How much lower is the pay in 4 year GIM vs. 5 year GIM?

[lovemedicinesomuch]

How much lower is the pay in 4 year GIM vs. 5 year GIM?

[CGreens]

Better question is what is the opportunity cost of the 5th year and will any pay differences gained by completing the 5 year program offset the loss of a year of staff income. Further, I have always heard rumblings of new codes to be introduced for 5 year GIM specialists, but to my understanding this has not happened as of yet in ON. Basically, unless you want to work at a core academic hospital, don't do it. It's just more unnecessary degree inflation and not paying trainees what they are worth (which is rampant in medicine). 

[rmorelan]

Actually curious - is there any actual difference at all? Same billing codes no? 

[CGreens]

21 hours ago, rmorelan said:

Actually curious - is there any actual difference at all? Same billing codes no? 

No difference for billing codes that I’m aware of.

Major difference I’ve seen talking with GIM friends would be theoretical access to more academic jobs as a 5-year GIM and opportunity to carve out more of a clinical niche in that 5th year. They always mention that in the future that there is potential to introduce GIM vs IM specific billing codes, but not sure if that will ever actually happen, especially when the 4 year IMs do the same job in community.

[blah1234]

It should only impact potential places of employment. All my friends in community make more than my friends in academic practices. I have some academic physician mentors that have lucrative niches that are only possible at academic centres but they're in sub-specialties with research interests that private industry values. I'm not sure of anyone in GIM being in that situation.

[ACHQ]

On 7/28/2023 at 10:55 AM, rmorelan said:

Actually curious - is there any actual difference at all? Same billing codes no? 

No difference in pay or billing codes.

The difference in pay would really be at the academic vs community level (where many 5 year GIM's opt to do academics, although I still think the majority end up in community settings, where as 4 year GIM's almost always end up in community settings). When it comes to comparing those, by far and away community blows academics out of the water, and its not even close. We're talking about 200-300k difference in pay... (unless an academic GIM is making 450-500k, which I don't think any are, most are making 300-350k).

 

I don't think 5-year specific billing codes will come anytime soon (or ever at all) in Ontario. The reason being is the vast majority of GIM's in Ontario are 4 year trained. To have things changed at the MOH level, there has to be enough support/push from the OMA level. The OMA has bigger fish to fry from a billing perspective, than introducing specific codes for 5 year GIM's for which an extremely small portion of the membership would benefit. Won't happen when we are struggling as a collective group (physicians in general, all specialities) to get pay raises/increase to billing codes for work we do that is truly undervalued.

[rmorelan]

On 7/29/2023 at 2:47 PM, ACHQ said:

No difference in pay or billing codes.

The difference in pay would really be at the academic vs community level (where many 5 year GIM's opt to do academics, although I still think the majority end up in community settings, where as 4 year GIM's almost always end up in community settings). When it comes to comparing those, by far and away community blows academics out of the water, and its not even close. We're talking about 200-300k difference in pay... (unless an academic GIM is making 450-500k, which I don't think any are, most are making 300-350k).

 

I don't think 5-year specific billing codes will come anytime soon (or ever at all) in Ontario. The reason being is the vast majority of GIM's in Ontario are 4 year trained. To have things changed at the MOH level, there has to be enough support/push from the OMA level. The OMA has bigger fish to fry from a billing perspective, than introducing specific codes for 5 year GIM's for which an extremely small portion of the membership would benefit. Won't happen when we are struggling as a collective group (physicians in general, all specialities) to get pay raises/increase to billing codes for work we do that is truly undervalued.

that is what I thought - I mean it isn't unusual for people with less specialization in medicine in effect to actually make more money etc. in large part as they do end up in the community but also just they can tailor things to their own practise. 

It usually it pretty hard to get specific billing codes like that anyway - you have to argue just on the basis of education that someone who is doing the same job as someone else gets paid different rates - good luck with that. Also it probably doesn't make much sense. Ok sure you have 1 extra year and that initially is important......but what about 10 years out? Our careers are 30+ years usually.  Even ER docs from the widely different training pathways all make the same effectively (they may not get hired at the same places of course but if they are both at the same place there isn't much billing difference). Imagine everyone started to do that - should a radiologist with a fellowship in a particular area be able to charge more than one that doesn't if they are reading the same type of study? Fellowships are all over the place in medicine. 

 

 

[ConfusedGunner]

On 7/29/2023 at 2:47 PM, ACHQ said:

No difference in pay or billing codes.

The difference in pay would really be at the academic vs community level (where many 5 year GIM's opt to do academics, although I still think the majority end up in community settings, where as 4 year GIM's almost always end up in community settings). When it comes to comparing those, by far and away community blows academics out of the water, and its not even close. We're talking about 200-300k difference in pay... (unless an academic GIM is making 450-500k, which I don't think any are, most are making 300-350k).

Do community GIMs make 450-500K? Do they follow the same 2 weeks on, 2 weeks off model in academic sites? And are they working clinics and other things during their 2 weeks off? 
 

How much do community surgeons make? 

[ACHQ]

On 8/7/2023 at 11:52 PM, ConfusedGunner said:

Do community GIMs make 450-500K? Do they follow the same 2 weeks on, 2 weeks off model in academic sites? And are they working clinics and other things during their 2 weeks off? 
 

How much do community surgeons make? 

Easily. no its not as simple as 2 weeks on 2 weeks off model in CTU, because in real world medicine there is more than medicine wards. (ER consults, urgent GIM clinic, inpatient medical consults, etc...)

[lovemedicinesomuch]

On 7/29/2023 at 11:47 AM, ACHQ said:

No difference in pay or billing codes.

