Good family practice + above-average income possible?

[gogogo]

Reading around, it seems that to make more than average as a family physician (defining above-average as 300k+ post-overhead), you have several options:

a) Practice bad medicine (quickly go through patients, miss diagnoses, refer a lot);

b) Work long hours (60+);

c) Go rural (and work nonstop hours); and/or

d) Get very lucky and get a rare FHO position.

 

Is this true? Can you be a good family doctor in the typical community setting, work decent hours (50-55ish), and still make a good amount?

[JohnGrisham]

"300k post-overhead" is a minimum of 427k gross billings.   You're going to need to do a combination of the above to achieve that, and certaintly a big part depends on the community you work in, and the type of settings you can work in (hospital, clinic, facilities, ER coverage etc).  Provincial variations in billing will play a large role as well. Certainly on average also depends on where you are at in your career - First five years out of residency or settled into practice.  Too many variables.

You mention FHO, so assumingly you're in Ontario. Ontario doesn't have daily caps of patients, so you can just work longer hours and still practice good medicine, 

[-JAG-]

The 427k gross billings assumes 30% overhead. Even working in someone else's clinic you can go lower than that. 

In response to your points.

a) you can practice good medicine seeing 60 patients a day just as you can practice bad medicine seeing 15. That being said, a lot of achieving high patient volumes comes from cutting out chit-chat, limiting your patients to one issue per visit, charging for forms and not refilling Rx by phone.

b) very few family physicians work this much

c) the benefits of rural medicine are often overstated on this forum. People act like going rural will mean making tons of cash and having a great lifestyle. In reality, going rural usually gets you a 20-30 bonus, which is nothing special. In some provinces you get practically nothing unless you're really isolated.  The money comes from high volume office work, lower overhead and ER work done in rural places, but all of these can be done in the city.

300k is very possible. Here's some examples that don't include any of the above.

Pain clinic anywhere is very lucrative and has huge waiting lists even in major cities. Patient population sucks but the money is there. Even in the worst paid province, Alberta, its over 200 an hour, which easily gets you to your goal provided you keep overhead low (cheap rent, not having more than one medical assistant, etc.) In other provinces sky's the limit.

In Alberta, family doctors who become generalists in mental health make around 200/hr. for counselling/psych management. Also gets you to your goals with a great lifestyle.

In Quebec, a basic visit is 43$. Add to that CSST and add ons like STI counselling, reassessments etc. and you can easily get to 50-55$ per patient. Let's call it 50$. If you see 35 patients a day, which is quite reasonable, you'll bill 1750$. Add another 60$ for your prise en charge bonus (seeing patients registered to you) That comes out to a bit over 1800$ a day. Let's say you take 1.5 months off per year, that gives you nearly 400k in annual billings. You also get capitation payments for having vulnerable patients, which can easily add another 20k/yr. Assuming 25% overhead you've again hit your goal with 15k to spare.

[gogogo]

 

2 hours ago, JohnGrisham said:

"300k post-overhead" is a minimum of 427k gross billings.   You're going to need to do a combination of the above to achieve that, and certaintly a big part depends on the community you work in, and the type of settings you can work in (hospital, clinic, facilities, ER coverage etc).  Provincial variations in billing will play a large role as well. Certainly on average also depends on where you are at in your career - First five years out of residency or settled into practice.  Too many variables.

You mention FHO, so assumingly you're in Ontario. Ontario doesn't have daily caps of patients, so you can just work longer hours and still practice good medicine, 

 

49 minutes ago, -JAG- said:

The 427k gross billings assumes 30% overhead. Even working in someone else's clinic you can go lower than that. 

In response to your points.

a) you can practice good medicine seeing 60 patients a day just as you can practice bad medicine seeing 15. That being said, a lot of achieving high patient volumes comes from cutting out chit-chat, limiting your patients to one issue per visit, charging for forms and not refilling Rx by phone.

b) very few family physicians work this much

c) the benefits of rural medicine are often overstated on this forum. People act like going rural will mean making tons of cash and having a great lifestyle. In reality, going rural usually gets you a 20-30 bonus, which is nothing special. In some provinces you get practically nothing unless you're really isolated.  The money comes from high volume office work, lower overhead and ER work done in rural places, but all of these can be done in the city.

300k is very possible. Here's some examples that don't include any of the above.

Pain clinic anywhere is very lucrative and has huge waiting lists even in major cities. Patient population sucks but the money is there. Even in the worst paid province, Alberta, its over 200 an hour, which easily gets you to your goal provided you keep overhead low (cheap rent, not having more than one medical assistant, etc.) In other provinces sky's the limit.

