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Australian Trained GP - salary coming back to Canada


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Hiya guys, 

I’m a GP In Australia originally from Canada (did my undergrad and masters in astrophysics at Mac so didn’t have the grades for med) but I went down under 8 yrs ago for med (also just to settle things cus I have seen recent comments about how “hard” it is to get an internship spot in Australia- it’s not or not now at least everyone gets one if they apply somewhere most internationals in regional centres- matching to Canada however apart from fam med is pretty hard but those that wanted to did it).  Anyways I’m fully licensed here and am earning about 290k per yr AUD. My wife who’s also a GP and Canadian are thinking of moving to Canada and I was wondering what kind of salary would I be looking at in Ontario. I’ve talked to a recruiter and they say it varies from 250-500k which is a massive range. 
 

I plan to work 50 hrs a week hopefully as a hospitalist ? But clinics will do as well. 
Since Aus has a reciprocity agreement I don’t have to do the CFPC and only the MCCQE’s which I plan to write soon so I’ll be fully licensed when I start. 
 

Any numbers as to salaries would be greatly appreciated... I don’t wanna feel cheated if I sign a contract. 

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On 8/1/2020 at 8:26 AM, aus_trained said:

Hiya guys, 

I’m a GP In Australia originally from Canada (did my undergrad and masters in astrophysics at Mac so didn’t have the grades for med) but I went down under 8 yrs ago for med (also just to settle things cus I have seen recent comments about how “hard” it is to get an internship spot in Australia- it’s not or not now at least everyone gets one if they apply somewhere most internationals in regional centres- matching to Canada however apart from fam med is pretty hard but those that wanted to did it).  Anyways I’m fully licensed here and am earning about 290k per yr AUD. My wife who’s also a GP and Canadian are thinking of moving to Canada and I was wondering what kind of salary would I be looking at in Ontario. I’ve talked to a recruiter and they say it varies from 250-500k which is a massive range. 
 

I plan to work 50 hrs a week hopefully as a hospitalist ? But clinics will do as well. 
Since Aus has a reciprocity agreement I don’t have to do the CFPC and only the MCCQE’s which I plan to write soon so I’ll be fully licensed when I start. 
 

Any numbers as to salaries would be greatly appreciated... I don’t wanna feel cheated if I sign a contract. 

Hey, 

Hopefully someone with more insight will comment, but what I do know is that $250K is on the very low end in Ontario. Average salary for FM docs was $363K in 2016. I expect that number to be closer to $400K now. With a 50h work week, That should be a realistic salary. 
Also, the range is actually much greater than 500K. There are FM docs making more than a million in Ontario. But they see a lot of patients and tend to have a pain clinic. 
Sources:

https://www.canadianhealthcarenetwork.ca/files/2018/03/20-years-compensation-chart.pdf

https://wwwhive.com/2019/06/28/revealed-ontarios-top-10-highest-billing-doctors/

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2 hours ago, bruh said:

Hey, 

Hopefully someone with more insight will comment, but what I do know is that $250K is on the very low end in Ontario. Average salary for FM docs was $363K in 2016. I expect that number to be closer to $400K now. With a 50h work week, That should be a realistic salary. 
Also, the range is actually much greater than 500K. There are FM docs making more than a million in Ontario. But they see a lot of patients and tend to have a pain clinic. 
Sources:

https://www.canadianhealthcarenetwork.ca/files/2018/03/20-years-compensation-chart.pdf

https://wwwhive.com/2019/06/28/revealed-ontarios-top-10-highest-billing-doctors/

You're confusing "income" and "billings". These sources show billings. Actual income will be billings - overhead - taxes. Overhead and taxes will vary by situation and province/if you have a corporation, etc. so that's where a lot of the variability comes in.

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3 hours ago, bruh said:

Hey, 

Hopefully someone with more insight will comment, but what I do know is that $250K is on the very low end in Ontario. Average salary for FM docs was $363K in 2016. I expect that number to be closer to $400K now. With a 50h work week, That should be a realistic salary. 
Also, the range is actually much greater than 500K. There are FM docs making more than a million in Ontario. But they see a lot of patients and tend to have a pain clinic. 
Sources:

https://www.canadianhealthcarenetwork.ca/files/2018/03/20-years-compensation-chart.pdf

https://wwwhive.com/2019/06/28/revealed-ontarios-top-10-highest-billing-doctors/

What exactly makes pain clinic so lucrative?

