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

[silver_08]

On 8/1/2021 at 5:24 PM, jb24 said:

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.

 

Well, I hate to break it to you, but that's the nature of having a publicly funded profession, where cuts or freezes to healthcare budgets due to a lack of resources (i.e. governments trying to make up for misspending elsewhere) happen often, and can impact workers' wages. The largest fraction of provincial healthcare budgets is devoted to wages. If we want to complain that physicians are underpaid in Canada, imagine how many nurses feel underpaid (especially those in Quebec where 40-50% of your paycheck is eaten up by high taxes). Physicians at least seem to be more respected and aren't seen as expendable as nurses in our healthcare system, as our healthcare system would severely hurt if we lost physicians to the U.S. (and governments thus try to keep us happy). 

Given the astronomical debt that we are seeing in Canada right now, and rising inflation caused by money printing / stimulus spending, I have a feeling that the next 10-15 years are going to be marked by austerity and little change in the remuneration of physicians in Canada. It won't be easy for anyone, which is why I would say that now is an important time to brush up and improve your financial literacy, and see how you can make the most out of your salary to enjoy a relatively comfortable lifestyle. Will we see a brain drain to the U.S. as a result? I guess time will show whether that is the case or not, but as other posters have already stated, there are more barriers to working in the U.S. than 20-30 years ago. 

It sucks to say this, but we're probably going to have to all bite the bullet at some point. Besides, aren't the other reasons for being a physician in Canada more important than how much you're getting paid? 

[Edict]

1 hour ago, blah1234 said:

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.

In the US, pay is purely dependent on supply and demand. So, if the market is in your favour, you can earn 1.5-2x what you would have earned for the same work in a bad market. Academic positions tend to pay less than community positions which isn't dissimilar from what it is in Canada. A lot of Canadians do end up finding positions, but usually you don't get what the Americans want because you are somewhat of an outsider and don't have the network that locals have. 

[zoxy]

4 hours ago, blah1234 said:

Boston Children's Hospital because it would pay even less than Sick Kids.

Pediatrics at Harvard is probably the worst paying job in the entire US. Pediatrics is the lowest paying specialty in the US, even lower than FM. Academics pays worse than community practice, and big cities pay worse than small ones.  Prestigious places also pay worse than no name places. So I'd imagine that Boston Children's is probably the worst paying hospital in the entire US.

[Zachary Turbide]

On 7/27/2021 at 4:53 PM, 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.

Your salary figures are from 20 years ago! My dad went into engineering and makes way more money that he can spend (granted he's cheap as F$$K). An electrician will make 100K$ a year and those people aren't the brightest. I'm just saying med school is no way to get rich. Try law.

[Persephone]

2 hours ago, Zachary Turbide said:

Your salary figures are from 20 years ago! My dad went into engineering and makes way more money that he can spend (granted he's cheap as F$$K). An electrician will make 100K$ a year and those people aren't the brightest. I'm just saying med school is no way to get rich. Try law.

Law is not a sure fire way to make lots of money, and you will usually have to work your ass off in an abusive environment to do it. Also becoming an electrician is not easy. Don't love the disparaging remark.

[silver_08]

On 8/6/2021 at 5:03 PM, Persephone said:

Law is not a sure fire way to make lots of money, and you will usually have to work your ass off in an abusive environment to do it. Also becoming an electrician is not easy. Don't love the disparaging remark.

Yeah, it's classical academic elitism at its finest. While doctors tend to have this perceived view from the top of their academic towers that all our education makes us entitled to a high salary, let's remember that all professions are valuable and should be treated with dignity. That extends beyond nurses, physios, receptionists and other healthcare workers in your immediate working environment, to people in trades, education, support roles, janitorial roles, etc. Remember all of these people could be your patients someday and you don't want to project your elitist attitude onto them when they are under your care. 

Back to the topic of salary, I remember a conversation with a friend who works on Bay Street as an investment banker, easily making 6 figures. He told me that he believes that there is no such thing as "easy money." Mind you that this is coming from someone who puts in around 70 hours of work a week. Anyone who is trying to tell you otherwise or convincing you to enter professions where there is a get rich quick scheme is either ignorant about the hard work required to earn that kind of money, or is a con artist. 

