Family Practice Anesthesia - Lucrative?

[BCelectrophile]

I am looking at the FPA program and wondering if anyone has any info on the financial aspects .Curious to see what FPA's may be billing and how much is from anesthesia work (I'm in BC).

[JohnGrisham]

11 hours ago, BCelectrophile said:

I am looking at the FPA program and wondering if anyone has any info on the financial aspects .Curious to see what FPA's may be billing and how much is from anesthesia work (I'm in BC).

In what way are you wondering that?

+1 Anesthesia lets you work in lower OSA risk Anesthesia cases, and emergent cases etc. You can bill FFS usually for FPA fee codes, mostly in rural locations, smaller centres and maybe mid sized centres depending on your definition of that. You will not be working in a big city like Vancouver, Victoria, or Kelowna as far as i know.

As with FFS for all aspects of FM, no one can give you accurate information due to the variables. People do FPA due to interest in field/work type, and need for their rural/semirural communities of need anesthesia providers.

 

[drdean]

I am fairly confident that FPA's use the same billing codes as royal college specialists when providing anesthetic care. The reason they won't bill as much as a RC anes, is because they aren't doing as complicated cases so they miss out on the billing code modifiers (i.e. +20% for BMI >40 or ASA 4).

Some FPA's work exclusively in the OR, where as for others it is just a portion of their practice. This is extremely dependent on the local supply of royal college specialists. Historically FPA's were essentially limited to practicing in rural communities, but due to the national shortage of anesthesiologists there are some regional centers (pop. ~ < 20,000) in the country that are hiring FPA's. I've heard Courtenay/Comox was hiring FPA's for a while but not sure if they still are. 

[BCelectrophile]

9 minutes ago, JohnGrisham said:

In what way are you wondering that?

+1 Anesthesia lets you work in lower OSA risk Anesthesia cases, and emergent cases etc. You can bill FFS usually for FPA fee codes, mostly in rural locations, smaller centres and maybe mid sized centres depending on your definition of that. You will not be working in a big city like Vancouver, Victoria, or Kelowna as far as i know.

As with FFS for all aspects of FM, no one can give you accurate information due to the variables. People do FPA due to interest in field/work type, and need for their rural/semirural communities of need anesthesia providers.

 

I’ve seen various vague anecdotes on this forum saying it doesn’t add much income and some saying it adds a lot, I’m curious what a motivated individual working a lot could add to their income with FPA (OR day shifts vs call coverage, compared to other fm gigs such as em/Obs). I want to work rurally anyway and I like anesthesia, but is it worth the opportunity cost of adding another year to residency? (even with moonlighting?).

Also interested in other potential FPA revenue streams such as very northern/remote locums, pain clinic, etc.

Have tried looking in the blue book but it’s hard to find out who is doing FPA and know if they are working extra hard vs part time etc.

[hero147]

15 minutes ago, drdean said:

I am fairly confident that FPA's use the same billing codes as royal college specialists when providing anesthetic care. The reason they won't bill as much as a RC anes, is because they aren't doing as complicated cases so they miss out on the billing code modifiers (i.e. +20% for BMI >40 or ASA 4).

Some FPA's work exclusively in the OR, where as for others it is just a portion of their practice. This is extremely dependent on the local supply of royal college specialists. Historically FPA's were essentially limited to practicing in rural communities, but due to the national shortage of anesthesiologists there are some regional centers (pop. ~ < 20,000) in the country that are hiring FPA's. I've heard Courtenay/Comox was hiring FPA's for a while but not sure if they still are. 

I find its very rare to have an ASA 4 case. BMI > 40 is more common but still pretty uncommon. Most FRCPC anesthesiologists are still making the majority of their money doing bread and butter cases of ASA 1/2 and the occasional ASA 3 especially in the community. If the billing codes are the same, I can't imagine the incomes between the FRCPC and +1 to be all that different. 

