Are physician salaries in Canada a bubble that is waiting to pop?

[zxcccxz]

1 hour ago, whatdoido said:

i'm so tired of the "don't go into medicine for money" argument. people constantly say if you're after money, go into finance, tech, or engineering. fact is, engineers do not make on average $350k-400k a year like physicians do (this is the average. many will bill into the 7 figures depending on speciality/workload). most of my friends who went into business work as consultants or in a bank making $60-70k a year. computer science is great but you will max out at $120k-150k/year as a senior coder/computer engineer.

of course, with all of these careers, you WILL have the outlier who makes $200-300k+ or even gets into 7 figures... but they're the outliers. they're the top of their field. however, EVERYBODY who graduates from a Canadian medical school is pretty much guaranteed $400k/year (before tax and overhead, yes). there's no other career with this level of job security and guaranteed mid-six figure earnings.

having said all of that, if you truly hate biology/medicine, the money will not make the career worth it.

People make the "don't go into medicine for the money" argument because the math has been done many times, and compared to someone like an engineer or a banker you don't get ahead financially usually into your 40s (or sometimes much later... e.g., consider a US family doctor with $250k debt and high malpractice insurance costs in a big city). I won't re-hash this since you can easily look up these analyses. Something that also needs to be considered is that it's not really fair to make a "average doctor" vs. "average engineer" comparison. To even get a position in any med school you have to be among the very top of the student in your cohort, and people who become physicians are in general quite intelligent, hardworking, and have things like soft-skills which in other fields, in a barrier to advancement to management-level positions for many. 

So if we compare the top students in pre-med program (since only these people will get into med) with the top students in an engineering program, you can see why it's not such as sweet deal anymore. Starting salaries at for full-time engineers at FAANG companies are $150k and push a million at director/senior director level positions. Not to mention stock options, bonuses etc. which you don't get as a physician. Or that they don't have overhead like you will. Oh yeah, and the years of slaving away as a resident/fellow while making a measly salary that will barely cover your student loans while your engineering friends are making returns from having their money in the market. 

Medicine is a sweet deal yes--job security, satisfaction, and prestige being a big element of it--that's why so many want it. But pretending that it's like winning the lottery is a very naive view IMO.

[JohnGrisham]

1 hour ago, whatdoido said:

most of my friends who went into business work as consultants or in a bank making $60-70k a year. computer science is great but you will max out at $120k-150k/year as a senior coder/computer engineer.

I think this is just a difference in observer-ship bias and personal social circle differences.  Myself with just a simple bachelor degree was making more than your supposed banking consultant friends before i left for medical school.  Certainly i think the terminology may be causing confusion, because i know a fair number of business consultants due to my before medical school life, and no one i know is only making 60k. That is the wage of a fresh junior business sales rep, not business consultants. Heck, i was making 60k adjusted as a junior co-op student without much skills at all(and this was very common). Most of my friends with BComms and BAscs were all making >100k within a few years of graduation. The ones who are highly motivated, have moved around different roles and worked their way up, and are now clearing near 150-180k(but also working reasonably hard 60 hour+ work weeks). 

Also, not sure why you are including friends who work "in a bank" - that is not a highly sought after or difficult realm to get into retail banking... A few friends started there and promptly moved into commercial once they got a foothold and realized they had a lot more to offer than being retail bank product salespeople.

The lowest paid of my computer science friends are around 110kCAD working in Canada, in a more relaxed environment. The rest all make much much more working in the U.S. or remotely making USD but living in Canada full-time. And certainly not in "senior" positions. Senior in the sense they have been working for >5 years, but not in hierarchy. 

I think this is just a difference in observer-ship bias and personal social circle differences.

--

But I agree medicine generally pays well, but if you factor in time, effort and requirements - and the 60% that will be in family medicine/psychiatry/gen peads... it isn't as rosy as you paint. 

The math based on my pre medicine income, to my trajectory in medicine towards primary care, shows I won't surpass my income stream until my late 40s.  The benefits are that i can pick up extra work, work longer hours, or choose to work less, take a lot more vacation(potentially), and be very portable. Whereas if i had my income that missed with medical school and residency, that could have been invested sooner - compounded; and I could have bought a house sooner (and saved at least 600k based on my market).  Still worth it for me due to my interest in medicine, but it definitely wasn't the best financial decision for my personal situation. More money later on in life, but less money earlier in life so to speak. 

[deeman101]

2 hours ago, JohnGrisham said:

I think this is just a difference in observer-ship bias and personal social circle differences.  Myself with just a simple bachelor degree was making more than your supposed banking consultant friends before i left for medical school.  Certainly i think the terminology may be causing confusion, because i know a fair number of business consultants due to my before medical school life, and no one i know is only making 60k. That is the wage of a fresh junior business sales rep, not business consultants. Heck, i was making 60k adjusted as a junior co-op student without much skills at all(and this was very common). Most of my friends with BComms and BAscs were all making >100k within a few years of graduation. The ones who are highly motivated, have moved around different roles and worked their way up, and are now clearing near 150-180k(but also working reasonably hard 60 hour+ work weeks). 

Also, not sure why you are including friends who work "in a bank" - that is not a highly sought after or difficult realm to get into retail banking... A few friends started there and promptly moved into commercial once they got a foothold and realized they had a lot more to offer than being retail bank product salespeople.

