Salary in Family medicine

[AndreaM]

Is that really how much it costs for admin assistant? Just curious

 

I'm sure it varies based on region and cost of living and whether or not the assistant has benefits or not. For where I live, $50,000 would probably be on the high side, but I don't really know. Plus, many docs I've met share their office and thus the cost of admin staff and overhead.

[JewelLeigh]

It is more accurate to estimate overhead expenses in terms of a percentage of billings. I would say in my experience, average is 30%, but as mentioned previously, this would vary based on location, clinic, number of doctors in the group, etc.

 

I also agree that estimating a gross government billing of 200k is too low if you are going for average.

 

Additionally, doctors get paid in other ways outside of ministry of health billings - for example - direct billing to patient (for insurance forms, work notes, etc.) and WSIB billings. Thus, even a physician with a gross ministry of health billing of $200k would be billing more than that overall.

[rmorelan]

I'm sure it varies based on region and cost of living and whether or not the assistant has benefits or not. For where I live, $50,000 would probably be on the high side, but I don't really know. Plus, many docs I've met share their office and thus the cost of admin staff and overhead.

 

That was what I was thinking - but I am sure it does vary

[future_doc]

You create a PC, Professional Corporation, in ON anyways, with the physician being the sole director and owner of all the shares with general voting rights, other family members can own non-voting shares, and it can earn up to $400,000 per year of active business income at the 18.6% tax rate. This provides a tax savings of approx. 27.8%, compared to the personal tax rate in Ontario that applies if the physicianm earns the practice income personally (46.4%).

[bloh]

That was what I was thinking - but I am sure it does vary

 

I did lowball it a bit; the average FP in AB is around 230k for 2009. 50k for an admin assistant would probably be lowballing it as well. I have a few friends in the admin assistant position and they make 45-52k but then again they've been at the job 1-3 years so you can expect that 50k to be much higher assuming the doc keeps their assistant for the long stretch (and why wouldn't they?).

 

That's some good information future_doc. I wonder if that applies to other provinces as well.

[JewelLeigh]

You create a PC, Professional Corporation, in ON anyways, with the physician being the sole director and owner of all the shares with general voting rights, other family members can own non-voting shares, and it can earn up to $400,000 per year of active business income at the 18.6% tax rate. This provides a tax savings of approx. 27.8%, compared to the personal tax rate in Ontario that applies if the physicianm earns the practice income personally (46.4%).

The 18.6% is only for money left in the corporation. Physicians who are incorporated pay themselves a salary which is still taxed at the personal income rates. Money left in the corporation can be used for a variety of things including retirement savings, legacy building, education savings, etc., but is not accessible for daily use by the physician (i.e. can't use it to buy groceries, pay mortgage, etc.) Money needed for month-to-month spending by the physician must be paid as either a salary or a dividend.

 

Medical Professional Corporations can pay out dividends to shareholders (including family members), which are taxed at a lower rate than regular personal income, but do not contribute to RRSP contribution allowance calculations. Doctors can also use the corporation to income split if a low-income-earning spouse can do some work for them - the doc can then pay the spouse a salary (which will be taxed at a lower rate if the spouse is in a lower tax-bracket). This is on top of the income-splitting opportunities offered with dividends.

[future_doc]

Yes, I did not give the full information. By being creative with an otherwise non working spouse and dividending out to the children and o ther tax/retirement planning, one can reduce overall taxes and accomplish marvelous things.

[bloh]

I did an experiment.

 

 

1. Search family physicians accepting new patients in Abbotsford (6 physicians)

2. Look up how much they billed in 2009

 

341,000

574,000

483,000

111,000

no result

37,000

 

How?

[future_doc]

moo has discussed this.

[moo]

I did an experiment.

 

 

1. Search family physicians accepting new patients in Abbotsford (6 physicians)

2. Look up how much they billed in 2009

 

341,000

574,000

483,000

111,000

no result

37,000

 

How?

 

Easy. You work hard.

 

As a resident last year, I grossed about 250K working part time (30 hours a week before taxes, after overhead). Add on my residency salary and I made over 300K (before taxes).

 

As I reiterated before, you can make a lot as a family doc. Keep in mind these are only MSP billings. Add at least another 15% for WCB, ICBC, private billings (sick notes, form fees, private patients, private medicals for camp, school, work, medicolegal reports (1000 bucks a pop)) and you can be really raking it in.

 

In a 6 hour walk-in shift on a Saturday/Sunday, I usually bill 1800-2000 bucks, minus overhead (30%) and I'm pulling 1200-1400 easy.

