Going into FM without liking the core aspects of the program?

[bellejolie]

3 hours ago, MDee2B said:

Is that really the case, in Quebec? That must be before overhead but still, I thought for FM, the average was lower, more like 250k before overhead -> around 180k after overhead. Obviously depends on different factors. But have really never heard of anyone in FM in QC earning less than 350k working 5 days, with most making more? 

yeah from my experiences! it's before overhead yes, and perhaps the average is lower when you google but i definitely find quebec doctors are compensated really well and new schemes came out. i had a preceptor tell me he billed 400K in one year working 5 days a week (and part of his work was academic) and he did a sports clinic for one half day on saturday (which obviously helped with the compensation). any weekends, evenings, LTC, high need things, vulnerable populations etc all bill more. Another new staff told me he made 65K in one month but was working 8-8 mon-saturday (but that's on track to making 700-800K in a year). You work more, you make more. Thats how billing works. Family physicians have a ton of potential income it's just many choose to go into the specialty for the work-life balance to begin with, so many work less. my point was more if a family physician works the same number of hours doing patient care as a surgeon (let's estimate 60 hours a week just on patient care, not including admin work or anything), they'd likely bill 400K plus. People have this misconception it's not well remunerated but that's not the case at all. Add in rural medicine where you make maybe $2500 a day, procedures, hospitalist etc. you can really do well. 

 

56 minutes ago, MDinCanada said:

I'm from Quebec too and I'd like to eventually practice in Montreal for factors that you mentioned above (quality of life, culture, cost of living, etc.)

A big factor motivating me to do family medicine is the shorter training, career flexibility (you can sort of change careers as you age depending on your interests), lifestyle flexibility (being able to reduce hours when I'll have a family), etc. Does it scare you that the government may want to impose a large amount of patients on each family doctor? Possibly turning it into something that is very not lifestyle? Instead of threatening family doctors, they could make going into family medicine more attractive to students...

The political and administrative bs in medicine bothers me the most... If all goes to shit, I would have no problem changing provinces/going private or doing non-clinical work.

it's easy to go from quebec to other provinces, so just give it a shot! it doesn't scare me, 2000 patients for example is pretty reasonable and what everyone does anyway from my understanding. i also (personally) think governments should have a say on how we practice just because it is at the end of the day tax dollars that support our income, and doctors contrary to what many think, work for the people not for themselves. 

[CrazyRay]

A lot of great info here. I'm wondering if anyone could comment on what the future of FP might look like - particularly with telemedicine and the FHO models?

[Lilirose]

On 1/25/2021 at 10:36 AM, bellejolie said:

Honestly I'm not an expert, i think I will learn more in residency if i match to a quebec school, but from what i understand the only mandatory thing is to register a minimum number of patients. however you see them is up to you but you have to have that many registered to see them. I've never heard of mandatory 1 day CHSLD before. everything outside of your personal clinic is extra. you have to do 55% of your practice in your prem region, and 45% can be in anything else (this is how people do the hospitalist, ER, deliveries etc) http://www.fmrq.qc.ca/en/pem-prem-en-mf/vos-obligations-apres-obtention-PREM

More info can be found here but it's only in french: https://www.msss.gouv.qc.ca/professionnels/medecine-au-quebec/prem/

If you don't meet the obligations you lose 30% of your salary, and if you practice without a prem i believe it's the same. it's complicated but don't worry about that now. 

i dont know of anyone who just does private family medicine, but i imagine if you're not billing through RAMQ and only through patients then yes you'd be exempt. but i really don't think this is common here, private practice is obviously discouraged. 

Thanks so much for all the info @bellejolie! I was able to find what I was trying to explain in the links that you posted. The additionnal activities I was mentionning, such as work in CHSLD, are called Specific Medical activities. The FMRQ page says:

"Physicians with less than 15 years’ practice have to commit to 12 hours of AMPs per week, or the equivalent. In the event of non-compliance with the AMP Special Arrangement, the physician is subject to a 30% cutback on all his billings to the Quebec Health Insurance Board (RAMQ)." 

So with a 12 hours dedicated to those activities, there are less time to dedicate to the principal practice, and it makes working part time less possible... However I understand the importance of filling the population needs. The info provided by the government is so opaque in my opinion!! I would like to have real example of this!... 

 

[bellejolie]

42 minutes ago, Lilirose said:

Thanks so much for all the info @bellejolie! I was able to find what I was trying to explain in the links that you posted. The additionnal activities I was mentionning, such as work in CHSLD, are called Specific Medical activities. The FMRQ page says:

"Physicians with less than 15 years’ practice have to commit to 12 hours of AMPs per week, or the equivalent. In the event of non-compliance with the AMP Special Arrangement, the physician is subject to a 30% cutback on all his billings to the Quebec Health Insurance Board (RAMQ)." 