[BCelectrophile]

12 minutes ago, hero147 said:

I find its very rare to have an ASA 4 case. BMI > 40 is more common but still pretty uncommon. Most FRCPC anesthesiologists are still making the majority of their money doing bread and butter cases of ASA 1/2 and the occasional ASA 3 especially in the community. If the billing codes are the same, I can't imagine the incomes between the FRCPC and +1 to be all that different. 

I’ve also heard several times that RC anesthesiologists make their money from call and not the bread and butter, so wouldn’t this be the case for FPAs as well? If you’re on call q3 or q4 and are far from a major center + are confident enough in your skills/experience, couldn’t FPAs handle a decent amount of emergent ASA3 cases?

Also as an FPA who does obs as well, Could you theoretically do epidurals on your own mat patients/deliveries?

[jb24]

FPA is lucrative for sure. You are location restricted though. Probably better to talk to FPA staff directly. Also, lifestyle must be quite good.

[JohnGrisham]

1 hour ago, hero147 said:

I find its very rare to have an ASA 4 case. BMI > 40 is more common but still pretty uncommon. Most FRCPC anesthesiologists are still making the majority of their money doing bread and butter cases of ASA 1/2 and the occasional ASA 3 especially in the community. If the billing codes are the same, I can't imagine the incomes between the FRCPC and +1 to be all that different. 

The incomes are definitely different - by virtue of where you are practicing. You aren't going to have full bread and butter slates 9-5 m-f in a small rural centre for example. 

That is the main difference - and if the only rural surgeon in your town decides to leave/retire, then the FP-As are left without significant amount of their predictable work, and then pivot back to their clinic/hospital based family practice. I have seen this happen in two semi-rural towns in BC and AB.

[JohnGrisham]

1 hour ago, BCelectrophile said:

I’ve also heard several times that RC anesthesiologists make their money from call and not the bread and butter, so wouldn’t this be the case for FPAs as well? If you’re on call q3 or q4 and are far from a major center + are confident enough in your skills/experience, couldn’t FPAs handle a decent amount of emergent ASA3 cases?

Also as an FPA who does obs as well, Could you theoretically do epidurals on your own mat patients/deliveries?

Again, extremely Location dependent.  Call stipends and MOCAP vary hugely - and what is available for rural may actually be better, or may be significantly worse (because they are usually tied to full-scope FM not just FPA providers who only provide a small percentage of the overall care in a rural community).

Talk to some FPAs in your region, and ask them what their split between FPA work and other work is.  Don't forget, OB again is heavily dependent on your centre - maybe lack of access to OBGYN backup prevents a significant amount of deliveries even staying in town.  And lack of maternity nurses is often a big consideration too - you can't do scheduled/planned low risk deliveries without access to maternity nurses.

You can see the picture i am trying to paint here: unlike 5 year anesthesia that can work anywhere, FPA are usually restricted to smaller centres, where you have +++ variables that are usually out of your control, that will affect your income potentials if you wanted to do solely FPA work(which in many centres is not possible, if you want higher income), and/or mix of FPA/GP-Obs/FM full scope etc.

[JohnGrisham]

1 minute ago, JohnGrisham said:

Again, extremely Location dependent.  Call stipends and MOCAP vary hugely - and what is available for rural may actually be better, or may be significantly worse (because they are usually tied to full-scope FM not just FPA providers who only provide a small percentage of the overall care in a rural community).

Talk to some FPAs in your region, and ask them what their split between FPA work and other work is.  Don't forget, OB again is heavily dependent on your centre - maybe lack of access to OBGYN backup prevents a significant amount of deliveries even staying in town.  And lack of maternity nurses is often a big consideration too - you can't do scheduled/planned low risk deliveries without access to maternity nurses.