The lowest paid of my computer science friends are around 110kCAD working in Canada, in a more relaxed environment. The rest all make much much more working in the U.S. or remotely making USD but living in Canada full-time. And certainly not in "senior" positions. Senior in the sense they have been working for >5 years, but not in hierarchy. 

I think this is just a difference in observer-ship bias and personal social circle differences.

--

But I agree medicine generally pays well, but if you factor in time, effort and requirements - and the 60% that will be in family medicine/psychiatry/gen peads... it isn't as rosy as you paint. 

The math based on my pre medicine income, to my trajectory in medicine towards primary care, shows I won't surpass my income stream until my late 40s.  The benefits are that i can pick up extra work, work longer hours, or choose to work less, take a lot more vacation(potentially), and be very portable. Whereas if i had my income that missed with medical school and residency, that could have been invested sooner - compounded; and I could have bought a house sooner (and saved at least 600k based on my market).  Still worth it for me due to my interest in medicine, but it definitely wasn't the best financial decision for my personal situation. More money later on in life, but less money earlier in life so to speak. 

Good analysis. One that I would mostly echo. I've kept an informal cohort analysis of my high school friends and I think the biggest misconception I had when comparing cross-profession income is the difference in personal intelligence and aptitude. My friends of similar aptitude to me in engineering/compsci/business could easily make enough to rival average doctor pay across most specialties. If you adjust for $/hours work (ignoring opportunity cost) and add in overhead/costs to practice it won't be close. Having said that, there are plenty of ways to make a lot of money as a doc if you're willing to come down on some ethics and morals. I know about 10-15 staff physicians billing in the $1-3.5mill range and don't work crazy hours.

Other thing that I think most incorporated physicians realize is you may make $400-500k but you won't feel like you do. Thats because the urge is strong to leave as much as possible in the PC for tax deferral so you don't end up having access to that much cash to spend. 

Last thing, even when you eventually consciously/subconsciously realize what being a doctor means, which is basically a highly skilled labourer churning through an assembly line of patients proficiently making clinical decisions from the brainstem level 99% of the time, and then realize the pay is not so sky-high and the drawbacks of how you're treated by your overlords / government is maybe not the best deal you could've made for yourself in life, you can at least take some comfort in the relative freedom we have in determining your own schedules, where you work most of the time, and what kind of medical practice environment you are engaged in. Those are intangible perks that are often very lacking in other fields. 

[deeman101]

4 hours ago, whatdoido said:

however, EVERYBODY who graduates from a Canadian medical school is pretty much guaranteed $400k/year (before tax and overhead, yes). there's no other career with this level of job security and guaranteed mid-six figure earnings.

My dude. No...... 

[1029384756md]

Having been in and out of medicine, I'd say the real perks of medicine are its high earnings floor, career longevity, and career flexibility. Money, work environment, scheduling, WLB, etc all together can be better elsewhere. As you get older, you start to appreciate how comforting true career longevity feels.

[whatdoido]

4 hours ago, zxcccxz said:

People make the "don't go into medicine for the money" argument because the math has been done many times, and compared to someone like an engineer or a banker you don't get ahead financially usually into your 40s (or sometimes much later... e.g., consider a US family doctor with $250k debt and high malpractice insurance costs in a big city). I won't re-hash this since you can easily look up these analyses.

Yes, this is true for primary care in US, but we're in Canada. Our tuition is $25k/year. A lot of this can be subsidized with OSAP grants and scholarships. Speaking from my personal experience, so far I have received $10k in grants from OSAP and about $15k in scholarships, effectively paying my tuition for the year. Many students I know are granted similar help. Even without any subsidies, $100k (+living costs, but this is a constant anyways) at prime - 0.25% will not be difficult to pay off as a family med resident and attending. I would never ever do primary care in the states because there it is absolutely not worth it and pretty well any other career will net you a better lifestyle + financial health, but again, we're in Canada.

Having said that, I'm basing my opinions off of pursuing family med, which imo is very well akin to a lottery win if you get in before the age of 24-25. With other specialties, the math probably works out such that you break even much later, but I'm of the opinion that you shouldn't pursue any speciality unless you're very passionate about it- the rigorous and underpaid years as a resident (as well as lost income) aren't worth it imo.

4 hours ago, zxcccxz said:

Something that also needs to be considered is that it's not really fair to make a "average doctor" vs. "average engineer" comparison. To even get a position in any med school you have to be among the very top of the student in your cohort, and people who become physicians are in general quite intelligent, hardworking, and have things like soft-skills which in other fields, in a barrier to advancement to management-level positions for many. 

This is my point, though. If you're of the caliber and intelligence and discipline to get into a medical school in Canada (not the Carribean, not Ireland, not even the US), you're probably better off pursuing that rather than engineering/CS/finance/whatever other career field unless you're already established in such a field (and if you can tolerate medicine). My point is, it's very easy to say that others in these careers will achieve these very high-paying positions (and I'm sure someone who could have gained admission has the intelligence and drive to do so), but there's only so many to give out whereas an MD will guarantee you the same (or more) income. As a rule, your average MD will make more than your average computer scientist or your average engineer. Not every engineer is on the career track to a senior manager or whatever. I will also point out that these promotions typically happen 10+years into someone's career, so it's not like you start there after a 4-year degree.