The high volume? Procedures (steroid injections I'm assuming?)? Mental health billing codes? Something else? I can't seem to figure it out

And what are the bread & butter cases in pain clinic? I'm guessing they're more complicated than just a regular "shoulder pain" you would see in fm clinic.

 

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21 minutes ago, MDinCanada said:

What exactly makes pain clinic so lucrative?

The high volume? Procedures (steroid injections I'm assuming?)? Mental health billing codes? Something else? I can't seem to figure it out

And what are the bread & butter cases in pain clinic? I'm guessing they're more complicated than just a regular "shoulder pain" you would see in fm clinic.

 

To add another question onto this, the people I've spoken to about pain clinics often cite the "difficult" patient population as being a detractor. What exactly is meant by a "difficult" patient population in the context of pain clinics?

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43 minutes ago, Determinance said:

To add another question onto this, the people I've spoken to about pain clinics often cite the "difficult" patient population as being a detractor. What exactly is meant by a "difficult" patient population in the context of pain clinics?

There can be a big mental health component to chronic pain - and for some people who experience chronic pain or any other chronic physical symptom, it's really difficult/impossible to accept that there may not be a "medical" diagnosis/explanation or cure, so people continue to request demand more tests and more treatments (e.g. opioids) that are not really clinically indicated, and this can be a point of major polarization.

In many cases, we feel it might be most helpful for people to accept that pain is likely to be part of their life going forward, that there may never be a clear medical diagnosis that can be "fixed" and that it may be important to do things like rehabilitation, engaging in daily activities as best as possible, trying to get back to work, and working on addressing ways of thinking about and interpreting pain, whereas some people may experience that as invalidating and continue to request/demand that a solution be found to the point of being unwilling to engage in any other kind of approach.  Also high comorbidity with various mental illnesses, and many non-psychiatrists don't always enjoy working with people with things like personality disorders or trauma or somatoform disorders or substance use disorder or things like that because it isn't always really imminently fixable and it tends to create difficulties building and maintaining a therapeutic alliance, leading to anger, lots of emotion on both sides, etc.  Many doctors also struggle with treating patients with problems that can't be fixed, because for some people, that doesn't feel as satisfying and can feel pretty frustrating.  Others are ok with it - it's just a personality thing about what we derive value from in our work.

That would be my best guess - I don't work in pain but I do see a bunch of these folks from the other side.

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3 hours ago, bearded frog said:

You're confusing "income" and "billings". These sources show billings. Actual income will be billings - overhead - taxes. Overhead and taxes will vary by situation and province/if you have a corporation, etc. so that's where a lot of the variability comes in.

I mean, net income is rarely ever used as a measure of one’s salary. When my engineer friend tells me he got a $110K job offer, I already know that’s not his take-home pay. When we say professors make 140K or lawyers make 150K, no one is talking about their take-home pay. This persistence on emphasizing taxes and overhead is mostly mentioned in the context of physicians. I can see this happening because the higher the pay, the higher the taxes one pays, but it is not unique to doctors. It just means that doctors pay a proportionally larger amount of taxes and overhead compared to other professions. Regardless, if we want to start saying doctors “really” only make $190K we should also say engineers “really” only make $70K.

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46 minutes ago, bruh said:

I mean, net income is rarely ever used as a measure of one’s salary. When my engineer friend tells me he got a $110K job offer, I already know that’s not his take-home pay. When we say professors make 140K or lawyers make 150K, no one is talking about their take-home pay. This persistence on emphasizing taxes and overhead is mostly mentioned in the context of physicians. I can see this happening because the higher the pay, the higher the taxes one pays, but it is not unique to doctors. It just means that doctors pay a proportionally larger amount of taxes and overhead compared to other professions. Regardless, if we want to start saying doctors “really” only make $190K we should also say engineers “really” only make $70K.

I think the issue with what you’re saying is that you’re dumping taxes and overhead into the same bin. They’re not the same. 