So with a 12 hours dedicated to those activities, there are less time to dedicate to the principal practice, and it makes working part time less possible... However I understand the importance of filling the population needs. The info provided by the government is so opaque in my opinion!! I would like to have real example of this!... 

 

definitely - i think this is quite flexible though! the 12 hours, you might even fulfill it by having vulnerable patients that you see for instance. don't worry - residency will clarify everything and this is not something i have heard staff physicians having an issue with. 

[jadawo]

On 1/25/2021 at 5:31 PM, bellejolie said:

yeah from my experiences! it's before overhead yes, and perhaps the average is lower when you google but i definitely find quebec doctors are compensated really well and new schemes came out. i had a preceptor tell me he billed 400K in one year working 5 days a week (and part of his work was academic) and he did a sports clinic for one half day on saturday (which obviously helped with the compensation). any weekends, evenings, LTC, high need things, vulnerable populations etc all bill more. Another new staff told me he made 65K in one month but was working 8-8 mon-saturday (but that's on track to making 700-800K in a year). You work more, you make more. Thats how billing works. Family physicians have a ton of potential income it's just many choose to go into the specialty for the work-life balance to begin with, so many work less. my point was more if a family physician works the same number of hours doing patient care as a surgeon (let's estimate 60 hours a week just on patient care, not including admin work or anything), they'd likely bill 400K plus. People have this misconception it's not well remunerated but that's not the case at all. Add in rural medicine where you make maybe $2500 a day, procedures, hospitalist etc. you can really do well. 

 

it's easy to go from quebec to other provinces, so just give it a shot! it doesn't scare me, 2000 patients for example is pretty reasonable and what everyone does anyway from my understanding. i also (personally) think governments should have a say on how we practice just because it is at the end of the day tax dollars that support our income, and doctors contrary to what many think, work for the people not for themselves. 

$2500/day in rural medicine?! 5 days a week and 6 weeks of vacation, you would be billing $575k per year, some of that hospital work without overhead. Seems really high. Do you mind explaining that math?

[JohnGrisham]

1 hour ago, jadawo said:

$2500/day in rural medicine?! 5 days a week and 6 weeks of vacation, you would be billing $575k per year, some of that hospital work without overhead. Seems really high. Do you mind explaining that math?

Rural FM docs I know make anywhere from 300-700k in billings.     It is hugely variable.  Again, when you work clinic, in hospital and Emerg with call/overnight shifts, you are naturally working lots of hours..so you make more. And yes often less overhead in hospital, and even clinics can have less overhead due to leasing costs being lower in some rural centres than big urban centres where real estate is expensive.

I also know urban docs who comfortable bill 400-500k before overhead cuts, doing mostly community medicine(clinics, care homes, methadone/pain etc).  

Hugely variable depending on province, practice style and of course - time. The ones billing a lot aren't only working 40hrs a week.

[blah1234]

9 minutes ago, JohnGrisham said:

Rural FM docs I know make anywhere from 300-700k in billings.     It is hugely variable.  Again, when you work clinic, in hospital and Emerg with call/overnight shifts, you are naturally working lots of hours..so you make more. And yes often less overhead in hospital, and even clinics can have less overhead due to leasing costs being lower in some rural centres than big urban centres where real estate is expensive.

I also know urban docs who comfortable bill 400-500k before overhead cuts, doing mostly community medicine(clinics, care homes, methadone/pain etc).  

Hugely variable depending on province, practice style and of course - time. The ones billing a lot aren't only working 40hrs a week.

The fee schedule can provide a good view in terms of what your earning potential is. At some point to hit high billings you just need to put in long hours as the codes are the codes. There are stipends and bonuses that can cloud the matter but at the end of the day most physicians will be dependent on FFS.

[bellejolie]

1 hour ago, jadawo said:

$2500/day in rural medicine?! 5 days a week and 6 weeks of vacation, you would be billing $575k per year, some of that hospital work without overhead. Seems really high. Do you mind explaining that math?

its as the other poster said - its mixed and in rural the codes are higher (1.5 depending) because the need is greater, and also often you're on call overnight so there are premiums and everything. but again like the other poster said you can make 400K comfortably as a family doc working in an urban setting too. it's a big misconception that family physicians don't bill much. they tend to make more than both pediatricians and psychiatrists and for hours worked make equal to many specialists. 

[jadawo]

36 minutes ago, bellejolie said:

its as the other poster said - its mixed and in rural the codes are higher (1.5 depending) because the need is greater, and also often you're on call overnight so there are premiums and everything. but again like the other poster said you can make 400K comfortably as a family doc working in an urban setting too. it's a big misconception that family physicians don't bill much. they tend to make more than both pediatricians and psychiatrists and for hours worked make equal to many specialists. 

Thanks for the reply  yeah I was looking at the Alberta billing codes after I posted that and it’s easy to see how after-hours, call, weekends, etc can start to add up quickly with the modifiers and multipliers in the billing code.