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


MasterDoc

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31 minutes ago, deeman101 said:

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. :cool:

 

 

You have to remember though that lambos and ferraris are only one way to spend your money. Given a 700k a year income i'm willing to bet more surgeons would choose to spend that extra money on a lambo than family doctors would. 

Also I have to say that the average family doctor does not work the same number of hours as the average surgeon usually because family doctors have that flexibility that many surgeons don't have.

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13 hours ago, deeman101 said:

$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. :cool:

 

 

The method of data collection was in the left hand column - it was actually the CIHI that collected the data, but they explicitly mention that they used gross payments rather than gross FFS to capture that nuance (AB it seems doesn't released gross payment level though).  One other thing to note (besides that it's 5-6 years old) is that it's done for "full-time" - i.e. physicians whose gross billings exceed 100K/yr.  Definitely some FPs may make the choice to work 1/2 or 2/3 time and still be able to bill over 100K, as implied above.  Plus, diagnostic (lab & imaging) specialties were not included in the table.  

BUt, I don't think you'll get much of an argument from me wrt FM pay - except for some unusual practice models (like pain), FPs will generally not be driving lambos, especially not in TO/Vancouver/Mtl.  There can easily be a 2-3x gross pay difference with avg FM vs avg lucrative specialty.  When calculating overall avg pay, they should at least do a weighted avg taking into account proportion of specialists in the discipline.  

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16 hours ago, Edict said:

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.

 

16 hours ago, Edict said:

You have to remember though that lambos and ferraris are only one way to spend your money. Given a 700k a year income i'm willing to bet more surgeons would choose to spend that extra money on a lambo than family doctors would. 

Also I have to say that the average family doctor does not work the same number of hours as the average surgeon usually because family doctors have that flexibility that many surgeons don't have.

Given the sentiment on these forums I am quite surprised to read that surgeons are driving lambos in Canada. It seems that people on here feel that surgeons are poorly compensated for what they do and IM usually has better bang for your buck. 

Can your average general surgeon or ortho really afford to whip around in Ferraris or lambos?

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14 minutes ago, MasterDoc said:

Given the sentiment on these forums I am quite surprised to read that surgeons are driving lambos in Canada. It seems that people on here feel that surgeons are poorly compensated for what they do and IM usually has better bang for your buck. 

Can your average general surgeon or ortho really afford to whip around in Ferraris or lambos?

I don't think anyone thinks surgeons are paid poorly. But there are a lot of issues with certain fields due to saturation, which has led to difficulties finding a full time job and increased training lengths. One could make an argument that from a career perspective, that for some surgical fields the opportunity cost makes IM the more appealing choice. Many issues we face in the modern day were less severe for the previous generation of physicians as well.

Affording a lambo as a newly independent orthopod would not be easy for most I imagine (probably had the opportunity cost of a second fellowship, plus probably pretty deep in debt if you're looking at a mortgage). After a few years if that was a top priority, you probably could.

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most doctors dont even get paid much, especially for the amount of time and effort, and sacrifice it requires. with years spent in school and shit pay during residency. nowadays, you can do a 4 yr comp sci degree and get a tech job with a 6 figure salary starting being the norm and even more in the US. It is really gonna be a big slap in the face if they cut physician salary, but it is the government that pays most physicans and they are always looking for ways to shortchange you so you can never really know when they will throw you under the bus.

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On 7/30/2021 at 6:45 PM, MasterDoc said:

 

Given the sentiment on these forums I am quite surprised to read that surgeons are driving lambos in Canada. It seems that people on here feel that surgeons are poorly compensated for what they do and IM usually has better bang for your buck. 

Can your average general surgeon or ortho really afford to whip around in Ferraris or lambos?

I don't know a single surgeon who drives a lambo, but I do know of some who drive fancy cars around the same level. These aren't your average surgeon however and none are new grads, and they do put in longer hours than almost any other doctor, something closer to average 70 hours a week. 

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On 7/30/2021 at 4:45 PM, MasterDoc said:

Given the sentiment on these forums I am quite surprised to read that surgeons are driving lambos in Canada.

It's the older surgeons with plenty of OR time, who've also had their investments multiply in the past 20 years with buoyant financial markets and the money printer going brrr.

They also love their jobs so much that they won't retire to open up room for the young surgeons. BC, Manitoba, and Ontario have public billings. Go look up how much the newly graduated surgeons are billing, I guarantee that it's not the buy a Lamborghini money. That's if they're lucky to have jobs. You'll find some Ortho surgeons still doing locums two years after finishing their fellowship.

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Physician salaries are hardly a bubble. We aren't that well paid, and we devote 10+ years to education to get there. If anything we are underpaid. Only medical students seem to think medicine is the road to riches. It's a good field to be comfortable, but good luck buying a house in Vancouver or Toronto with a family doctor salary. Times have changed, even in the last 5-10 years things have gotten ridiculously expensive and doctor salaries have not kept pace.