When talking salaried incomes, you’re right that people don’t tend to deduct the taxes and we just talk gross income. Everyone understands that the true take home pay of a 100k salary is less after tax. But lets say you have a small business generating 100k in gross income/billings - what does that mean? Is that a good income? A bad one? You can’t tell from that information alone, because before you can calculate the owner’s personal gross income, first you have to deduct expenses from the business gross income. If you make 100k in earnings and you run a small business out of your home with no employees, you’re going to have a much higher pre-tax net income than someone who makes the same but has an employee and rent to pay out of those billings. The ‘gross income’ of a business owner is the ‘net income’ of the business itself (assuming the owner has no other income streams).

If you want to usefully compare the income of someone who runs a small business to the income of some who is ‘salaried’, you need to deduct the overhead first, so that you’re actually comparing each person’s true gross income after expenses. Similarly, if you want to compare the true incomes of doctors, you also need to deduct overhead, because different types of positions or specialities have different levels of overhead. That’s why we tend to talk about it this way. 

Edited by frenchpress
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14 minutes ago, frenchpress said:

I think the issue with what you’re saying is that you’re dumping taxes and overhead into the same bin. They’re not the same. 

When talking salaried incomes, you’re right that people don’t tend to deduct the taxes and we just talk gross income. Everyone understands that the true take home pay of a 100k salary is less after tax. But lets say you have a small business generating 100k in gross income/billings - what does that mean? Is that a good income? A bad one? You can’t tell from that information alone, because before you can calculate the owner’s personal gross income, first you have to deduct expenses from the business gross income. If you make 100k in earnings and you run a small business out of your home with no employees, you’re going to have a much higher pre-tax net income than someone who makes the same but has an employee and rent to pay out of those billings. The ‘gross income’ of a business owner is the ‘net income’ of the business itself (assuming the owner has no other income streams).

If you want to usefully compare the income of someone who runs a small business to the income of some who is ‘salaried’, you need to deduct the overhead first, so that you’re actually comparing each person’s true gross income after expenses. Similarly, if you want to compare the true incomes of doctors, you also need to deduct overhead, because different types of positions or specialities have different levels of overhead. That’s why we tend to talk about it this way. 

yeah that this is true - billings after all isn't gross income of course and I think everyone gets that. I see the similar descriptions used  for other professions that actually own their business. Among that group of professional talk about overhead constantly comes up as a separate things because it is a business expense and also controllable to an extent - so it isn't standardized (unlike say two people with roughly the same salary - sure there are different deductions but you immediate get a sense of their tax rate and thus net income ball parked.) Overhead varies so much that you have to talk about it as something different. In medicine I have seen that range from 0-60%+ percent for instance. Cannot compute things with that kind of range in play unless you know what it is! 

 

 

 

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On 8/2/2020 at 3:55 PM, bruh said:

I mean, net income is rarely ever used as a measure of one’s salary. When my engineer friend tells me he got a $110K job offer, I already know that’s not his take-home pay. When we say professors make 140K or lawyers make 150K, no one is talking about their take-home pay. This persistence on emphasizing taxes and overhead is mostly mentioned in the context of physicians. I can see this happening because the higher the pay, the higher the taxes one pays, but it is not unique to doctors. It just means that doctors pay a proportionally larger amount of taxes and overhead compared to other professions. Regardless, if we want to start saying doctors “really” only make $190K we should also say engineers “really” only make $70K.

A family physician with gross billings of 270k might make 190K after overhead.  But unlike academics and nurses for example, the doctor doesn’t  generally have a pension.  So to make it “comparable” to a salary pay - you’d need to deduct at least 40k year for pension and  benefits.  You’re left with 150K in “salary” after very costly medical school and unknown benefits like vacation time (before taxes).  That’s a good salary as much as a senior nurse administrator - but only a little more than a NP in AB who is paid 125k but with defined benefits and shorter/less costly training and often less work hours .  Many other professionals downplay their earnings - it doesn’t help people to think doctors earn much more than they do.  In this case the “salary” was literally barely over half the gross revenue
 

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1 hour ago, frenchpress said:

I think the issue with what you’re saying is that you’re dumping taxes and overhead into the same bin. They’re not the same. 

When talking salaried incomes, you’re right that people don’t tend to deduct the taxes and we just talk gross income. Everyone understands that the true take home pay of a 100k salary is less after tax. But lets say you have a small business generating 100k in gross income/billings - what does that mean? Is that a good income? A bad one? You can’t tell from that information alone, because before you can calculate the owner’s personal gross income, first you have to deduct expenses from the business gross income. If you make 100k in earnings and you run a small business out of your home with no employees, you’re going to have a much higher pre-tax net income than someone who makes the same but has an employee and rent to pay out of those billings. The ‘gross income’ of a business owner is the ‘net income’ of the business itself (assuming the owner has no other income streams).