4 hours ago, zxcccxz said:

So if we compare the top students in pre-med program (since only these people will get into med) with the top students in an engineering program, you can see why it's not such as sweet deal anymore. Starting salaries at for full-time engineers at FAANG companies are $150k and push a million at director/senior director level positions. Not to mention stock options, bonuses etc. which you don't get as a physician. Or that they don't have overhead like you will. Oh yeah, and the years of slaving away as a resident/fellow while making a measly salary that will barely cover your student loans while your engineering friends are making returns from having their money in the market. 

Again, not every engineer is going to start at a FAANG company. These are very prestigious and difficult positions to achieve. I'd also like to see a source for that $150k- the research I've done shows an average starting salary of $110k. Also, most of these positions require living in tech cities with extremely high cost of living, so unless you can manage a remote gig, you're typically not as well off as your salary would suggest.

4 hours ago, JohnGrisham said:

I think this is just a difference in observer-ship bias and personal social circle differences.  Myself with just a simple bachelor degree was making more than your supposed banking consultant friends before i left for medical school.  Certainly i think the terminology may be causing confusion, because i know a fair number of business consultants due to my before medical school life, and no one i know is only making 60k. That is the wage of a fresh junior business sales rep, not business consultants. Heck, i was making 60k adjusted as a junior co-op student without much skills at all(and this was very common). Most of my friends with BComms and BAscs were all making >100k within a few years of graduation. The ones who are highly motivated, have moved around different roles and worked their way up, and are now clearing near 150-180k(but also working reasonably hard 60 hour+ work weeks). 

Also, not sure why you are including friends who work "in a bank" - that is not a highly sought after or difficult realm to get into retail banking... A few friends started there and promptly moved into commercial once they got a foothold and realized they had a lot more to offer than being retail bank product salespeople.

I wasn't being very accurate with my job titles, so you're right about using the wrong terminology. My point is my friends were business, engineering and computer science graduates. They were all top of their class, fyi, and completed many co-ops/internships/what-have-you to network/establish themselves in their respective fields. Most started at $60k-70kCAD/year salaries, some started at $80k USD (engineering or software dev jobs in the US). You obviously grow from there, but from the research I've done, most will max out at $150k CAD (gross, not net) unless you are singled out and placed on a route to a senior manager position. As I said above, this is difficult, doesn't happen until much later in your career, and only so many positions exist. It becomes a game of performing extremely well, pulling extremely long and difficult hours, and lots of rubbing elbows and licking butt. Just to begin making what you would make as a family physician at age 28/29 in Canada.

Mind you, these salaries are great and certainly higher than the average Canadian household, but again, it's not easy to achieve and a Canadian physician will still usually make more.

4 hours ago, JohnGrisham said:

The lowest paid of my computer science friends are around 110kCAD working in Canada, in a more relaxed environment. The rest all make much much more working in the U.S. or remotely making USD but living in Canada full-time. And certainly not in "senior" positions. Senior in the sense they have been working for >5 years, but not in hierarchy. 

I've had my toe in the field for quite a bit (self-taught developer). I was making $100/hour USD as a freelancer prior to beginning med school. Obviously we are comparing anecdotes here, but I'll have to disagree that a $110k CAD salary is typical, unless they are senior developers (not in hierarchy, but in skill level/competence). Toronto developers usually average around $80k. They cap at around $120k-150k depending on the stack they're using and how niche it is. The upper salaries are usually reserved for people managing a team, no longer actually doing any development work.

https://www.**DELETED**.com/r/PersonalFinanceCanada/comments/igynyo/what_are_software_engineers_making_these_days_in/

I think you're vastly overestimating just how much folks in CS make.

Anyways, working remotely and making USD while living somewhere in rural Ontario with a low cost of living is a great gig, but even then, the money doesn't compare to the same hours as a family physician.

As for the more relaxed environment- again, past residency, family med is usually a pretty chill gig. I'd wager a developer making $150k/year is pulling a lot more hours/dealing with a lot more stress than a family doc.

4 hours ago, JohnGrisham said:

But I agree medicine generally pays well, but if you factor in time, effort and requirements - and the 60% that will be in family medicine/psychiatry/gen peads... it isn't as rosy as you paint. 

The math based on my pre medicine income, to my trajectory in medicine towards primary care, shows I won't surpass my income stream until my late 40s.  The benefits are that i can pick up extra work, work longer hours, or choose to work less, take a lot more vacation(potentially), and be very portable. Whereas if i had my income that missed with medical school and residency, that could have been invested sooner - compounded; and I could have bought a house sooner (and saved at least 600k based on my market).  Still worth it for me due to my interest in medicine, but it definitely wasn't the best financial decision for my personal situation. More money later on in life, but less money earlier in life so to speak. 

Actually, I think family medicine in Ontario is the best bang for your time/energy. Making $400k/year as a 28 year old is nothing to sneeze at. You can work anywhere. You can work part-time and if you bill intelligently, you can make as much as someone working full-time in one of these other fields with months and months of free time to yourself/your other interests. I certainly wouldn't be able to afford to work part time as a developer or someone in finance at the beginning of my career, but if I wanted to, I could work half the year as a hospitalist or other locum gig and make more than the avg household in Canada. Try doing that as a developer and still having that high-paying job (which will usually require insane hours, btw) when you come back.

