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Trying to Decide Between These Two Specialties


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Hi everyone,

I applied to both internal medicine and family medicine this year. I really do enjoy both of them and both have their own pros and cons. I am currently in the process of making my Rank Order List and am now more conflicted than ever. 

One of the factors influencing my decision is salary. This isn't the only factor but it is something that I want to think about, especially with the though of having to pay back undergraduate and medical school loans (I know all doctors will eventually pay back their loans, but I would rather do it sooner)

I know that the average salaries for internal medicine are higher than for family for many things, but reading on the forums for the past few days I have seen that if family doctors work full-time/as much as internal doctors, they can make just as much as IM, or more. 

I just wanted some insight on this, regarding the financial side of family medicine vs internal medicine as I would be happy in both.

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A close person to me is a family doctor and it really depends on the payment scheme you are part of. If you part of a FHO you can make a LOT depending on roster. Friend quoted around 450k (before tax, before overhead, including access bonus) for 1700 roster. It also depends if you work in a cheap or expensive area, and how big the FHO is since that can increase/decrease your overhead. 

No idea for internal but there were some numbers floating around in a Toronto Star article. If someone can dig that up. 

EDIT: maybe "a LOT" is subjective. Some people may say 450k isnt a lot?

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If salary is the differentiating factor for you then really personally I don’t think there’s a huge difference. IM is 5 years vs fam med 2 years where you can start paying off loans much sooner and make $1million total in those extra 3 years if you start working earlier. The pay difference between the two isn’t that much. It’s not like radiology/optho vs fam med. Plus job market is obviously better in family and you can be much more mobile. These are not two specialties where salary difference is insane. Also doctors generally do very well. Avg Canadian income is $50K let’s not forget so anything above 300K already puts us in the top 1% of the population. You will be fine money wise whichever you choose so focus on the residency training, and actual specialty differences as opposed to salary in making your decision IMO. 

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I'm also trying to decide between internal medicine and family medicine, and the flexibility is definitely the most appealing aspect of family medicine to me. 

For internists who choose to subspecialize, there's no guarantee of matching to the desired program/location in CaRMS round 2, and depending on the subspecialty, one might not be able to find work in the desired location after 5 years of training. I feel like I like the day-to-day of an internist better than that of a family doc, but there's so much more uncertainty in internal medicine >.<.

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On 3/27/2021 at 4:51 PM, dooogs said:

A close person to me is a family doctor and it really depends on the payment scheme you are part of. If you part of a FHO you can make a LOT depending on roster. Friend quoted around 450k (before tax, before overhead, including access bonus) for 1700 roster. It also depends if you work in a cheap or expensive area, and how big the FHO is since that can increase/decrease your overhead. 

No idea for internal but there were some numbers floating around in a Toronto Star article. If someone can dig that up. 

EDIT: maybe "a LOT" is subjective. Some people may say 450k isnt a lot?

That's very interesting. I think 450k is absolutely a lot of money. Is it still difficult to get a position in an FHO?

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On 3/28/2021 at 8:28 AM, bellejolie said:

If salary is the differentiating factor for you then really personally I don’t think there’s a huge difference. IM is 5 years vs fam med 2 years where you can start paying off loans much sooner and make $1million total in those extra 3 years if you start working earlier. The pay difference between the two isn’t that much. It’s not like radiology/optho vs fam med. Plus job market is obviously better in family and you can be much more mobile. These are not two specialties where salary difference is insane. Also doctors generally do very well. Avg Canadian income is $50K let’s not forget so anything above 300K already puts us in the top 1% of the population. You will be fine money wise whichever you choose so focus on the residency training, and actual specialty differences as opposed to salary in making your decision IMO. 

Great point! 

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On 3/28/2021 at 9:34 AM, ihsh said:

I'm also trying to decide between internal medicine and family medicine, and the flexibility is definitely the most appealing aspect of family medicine to me. 

For internists who choose to subspecialize, there's no guarantee of matching to the desired program/location in CaRMS round 2, and depending on the subspecialty, one might not be able to find work in the desired location after 5 years of training. I feel like I like the day-to-day of an internist better than that of a family doc, but there's so much more uncertainty in internal medicine >.<.

I really like the flexibility of family medicine as well! The uncertainty of the second CaRMS match is also very anxiety-inducing for me, and definitely a big negative of internal lol

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On 3/28/2021 at 1:50 PM, bearded frog said:

I think a lot of the disparity comes from medicine sub-specialties, and the day-to-day from a sub-specialist vs family doc is pretty different. If you went medicine with the goal of GIM then there is more overlap.

