how do people get through FRCPC residences?

[indefatigable]

5 minutes ago, offmychestplease said:

yes but average FM works less hours than the average specialist. If the FM worked the same hours as a specialist than the gap gets much less (and sometimes FM will outpace the specialist working the same number of hours). If an FM worked surgeon hours the gap would need be as wide as the averages show for example

That's why I mentioned normalizing by hours worked  - which is a tricky concept.  As mentioned, FM is heavier on the administrative burden, which may (or may not) actually count as hours worked - since you're not actually seeing patients/doing interventions during that time.  That also assumes work enjoyment is equal - I don't see FM docs breaking into jokes, singing while charting like some surgeons in the OR.  

[Monkey D. Luffy]

1 hour ago, offmychestplease said:

Peds, Psych, and path fields are some of the biggest FRCPC fields so they were used to compare not just because they are "low paying" but because they make a good proportion of FRCPC docs. Sure, we know rads/optho make way more but what % of people entering FRCPC fields really enter those fields?

Also, it's not "just 3 extra years." For most FRCPC fields you need a fellowship(s)/grad degree to land a decent job in a city so it's more like "4-5 extra brutal years". In fact even in your rads example it is a fact that it is basically required to do a fellowship (1-2 years) after the 5 year radiology residency to get any job in a city. This is after undergrad (+ any extra training before medical school), and then after medical school. Many people with the mentality that it's "just 3 extra years" and not "4-5 extra brutal years during peak age of marriage/kids etc" are the ones that get burnt out and end up very jaded before those years even finish. It's easy to say it's a drop in a bucket but living it is a different story for many people. An extra 4-5 years earning attending income and investing could make a difference where it takes 10+ years to catch up for even the more lucrative FRCPC fields....is 10 years still a drop in a bucket?

Also, there is a forum member here who was working very hard in QC (the province you mentioned with low FM pay) and was billing 600K+ in his first year out. And this was not in AB or ON. If you are motivated to work very hard and know what you're doing, you can kill in FM (since you brought up money). 

Not wanting FM because you don't like the nature of the job or you're very passionate about another field are valid reasons but not choosing FM for money reasons is a very misguided thought process once you break things down.

You title your post as "FRCPC" residencies painting them all as if they were the same. You frame your argument by comparing FM $ to peds/psych and using it to argue "how do people get through FRCPC residencies" lmao. Trying to hide it by arguing that these are the "biggest FRCPC specialties" is bs because you mentioned pathology which is one of the smallest.

The point is that there are residencies out there which do NOT need an extra "4-5 extra brutal years during peak age of marriage/kids etc." which end up outscaling FM hard in terms of income & overall life quality (if that is what you choose to optimize for in your work schedule vs. just making a ton of money for a few years then retiring early). Sure some random FM in QC might be making 600k working his/her ass off, but almost every rad or ophtho can make that by default with a way more chill schedule nearly anywhere in the country (plus have the option of going to the US, which by the way as a Canadian trained FM, you permanently close this option and can never practice in the US as far as I understand- feel free to correct me if I'm wrong on this). If you actually compare apples to apples, a specialist (in a field that actually makes decent $) can bill double that by "working very hard".

And yes, when someone goes down the path of medicine needing 3-4 years of UG + 3-4 years of med school + at least 2 years of residency (at minimum assuming getting into med school on the first attempt), another 3 years is a drop in the bucket compared to the next 30-40 years of attending life.

[insomnias]

5 minutes ago, Monkey D. Luffy said:

 (plus have the option of going to the US, which by the way as a Canadian trained FM, you permanently close this option and can never practice in the US as far as I understand- feel free to correct me if I'm wrong on this).

https://www.theabfm.org/become-certified/i-am-certified-country-outside-united-states

 

Incidentally, FRCPSC neurosurgery and anesthesiology are ineligible for US board certification (but of course anyone can practice in the US under an unrestricted license after PGY1 - the question is whether they'll be credentialed for it), and radiology and family medicine are the only two Canadian specialties that the UK accepts as equivalent without further assessment.