If you want to usefully compare the income of someone who runs a small business to the income of some who is ‘salaried’, you need to deduct the overhead first, so that you’re actually comparing each person’s true gross income after expenses. Similarly, if you want to compare the true incomes of doctors, you also need to deduct overhead, because different types of positions or specialities have different levels of overhead. That’s why we tend to talk about it this way. 

That's a good point. Thank you for the clarification. Since taxes are standardized based on income, it's pretty easy to say how much each person will be taxed based on their salary, but overhead is a whole different topic that some professions don't even deal with. That variability makes it difficult to grasp a true understanding of a doctor's pay when compared to other professions. My point regarding after-tax income stands, however. So I think the discussion should be more geared towards overhead rather than taxes. In essence, a doctor's pay after overhead can be fairly compared to an engineer's pay who doesn't have overhead. But having that discussion is obviously a difficult one as @rmorelan mentioned. 

 

46 minutes ago, indefatigable said:

A family physician with gross billings of 270k might make 190K after overhead.  But unlike academics and nurses for example, the doctor doesn’t  generally have a pension.  So to make it “comparable” to a salary pay - you’d need to deduct at least 40k year for pension and  benefits.  You’re left with 150K in “salary” after very costly medical school and unknown benefits like vacation time (before taxes).  That’s a good salary as much as a senior nurse manager - but only a little more than a NP in AB who is paid 125k but with defined benefits and shorter/less costly training and often less work hours .  Many other professionals downplay their earnings - it doesn’t help people to think doctors earn much more than they do.  In this case the “salary” was literally barely over half the gross revenue
 

Well, respectfully, I still don't think your comparison is fair. You are comparing an NP making 125K pre-tax with a doctor making $190K after-tax. Second, you are comparing an NP in AB to a non-AB doctor. Average FM salary in AB is around $360K (gross). Also, an NP must have gone through additional years of schooling and experience. I'm not totally familiar with the path but you have to have a minimum of 2 years of experience as an RN and have a graduate degree to become an NP. When we look at academia, professors go through 4 years of Bachelors + 2 years of Masters + 5 years of PhD and sometimes Post-doc. Also, doctors are still paid as residents. In fact, the 60-80K residents are paid is comparable to how much PhD students and RNs are paid.

I'm not trying to say doctors are overpaid, I just think that people really really want to downplay how much doctors make and make it seem like other professions are totally on-par. But the comparisons are never truly "fair". Even when speaking about med school fees, people say it costs about $200K to go to med school. Well, $100K of that is rent/other expenses which is what you pay for whether you went to med school or not. The other 100K is tuition, and I'm personally finding that more than half of that is paid for by school bursaries and OSAP grants. The average UofT med student gets about 10K of bursaries and 6K of OSAP grants, every year. 

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4 hours ago, bruh said:

Well, respectfully, I still don't think your comparison is fair. You are comparing an NP making 125K pre-tax with a doctor making $190K after-tax. Second, you are comparing an NP in AB to a non-AB doctor. Average FM salary in AB is around $360K (gross). Also, an NP must have gone through additional years of schooling and experience. I'm not totally familiar with the path but you have to have a minimum of 2 years of experience as an RN and have a graduate degree to become an NP. When we look at academia, professors go through 4 years of Bachelors + 2 years of Masters + 5 years of PhD and sometimes Post-doc. Also, doctors are still paid as residents. In fact, the 60-80K residents are paid is comparable to how much PhD students and RNs are paid.

No - 190K was pre-tax as well.  I took the avg FM income in BC which is about 270K and deducted 30% overhead which left 190K pre-tax.  That doesn't include any benefits or pension, which if deducted from the 190K works out to be 150K/year as "salary".   You're right I took the NP salary from AB - from BC it's less at 100K (vs 125K in AB).  The NP training needs roughly a Masters on top of work training  - which they're paid for as well, probably at comparable if not better rates than residents.    It costs much more in time and money to go to med school - than to become a NP.  The NPs can have better work hours as well.  The point is 150K "salary" sounds a whole lot different to the almost anyone vs 270K "billings".  They're very different concepts.  