Do you know how likely it is for someone to be aiming for a sub-specialty but then not matching and getting stuck with GIM? Because as of now, I don't know how much I would like a career in GIM 

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6 minutes ago, CaRMSthrowaway__ said:

I really like the flexibility of family medicine as well! The uncertainty of the second CaRMS match is also very anxiety-inducing for me, and definitely a big negative of internal lol

Well then, this is encouraging your decision in a specific direction.

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1 hour ago, CaRMSthrowaway__ said:

That's very interesting. I think 450k is absolutely a lot of money. Is it still difficult to get a position in an FHO?

depends on the city. In Toronto it is difficult and some family doctors ask for money when they retire. 

In smaller cities it's not too hard. There is https://hfojobs.healthforceontario.ca/en/ you can make a guest account and see what jobs are available for FHOs

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7 hours ago, CaRMSthrowaway__ said:

Do you know how likely it is for someone to be aiming for a sub-specialty but then not matching and getting stuck with GIM? Because as of now, I don't know how much I would like a career in GIM 

I admit I am extremely unfamiliar with the MSM situation as I exist in a different world, but I assume it will vary depending on what subspeciality you desire, but there is a non-zero chance that you could end up defaulting to GIM if you follow the IM route.

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2 minutes ago, bearded frog said:

I admit I am extremely unfamiliar with the MSM situation as I exist in a different world, but I assume it will vary depending on what subspeciality you desire, but there is a non-zero chance that you could end up defaulting to GIM if you follow the IM route.

very much so :)

if the OP had an idea of which sub-fields are of interest then some idea can probably be given. These do also change yearly - the further you get in any field of medicine the smaller the groups get. That means an random effect - like a bunch of people happening to like a particular field in one year - can radically change some things. Worse the easier it is to get into someone one year seems to shift more people to apply to it which then makes it harder. Messy. 

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Hi, I wasn't sure if I should make a different post but I am in the exact similar situation and I dreading finalizing my ROL because I cannot decide if I want to rank my home IM or FM program first :(

I like Medicine and I enjoy the intellectual stimulation of IM but at the same time, I am in my 30s already and thinking about a 5 year residency program (at least 3 years of avg 1 in 4 calls) with the uncertainty of matching to my desired specialty (Rheumatology) in my desired location and also having to work really hard and try to impress everyone for a successful second round of CaRMS sounds very daunting to me (maybe I am just so tired after going through CaRMS)!

I can also see myself doing FM; the flexibility is a huge BONUS for me as I like to live in an urban area and I know I can pretty much find a job wherever I want but the financial aspect of it seems discouraging especially with the cost of overhead and having to see 40 patients per day to have a reasonable income (~150K take home). Looks like FM have to work increasingly hard to make that much income and you can potentially work a lot less as a rheumatologist and still have a decent income.

I would also appreciate some suggestions.

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  • 3 months later...
On 3/28/2021 at 5:28 AM, bellejolie said:

If salary is the differentiating factor for you then really personally I don’t think there’s a huge difference. IM is 5 years vs fam med 2 years where you can start paying off loans much sooner and make $1million total in those extra 3 years if you start working earlier. The pay difference between the two isn’t that much. It’s not like radiology/optho vs fam med. Plus job market is obviously better in family and you can be much more mobile. These are not two specialties where salary difference is insane. Also doctors generally do very well. Avg Canadian income is $50K let’s not forget so anything above 300K already puts us in the top 1% of the population. You will be fine money wise whichever you choose so focus on the residency training, and actual specialty differences as opposed to salary in making your decision IMO. 

I don't think you would make a million in FM in those extra 3 years but I agree with you that you are out sooner and can start paying your loans and invest.

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  • 2 weeks later...
On 4/1/2021 at 10:52 PM, MedZZZ said:

Hi, I wasn't sure if I should make a different post but I am in the exact similar situation and I dreading finalizing my ROL because I cannot decide if I want to rank my home IM or FM program first :(

I like Medicine and I enjoy the intellectual stimulation of IM but at the same time, I am in my 30s already and thinking about a 5 year residency program (at least 3 years of avg 1 in 4 calls) with the uncertainty of matching to my desired specialty (Rheumatology) in my desired location and also having to work really hard and try to impress everyone for a successful second round of CaRMS sounds very daunting to me (maybe I am just so tired after going through CaRMS)!

I can also see myself doing FM; the flexibility is a huge BONUS for me as I like to live in an urban area and I know I can pretty much find a job wherever I want but the financial aspect of it seems discouraging especially with the cost of overhead and having to see 40 patients per day to have a reasonable income (~150K take home). Looks like FM have to work increasingly hard to make that much income and you can potentially work a lot less as a rheumatologist and still have a decent income.

I would also appreciate some suggestions.

