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What are the highest paid 9-5 specialties?


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12 hours ago, DPH said:

Yeah - usually OMFS residencies are 4-6 years (depends whether you want the MD) and there are only 6 spots in Canada which is true. It is competitive probably on the same level as ROAD specialties in medical school, but is definitely doable if you aim for it in the beginning. The reason for this is that there are a fair number of US OMFS residencies that accept Canadians as well. US and Canadian programs can take students right after dent school, but some prefer the student completes a 1 year GPR beforehand. 

As for med vs dent... I am having hard time deciding. I feel like both careers are so amazing and you will be well off regardless of which path you take. I feel passionate about both fields and after shadowing OMFS surgeons, I feel as though their job provides the perfect balance between both. Either way If I were to do medical school, I would probably go for ENT!  Also, coming from a typical asian household, both my parents are supportive with whatever i choose, as the "my child is a doc" box is checked off either way haha!

Anyways thanks for your input swoman!

also things to consider:

1. it's easier to switch into dent after med than vice versa. 

2. going into dent is like an end point (you become a dentist, and then you can choose to specialize). going into med, you still have to choose among a ton of different specialties and there's something for everyone.

If you're young, I'd suggest med because it really takes a long time and real clinical experience to determine if your more the surgical type or the medical type.

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3 hours ago, MDinCanada said:

also things to consider:

1. it's easier to switch into dent after med than vice versa. 

2. going into dent is like an end point (you become a dentist, and then you can choose to specialize). going into med, you still have to choose among a ton of different specialties and there's something for everyone.

If you're young, I'd suggest med because it really takes a long time and real clinical experience to determine if your more the surgical type or the medical type.

There is actually a lot more variability in dentistry then people give credit too, but yes of course that pales in comparison to all of the med specialties. I am having a little trouble with what you mean by surgical type vs medical type.

All I know is I enjoy working with my hands, and look forward to the potential autonomy in opening up my own clinic. There are very few medical surgical specialties that allow you to do both, especially in Canada. However, I will carefully weigh out my options depending on the acceptances I get. I am sure I would be happy to be a part of either profession as they both serve such important roles.

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On 4/9/2020 at 2:01 AM, MDinCanada said:

Did a few derm electives and that was my understanding after speaking to derms and residents.

If you look at the revenue reports, derms are payed similarly to internal med specialists. 

What are your sources?

[1] Leaked report from AMA showing that average daily billings for derm in Alberta are nearly 5k (doesn’t include cosmetics). These overhead numbers are way out of whack for all specialties, but even if we assume that these numbers are true (which they aren’t, derm overhead is manageable unless you own lasers and other equipment used in cosmetics), the average derm is still taking home 800k after practice expenses in the worst case scenario.

Source - https://c2-preview.prosites.com/213099/wy/docs/Attachment 01 - Fee and Income Relativity 101 for Spring 2017 RF FINAL 2017-02-10.pdf

[2] CIHI data that confirms AMA study.  Average dermatologist in Alberta makes 900k+ INCLUDING part-timers and private-based. Manitoba numbers also look good. Look up some dermatologists in Winnipeg in the Ministry’s annual report. If you find one billing under a million they are either inefficient, working part-time or reduced hours, or mainly doing private work. The highest I could find was Dr. Shane Silver who easily clears 2MM.

Sources - 20-years-compensation-chart.pdf#page220

https://www.gov.mb.ca/health/annualreports/
 

As you can see, derm remuneration is incredibly variable between provinces, more-so practically than any other specialty in Canada. This something I’ve never been able to understand. Go through each provinces fee schedule for derm and you’ll find that they aren’t THAT different. Quebec in particular is a head scratcher for me. Consult fee is 80$ in a private office and 100$ (!) in a hospital setting, yet average billings for derms billing RAMQ over 150k are under 500k. Of course, Quebec has limitations that no other province has (looking at you “plafonnements particuliers”) but it still doesn’t explain the discrepancy. 
 

In short, those derm residents are either unaware of their own specialty’s remuneration prospects or simply lying to you.

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4 minutes ago, -JAG- said:

[1] Leaked report from AMA showing that average daily billings for derm in Alberta are nearly 5k (doesn’t include cosmetics). These overhead numbers are way out of whack for all specialties, but even if we assume that these numbers are true (which they aren’t, derm overhead is manageable unless you own lasers and other equipment used in cosmetics), the average derm is still taking home 800k after practice expenses in the worst case scenario.