I can't speak to your personal situation. I think much of medicine is delayed gratification- you are sacrificing a lot of your youth and earning potential to have an excellent quality of life in your middle/later years. Life expectancy is ever increasing (thanks, medicine), so it's not like your life is near over in your late forties...

I do think if you enter medicine later in life, it begins to have rapidly diminishing returns re: the financials, especially if you already had a good paying career that you enjoyed with potential for growth. You'd better adore medicine to leave that.

1 hour ago, deeman101 said:

My dude. No...... 

Okay, I'll bite. What specialty in Canada working full time and who knows how to bill properly doesn't gross at least $350-400k a year?

[deeman101]

22 minutes ago, whatdoido said:

Okay, I'll bite. What specialty in Canada working full time and who knows how to bill properly doesn't gross at least $350-400k a year?

I recommend familiarizing yourself with actual data. Here's CIHI data on the subject: https://www.cihi.ca/en/a-profile-of-physicians-in-canada-2019

 

Family docs make up ~50% of Canadian physicians so the median will almost certainly be lower than the average of $350k. And this excludes the salaried physicians which make up 1/3rd of Canadian docs and generally (not always) earn lower than their FPP counterparts. The lowest 1.0 FTE salaried position I've personally heard of as an employment offer for FM is $115k in a Quebec CLSC clinic to carry a patient panel of about 1500-2000.

[whatdoido]

21 minutes ago, deeman101 said:

I recommend familiarizing yourself with actual data. Here's CIHI data on the subject: https://www.cihi.ca/en/a-profile-of-physicians-in-canada-2019

 

Family docs make up ~50% of Canadian physicians so the median will almost certainly be lower than the average of $350k. And this excludes the salaried physicians which make up 1/3rd of Canadian docs and generally (not always) earn lower than their FPP counterparts. The lowest 1.0 FTE salaried position I've personally heard of as an employment offer for FM is $115k in a Quebec CLSC clinic to carry a patient panel of about 1500-2000.

one source out of the many i've reviewed over the years. i dont think 280k gross for FFS is accurate. search other official sources or even this forum for more accurate data.

[deeman101]

1 minute ago, whatdoido said:

one source out of the many i've reviewed over the years. i dont think 280k gross for FFS is accurate. search other official sources or even this forum for more accurate data.

....you want more official data than CIHI........you think the Canadian government actually has no idea how much they pay doctors out of their own budget? You'd rather believe data from an internet forum instead?

[whatdoido]

Just now, deeman101 said:

....you want more official data than CIHI........you think the Canadian government actually has no idea how much they pay doctors out of their own budget? You'd rather believe data from an internet forum instead?

no, i don't think it's an accurate picture of what family physicians seeing more than 20 patients a day gross. a ton of FPs also work less than part time and bill less than 100k and i'm sure that brings the avg way down. if money is the goal, there's tons of ways to gross 350k+ (working weekends in rural communities, seeing more patients per hour, maximizing billing...)

[deeman101]

1 minute ago, whatdoido said:

no, i don't think it's an accurate picture of what family physicians seeing more than 20 patients a day gross. a ton of FPs also work less than part time and bill less than 100k and i'm sure that brings the avg way down. if money is the goal, there's tons of ways to gross 350k+ (working weekends in rural communities, seeing more patients per hour, maximizing billing...)

I'm sorry man. Whatever helps you sleep at night but cold reality hits when you start your practice. Maybe this is why so many new-in-practice docs are so disgruntled. My wife as a FM does hit $350k-$380k billing in the most lucrative province (Alberta) working semi-rurally but its not a relaxed 8hr day, 5 days a week pace. You're not going to hit your billing targets by seeing 20 patients a day 5 days a week at an average of $45 per visit. If you're averaging above $45/visit in Ontario you more than likely have a complex patient panel that you likely can't pump through 20/day with (assuming competent medical care) including visit time, charting, billing, and doing referral letters/insurance forms etc. 

Here's Ontario's fee codes if you want to try some math. Try to gross $350k with 8 hour days, 5 days a week without fraudulently billing (1 comprehensive care visit per patient per year, 75 minutes minimum!). https://www.dr-bill.ca/ohip_billing_codes/10/family-practice-practice-in-general. Of course if you expand your hours / days worked you can make it happen if you work hard enough. Residency will train you to work way harder than the average Canadian anyways. But those CIHI numbers are not lying to you about the averages.

You think the $363k average for medical specialists is also a lie? Are there really that many part-time medical specialists to explain them barely making more than what you think FMs make on average?

 

[1D7]

7 hours ago, whatdoido said:

Okay, I'll bite. What specialty in Canada working full time and who knows how to bill properly doesn't gross at least $350-400k a year?

Most pediatric and pediatric subspecialties, many outpatient FM, many outpatient psychs, and a few of the IM subspecialties. Academics will also usually have lower income than their community counterparts.

Those combined probably encapsulate more than 50% of physicians FYI.

Quote

most of my friends who went into business work as consultants or in a bank making $60-70k a year

...

I wasn't being very accurate with my job titles, so you're right about using the wrong terminology. My point is my friends were business, engineering and computer science graduates. They were all top of their class, fyi, and completed many co-ops/internships/what-have-you to network/establish themselves in their respective fields. Most started at $60k-70kCAD/year salaries, some started at $80k USD (engineering or software dev jobs in the US).