[MasterDoc]

On 8/9/2021 at 2:02 PM, silver_08 said:

Yeah, it's classical academic elitism at its finest. While doctors tend to have this perceived view from the top of their academic towers that all our education makes us entitled to a high salary, let's remember that all professions are valuable and should be treated with dignity. That extends beyond nurses, physios, receptionists and other healthcare workers in your immediate working environment, to people in trades, education, support roles, janitorial roles, etc. Remember all of these people could be your patients someday and you don't want to project your elitist attitude onto them when they are under your care. 

Of course all professions should be treated with respect, but you do understand that there needs to be a sense of a hierarchy right? Doctors deserve to be paid well because they go through shit that other professionals don't go through. If you paid nurses, janitors and doctors the same then you would get some pretty shit doctors since the high pay attracts the best and the brightest people. 

Hierarchies matter because not all jobs require the same level on competence. When your father has a brain hemorrhage at 2AM in the morning you want to best possible qualified person operating on them. When shit hits the fan and you are faced with REAL problems all talk of equality goes out the window.

There is a reason why a Colonel gets more respect and income than a Sergeant.

[Edict]

Doctors do deserve to be paid more because of the amount of effort we put into what we do. Preclerks haven't actually gone through those tough times and preclerkship teaching is just not preparing them for what is to come. 

[1D7]

1 hour ago, MasterDoc said:

When your father has a brain hemorrhage at 2AM in the morning you want to best possible qualified person operating on them.

This would've made a great Pros vs Joes episode!

[Snowmen]

On 8/9/2021 at 3:02 PM, silver_08 said:

Yeah, it's classical academic elitism at its finest. While doctors tend to have this perceived view from the top of their academic towers that all our education makes us entitled to a high salary, let's remember that all professions are valuable and should be treated with dignity. That extends beyond nurses, physios, receptionists and other healthcare workers in your immediate working environment, to people in trades, education, support roles, janitorial roles, etc. Remember all of these people could be your patients someday and you don't want to project your elitist attitude onto them when they are under your care.

Yeah, easy to say before you've done your first overnight call shift, or your taken your first block of medical school for that matter. Or before you've had all responsibility dumped upon you by one of these professionals.

Not only do doctors work more hours and study longer, they also get no benefit and mediocre work conditions. To make it even better, they're the ones who typically end up being responsible for everything that happens and that alone deserves the salary. Sure, making a quick "easy" consult sometimes feels like it's overpaid but every single time you decide the patient doesn't have anything significant, you're putting your ass on the line saying that and accepting to assume all legal and moral responsibility if you end up missing something that causes the patient to become crippled or dead.

[jb24]

On 8/3/2021 at 1:52 PM, silver_08 said:

Well, I hate to break it to you, but that's the nature of having a publicly funded profession, where cuts or freezes to healthcare budgets due to a lack of resources (i.e. governments trying to make up for misspending elsewhere) happen often, and can impact workers' wages. The largest fraction of provincial healthcare budgets is devoted to wages. If we want to complain that physicians are underpaid in Canada, imagine how many nurses feel underpaid (especially those in Quebec where 40-50% of your paycheck is eaten up by high taxes). Physicians at least seem to be more respected and aren't seen as expendable as nurses in our healthcare system, as our healthcare system would severely hurt if we lost physicians to the U.S. (and governments thus try to keep us happy). 

Given the astronomical debt that we are seeing in Canada right now, and rising inflation caused by money printing / stimulus spending, I have a feeling that the next 10-15 years are going to be marked by austerity and little change in the remuneration of physicians in Canada. It won't be easy for anyone, which is why I would say that now is an important time to brush up and improve your financial literacy, and see how you can make the most out of your salary to enjoy a relatively comfortable lifestyle. Will we see a brain drain to the U.S. as a result? I guess time will show whether that is the case or not, but as other posters have already stated, there are more barriers to working in the U.S. than 20-30 years ago. 