Source - https://c2-preview.prosites.com/213099/wy/docs/Attachment 01 - Fee and Income Relativity 101 for Spring 2017 RF FINAL 2017-02-10.pdf

[2] CIHI data that confirms AMA study.  Average dermatologist in Alberta makes 900k+ INCLUDING part-timers and private-based. Manitoba numbers also look good. Look up some dermatologists in Winnipeg in the Ministry’s annual report. If you find one billing under a million they are either inefficient, working part-time or reduced hours, or mainly doing private work. The highest I could find was Dr. Shane Silver who easily clears 2MM.

Sources - 20-years-compensation-chart.pdf#page220

https://www.gov.mb.ca/health/annualreports/
 

As you can see, derm remuneration is incredibly variable between provinces, more-so practically than any other specialty in Canada. This something I’ve never been able to understand. Go through each provinces fee schedule for derm and you’ll find that they aren’t THAT different. Quebec in particular is a head scratcher for me. Consult fee is 80$ in a private office and 100$ (!) in a hospital setting, yet average billings for derms billing RAMQ over 150k are under 500k. Of course, Quebec has limitations that no other province has (looking at you “plafonnements particuliers”) but it still doesn’t explain the discrepancy. 
 

In short, those derm residents are either unaware of their own specialty’s remuneration prospects or simply lying to you.

I've only spoken to derms and residents from Quebec, so that's possible!

Is the plafonnement a thing for private clinics too?

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Just now, MDinCanada said:

I've only spoken to derms and residents from Quebec, so that's possible!

I wonder if it would be too intrusive to ask if the fact that they can only bill 12k worth of excisions of benign or pre-cancerous tumours every 6 months is what’s holding them down. At the very least, it would make a great conversation starter.

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21 hours ago, MDinCanada said:

Is the plafonnement a thing for private clinics too?

If by private you mean outside RAMQ, then the answer is no. If you're not charging Medicare, you can do whatever you want (especially with Chaoulli vs Quebec)

If you mean private offices that provide insured services, the answer is more complicated. The billing cap for most specialties is different, but is usually between 5-600k. For anything done in a private office (cabinet) only 65 cents of every dollar goes towards this cap. That being said, some specialties, like psych, also have a hard billing cap IN ADDITION to these restrictions. Whichever you hit first applies. For example: the soft plafonnement for psych is around 550k. Take a psychiatrist billing 750k working exclusively in a private office. Because of the 65 cents rule, only 488k will go towards the cap. HOWEVER, psych also has a HARD billing cap of around 700k. Because they hit this one first, that 50k will only amount to 20k after associated penalties. This isn't that bad. The real killers are the plafonnements on certain procedures and practice settings. If you're a cardiologist or internal medicine physician, you have a very low hard billing cap for anything done in a private office. For IM it's 350k, for cards it's a bit over 500k. For the restrictions on procedures, anesthesia is hit very hard. There is a very low limit on nerve blocks. Any quick diagnostic tests that make a lot of $$$ are also restricted. Munsell tests for ophtho, audiometry for ENT, you get the picture. This is the opposite of Ontario's method, where you can bill as many of those as you want, but you have strict conditions to be able to do so (for an audiometry you need special training or an audiologist). Quebec just limits how many you can do. Usually these things are about 500-1000 per year. Quebec also severely limits how much certain specialties can bill for rounding, especially rounding on weekends, as well as how many follow-ups you can do. This can be a big problem if you're efficient. (side-note: the RAMQ also flags you if you see more than 81 patients a day, there's no hard cap like in BC but if you see more than 81 they'll either call your patients to make sure you actually saw them and/or have a chat with you on wether your style of practice is best for patient care)

If you want to escape plafonnement, either do FM or Radiology. For rads, MRI doesn't count, facility fees don't count, and only 30 cents of the rest goes towards the cap if you're in a private office. (side-note: I will never understand why QC radiologists refused to cover CT and MRI in private offices, especially in light of Chaoulli vs Quebec protecting private MRI and CT, as well as the public reports on how much the few facilities that were granted the permission to do so in Ontario made)

 

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2 hours ago, -JAG- said:

If by private you mean outside RAMQ, then the answer is no. If you're not charging Medicare, you can do whatever you want (especially with Chaoulli vs Quebec)