 

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4 hours ago, jb24 said:

We aren't that well paid, and we devote 10+ years to education to get there. If anything we are underpaid.

I agree with this statement, but the fact is that the average Canadian doesn't agree with this. They just see the 450k billings on a sunshine list and make assumptions that docs are overpaid. They won't consider that fact that it took 10 - 15 years, 80+ hour work weeks, crippling debt and stress to get there. Also it doesn't help with the fact that most people don't realize that the doc is probably only netting 1/3 of their billing amounts.

If you go around on Canadian subreddits most people want docs to be salaried with a cap somewhere in the 150k range. And these people have the power to vote for a government which may make this happen. I just hate how the government controls every aspect of a doc's life.

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9 hours ago, MasterDoc said:

I agree with this statement, but the fact is that the average Canadian doesn't agree with this. They just see the 450k billings on a sunshine list and make assumptions that docs are overpaid. They won't consider that fact that it took 10 - 15 years, 80+ hour work weeks, crippling debt and stress to get there. Also it doesn't help with the fact that most people don't realize that the doc is probably only netting 1/3 of their billing amounts.

If you go around on Canadian subreddits most people want docs to be salaried with a cap somewhere in the 150k range. And these people have the power to vote for a government which may make this happen. I just hate how the government controls every aspect of a doc's life.

That wouldn't happen though because doctor's would leave en masse mostly to the US.

The only thing that would actually tank doctor's salaries would be if they just opened licensing up to anyone or made it easy for a foreign trained doctor to open up shop. 

 

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6 hours ago, Edict said:

That wouldn't happen though because doctor's would leave en masse mostly to the US.

I keep saying this as well but no one pays attention. Look at the physician drain of the 90's when the deficit forced savage government cuts across Canada. It was the equivalent of losing 30 percent of the graduating class of all medical schools in Canada each year. It was an even greater percentage in English Canada and for surgical specialists.

6 hours ago, Edict said:

they

"They" is the Royal College which is run by doctors. Although the government would love such a scenario, I don't think the Royal College would let it happen.

As I also said before, Canadian physicians earn some of the highest multiple of the median wage in their country among the OECD. This is caused by Canada having to pay salaries that are somewhat competitive with the US, while having a much weaker economy.

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5 minutes ago, zoxy said:

I keep saying this as well but no one pays attention. Look at the physician drain of the 90's when the deficit forced savage government cuts across Canada. It was the equivalent of 30 percent of the graduating class of all medical schools in Canada. It was even greater in English Canada and for surgical specialists.

This is a bit more reassuring. But the difference between now and the 90's is that it is not as easy to cross the border anymore. I think H1B visas are more limited than in the past and also several specialties are not recognized in the US.

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I actually feel like the drain wouldn't be as bad today. This is anecdotal evidence but I've talked to many friends who had to go to the US for fellowships and they've all said they would never want to practice full time in the US for a variety of reasons (e.g., didn't like the work environment, didn't want to live in the US for family reasons). Perhaps this used to be different in the past but I do feel like there are growing differences between living in Canada vs. US.

I have to imagine that if things get really bad from a physician standpoint the government would heavily pressure the colleges and societies to relax guidelines and let physicians practice who currently wouldn't be able to. I remember reading a CBC article about a German physician who couldn't practice here without jumping through a bunch of hoops. I assume if there was truly significant need there would be greasing of the wheels for quick political brownie points.

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1 hour ago, blah1234 said:

I actually feel like the drain wouldn't be as bad today. This is anecdotal evidence but I've talked to many friends who had to go to the US for fellowships and they've all said they would never want to practice full time in the US for a variety of reasons (e.g., didn't like the work environment, didn't want to live in the US for family reasons). Perhaps this used to be different in the past but I do feel like there are growing differences between living in Canada vs. US.

I have to imagine that if things get really bad from a physician standpoint the government would heavily pressure the colleges and societies to relax guidelines and let physicians practice who currently wouldn't be able to. I remember reading a CBC article about a German physician who couldn't practice here without jumping through a bunch of hoops. I assume if there was truly significant need there would be greasing of the wheels for quick political brownie points.

But I think a lot of people say they don't want to practice in the US precisely because Canada offers very competitive salaries compared to the US. But I believe during the last brain drain, doctors were being paid double in the US, which would be more likely to convince people. 

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33 minutes ago, Edict said:

But I think a lot of people say they don't want to practice in the US precisely because Canada offers very competitive salaries compared to the US. But I believe during the last brain drain, doctors were being paid double in the US, which would be more likely to convince people. 

Maybe for new grads but I have a hard time believing that people mid-career that have put down roots (e.g., kids in schools, spouse with a non-US portable job) would just pack up and go. Given how many new grads struggle with underemployment or unemployment I feel as though the dynamics are little bit different now with most spots populated with mid-career physicians. I forget the data surrounding training cohort sizes but I feel we have been pumping residents through like crazy without a commensurate increase in employment opportunities. For community based practices I have to guess we are often more salary competitive than the US without breaking the government piggy bank (although this is second hand info from FM friends).