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3 hours ago, offmychestplease said:

50th percentile FM income AFTER overhead is 300K, 75th percentile is 450K after overhead, 99th percentile is 1.1 million after overhead. There are 5 FM  doctors in AB that bill over 2 million (before overhead). It’s very comical to see people from specialties especially downplay fm income 

Where are these numbers from... This doesn't seem realistic.

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As a med student, I think GP income is quite an enigma and still haven't been able to get an handle on it. Offmychestplease's numbers seem justified for Alberta (based on another post, he'll show you the data to back it up). But, I've spoken to residents who will say that the typical family doctor will gross (i.e., pre-overhead, pre-tax) 300k in FFS and 400k in FHO (I'm speaking about Ontario specifically). FHO positions are very hard to come by in metro areas and usually only open up ~2+ hours outside of the city.

If you want another source of data, go here: https://www.cihi.ca/en/national-physician-database-metadata. Download the NPDB data table release and go to the table showing "Gross clinical payment per physician, by specialty, 2017–2018" (Table 3.3). Looking at Ontario, those in the 60th percentile are grossing 335k (roughly 234k after an average 30% overhead) and in the 80th percentile 460k (roughly 322k after overhead). Trimming the data by those who gross at least 100k, we find that the mean in Ontario for FM is 364k (roughly 250k after overhead). So, 250k seems to actually be the average rather than on the low end. But also remember that this is an average of those who work FFS and those who work in a capitation model (e.g., FHO). FHO is likely pulling it up a bit.

From my understanding, to beat this average, you can (a) go rural, (b) do high volume/be efficient (e.g., cut out social chat or do walk-ins), (c) some niche (e.g., pain clinic), (d) work longer hours (your 50 hours is above-average, from what I hear), or (e) learning how to maximize billings properly. Some also state that family doctors make extra income from private fees (e.g., workplace forms). But, I'm not sure how prevalent that is. All in all, I think it's safe to assume 200k-250k, but with some creativity, perhaps you can exceed that.

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Comparing to NPs here, we should add in PAs. They obviously don’t practice everywhere in Canada but having PAs pre tax making 150k after 6 years of practice with a pension and benefits is pretty good I’d say for the schooling and hours of work. Top salary PA in Manitoba makes 220k with benefits and pension in cardiology with 16 years experience and a 9-5 type job, I’d say it’s a good salary when comparing to the avg physicians in family medicine

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4 hours ago, offmychestplease said:

MD Cardiologists make 1 mill+ after overhead tho which is more than 5x that..that is after 16 years of post--secondary (4 year UG, 4 year MD, 3 year IM, 3 year Cards, 2 year graduate degree/sub spec to get a job) so it is deserved. But if you want to compare PA Cardiology don't compare to FM but MD Cardiology .

Do you have a source for cardio income? Not broken down by sub-specialty on that AMA report.

 

9 hours ago, offmychestplease said:

50th percentile FM income AFTER overhead is 300K, 75th percentile is 450K after overhead, 99th percentile is 1.1 million after overhead. There are 5 FM  doctors in AB that bill over 2 million (before overhead). It’s very comical to see people from specialties especially downplay fm income 

Full disclosure, I went through your post history bc your comment complaining about family docs complaining about making 150k annoyed me. Seems like you're entering this year but amazing to see you already know so much about physician compensation and what is fair.

The report you link has median FM billing at 200-300k, is it so hard to believe that there are a sizeable chunk of FM docs that are receiving 150k after overhead? Unless you understand the day to day lives of the FM docs you're posting data about, that information is useless. How many hours are they working? What's the practice setting? What type of work are they doing? Some of the schedules rural docs have are insane and it makes sense they have those massive billing numbers. Now there may be some that are billing inappropriately to hit those numbers, I have no idea, but that would be a separate issue.

Physicians are well compensated sure, and some specialties certainly seem out of line for the hours they work especially compared to others, but it annoys me to no end when you clearly don't have practical experience in this and are quoting off numbers like you understand them. Especially at a time when the government is pushing a narrative that doctors are greedy and overpaid. At least try to understand it from both sides first.

Honestly, I hope you'll be going to the same school as me and I get to see you be humbled. Talk to actual doctors, do a rural rotation and learn.

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