Family Medicine + Anesthesia or Addiction Medicine

[HiImBritt]

Hey everyone,

I am currently in clerkship and I am pretty committed to FM. I'm trying to decide if doing a +1 is something I would want to consider.

I was wondering if there are any considerable salary incentives to pursuing such programs. Or is it simply for those who are truly passionate about these fields?

I'm really interested in anesthesia and addiction medicine, but being an older student who has to take care of a family, I don't think I can justify spending an extra year "just for fun".

Thanks in advance!

[jb24]

I think the FM+1 in EM has huge lifestyle and salary advantages. FM has tons of coordinating care for patients, following up on labs/reports/specialist consults. There's a bunch of stuff people don't routinely think about that's part of the job. Also no overhead in EM. Off time, is 100% off time, whereas to be a good FM you need to be available for your roster of patients.

 

[frenchpress]

In my experience most people who do a +1 are doing it to specialize and/or increase their scope of practice, which is sometimes for passion to serve a particular population or because of financial incentives, rarely its just for ‘fun’ or to know more about a topic.

Some +1s like EM are a bit more clear cut in terms of financial benefits, but for other +1s, how it would effect your income relative to what you’d make as a regular FP would depend a lot on individual practice

I have worked with several +1 anesthetists, some who do it full-time and some only part-time while doing other work on the side. For those who do it full time it’s pretty flexible and lucrative, and significantly less overhead. But locations where you can work may be quite limited - here in BC I know only one GP anesthetist working in a suburban hospital, everyone else I know works rurally.

Addictions on the other hand seems more flexible, but I don’t know enough about it to say whether it tends to pay much more compared to family practice. Most practitioners I’ve met are doing addictions because it’s a passion. Some hospitals will have a consulting team, and that can be fairly high volume low-overhead work. But in other places docs who have specialized in addictions I’ve met seem to do primarily outpatient, which can be sessional/salary type gigs or ffs.

[Sisushi]

Am in a "soft" +1, as in not regulated or licensed like +1 EM. Evaluate how much you enjoy the kinds of work and do your +1 based on that. I know EM has better lifestyle for some people but I hate the ER. I have nightmares after every ER shift about something I forgot to do, or should have asked. I will happily never do an ER shift again in my life. Other friends of mine think clinic grates their nerves to shreds and would live in the ER, so +1 was pretty good for them. +1 in anesthesia as someone else said can be limiting, I believe a lot of bigger city hospitals would be harder to work at compared to smaller and rural places, partially because there are full 5yr anesthesiologists in bigger centers. 

The soft +1s don't tend to come with a huge paycheck jump. I did it because it's an area that I'm interested in and want to be more comfortable doing. I don't intend to narrow my scope to just this +1 area but I just wanted more comfort with this extra challenging area. I may have 1-2 clinic days dedicated to this interest but it would still be family practice patients, so not really earning more money. Just an extra year of resident pay LOL 

[medisforme]

Re: +1 in addiction.

Unless you want to do full time addiction with focus on in-patient/hospital consults you really don't need +1. (at least in BC).   In BC they are so desperate for people to get into addiction that they will pay GP's (without +1) sessional fees to learn on the go.

It's definitely not an area you go into to make extra money.  Having said that, if you are able to build up a relatively stable patient base (somewhat of an oxymoron in addiction medicine i know), its actually extremely lucrative.  The problem is the time and effort to get to that point.  It makes more sense to enter it through signing a contract with a health authority/addiction centre (where often you will start out on sessional pay until you can build up a base).  If you approach it from a private practice standpoint, it will be a lot of hard work to get up and running.

 

[mdlifecrisis]

On 5/15/2021 at 11:36 AM, medisforme said:

Re: +1 in addiction.

Unless you want to do full time addiction with focus on in-patient/hospital consults you really don't need +1. (at least in BC).   In BC they are so desperate for people to get into addiction that they will pay GP's (without +1) sessional fees to learn on the go.

It's definitely not an area you go into to make extra money.  Having said that, if you are able to build up a relatively stable patient base (somewhat of an oxymoron in addiction medicine i know), its actually extremely lucrative.  The problem is the time and effort to get to that point.  It makes more sense to enter it through signing a contract with a health authority/addiction centre (where often you will start out on sessional pay until you can build up a base).  If you approach it from a private practice standpoint, it will be a lot of hard work to get up and running.