It sucks to say this, but we're probably going to have to all bite the bullet at some point. Besides, aren't the other reasons for being a physician in Canada more important than how much you're getting paid? 

You don't need to "break" anything to me, because so much of your post is inaccurate. For one, public sector salaries are rising not decreasing across the board in Canada. When was the last time your MLA/MP took a pay cut? They also enjoy great pensions, which we as physicians do not. 

Of course there are many reasons for being a physician, although being paid properly for our services is and should be a priority. Where did I say otherwise?

And are you calling me financially illiterate because I think physicians should be reimbursed for services fairly? Ridiculous. Of course you are a pre-clerk, lol. And lol at comparing nursing to being a physician. The jobs and responsibilities are entirely different. 

Please "brush up" on advocating for your own future profession.

[jb24]

On 8/9/2021 at 12:02 PM, silver_08 said:

Yeah, it's classical academic elitism at its finest. While doctors tend to have this perceived view from the top of their academic towers that all our education makes us entitled to a high salary, let's remember that all professions are valuable and should be treated with dignity. That extends beyond nurses, physios, receptionists and other healthcare workers in your immediate working environment, to people in trades, education, support roles, janitorial roles, etc. Remember all of these people could be your patients someday and you don't want to project your elitist attitude onto them when they are under your care. 

Back to the topic of salary, I remember a conversation with a friend who works on Bay Street as an investment banker, easily making 6 figures. He told me that he believes that there is no such thing as "easy money." Mind you that this is coming from someone who puts in around 70 hours of work a week. Anyone who is trying to tell you otherwise or convincing you to enter professions where there is a get rich quick scheme is either ignorant about the hard work required to earn that kind of money, or is a con artist. 

Get out with your "academic elitism" nonsense. The one with the elitist holier than thou attitude is you.

As someone who has worked in allied health for several years, the responsibilities are entirely different and are orders of magnitude higher as a physician compared to anything in allied health. The stress of being a physician is far beyond any other health profession. Medico-legally the buck stops with us.

Seriously working in allied health is not remotely comparable. Just stop posting.
 

[deeman101]

Its alright, RNs, NPs, ANPs, pharmacists, hell even LPNs are happy to become demi-doctors or even full-speed primary care clinicians depending on the province and the setting. They're demanding fair compensation for doing that despite still a significant gap in training length/breadth and capability. If the provincial associations negotiate well this can be used to justify the pay for the remaining docs that didn't get replaced by these ambitious allied health professionals. The no-fault Canadian system works very well to accommodate them.

 

[Pakoon]

3 hours ago, deeman101 said:

Its alright, RNs, NPs, ANPs, pharmacists, hell even LPNs are happy to become demi-doctors or even full-speed primary care clinicians depending on the province and the setting. They're demanding fair compensation for doing that despite still a significant gap in training length/breadth and capability. If the provincial associations negotiate well this can be used to justify the pay for the remaining docs that didn't get replaced by these ambitious allied health professionals. The no-fault Canadian system works very well to accommodate them.

 

Thankfully for us (maybe not patients) that gap in training leads them to order more tests and cost the system more money. unlike the US, this actually means something in a publicly funded system. This fundamental difference is what's holding off scope creep for the time being. of course it's just a matter of time.

[blah1234]

5 hours ago, Pakoon said:

Thankfully for us (maybe not patients) that gap in training leads them to order more tests and cost the system more money. unlike the US, this actually means something in a publicly funded system. This fundamental difference is what's holding off scope creep for the time being. of course it's just a matter of time.

I think if policy makers take a pure resource allocation approach than I agree the scope creep will be limited. However based on what I've seen during my career, the lobbying ability of mid-level providers is just much stronger than our associations. Also, the public seems to trust them more even if they may be less efficient or accurate. Frankly, I believe that the public is okay with many people making "less" money than a few physicians making "a lot" of money even if we are cheaper as an aggregate. I have rarely heard of people complaining about overpaid nurses while the opposite is true for us. I think the talking points of expanding healthcare access and reducing physician pay will always get political brownie points and resonate with the public. I'm afraid that the scope creep will only continue.