Sorry but they were definitely not top of their class. If you are "top of the class" in a solid business program you can start at a IB firm making >120k/yr, and probably a good amount more than that with bonus.

That said I think medicine is still well paid. FM is a good career choice, assuming it's something that one enjoys. What you described in terms of seeing more pts per hour does increase income... but by definition you no longer have a chill job because you're now grinding away. Even working rurally and doing 7-8am hospitalist rounds, 8am-5pm clinic, followed by a ER shift, is not something everyone can or wants to do.

I know FMs who are doing very well but mostly it's because they joined the right practice (FHO) at the right time. This is not something a new graduate can rely on.

 

[rice]

FWIW, I have several friends from high school that went into tech (while I went down the med school route). We were all around the same competency in high school (above average but not geniuses). I'm now in my PGY-2 year, and ALL of them are in the States now. The lowest earning among them makes 150k USD, and the highest makes 250k. If you're a bright student to get into med school early on (which is the only way to make this path break even imo), then you would definitely be better off financially having gone into CS instead. It's just the way it is. They all work way less hours than me too and it's all WFH, mostly at their own pace. The only way to outpace it is to get into med school early, then do rads or ophtho.

Of course, none of this should matter because hopefully people are going into med school because they enjoy it. And yes, medicine does have the benefits of portability, flexibility, prestige, etc. as an attending. But strictly financially speaking, it's almost never worth it if you're "smart" enough to excel in a select few other fields.

[JohnGrisham]

22 hours ago, whatdoido said:

no, i don't think it's an accurate picture of what family physicians seeing more than 20 patients a day gross. a ton of FPs also work less than part time and bill less than 100k and i'm sure that brings the avg way down. if money is the goal, there's tons of ways to gross 350k+ (working weekends in rural communities, seeing more patients per hour, maximizing billing...)

Ontariocentric data and walk-in style churn style of practice is likely colouring your perception is the likely source of disagreement.

I've been in a few provinces, and will say Ontario FHO/FHT is the top tier of payment for effort, that is not resembled in many other provinces. 

[JohnGrisham]

On 7/27/2021 at 10:53 PM, whatdoido said:

've had my toe in the field for quite a bit (self-taught developer). I was making $100/hour USD as a freelancer prior to beginning med school. Obviously we are comparing anecdotes here, but I'll have to disagree that a $110k CAD salary is typical, unless they are senior developers (not in hierarchy, but in skill level/competence). Toronto developers usually average around $80k. They cap at around $120k-150k depending on the stack they're using and how niche it is. The upper salaries are usually reserved for people managing a team, no longer actually doing any development work.

https://www.**DELETED**.com/r/PersonalFinanceCanada/comments/igynyo/what_are_software_engineers_making_these_days_in/

I think you're vastly overestimating just how much folks in CS make.

Anyways, working remotely and making USD while living somewhere in rural Ontario with a low cost of living is a great gig, but even then, the money doesn't compare to the same hours as a family physician.

As for the more relaxed environment- again, past residency, family med is usually a pretty chill gig. I'd wager a developer making $150k/year is pulling a lot more hours/dealing with a lot more stress than a family doc.

Again, I can only go based on my anecdotes - but the vast majority of my friends and social network outside of medicne, and my spouse's network are all business and tech grads, who all generally fit the mold of the wage trajectory i mentioned.  I can't say that they were all top top top tier university grads, mostly normal people  within the university sub-group, who worked hard and had good drive. But maybe thats just blinders.

This is a sample size of likely n=100 of immediate friends/acquaintances and their immediate spouses. 

Again, like i mentioned, even during my co-op terms, most of us made adjusted wages closer to 60k per year, and most of my close friends out of university were making closer to 100k and progressed upwards from there. Now are all settled down in their careers with homes, kids etc etc. 

I just helped my younger cousin with his 5th round of interviews with a tech company for a junior non-dev role focused on retail partner acquisition, and his offers were as follows: 80k base + stock/comp packages to 90k, 85K+25k options,  60k with performance bonus for likely 110k medium and top 20% hitting 120k.  These are all Toronto tech companies.   He has a psychology degree, with 1 year of experience during covid at a local consumer tech sales company making 65k.   For a similar role in the US that he applied to, he was offered 105k USD total compensation package.  (edited for currency). In a big city with lower COL than toronto.

Actual tech oriented roles are generally making at least that if not more, assuming you did co-op and have some experience.  Canadian salaries are much lower yes, but not as pitiful as you paint for average to above average candidates. (Which is what we were talking about).

But of course, it could be the small chance that I somehow have exceptional social circle! Surely we have to look at the numbers in the context of the average to above average individuals in those fields - while excluding the ones who end up by happenstance with minimal experience and drag numbers down. 

[JohnGrisham]

21 hours ago, deeman101 said:

'm sorry man. Whatever helps you sleep at night but cold reality hits when you start your practice. Maybe this is why so many new-in-practice docs are so disgruntled. My wife as a FM does hit $350k-$380k billing in the most lucrative province (Alberta) working semi-rurally but its not a relaxed 8hr day, 5 days a week pace. You're not going to hit your billing targets by seeing 20 patients a day 5 days a week at an average of $45 per visit. If you're averaging above $45/visit in Ontario you more than likely have a complex patient panel that you likely can't pump through 20/day with (assuming competent medical care) including visit time, charting, billing, and doing referral letters/insurance forms etc.