[Monkey D. Luffy]

Just now, insomnias said:

https://www.theabfm.org/become-certified/i-am-certified-country-outside-united-states

 

Incidentally, FRCPSC neurosurgery and anesthesiology are ineligible for US board certification

Fair enough, thanks for the correction.

[offmychestplease]

34 minutes ago, Monkey D. Luffy said:

You title your post as "FRCPC" residencies painting them all as if they were the same. You frame your argument by comparing FM $ to peds/psych and using it to argue "how do people get through FRCPC residencies" lmao. Trying to hide it by arguing that these are the "biggest FRCPC specialties" is bs because you mentioned pathology which is one of the smallest.

The point is that there are residencies out there which do NOT need an extra "4-5 extra brutal years during peak age of marriage/kids etc." which end up outscaling FM hard in terms of income & overall life quality (if that is what you choose to optimize for in your work schedule vs. just making a ton of money for a few years then retiring early). Sure some random FM in QC might be making 600k working his/her ass off, but almost every rad or ophtho can make that by default with a way more chill schedule nearly anywhere in the country (plus have the option of going to the US, which by the way as a Canadian trained FM, you permanently close this option and can never practice in the US as far as I understand- feel free to correct me if I'm wrong on this). If you actually compare apples to apples, a specialist (in a field that actually makes decent $) can bill double that by "working very hard".

And yes, when someone goes down the path of medicine needing 3-4 years of UG + 3-4 years of med school + at least 2 years of residency (at minimum assuming getting into med school on the first attempt), another 3 years is a drop in the bucket compared to the next 30-40 years of attending life.

why are you triggered lol? which fields are these - rads needs 1-2 year fellowship (6-7 years of residency) and optho needs 1-2 year fellowship (6-7 years of residency) to have a chance at a job in a city. Again, that's 4-5 years grinding extra not "just 3". Both also have brutal residencies and good luck trying to get OR time as a new optho grad to make the big bucks. And you really have no idea about rads and optho if you think they have a "chill schedule". I'll let @rmorelan enlighten you about the workload of rads. Further, FM makes more money in Canada without the midlevel and insurance issues than the US so no idea why closing that door matters...also rads and optho make way more here as well so the US argument is also irrelevant...

[JohnGrisham]

7 hours ago, offmychestplease said:

FM can make more than peds, psych, path to name a few working the same hours. That is not "working much harder."

Secondly, you aren't taking into account the 10+ years it will take you to catch up to FM due to your triple training time (6 VS 2 years)...

 

Additionally, the general surgeons in my region, tend to make about the same as a busy family doc.  When i rotated through as a resident, i was surprised at the similar pay range with the ++ call and long hours in OR. But they also have residents running the wards and doing pre/post of management for them, so its not that bad.

[JohnGrisham]

2 hours ago, Monkey D. Luffy said:

Sure some random FM in QC might be making 600k working his/her ass off, but almost every rad or ophtho can make that by default with a way more chill schedule nearly anywhere in the country (plus have the option of going to the US, which by the way as a Canadian trained FM, you permanently close this option and can never practice in the US as far as I understand- feel free to correct me if I'm wrong on this). I

Here is your correction: This is inaccurate. I have  2 colleagues that got their US licenses and practice in the US even without an extra +1 year. Much easier if you get a +1 year, for full portability (3year training length in the US vs 2 year in Canada). 

[LostLamb]

8 hours ago, offmychestplease said:

FM can make more than peds, psych, path to name a few working the same hours. That is not "working much harder."

Secondly, you aren't taking into account the 10+ years it will take you to catch up to FM due to your triple training time (6 VS 2 years)...

 

Looking forward to hearing about your ease of lifestyle and high earnings posts a few years into practice.

Alternately, looking forward to your "how do I switch from FM to FRCPC residency" posts, or maybe FIRE ones.

Its okay if you decide to change usernames to do them. We would understand.