 

What makes it lucrative?

[#YOLO]

1 hour ago, mdlifecrisis said:

What makes it lucrative?

money

[medisforme]

4 hours ago, mdlifecrisis said:

What makes it lucrative?

In BC you get paid $23/week for providing OAT, regardless of whether you see the patient or not.  Stable patients you only need to see once every 4 weeks.  Consequently, a 10min visit essentially pays you $92 (multiply that by 30-40 stable patients and you can see how it is lucrative).

Conversely, unstable patients often need to be checked in on weekly at a minimum and sometimes more if they relapse, fail to fill Rx etc..., in this case you would only make $11.50-23/visit.  no where near as lucrative.

[Redpill]

Necro-ing this thread... can anyone comment on how much inpatient/hospital consults pay for addictions?

[bellejolie]

So as someone who is interested in addictions not for money, I would really recommend you don’t do it for money? The patient population is extremely challenging, and requires physicians and caregivers who are empathetic and able to handle the multiple psychiatric co morbidities that come with the practice.

I’m drained every time I do it but I really enjoy it (I find the therapeutics very interesting and I have always enjoyed psych, motivational interviewing etc) and the impact you have on the people you’re helping but the emotional ups and downs with your patients is exhausting. I could never do it full full time and definitely envision a practice for myself that involves well babies. I just need the babies to balance the addiction patients. Can’t survive mentally otherwise. 
 

if you want to make money purely don’t do addictions. Do your anesthesia go into pain medicine/or ER. Addictions is for people who genuinely can handle it because it’s extremely emotionally exhausting (but rewarding if you like helping vulnerable folks) and it seems like money is your driver. 

[Redpill]

2 hours ago, bellejolie said:

So as someone who is interested in addictions not for money, I would really recommend you don’t do it for money? The patient population is extremely challenging, and requires physicians and caregivers who are empathetic and able to handle the multiple psychiatric co morbidities that come with the practice.

I’m drained every time I do it but I really enjoy it (I find the therapeutics very interesting and I have always enjoyed psych, motivational interviewing etc) and the impact you have on the people you’re helping but the emotional ups and downs with your patients is exhausting. I could never do it full full time and definitely envision a practice for myself that involves well babies. I just need the babies to balance the addiction patients. Can’t survive mentally otherwise. 
 

if you want to make money purely don’t do addictions. Do your anesthesia go into pain medicine/or ER. Addictions is for people who genuinely can handle it because it’s extremely emotionally exhausting (but rewarding if you like helping vulnerable folks) and it seems like money is your driver. 

This is a bit presumptuous. I have done electives in addictions, and I enjoyed it. Two of my three letters for my Family CaRMS applications are from Addictions physicians, and I received very positive feedback on my rotations.

I am just curious as to what the compensation is, and whether it is worth a 1 year fellowship (vs. 3 month enhanced skills, etc.). You don't have to answer if you don't want to.

[bellejolie]

54 minutes ago, Redpill said:

This is a bit presumptuous. I have done electives in addictions, and I enjoyed it. Two of my three letters for my Family CaRMS applications are from Addictions physicians, and I received very positive feedback on my rotations.

I am just curious as to what the compensation is, and whether it is worth a 1 year fellowship (vs. 3 month enhanced skills, etc.). You don't have to answer if you don't want to.

Ah ok your initial statement made it seem like the primary driver was compensation and not the “true passion”. 

I’m not sure how much it is, and it will vary by province. If you enjoy the practice and have had good exposure then yes go for it. Whether it’s worth the fellowship it depends on what your interests are. I don’t know any physicians in Quebec who have a fellowship and they’re all practicing just fine and billing great so hope that helps. A fellowship makes more sense If you want to do more hospitalist, see complex patients, work on service and make it a larger amount of your practice. But you will be able to practice it without the fellowship as well as others have said the need is great. More academic/hospitalist with it. If you like anesthesia also a viable option and much needed. Obviously anesthesia comes with an easier patient population depending on what you’re doing.