You could be right about a drain but I feel that there are less and less places to run as MDs. Healthcare has just become so expensive around the world and physicians are an easy target. I know in my situation I wouldn't be able to just run off to the US without jumping through a lot of hoops both professionally and personally. Even if my take home got cut in half I think I would be more likely to change back to my old profession than consider crossing the border as I would need to consider the ability/desire to move of my spouse.

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2 hours ago, Edict said:

But I think a lot of people say they don't want to practice in the US precisely because Canada offers very competitive salaries compared to the US. But I believe during the last brain drain, doctors were being paid double in the US, which would be more likely to convince people. 

Ortho probably pays 2 - 3x as much as here and Canadian training is recognized down there. Yet there is something like 160+ underemployed orthopods here. It has to be something other than pay. Maybe the visa situation?

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1 hour ago, MasterDoc said:

Ortho probably pays 2 - 3x as much as here and Canadian training is recognized down there. Yet there is something like 160+ underemployed orthopods here. It has to be something other than pay. Maybe the visa situation?

Once you've been through such lengthy training and fellowships(often in the US), you just want to enjoy life and live where you want to live i.e. Canada near your family and friends.  

A good friend is one of those under-employed orthopods; and is locuming around. He could make twice as much right now in the US working where he did his fellowship. He chooses to just locum here, and spend the underemployed time with loved ones and enjoying life.  Its not always about the money, especially for younger physicians - unless they are focused on buying a house in Toronto or Vancouver, and don't already come from upper-middle class families with wealth transfer(remember, this is very common among canadian medical students).

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2 hours ago, JohnGrisham said:

Once you've been through such lengthy training and fellowships(often in the US), you just want to enjoy life and live where you want to live i.e. Canada near your family and friends.  

A good friend is one of those under-employed orthopods; and is locuming around. He could make twice as much right now in the US working where he did his fellowship. He chooses to just locum here, and spend the underemployed time with loved ones and enjoying life.  Its not always about the money, especially for younger physicians - unless they are focused on buying a house in Toronto or Vancouver, and don't already come from upper-middle class families with wealth transfer(remember, this is very common among canadian medical students).

Yep, that's basically a template for someone else I know. I don't think money is enough to convince some people to go to the US and I almost feel like some fields have enough of these people waiting on the sidelines to fill any vacant hospital spots in Canada.

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On 8/1/2021 at 11:44 AM, Edict said:

I don't know a single surgeon who drives a lambo, but I do know of some who drive fancy cars around the same level. These aren't your average surgeon however and none are new grads, and they do put in longer hours than almost any other doctor, something closer to average 70 hours a week. 

The vast majority of rich people do not drive very fancy cars. It's actually not difficult to lease or finance a supercar at the lambo/ferrari tier. Insurance is actually relatively cheap. Your mileage is capped and clutch/tire replacements are not as frequent as they used to be.

A 250k income can definitely pull it off. It's all about interests and priorities and supercars do not top the list for most people in that income range (or even ones much higher than that). Even most pro athletes making millions a year aren't driving super cars always. You actually need a passion for it. 

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6 hours ago, MasterDoc said:

Ortho probably pays 2 - 3x as much as here and Canadian training is recognized down there. Yet there is something like 160+ underemployed orthopods here. It has to be something other than pay. Maybe the visa situation?

If you don't have US citizenship or green card then you're at the mercy of your sponsor for a H1B in terms of the contract you sign. Which is usually a pretty raw deal for Canadians depending on the center. That itself drives many Canadians back. 

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Re: capping physician billings - been tried in ON and the caps were lifted in early 2000s for many reasons. I'm sure Google will bring you to a great article about it. One reason is the US brain drain. 

 

Re: physician salary in Canada vs Europe. They are fundamentally employed in a different way and for the most part are actual employees, not contractor. And have working hours and working conditions commensurate to it. When North American physicians talk to European physicians the common theme is the North American physician is shocked by the low pay and can't imagine working there, and European physicians are shocked by the working conditions and can't imagine working there. 

Re: surgeons in Ferraris. I don't why this spawned so much conversation but it's not hard to find your way into exotic cars at much lower than physician pay. Depending on what you're buying they can have high residual and can work financially. The real reason for a lot of surgeons wanting to own them (anecdotally accurate) probably has something to do with how much opportunity cost they invested, how long their work hours are, and the desire to somehow make it all feel worth it. 

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Yea, I've heard that the institutions that will typically sponsor a H1B are larger centers like academic hospitals. However, the positions that pay the significantly higher salaries are often community positions that you may not have access to as a Canadian.

I have a friend at Sick Kids (who are already underpaid in my opinion) that told me that they turned down a role at Boston Children's Hospital because it would pay even less than Sick Kids.

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