I don't think you really know what FM entails. Unless you're planning to do private payment work (e.g. cosmetics) or high volume walk-in/urgent care I think you are going to be sadly mistaken in your assumptions. Lots of "cart before the horse" statements being made, IMHO.

 

[offmychestplease]

I never said ease of lifestyle and high earnings happened at the same time. When I was discussing lifestyle I was referring to training time and difficulty across fields. And when the topic of renumeration came up, I consistently said "if you work very hard" you can do really well. 

[LostLamb]

1 minute ago, offmychestplease said:

 "if you work very hard" you can do really well. 

Pretty true for all doctors on FFS. Doctors make good money.

Again...keep your disdain for those who pursue FRCPC or FRCSC to a minimum. It isn't a good look especially as a medical student. 

All the power to you for wanting FM and I hope it gives you what you want from life and medicine. 

[Aetherus]

8 hours ago, offmychestplease said:

why are you triggered lol? which fields are these - rads needs 1-2 year fellowship (6-7 years of residency) and optho needs 1-2 year fellowship (6-7 years of residency) to have a chance at a job in a city. Again, that's 4-5 years grinding extra not "just 3". Both also have brutal residencies and good luck trying to get OR time as a new optho grad to make the big bucks. And you really have no idea about rads and optho if you think they have a "chill schedule". I'll let @rmorelan enlighten you about the workload of rads. Further, FM makes more money in Canada without the midlevel and insurance issues than the US so no idea why closing that door matters...also rads and optho make way more here as well so the US argument is also irrelevant...

Ophtho does not necessary need a fellowship, and it sure doesn’t need two. A few have done two fellowships, but that’s more to create a specific practice that caters to their interest. Many cities have hired graduates with 0 fellowships. 
 

Calling out someone for their knowledge on certain specialities is rich when you don’t have any first hand experience and are parroting information you’ve heard with no true insight. The lifestyle of an Ophthalmologist is highly dependent on their sub specialty and how they set up their practice. You can work as little or as much as you want.

Finally, I’m not sure why you started this post if you go on to argue against people who explain to you the allure of a Royal College Specialty. 
 

Family Medicine has its benefits including flexibility, portability and quick training. However there is no point in arguing that Family is as lucrative as certain specialties. You quote anecdotal evidence of certain rural family doctors who bill like crazy. If you are billing that much as a Family Physician you are either doing addictions or you are shuttling patients so quickly through your clinic that you aren’t addressing any of their concerns and most likely referring on any case that takes thought. 

[DrOtter]

2 hours ago, Aetherus said:

Ophtho does not necessary need a fellowship, and it sure doesn’t need two. A few have done two fellowships, but that’s more to create a specific practice that caters to their interest. Many cities have hired graduates with 0 fellowships. 
 

Calling out someone for their knowledge on certain specialities is rich when you don’t have any first hand experience and are parroting information you’ve heard with no true insight. The lifestyle of an Ophthalmologist is highly dependent on their sub specialty and how they set up their practice. You can work as little or as much as you want.

Finally, I’m not sure why you started this post if you go on to argue against people who explain to you the allure of a Royal College Specialty. 
 

Family Medicine has its benefits including flexibility, portability and quick training. However there is no point in arguing that Family is as lucrative as certain specialties. You quote anecdotal evidence of certain rural family doctors who bill like crazy. If you are billing that much as a Family Physician you are either doing addictions or you are shuttling patients so quickly through your clinic that you aren’t addressing any of their concerns and most likely referring on any case that takes thought. 

oh god THANK YOU for saying it.

This thread has gone SO FAR beyond what the question was started to ask.

[Pakoon]

At this point it comes back to the whole opportunity cost argument that going into other fields such as Nursing or Engineering might out earn physicians. While those are only 4 years of undergraduate, FM would be another 4 years of medical school and 2 of residency. Do they make more in the long run as well? And hope about people who don't even go to university and instead opt for a 1-2 college year college degree, do they make more thanks to same logic here? 