[medigeek]

On 8/3/2021 at 3:52 PM, silver_08 said:

Well, I hate to break it to you, but that's the nature of having a publicly funded profession, where cuts or freezes to healthcare budgets due to a lack of resources (i.e. governments trying to make up for misspending elsewhere) happen often, and can impact workers' wages. The largest fraction of provincial healthcare budgets is devoted to wages. If we want to complain that physicians are underpaid in Canada, imagine how many nurses feel underpaid (especially those in Quebec where 40-50% of your paycheck is eaten up by high taxes). Physicians at least seem to be more respected and aren't seen as expendable as nurses in our healthcare system, as our healthcare system would severely hurt if we lost physicians to the U.S. (and governments thus try to keep us happy). 

Given the astronomical debt that we are seeing in Canada right now, and rising inflation caused by money printing / stimulus spending, I have a feeling that the next 10-15 years are going to be marked by austerity and little change in the remuneration of physicians in Canada. It won't be easy for anyone, which is why I would say that now is an important time to brush up and improve your financial literacy, and see how you can make the most out of your salary to enjoy a relatively comfortable lifestyle. Will we see a brain drain to the U.S. as a result? I guess time will show whether that is the case or not, but as other posters have already stated, there are more barriers to working in the U.S. than 20-30 years ago. 

It sucks to say this, but we're probably going to have to all bite the bullet at some point. Besides, aren't the other reasons for being a physician in Canada more important than how much you're getting paid? 

Interesting you bring up nurses. In the US right now, they are doing travel nursing and getting paid up to 15k per week. Yes. 15,000$ (US dollars) per week (I'll repeat once more, . That is on the higher end but 120-150$ per hour is now the norm for travel nursing in the US. That's the same as what family doctors make in the US, higher than pediatrics and like 10x what residents make.  You can find a million job ads for these positions with the cited pay. 

How do you feel about that?

[JohnGrisham]

16 hours ago, medigeek said:

Interesting you bring up nurses. In the US right now, they are doing travel nursing and getting paid up to 15k per week. Yes. 15,000$ (US dollars) per week (I'll repeat once more, . That is on the higher end but 120-150$ per hour is now the norm for travel nursing in the US. That's the same as what family doctors make in the US, higher than pediatrics and like 10x what residents make.  You can find a million job ads for these positions with the cited pay. 

How do you feel about that?

As a family doc you can go to rural places in some provinces and instantly gain a 30% premium on your FFS billing as well.

Having a friend whos wife did travel nursing, it definitely paid well but was more rural places, where she would just be there for work 1-2 weeks then go back home to her city.

 

[medigeek]

2 hours ago, JohnGrisham said:

As a family doc you can go to rural places in some provinces and instantly gain a 30% premium on your FFS billing as well.

Having a friend whos wife did travel nursing, it definitely paid well but was more rural places, where she would just be there for work 1-2 weeks then go back home to her city.

 

Yeah but these gigs recently have really blown up and are paying insane amounts of money and they're usually staying for decent periods of time too (not very short term). NPs can make 150-200k in the US as can PAs. Whereas Peds subspecialties make less than that (sometimes 120-130k).

[JohnGrisham]

3 hours ago, medigeek said:

Yeah but these gigs recently have really blown up and are paying insane amounts of money and they're usually staying for decent periods of time too (not very short term). NPs can make 150-200k in the US as can PAs. Whereas Peds subspecialties make less than that (sometimes 120-130k).

My point was that the vast majority of those positions are rural, and MDs can also go rural and make more money. I.e. a rural pediatrician would be making more than an urban pediatrician. 

[MasterDoc]

On 9/9/2021 at 5:27 PM, medigeek said:

Yeah but these gigs recently have really blown up and are paying insane amounts of money and they're usually staying for decent periods of time too (not very short term). NPs can make 150-200k in the US as can PAs. Whereas Peds subspecialties make less than that (sometimes 120-130k).