This is the answer.

The next time a patient comes in, anxious and soft-signs for suicide, at 4;55pm, let me know how efficiently you can get through their visit, knowing you're billing 35$ and getting 30% taken off for over head...

[JohnGrisham]

Something that trainees often miss, is the unethical billing and sometimes fradulent(often due to ignorance) billing that occurs in FFS practices in many provinces. Often it is normalized since everyone does it, but remember if the gov't decides to suddenly clamp down, there goes that niche way to keep your billings padded. 

[indefatigable]

17 hours ago, JohnGrisham said:

Again, like i mentioned, even during my co-op terms, most of us made adjusted wages closer to 60k per year, and most of my close friends out of university were making closer to 100k and progressed upwards from there. Now are all settled down in their careers with homes, kids etc etc. 

I just helped my younger cousin with his 5th round of interviews with a tech company for a junior non-dev role focused on retail partner acquisition, and his offers were as follows: 80k base + stock/comp packages to 90k, 85K+25k options,  60k with performance bonus for likely 110k medium and top 20% hitting 120k.  These are all Toronto tech companies.   He has a psychology degree, with 1 year of experience during covid at a local consumer tech sales company making 65k.   For a similar role in the US that he applied to, he was offered 105k USD total compensation package.  (edited for currency). In a big city with lower COL than toronto.

Actual tech oriented roles are generally making at least that if not more, assuming you did co-op and have some experience.  Canadian salaries are much lower yes, but not as pitiful as you paint for average to above average candidates. (Which is what we were talking about).

 

On 7/28/2021 at 1:53 AM, whatdoido said:

Again, not every engineer is going to start at a FAANG company. These are very prestigious and difficult positions to achieve. I'd also like to see a source for that $150k- the research I've done shows an average starting salary of $110k. Also, most of these positions require living in tech cities with extremely high cost of living, so unless you can manage a remote gig, you're typically not as well off as your salary would suggest.

I wasn't being very accurate with my job titles, so you're right about using the wrong terminology. My point is my friends were business, engineering and computer science graduates. They were all top of their class, fyi, and completed many co-ops/internships/what-have-you to network/establish themselves in their respective fields. Most started at $60k-70kCAD/year salaries, some started at $80k USD (engineering or software dev jobs in the US). You obviously grow from there, but from the research I've done, most will max out at $150k CAD (gross, not net) unless you are singled out and placed on a route to a senior manager position. As I said above, this is difficult, doesn't happen until much later in your career, and only so many positions exist. It becomes a game of performing extremely well, pulling extremely long and difficult hours, and lots of rubbing elbows and licking butt. Just to begin making what you would make as a family physician at age 28/29 in Canada.

Strictly looking at the numbers from levels.fyi for software engineering/CS in TO suggests that the median total compensation there is around 160k/year across all years of experience and positions (which are verified salaries).  It seems there's some correlation with experience, but it's not a perfect correlation for sure - more correlation with seniority (company name is obviously v. important too).  

Only 10% of the salaries posted (about 500) are under 100K.  There could be some sampling or selection bias though (these seems like higher end jobs)

 While 160K/yr is nothing to be ashamed of, it's not much of a windfall either given COL.  I can't imagine too many MDs wanting to live in TO at that rate.  

Tech can be difficult to have a longer career, given burnout, high work demands, and chances of becoming obsolete.  I also think that tech and medicine tend to build on different strengths - can be some overlap for sure, but not sure if the average soft eng would like medicine and vice versa.

There's a discussion on *DELETED* which suggest median for Canada is quite a bit lower.

https://www.levels.fyi/Salaries/Software-Engineer/Toronto-Canada/

 

 

[deeman101]

49 minutes ago, indefatigable said:

 

Strictly looking at the numbers from levels.fyi for software engineering/CS in TO suggests that the median total compensation there is around 160k/year across all years of experience and positions (which are verified salaries).  It seems there's some correlation with experience, but it's not a perfect correlation for sure - more correlation with seniority (company name is important too).  

Only 10% of the salaries posted (about 500) are under 100K.  There could be some sampling or selection bias though (these seems like higher end jobs)

 While 160K/yr is nothing to be ashamed of, it's not much of a windfall either given COL.  I can't imagine too many MDs wanting to live in TO at that rate.  

Tech can be difficult to have a longer career, given burnout, high work demands, and chances of becoming obsolete.  I also think that tech and medicine tend to build on different strengths - can be some overlap for sure, but not sure if the average soft eng would like medicine and vice versa.

There's a discussion on *DELETED* which suggest median for Canada is quite a bit lower.

https://www.levels.fyi/Salaries/Software-Engineer/Toronto-Canada/

 

 

Living off $150k is not far off what a lot of physicians actually live with. I don't know why this is continuously glossed over in this thread but billing $310k (the actual mean FM billings in ON) doesn't mean you actually have $310k for yourself. Physicians are basically running small businesses. In the same way your local bakery store owner is not mega rich for grossing $800k revenue a year because of expenses before they take money home. You take off overhead, professional expenses, and your savings that you want to tax defer for retirement and what you're left with is around that $150k mark for declared personal income. There was a study done in the last 2 years based on CRA revenue data on family docs that did show taxed income was averaging $150k. Conversely, my friends in compsci per your example do have base salaries in that range but also make year-end performance bonuses in the $25-50k range and have preferred stock options, pension options, free hardware support (phones, computers, etc.), COLA adjustments and negligible professional fees. They actually live a pretty equivalent life to most FMs I know in Toronto (minus work hours).