 

I just don't understand why it's so hard to accept that the extra time, training and sacrifice might give someone better opportunities/ compensation. FM is great for a number of reasons, but I just don't understand the underlying need here to somehow prove it is the ultimate specialty. With about half of Canadian medical graduates going into FM, it's obvious that you would see a full spectrum of practice styles and their compensations. It's such a large field that sure there's the 3 million+ biller, but theres also the 100k part time biller too. I think it speaks more to these individuals business acumen, and less to family medicine renumeration as a whole. I'm sure these same high billers would have found ways to make money no matter where they ended up.

[blah1234]

Money/Lifestyle isn't enough for everyone as FM isn't appealing from a practice pattern or a subject matter perspective to everyone. Some people actually enjoy the patient population and cases in their field and/or feel more comfort with specialization.

Also, in a FFS environment it's a grind to be a high biller in any specialty. In my opinion you would really have to enjoy the work to see the number of patients or work the number of hours needed. Some people do have unique setups where they take home a lot while working reasonable hours but that is not really the norm. I think it's much safer to assume you will be a median practitioner than assume anything else.

[MasterDoc]

I got interested in medicine because of the cool shit that some of the FRCPC specialists do. If we lived in an alternate universe where medical school only leads to FM, then I think I would rather become a software engineer. 

[Haribo7173]

6 hours ago, blah1234 said:

Money/Lifestyle isn't enough for everyone as FM isn't appealing from a practice pattern or a subject matter perspective to everyone. Some people actually enjoy the patient population and cases in their field and/or feel more comfort with specialization.

It’s really this simple for a lot of people.

[robclem21]

19 hours ago, DrOtter said:

oh god THANK YOU for saying it.

This thread has gone SO FAR beyond what the question was started to ask.

I've noticed a very disturbing trend on this forum of medical students (or even pre-meds for that matter) who post a question, and then proceed to disregard/argue with all of the advice given by those with more experience (residents, staff, etc.). It seems like the true purpose of most of these threads is to seek reassurance of their pre-conceived opinions rather than actually have an open mind to the views of others and gain insight into their questions. Then, when they don't get it, it turns into an unrelated argument about billing and how much money each specialty can make.

Just how OP here as their reasons for not wanting FRCPC, many people have reasons for not wanting family medicine. Just because it's different, doesn't mean you have to keep pushing your own views or defend them because someone thinks differently. Divergence of opinion is good or else we'd all be the exact same. I think this mindset creates a lot of animosity within our field that down the road is detrimental to our relationships with each other inside and outside the hospital/clinic.

We need to put more emphasis in medical school clearly on understanding the important role both primary care and consultants play, and accept less students who's first focus is how to maximize their billing with the least amount of work to get in the top 1%.

[Snowmen]

On 8/4/2021 at 10:15 PM, offmychestplease said:

Also, there is a forum member here who was working very hard in QC (the province you mentioned with low FM pay) and was billing 600K+ in his first year out. And this was not in AB or ON. If you are motivated to work very hard and know what you're doing, you can kill in FM (since you brought up money).

Exactly, working very hard. I could make roughly 800k in my "low-paying specialty" while working 8-to-5 without call and taking 40 minutes for new patients and 20 minutes for follow-ups.

You officially have a PhD in nitpicking.

You simply have to look at the numbers: if you're billing 40$ for a follow-up instead of 100-150$, you'll have to work harder. Simple.

[blah1234]

31 minutes ago, Snowmen said:

Exactly, working very hard. I could make roughly 800k in my "low-paying specialty" while working 8-to-5 without call and taking 40 minutes for new patients and 20 minutes for follow-ups.

You officially have a PhD in nitpicking.

You simply have to look at the numbers: if you're billing 40$ for a follow-up instead of 100-150$, you'll have to work harder. Simple.

Agreed. The billing schedule is public info so you just need a sense of the daily workflow after seeing it in clerkship/residency to ballpark how hard you'll have to work.

[indefatigable]

I agree that this discussion seems to have degenerated some time ago.  I've also noticed a tendency of black/white thinking i.e. splitting - people sometimes seem unwilling to see both sides of a discussion.  