150k-200k for NPs is really on the high end and most likely its the rural NPs making this kind of money. Yes that is more than Peds sometimes, but physicians at the same hospitals are likely making more than average also. If a NP in Pediatric is making 200k, I assure you that the pediatrician at the same hospital is making well above average for their specialty. Also, if a pediatrician is making 120-130k it sounds like they aren't working fulltime.

I don't think we really have to worry about NPs making the same as physicians. Because who in their right mind would want an NP or a physician for the same price.

[medigeek]

2 hours ago, MasterDoc said:

150k-200k for NPs is really on the high end and most likely its the rural NPs making this kind of money. Yes that is more than Peds sometimes, but physicians at the same hospitals are likely making more than average also. If a NP in Pediatric is making 200k, I assure you that the pediatrician at the same hospital is making well above average for their specialty. Also, if a pediatrician is making 120-130k it sounds like they aren't working fulltime.

I don't think we really have to worry about NPs making the same as physicians. Because who in their right mind would want an NP or a physician for the same price.

Is it really reasonable though if NPs make 200k in one location working 50 hours a week and doctors make 175k an hour away working 40-45 hours a week? Or travel nurses outearning hospitalists? 

They're catching up and exceeding doctors in even money now. They've already passed doctors in everything else.

While the above is true for the US, Canada is catching up and Canadian doctors are clueless on this issue. 

[zoxy]

On 9/14/2021 at 7:29 PM, medigeek said:

Is it really reasonable though if NPs make 200k in one location working 50 hours a week and doctors make 175k an hour away working 40-45 hours a week?

You're using anecdotes and outliers to build a false narrative about pay in the US. Then applying this false narrative to Canada.

On 9/14/2021 at 7:29 PM, medigeek said:

They're catching up and exceeding doctors in even money now. They've already passed doctors in everything else.

The data doesn't show this. MGMA and AMGA have median NP pay in the US at around 115K. Pediatricians on the other hand have medians around 230 for general pediatrics. Some procedure based specialties like peds cardiology and peds GI are around 300 while other sub-specialties are less than 230K. You should also remember that pediatricians in the US earn less than FM and primary care IM because a disproportionate number of kids are on Medicaid, and Medicaid underpays Medicare and private insurance. I would highly doubt that an NP is making 200K working 50 hours a week while an MD an hour away makes 175K working 45 hours a week. No MD is that stupid.

On 9/14/2021 at 7:29 PM, medigeek said:

While the above is true for the US, Canada is catching up and Canadian doctors are clueless on this issue. 

Additionally as someone mentioned above, NPs are popular in the US because they INCREASE healthcare spending. They might earn less than the equivalent physician, but their inferior diagnosis skills result in more testing and referrals to specialists, which in turn increases overall healthcare spending. While this is a desired outcome in the US system, I can't see provincial governments being OK with this. So inaction on the part of Canadian MDs is not a case of Canadian doctors being clueless. It's rather a case of Canada having substantially different healthcare dynamics than the US.

Now I'm not saying physician pay will necessarily remain stable/increase in Canada. Rather that NPs will not lead to a decline. A rise in interest rates would put serious strain on government coffers and cuts in healthcare spending would be unavoidable in such a scenario.

 

[shikimate]

damn pediatricians are paid pretty well there in comparison.

starting academic job salary for pathologist with 2 fellowships is like 160K non-tenured, only have to work 6 days a week not 7.

no wonder 90% of pathology resident there graduated from Timbuktu academy of medical sciences.

[zoxy]

37 minutes ago, shikimate said:

damn pediatricians are paid pretty well there in comparison.

The numbers I quoted are for ALL pediatricians in the US. Academic pediatrics would pay way less than private practice. Starting academic pediatrics would be lowest of the low. I'd estimate that the starting salary for academic pediatrics would be 120-140K in the US.

[Zachary Turbide]

22 hours ago, shikimate said:

damn pediatricians are paid pretty well there in comparison.

starting academic job salary for pathologist with 2 fellowships is like 160K non-tenured, only have to work 6 days a week not 7.

no wonder 90% of pathology resident there graduated from Timbuktu academy of medical sciences.

Kind of racist but I'm with you on this.

Don't want to work as a slave for no money.