If you mean private offices that provide insured services, the answer is more complicated. The billing cap for most specialties is different, but is usually between 5-600k. For anything done in a private office (cabinet) only 65 cents of every dollar goes towards this cap. That being said, some specialties, like psych, also have a hard billing cap IN ADDITION to these restrictions. Whichever you hit first applies. For example: the soft plafonnement for psych is around 550k. Take a psychiatrist billing 750k working exclusively in a private office. Because of the 65 cents rule, only 488k will go towards the cap. HOWEVER, psych also has a HARD billing cap of around 700k. Because they hit this one first, that 50k will only amount to 20k after associated penalties. This isn't that bad. The real killers are the plafonnements on certain procedures and practice settings. If you're a cardiologist or internal medicine physician, you have a very low hard billing cap for anything done in a private office. For IM it's 350k, for cards it's a bit over 500k. For the restrictions on procedures, anesthesia is hit very hard. There is a very low limit on nerve blocks. Any quick diagnostic tests that make a lot of $$$ are also restricted. Munsell tests for ophtho, audiometry for ENT, you get the picture. This is the opposite of Ontario's method, where you can bill as many of those as you want, but you have strict conditions to be able to do so (for an audiometry you need special training or an audiologist). Quebec just limits how many you can do. Usually these things are about 500-1000 per year. Quebec also severely limits how much certain specialties can bill for rounding, especially rounding on weekends, as well as how many follow-ups you can do. This can be a big problem if you're efficient. (side-note: the RAMQ also flags you if you see more than 81 patients a day, there's no hard cap like in BC but if you see more than 81 they'll either call your patients to make sure you actually saw them and/or have a chat with you on wether your style of practice is best for patient care)

If you want to escape plafonnement, either do FM or Radiology. For rads, MRI doesn't count, facility fees don't count, and only 30 cents of the rest goes towards the cap if you're in a private office. (side-note: I will never understand why QC radiologists refused to cover CT and MRI in private offices, especially in light of Chaoulli vs Quebec protecting private MRI and CT, as well as the public reports on how much the few facilities that were granted the permission to do so in Ontario made)

 

Correct me if I'm wrong but I feel like the nerve block (code 00255, 500 per semester) and paravertebral block (code 00267, 500 per semester) restrictions wouldn't make that much of a difference when it comes to chronic pain. Aren't epidurals and facet joint injections (both under fluoroscopic guidance) the real money makers in chronic pain?

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On 4/24/2020 at 12:32 AM, Snowmen said:

Correct me if I'm wrong but I feel like the nerve block (code 00255, 500 per semester) and paravertebral block (code 00267, 500 per semester) restrictions wouldn't make that much of a difference when it comes to chronic pain. Aren't epidurals and facet joint injections (both under fluoroscopic guidance) the real money makers in chronic pain?

By epidurals do you mean steroid injections? That is a big money maker (in some provinces, as long as you're FFS and not hourly pain clinic like Alberta). You may be right for nerve blocks, but I always saw that they were quite à la mode. (Femoral blocks seem to be pretty prevalent but I'm not a pain medicine expert so don't quote me on that.) Nonetheless because pain patient rosters are so small (1000 patients will keep you busy year round) there's quite a bit of room for variation from clinic to clinic and doctor to doctor.

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  • 2 weeks later...
On 4/9/2020 at 11:33 AM, rice said:

Other specialties making relatively high income working 9-5 would be radiation oncology and physiatry (doing some component of insurance work).

Do you (or anyone else) know what a physiatrist's income is like if you DON'T do any insurance or procedural work? Like if you only worked inpatient rehab.

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11 hours ago, idekanymore7 said:

Do you (or anyone else) know what a physiatrist's income is like if you DON'T do any insurance or procedural work? Like if you only worked inpatient rehab.

The average pay for physiatrists in Quebec is around 435,000$.

The thing is, it would be difficult to only do rehab without doing procedural work as well. For instance, if you're a spine injury rehab specialist, your patients will pretty much all have spasticity which means you'll also have to be a spasticity specialist and do botox injections. Also, you'd probably be expected to follow up on your discharged patient and therefore follow them for the ongoing management of their spasticity, amongst other things, and end up doing more botox.

Now, you can obviously decide to focus more on the rehab aspect. If you did decide to go that way, I'd say you can expect to earn below average income for physiatrists but also have less overhead. I don't have any hard data but I'd speculate that this would probably amount to around 300,000$-350,000$ in Quebec (before overhead).

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