To set the record straight, regarding income, I can't over-emphasize how there is no Canada-wide standard when it comes to billing with a lot of variation even with provinces e.g. urban/rural.  Whatever income/billing scheme exists in your province/region doesn't necessarily exist in another province/region.  

Regarding, FM  in Quebec for instance, the following two images (in French) show the number of "high billers"  (over 500 000$) and average income in specialty (in red) vs fm docs (in blue).  One can see that the odds of being a high biller as a FP would be considerably lower (as there are 3000+ specialists vs <500 FPs in absolute numbers of "high billers").  

This doesn't mean the same holds true in AB or any other province - but certainly whichever FP poster is earning that money is far from typical in QC (likely 95th percentile+ in terms of billing).  The other graphic shows there is quite a gap in QC between specialist and FP.  

Quebec is different in many ways though as there are almost no "lower paid" specialties (Public Health I think is an exception).

https://ici.radio-canada.ca/nouvelle/1146753/revenu-moyen-nombre-medecins-specialistes-omnipraticiens-quebec [The article is a couple of years old, but I would expect comparable numbers today]

By the same token however, stories of high-billing hard-working FM docs shouldn't simply be dismissed either  The Northern Ontario FP was very transparent in working in a small, underservered, northern community, seemingly a FHO/FHT and performing multiple roles (e.g. outpatient, hospitalist and ER).  FHO/FHT means mostly getting paid per rostered patient and not directly FFS.

 The practitioner also specifically mentioned wanting to practice good quality medicine and was clearly working very hard, but earning a good income.  Not only was he putting in the hours, he was working in a province and small northern community which pays FPs more on average.  This doesn't imply that every FP working in every province and location/practice setting could earn that type of income.  

In fact, the most controversial billing of FPs that I know of from was the lucrative Pain/nerve block specialists in large urban centres in ON (some earning 1M+).  From what I understand, that is no longer a supported practice model for new practioners.  

[premed72]

Doing something you hate for 30+ years would kinda suck 

[gogogo]

On 8/6/2021 at 12:38 PM, Snowmen said:

Exactly, working very hard. I could make roughly 800k in my "low-paying specialty" while working 8-to-5 without call and taking 40 minutes for new patients and 20 minutes for follow-ups.

You officially have a PhD in nitpicking.

You simply have to look at the numbers: if you're billing 40$ for a follow-up instead of 100-150$, you'll have to work harder. Simple.

I agree with what you're saying, but which "low-paying specialty" pays 800k for 45h a week with no call? All I could imagine doing that is cosmetics derm, cosmetics plastics, and some of ophtho (cataracts or retina).

[jb24]

I agree FM is an excellent option given the opportunity cost of an additional three years of residency. But I honestly think a ton of people just hate clinic, and could never do regular FM, so they go into specialities. Also it's also pretty cool to be a specialist, they know so much about their area. 

Also FM is at risk for scope encroachment, although despite this happening in the USA things still seem fairly robust for the profession there.

[medisforme]

I would just add, the other huge benefit of FM is that you can set up shop/get a job literally anywhere in the country with almost no effort once you are done training.  There is no networking, job interviews, ass kissing, resume/CV building  etc... needed during residency and once you are out of residency.  Even highly desirable cities have many work options (ie. every month CMAJ and BCMJ advertise several FM jobs available in downtown vancouver for example).  This ease of work entry really doesn't exist with specialty residencies outside of possibly outpatient psychiatry and maybe outpatient peds.  If you are set on a particular location due to family circumstances or otherwise, you really never need to worry about this if you go FM route.

[LostLamb]

On 8/10/2021 at 4:08 PM, gogogo said:

I agree with what you're saying, but which "low-paying specialty" pays 800k for 45h a week with no call? All I could imagine doing that is cosmetics derm, cosmetics plastics, and some of ophtho (cataracts or retina).

or a LOT of private IME for insurance or court for psych. Plus expert testimony.
Not my bag by a LONG SHOT but it is possible.