one point - people are correct that on average (which is what we are talking about here) that non-FM specialties work fewer hours (CMA tracks that via a survey). A lot of those "missing hours" seem to be because they have less requirement to cover thing at weird hours. You should also factor in to get an apples to apples comparison a FM that works the roughly 10 more hours per week that makes up that gap. 

and yes not only are you earning more in during the same others are finishing residency/fellowships - but while those people are working 80+ hour weeks you are likely not (and probably have more than 4 weeks vacation - I have to say I am stunned how much vacation time staff get at least on paper). FM is a lot better than it might initially appear if you do things correctly - not to say that there aren't some specialities that still income wise much higher (although those again come with additional risks in even getting them and have other harder to directly compare to simply money problems - like say shift times to start with). 

again you much equalize all factors to do a fair comparison. It annoys me to a degree when that is not done ha - because it isn't fair for either side, and it is a distraction (instead of uniting we are all fighting endless among ourselves). 

[LittleDaisy]

On 3/2/2020 at 2:06 PM, rmorelan said:

oh I should add one point - people are correct that on average (which is what we are talking about here) that non-FM specialties work fewer hours (CMA tracks that via a survey). A lot of those "missing hours" seem to be because they have less requirement to cover thing at weird hours. You should also factor in to get an apples to apples comparison a FM that works the roughly 10 more hours per week that makes up that gap. 

and yes not only are you earning more in during the same others are finishing residency/fellowships - but while those people are working 80+ hour weeks you are likely not (and probably have more than 4 weeks vacation - I have to say I am stunned how much vacation time staff get at least on paper). FM is a lot better than it might initially appear if you do things correctly - not to say that there aren't some specialities that still income wise much higher (although those again come with additional risks in even getting them and have other harder to directly compare to simply money problems - like say shift times to start with). 

again you much equalize all factors to do a fair comparison. It annoys me to a degree when that is not done ha - because it isn't fair for either side, and it is a distraction (instead of uniting we are all fighting endless among ourselves). 

I echo this! We shouldn't be fighting among ourselves as physicians! We should support each other and pushing for a better life-work balance!

If anything, I am worried about the rising amount of PA/NPs, they might start to take away GP's jobs. I hope CFPC really does advocate for the role of family physician, but the government just cares about saving money, they rarely calculate the efficiency and the number of patients seen and the complexity of cases. 

[JuicyMango]

I'm just coming into this great discussion. I am happy that some shed light on that taboo topic.

 

I was wondering, is it viable to believe a GP could have only a practice of ER / Hospitalist .

If so, how would you say they would earn up to , money-wise.

 

I'm super interested in ER, but I keep hearing that CFCP-EM docs don't make any interesting money..

 

Thanks for your posts guys

[Wachaa]

2 hours ago, JuicyMango said:

I'm just coming into this great discussion. I am happy that some shed light on that taboo topic.

 

I was wondering, is it viable to believe a GP could have only a practice of ER / Hospitalist .

If so, how would you say they would earn up to , money-wise.

 

I'm super interested in ER, but I keep hearing that CFCP-EM docs don't make any interesting money..

 

Thanks for your posts guys

 

I think it's more viable for a GP to focus solely on ER/ hospitalist than you might expect.

On the other hand, if you tried to run a family practice at the same time as ER/ hospitalist, it would be difficult:

-If you do an ER/ hospitalist night shift, then you cannot run clinic the next day because that's your "rest" period.

-As a hospitalist, often you take on shifts for a week straight, and your family practice patients will bug you endlessly about where you disappeared to.

-It'd be more work to go home after a long ER/ hospitalist shift and yet still have to review my family practice patients' labs, tasks, paperwork, etc, which come flowing into your inbox on a constant basis, even if you aren't in clinic seeing patients

-Part of the attraction of ER/ hospitalist is the flexibility to pick shifts (and therefore control your time off). If you had a family practice on the side, then you constantly have to adjust to that schedule, find a locum to cover you when you're doing ER/ hospitalist.

 

I know people who would do ER/ hospitalist, and on the side, they would do locum/ walk in clinic shifts instead of family practice. By doing so, they still practice "general medicine" without the need to have patients attach to them.