In Alberta, family doctors who become generalists in mental health make around 200/hr. for counselling/psych management. Also gets you to your goals with a great lifestyle.

In Quebec, a basic visit is 43$. Add to that CSST and add ons like STI counselling, reassessments etc. and you can easily get to 50-55$ per patient. Let's call it 50$. If you see 35 patients a day, which is quite reasonable, you'll bill 1750$. Add another 60$ for your prise en charge bonus (seeing patients registered to you) That comes out to a bit over 1800$ a day. Let's say you take 1.5 months off per year, that gives you nearly 400k in annual billings. You also get capitation payments for having vulnerable patients, which can easily add another 20k/yr. Assuming 25% overhead you've again hit your goal with 15k to spare.

Thanks for both of your responses. To clarify, I am in Ontario and hope to practice 1-2 hours outside of the GTA. I'm just trying to understand how some family doctors end up with a good lifestyle + great pay whereas others have a terrible lifestyle with bad pay. Knowing the factors that influence how much family doctors make, and how those factors affect job satisfaction, hours, stress, and quality of service can really help for career planning, rather than just look at the average billings.

[Wachaa]

3 hours ago, -JAG- said:

The 427k gross billings assumes 30% overhead. Even working in someone else's clinic you can go lower than that. 

In response to your points.

a) you can practice good medicine seeing 60 patients a day just as you can practice bad medicine seeing 15. That being said, a lot of achieving high patient volumes comes from cutting out chit-chat, limiting your patients to one issue per visit, charging for forms and not refilling Rx by phone.

b) very few family physicians work this much

c) the benefits of rural medicine are often overstated on this forum. People act like going rural will mean making tons of cash and having a great lifestyle. In reality, going rural usually gets you a 20-30 bonus, which is nothing special. In some provinces you get practically nothing unless you're really isolated.  The money comes from high volume office work, lower overhead and ER work done in rural places, but all of these can be done in the city.

300k is very possible. Here's some examples that don't include any of the above.

Pain clinic anywhere is very lucrative and has huge waiting lists even in major cities. Patient population sucks but the money is there. Even in the worst paid province, Alberta, its over 200 an hour, which easily gets you to your goal provided you keep overhead low (cheap rent, not having more than one medical assistant, etc.) In other provinces sky's the limit.

In Alberta, family doctors who become generalists in mental health make around 200/hr. for counselling/psych management. Also gets you to your goals with a great lifestyle.

In Quebec, a basic visit is 43$. Add to that CSST and add ons like STI counselling, reassessments etc. and you can easily get to 50-55$ per patient. Let's call it 50$. If you see 35 patients a day, which is quite reasonable, you'll bill 1750$. Add another 60$ for your prise en charge bonus (seeing patients registered to you) That comes out to a bit over 1800$ a day. Let's say you take 1.5 months off per year, that gives you nearly 400k in annual billings. You also get capitation payments for having vulnerable patients, which can easily add another 20k/yr. Assuming 25% overhead you've again hit your goal with 15k to spare.

 

I agree with all points.

Couldn't agree more re: rural. In most cases the billing fee codes are identical, save for ~5% bonus. They're making more because in rural there's simply more work. It's very possible you're up all night on-call, you're in the ER, you're rounding on patients in hospital before you start your full clinic day, and you're rounding again after you leave the clinic. And then perhaps on weekends you're rounding on your nursing homes/ long term care.

[JohnGrisham]

Everything varies by province, and if you're in a big city or not.  30% is a fairly safe bet in many big cities, but sure, you can get it to 20-25, or even less but highly depends. 

In one province, rural retention premiums are 20-30% on top of the fee guide. + retention bonuses + other often lucrative fees. And sometimes government funded clinic overhead. (not often though).

One rural community i've worked in, doesn't have a walk in clinic, agreed to by the clinics in town, so therefore all the walk-in type stuff goes into the ED if they cant be fit into a slot by their own GP...and some people still dont have a GP either. Aka, no overhead to see quick refills, cough and colds while on ER shift.  

There is a lot at play, and it will depend on your situation. 

[medisforme]

The other thing no one has mentioned is being completely up to date or your province's billing codes.  It is worthwhile to take a mini course or memorize the billing codes so you can maximize your billings.  A couple of local GP's here recently hired a company to review their billings and it was found they were underbilling up to 50k/year.  Never assume your MOA/manager is maximizing your billing, you have to check it yourself (at least initially until you have them trained how to bill).