You can see the picture i am trying to paint here: unlike 5 year anesthesia that can work anywhere, FPA are usually restricted to smaller centres, where you have +++ variables that are usually out of your control, that will affect your income potentials if you wanted to do solely FPA work(which in many centres is not possible, if you want higher income), and/or mix of FPA/GP-Obs/FM full scope etc.

https://www.healthmatchbc.org/jobs-in-bc/Find-a-Job/Vacancy?VacancyId=27262&SearchPage=20&SearchItemIndex=9&RegionIds=&ProfessionId=1&SpecialityId=0&SubSpecialityId=0&PositionTypeIds=1,2,3&CommunityId=

Here is an example, of what could potentially be the mix of work flow. Williams lake is likely on the higher end of volume of work based on the associated specialists they have in their area(gen surg, obgyn, c-scope capability, busy ED).  Still as you can see, you would likely be wanting to do FM work on top of FPA work, because 2 days a week + call isn't typically enough for most people to be "satisfied" with their income.

[BCelectrophile]

@JohnGrisham thanks a lot for all your insights, ideally I want to practice full scope rural fm with er/clinic/gp-obs and am thinking about trying to add gas into the mix.

 Have also looked at locums in the territories where there is a high need of anesthesia services, but hoping to be able to speak to Fpa staff at some point.

[JohnGrisham]

2 hours ago, BCelectrophile said:

@JohnGrisham thanks a lot for all your insights, ideally I want to practice full scope rural fm with er/clinic/gp-obs and am thinking about trying to add gas into the mix.

 Have also looked at locums in the territories where there is a high need of anesthesia services, but hoping to be able to speak to Fpa staff at some point.

Certainly plausible, but very centre dependent and practice dependent. It may be hard to maintain skillsets in er+ob+anesthesia; not to mention balancing work between colleagues so everyone has enough of a foothold in a community to make it worth their while etc. Good luck.

[hero147]

6 hours ago, BCelectrophile said:

I’ve also heard several times that RC anesthesiologists make their money from call and not the bread and butter, so wouldn’t this be the case for FPAs as well? If you’re on call q3 or q4 and are far from a major center + are confident enough in your skills/experience, couldn’t FPAs handle a decent amount of emergent ASA3 cases?

Also as an FPA who does obs as well, Could you theoretically do epidurals on your own mat patients/deliveries?

FPAs could probably handle a decent amount of emergent ASA3 cases with the reasoning that a family doctor trained in anesthesia is better than no doctor at all. But I honestly wouldn't go FPA unless I would die enroute to the nearest hospital with anesthesia care if I had any significant comorbidity. There's a reason why anesthesia is 5 years. It's not feasible to learn intubations/fiberoptic intubations, art lines, IVs, Central lines, spinals/epidurals, and ?nerve blocks all in 1 year. That's in addition to the medicine you need to know and all the difficult airway algorithms and airway adjuncts. 

[hero147]

45 minutes ago, JohnGrisham said:

Certainly plausible, but very centre dependent and practice dependent. It may be hard to maintain skillsets in er+ob+anesthesia; not to mention balancing work between colleagues so everyone has enough of a foothold in a community to make it worth their while etc. Good luck.

I have never seen a family doc practice within 2 major +1 fields let alone 3. Again, I guess you could reason it out that some care is better than no care, but there better not be a specialist within 3 hours of your center. 

[cotecc]

Can a FPA practice in Quebec?

[indefatigable]

55 minutes ago, cotecc said:

Can a FPA practice in Quebec?

Yes.  I ran into a FPA working in a mid-sized community only an hour from Montreal who was relatively young.

I was surprised as I've also heard RC anesthesia sometimes need to take jobs in relatively remote locations in QC.

[gangliocytoma]

10 hours ago, hero147 said:

I have never seen a family doc practice within 2 major +1 fields let alone 3. Again, I guess you could reason it out that some care is better than no care, but there better not be a specialist within 3 hours of your center. 

I've seen many docs do +1 anes and work EM, with some also holding the CCFP EM designation. The airway management and resuscitation skills from anes are very obviously very transferable to EM

[shikimate]

Who does dental anesthesia? Is that something FRCPC anes does on the side?

[gangliocytoma]

8 hours ago, shikimate said:

Who does dental anesthesia? Is that something FRCPC anes does on the side?

I've seen GPAs do it where I've rotated through