I would choose FM, Fam docs definitely do not only take 150k take home, even in the worst case you could work as a hospitalist and make 250k with no overhead and there are plenty of jobs like that in the GTA. It sounds like FM is the better option for you, I don't think the additional salary of IM would even pay off for you until maybe your 50s and that is assuming you don't land a FHO. 

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12 hours ago, Edict said:

I would choose FM, Fam docs definitely do not only take 150k take home, even in the worst case you could work as a hospitalist and make 250k with no overhead and there are plenty of jobs like that in the GTA. It sounds like FM is the better option for you, I don't think the additional salary of IM would even pay off for you until maybe your 50s and that is assuming you don't land a FHO. 

Thank you for your advice :) I have been reading a lot in this forum and it seems like everyone is saying the additional salary in IM would pay off in the next 10 years or it takes a lot of specialists decades to catch up. I am wondering if someone could clarify this as it doesn't really make sense to me?

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8 hours ago, MedZZZ said:

Thank you for your advice :) I have been reading a lot in this forum and it seems like everyone is saying the additional salary in IM would pay off in the next 10 years or it takes a lot of specialists decades to catch up. I am wondering if someone could clarify this as it doesn't really make sense to me?

I'll try to explain it how I conceptualize it in my head:

  • To become a Family doctor (FM) it takes 2-years after medical school (excluding +1 years).
  • Residency for most specialties is 5-years (4 if you do IM without subspecialty -> but GIM can be 5-years if you go down that route).
  • Therefore, there is a difference, on average, of three years where the FM is making attending income while the specialist is only making resident income.

Because there is a wide spectrum of incomes within an individual specialty it is hard to say who will come out ahead or how long it would take a specialist to catch up (or even if they do!). During those 3-years as a FM, you also have to consider that you may be able to pay down school debt faster compared to the specialist, that you can take advantage of time in the market and invest your money long term, start "real life", and may have access to more signing bonuses/government incentive programs as FM is in high demand. This also doesn't consider lifestyle considerations. 

Excluding the concept of investing your money (which also would have a big impact!), let's run through two scenarios.

Someone fact check me on this, but I set up basically two linear equations and just solve for where the lines intersect as the point where one specialty comes ahead. First, using resident salaries consider that a FM makes e.g., $65K + 70K during residency, while the IM (lets use the 4-year IM as the example) makes 65 + 70 + 75 + 80K over their residency (basically the rough salary/year during residency across Canada). 

FM y intercept = residency salary + attending income while the IM is still in residency; FM slope = attending income/year

IM y intercept = residency salary; IM slope = attending income/year 

Scenarios:

A) FM collects 200k/year after overhead and IM collects 350K/year after overhead.

  • FM has 2 years of making attending income (400k + resident salary [65+70 = 135]) while the IM resident only makes their resident salary (65 + 70 + 75 + 80K = 290k).
  • FM line = 535 + 200x 
  • IM line =290 + 350x  
  • solve for x: 290 + 350x = 535 + 200x
  • x = 1.6 years

So in this scenario, 1.6-years after the IM has finished residency, they have caught up to the FM physician (or 3.6-years after the FM finished their residency). BUT, this does not take into account lifestyle factors, investments, etc that the FM has made. Both physicians also has the option to work more or less, so considering impact of lifestyle is important also.

b) FM collects 350k/year (reasonable in some settings and I know FMs who collect more) after overhead AND received a 20k signing bonus plus 50K retention grant vs. IM collects 400K/year after overhead.

  • FM has 2 years of making attending income (700k + resident salary [65+70 = 135] + 20k signing bonus + 50K retention grant) while the IM resident only makes their resident salary (65 + 70 + 75 + 80K = 290k).
  • FM line = 905 + 350x
  • IM line = 290 + 375x
  • solve for x: 290 + 375x = 905 + 350x
  • x =  ~24.6

So in this scenario, 24.6-years after the IM has finished residency, they have caught up to the FM physician (or 26.6-years after the FM finished their residency). BUT, this does not take into account lifestyle factors, investments, etc that the FM has made with that initial income they received. Basically in this scenario, the high billing IM did catch up to the high billing FM  as they near retirement age. However, I feel like it's unlikely to keep this level of billing up over your whole career. This also doesn't take into account the time value of money the FM would have had with that early attending income.

Okay so while these scenarios are not entirely accurate, you can play around with them to have a very rough idea of FM vs. other specialties billings and break even points. Based on billings there are scenarios where the FM can come out way ahead. If you enjoy FM and aren't in love with any specialty, I believe it can be a very good option financially.

If you are visual you could also plot this out to see the relationships on a graph. ALSO someone please fact check me because this is my mental model I have been using for this question! Obviously this doesn't take into account things like tax, which would also impact on these calculations.

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