The difference in pay would really be at the academic vs community level (where many 5 year GIM's opt to do academics, although I still think the majority end up in community settings, where as 4 year GIM's almost always end up in community settings). When it comes to comparing those, by far and away community blows academics out of the water, and its not even close. We're talking about 200-300k difference in pay... (unless an academic GIM is making 450-500k, which I don't think any are, most are making 300-350k).

 

I don't think 5-year specific billing codes will come anytime soon (or ever at all) in Ontario. The reason being is the vast majority of GIM's in Ontario are 4 year trained. To have things changed at the MOH level, there has to be enough support/push from the OMA level. The OMA has bigger fish to fry from a billing perspective, than introducing specific codes for 5 year GIM's for which an extremely small portion of the membership would benefit. Won't happen when we are struggling as a collective group (physicians in general, all specialities) to get pay raises/increase to billing codes for work we do that is truly undervalued.

Most of the MTU staff make 25-35k per week on service on MTU at where I am located - that's why it is very competitive to get an MTU position at one of the urban hospitals - It pays quite well and residents do a lot of your work. They hire their 5 year GIM grads mostly only. 

So these staff easily make 50K/month doing 2 weeks off MTU and then they are 2 week off. It is also nice b/c they often have fellows doing most of their work

I am not in Ontario - so maybe that plays a role. As a result,  to me at least, it makes sense to to do 5 year GIM over 4. year - but maybe I am missing something...

[1234561234]

21 hours ago, ACHQ said:

Easily. no its not as simple as 2 weeks on 2 weeks off model in CTU, because in real world medicine there is more than medicine wards. (ER consults, urgent GIM clinic, inpatient medical consults, etc...)

What would the work life balance be with this type of situation? I hear ~28-35 weeks worth of ER consults/urgent GIM clinic/inpatient consults/MRP is pretty common for community GIM to be considered FTE. Would billing that much be more ER consult heavy and be closer to 40-45 weeks a year with say 2 weekends of work a month and a few extra overnight/evening ER consult shifts a month? (Total of ~8 days off a month)

[ACHQ]

On 8/10/2023 at 3:49 PM, 1234561234 said:

What would the work life balance be with this type of situation? I hear ~28-35 weeks worth of ER consults/urgent GIM clinic/inpatient consults/MRP is pretty common for community GIM to be considered FTE. Would billing that much be more ER consult heavy and be closer to 40-45 weeks a year with say 2 weekends of work a month and a few extra overnight/evening ER consult shifts a month? (Total of ~8 days off a month)

What you described sounds about right, similar to what I do. Billing for that can range between 40-45k if not more.

[ConfusedGunner]

13 hours ago, ACHQ said:

What you described sounds about right, similar to what I do. Billing for that can range between 40-45k if not more.

Just so I understand, a typical month for you involves working two weekends a month, taking on extra call shifts during the week? Does this mean you work 60-80 hour work weeks? How many overnight shifts do you end up working? 
 

I spoke to my staff a little about remuneration and essentially they told me that overnight ED consults pay approximately $400 per consult, and doing consults at a rate of 1 per hour is pretty typical once you‘re at the level of staff. Is that why ED consult heavy schedules are more profitable? 
 

thank you so much! 

[ACHQ]

5 hours ago, ConfusedGunner said:

Just so I understand, a typical month for you involves working two weekends a month, taking on extra call shifts during the week? Does this mean you work 60-80 hour work weeks? How many overnight shifts do you end up working? 
 

I spoke to my staff a little about remuneration and essentially they told me that overnight ED consults pay approximately $400 per consult, and doing consults at a rate of 1 per hour is pretty typical once you‘re at the level of staff. Is that why ED consult heavy schedules are more profitable? 
 

thank you so much! 

every site is a bit different in how they structure the various medicine services at the hospital. My site we have a different hospitalist department (that consists of both FM-hospitalist and GIM hospitalist) and GIM division. The GIM division takes care of the ER consult call schedule, the inpatient medicine consult service (to surgery, OB, psych etc...), and our urgent GIM clinic. Most of the GIM's participate in hospitalist as well (but not to the same degree as those that just do hospitalist work).

Typically at my centre GIMs do 6-12 weeks of Hospitalist a year, 3-5 ER consult shifts a month (8 hour shifts, mix of days, evenings and nights), 3 weeks of inpatient medical consults a year, and 2-4 weeks of urgent GIM clinic a year. Again this is ONE site. Each site is a bit different.

 

In Ontario, an ER consult + admission is roughly 235 during the day, 275 in the evening, 290 on weekends or holidays, and 310 overnight.

[GIMPCx]

On 8/13/2023 at 2:48 PM, ACHQ said:

every site is a bit different in how they structure the various medicine services at the hospital. My site we have a different hospitalist department (that consists of both FM-hospitalist and GIM hospitalist) and GIM division. The GIM division takes care of the ER consult call schedule, the inpatient medicine consult service (to surgery, OB, psych etc...), and our urgent GIM clinic. Most of the GIM's participate in hospitalist as well (but not to the same degree as those that just do hospitalist work).

Typically at my centre GIMs do 6-12 weeks of Hospitalist a year, 3-5 ER consult shifts a month (8 hour shifts, mix of days, evenings and nights), 3 weeks of inpatient medical consults a year, and 2-4 weeks of urgent GIM clinic a year. Again this is ONE site. Each site is a bit different.

 

In Ontario, an ER consult + admission is roughly 235 during the day, 275 in the evening, 290 on weekends or holidays, and 310 overnight.

You aren’t using the A130 enough Lol

The larger the hospital and ER the more you get paid for ER work. An 8-12 hour overnight GIM shift is in the 4-6K range