[deeman101]

I'm not sure if OMA tracks this kind of stuff as carefully but here's a breakdown from the AMA for full-time physicians on actual gross compensation. And again I know from multiple people going back-and-forth between AB and ON that, save for a few special practice situations in ON, the AB FMs make more money.

As you can see, $340k gross billings in 2019 but heavily right skewed. 1/4 of them billed over $400k, 1/6 of them billed over $500k. As a side note, the lone FM billing $2mill there now has her license suspended and is indicted on criminal charges based on fraudulent billing.

[JohnGrisham]

36 minutes ago, deeman101 said:

Taxed income was averaging $150k

To be fair, its because many are also keeping income in professional corporations for investment, and around 150k is the usual ideal amount to withdraw from the corporation.

 

[indefatigable]

3 hours ago, deeman101 said:

Living off $150k is not far off what a lot of physicians actually live with. I don't know why this is continuously glossed over in this thread but billing $310k (the actual mean FM billings in ON) doesn't mean you actually have $310k for yourself. Physicians are basically running small businesses. In the same way your local bakery store owner is not mega rich for grossing $800k revenue a year because of expenses before they take money home. You take off overhead, professional expenses, and your savings that you want to tax defer for retirement and what you're left with is around that $150k mark for declared personal income. There was a study done in the last 2 years based on CRA revenue data on family docs that did show taxed income was averaging $150k. Conversely, my friends in compsci per your example do have base salaries in that range but also make year-end performance bonuses in the $25-50k range and have preferred stock options, pension options, free hardware support (phones, computers, etc.), COLA adjustments and negligible professional fees. They actually live a pretty equivalent life to most FMs I know in Toronto (minus work hours).

The distinction between gross billings vs take-home pay (with savings for pensions/benefits) is something that I've also found lost in many  discussions on these threads.  It's also something I'm well aware of after having worked in a different job prior to medicine.

However, the numbers that I quoted above were total compensation (including bonuses) and probably on the higher end given the company sampling and includes managerial positions.  The average salary on GlassDoor for Software Engineer in TO is much lower (around 95K/yr).

https://www.glassdoor.ca/Salaries/toronto-software-development-engineer-salary-SRCH_IL.0,7_IM976_KO8,37.htm

I don't think even the high-end estimate of 150K/yr+pension/benefits is that much in TO given COL.  3-4 x gross income would allow a mortgage of 400-600K which is really nothing in TO - barely a condo.  150K/year in a smaller community (with savings and without debt) could probably actually go pretty far, but it's a good point above explaining the number.    

I don't want to sidetracked into an argument on relativity, but there are many physicians that earn well above that amount after overhead .  FM is one of the lower paid disciplines (despite the fact it has the most practitioners).  

 

[deeman101]

17 minutes ago, indefatigable said:

The distinction between gross billings vs take-home pay (and savings for pensions/benefits) is something that I've also found lost in many  discussions on these threads.  It's also something I'm well aware of after having worked in a different job prior to medicine.

However, the numbers that I quoted above were total compensation (including bonuses) and probably on the higher end given the company sampling and includes managerial positions.  The average salary on GlassDoor for Software Engineer in TO is much lower (around 95K/yr).

https://www.glassdoor.ca/Salaries/toronto-software-development-engineer-salary-SRCH_IL.0,7_IM976_KO8,37.htm

I don't think even the high-end estimate of 150K/yr+pension/benefits is that much in TO given COL.  3-4 x gross income would allow a mortgage of 400-600K which is really nothing in TO - barely a condo.  

I don't want to sidetracked into an argument on relativity, but there are many physicians that earn well above that amount, after overhead - FM is one of the lower paid disciplines (despite the fact it has the most practitioners).  150K/year in a smaller community (with savings and without debt) could probably actually go pretty far, but it's a good point above.

 

The interesting thing is programmer pay has gone up drastically in the last 10 years at least in Toronto. One of my smartest friends got hired by a big bank into their stock exchange trading services division for $60k about 14 years ago now. The pay for that position has now drastically increased to closer to $100k. Physician pay has barely moved at all in comparison. 10 years ago I'd never talk about I.T. pay being comparable in any sense to physician pay.

Yes $150k is the magic number for marginal tax and is a major reason for physician taxable income to gravitate to that number. But for the physician population of interest (FM Ontario) its still not far off what they would take home post-overhead ($310k average @ 30% overhead = $217k). And assuming a reasonable savings amount (1/3rd of income) it still lands you pretty much $150k to be taxed on and roughly $100k ($8kish/mth) effectively to spend on yourself at the end of the day. Any Ontario FM want to check my math? I'm not FM myself. Unless you live in a low COL part of the country, it shouldn't come at as a surprise why most FMs drive Hondas and Toyotas and not Lambos and Ferraris.

[indefatigable]

46 minutes ago, deeman101 said:

The interesting thing is programmer pay has gone up drastically in the last 10 years at least in Toronto. One of my smartest friends got hired by a big bank into their stock exchange trading services division for $60k about 14 years ago now. The pay for that position has now drastically increased to closer to $100k. Physician pay has barely moved at all in comparison. 10 years ago I'd never talk about I.T. pay being comparable in any sense to physician pay.

Yes $150k is the magic number for marginal tax and is a major reason for physician taxable income to gravitate to that number. But for the physician population of interest (FM Ontario) its still not far off what they would take home post-overhead ($310k average @ 30% overhead = $217k). And assuming a reasonable savings amount (1/3rd of income) it still lands you pretty much $150k to be taxed on and roughly $100k ($8kish/mth) effectively to spend on yourself at the end of the day. Any Ontario FM want to check my math? I'm not FM myself. Unless you live in a low COL part of the country, it shouldn't come at as a surprise why most FMs drive Hondas and Toyotas and not Lambos and Ferraris.

Actually 14 years ago was the peak of the quant craze (before the big crash with CDOs) - big banks were paying $$$$, mostly in bonuses, to PhDs with CS skills.  100K still seems low for a an experienced coder, but better than 60K for sure - a lot software engineering depends on the company and how much rising stock prices figure into pay.

 I'm not sure where you're getting your numbers from - I have this reference from 2016 (it's a little dated), but still shows avg FM in ON is ~365K (about the same as AB).  As you've mentioned, there's a fairly sharp discrepancy between FFS vs FHO/FHT within ON.  Still, I think fees may have gone up a bit in ON - not sure in AB.  

An acquaintance brother ended up doing cosmetic plastics in NYC and I saw drives a high-end car.. Even staff in Canada that could afford to flash a Lambo/Ferrari probably wouldn't - a little conspicuous in most places (I'm sure in Vancouver/TO/Mtl there are some though..).  

Edit: Vancouver NeuroSurg suing $1M BC Public Insurer for crashed Ferrari (not the highest paid specialty/province either).  It looks like he billed a cool 1.3 M in 2020.

https://www.ctvnews.ca/canada/surgeon-demands-icbc-pay-out-nearly-1m-for-wrecked-ferrari-1.3840607

Radiologist in TO with a lambo (1M billing in 2018, #500 on the Star "list").

https://www.instagram.com/drvkhan/?hl=en

 

 

[deeman101]

2 hours ago, indefatigable said:

Actually 14 years ago was the peak of the quant craze (before the big crash with CDOs) - big banks were paying $$$$, mostly in bonuses, to PhDs with CS skills.  100K still seems low for a an experienced coder, but better than 60K for sure - a lot software engineering depends on the company and how much rising stock prices figure into pay.

 I'm not sure where you're getting your numbers from - I have this reference from 2016 (it's a little dated), but still shows avg FM in ON is ~365K (about the same as AB).  As you've mentioned, there's a fairly sharp discrepancy between FFS vs FHO/FHT within ON.  Still, I think fees may have gone up a bit in ON - not sure in AB.  

An acquaintance brother ended up doing cosmetic plastics in NYC and I saw drives a high-end car.. Even staff in Canada that could afford to flash a Lambo/Ferrari probably wouldn't - a little conspicuous in most places (I'm sure in Vancouver/TO/Mtl there are some though..).  

Edit: Vancouver NeuroSurg suing $1M BC Public Insurer for crashed Ferrari (not the highest paid specialty/province either).  It looks like he billed a cool 1.3 M in 2020.

https://www.ctvnews.ca/canada/surgeon-demands-icbc-pay-out-nearly-1m-for-wrecked-ferrari-1.3840607

Radiologist in TO with a lambo (1M billing in 2018, #500 on the Star "list").

https://www.instagram.com/drvkhan/?hl=en

 

 

$100k is that starting position which he got even before finishing undergrad. Which incidentally my friend is recruiting for right now. My friend himself is closer to $200k in the same firm excluding his side gig consulting business.

That table honestly does not seem accurate at all, judging purely from the AB numbers which I know well. Not from the Alberta Medical Association perspective or the Alberta Health funding perspective, and they are the two people sitting across each other at the table bargaining physician pay. And the AMA cross-province comparators definitely do not put ON FMs at $360k, or even above AB at $340Kish. If there was any permutation where that was the case they'd sure as hell slap that on the table during negotiations. CIHI data is directly collected from the provincial funders and is still seen as the most accurate numbers with the caveat that it only includes billings. If there was a blended cap model or salary system at play CIHI doesn't capture that.

CIHI for reference is Canadian Institute of Health Information and are funded by Health Canada since 1999 to report on a whole bunch of health outcomes stuff nationally, one being physician numbers and payment. It shouldn't be seen as just "another source" of data like the Toronto Star. Its literally the report from the sole payer of public healthcare in the country. 

I'm not saying I don't know docs that drive lambos and ferraris. The proportion of surgeons that do is quite healthy. I'm saying I know literally 2 FMs that drive something high end like that and they go all out billing in the $700k+ range. The vast majority of FMs don't and they represent the biggest fraction of doctors and also the lowest paid (usually) doctors. Thats what someone new to practice can expect in reality on average. If this thread was for top 5th percentile that want to know how-to-get-properly-rich-as-a-doctor then we can have a whole different set of conversations.