 

That's why I get so upset when family docs tell students not to do family medicine because you don't get paid for it. Nobody needs more than 40K a year to live comfortably. As a family doc, even if you work 3 days a week, you can easily make 150K, way more to live on than you need, even in an overpriced hole like Vancouver. And don't forget you can incorporate (which I have already done), saving you more money. A poster commented on the benefits of incorporation above, so I'm not going to go over that.

 

Now you won't be pulling in a million plus like the ophthalmologist down the street but seriously, who needs that kind of money? My advice to med students is to choose your career based on several things:

 

1) Location: Being a generalist will net you a job in any location. This includes FP, GIM, Gen peds, psych, etc. You can make good money wherever you go.

 

2) The more specialized you become the more limited your job options become. Canada is not like the US. We do not have a free market in medicine and we simply do not have the population. If you want to specialize in left-handed eczema, be prepared to to be in a location that is not as desirable or a location away from your family. If that's ok for you, then by all means go for it.

 

3) You will make a lot of money whatever specialty you choose, so don't chose your specialty based on $$$. But seriously, any specialty, you will be in the top 5% of income earners, so don't sweat it.

[Guest tongtongcuty]

What is the steps and how do you incorporate?

Thanks

[bloh]

Moo can you be a little more detailed about the "working hard part"? I just don't see how it's mathematically possible to rack up such huge billings if you're doing ~4 bookings/hour and working 8 hours/5-6 days a week. Are these docs instead working 12 hours/7 days a week and billing 6+ times/hr?

 

Because to me that's the mark of a crappy, tired physician. Is that what's needed?

[moo]

Moo can you be a little more detailed about the "working hard part"? I just don't see how it's mathematically possible to rack up such huge billings if you're doing ~4 bookings/hour and working 8 hours/5-6 days a week. Are these docs instead working 12 hours/7 days a week and billing 6+ times/hr?

 

Because to me that's the mark of a crappy, tired physician. Is that what's needed?

 

First, I see 6 patients an hour (bookings). In walk-in I average 7-8. Unfortunately, this is the reality of the situation when you have a waiting room full of folks. It is possible to give good care and see patients quickly. First, you know your own patients (don't have to take a full history every time). Second, some patients just want in and out (prescriptions, etc.). These make up for those that take longer. For isntance, in walk in I often do spend a lot of time with some patients that need it... the 20 year old woman with abdominal pain is typical. You get them to give a urine, while you go see someone else, come back in, get them to change, go see another patient, then go in and do a vaginal exam, with swabs, etc. I will have spent 20+ minutes on this woman all the while also being quick with the ones that only need a prescription or have the sniffles. More time does not equal better care. I also do counsel patients. Just the other day I had to tell a woman that her ultrasound likely shows ovarian cancer. I spent half an hour with her. By the time I was done 15 people had arrived in my waiting room. The other ones were all quick, easy prescriptions or skin things that take 1 minute each and I was caught up within 2 hours.

 

The other thing as I said is you get a lot of private billings. I typically get at least 3-4 privates a day. We bill 65-110 bucks per patient for these private patients. Driver's medicals--very lucrative, we bill 120 bucks each and each takes no more than 10 minutes to do because they're usually young and healthy. WSBC also adds way more. With form fees, it's 80 bucks per visit. Also there are form fees, etc that I listed above. Oh and I forgot chronic disease management fees. 125 bucks per patient per year with CHF, COPD, Diabetes. 50 bucks per patient with hypertension. 315 bucks per patient per year for patients with multiple chronic diseases. 100 bucks per male in 40s or females in 50s for doing cardiovascular assessment (framingham), etc etc. 100 bucks per patient per year for patients with mental health issues (depression, etc.) It all adds up. People think being a family doc = billing 30 bucks per patient and that is how much you make. Not so anymore. All these extra billings add another 30 percent to my take home. And if you do hospital and nursing homes like I do, it's even more lucrative (no overhead).

 

I don't know where you are in your stage of training but in med school and even first year of residency when you're doing clinics in a university/academic setting and are seeing 2-3 patients an hour, it's not realistic. If you work walk-in you almost HAVE TO see 50-60 per shift (what else are you going to do, turn them away when no other walk in is open in your vicinity? send them to emerg to wait 10 hours for a prescription/cold/wart/etc?), or even if you don't, patients get frustrated if they have to wait 3 days or more to see you. I guess another option is to institute user fees to stop those with useless things from coming in, but I'm not going to open that can of worms. In a typical day, about half of those 50 patients I see in walk in are for things that you probably didn't need to see a doctor for (the typical 20 year old girl... oh doctor, I have this spot on my face, can you laser it off for me, or the 30 year old man who complains he's losing hair, or the 25 year old who twisted his back lifting boxes). You can't expect to be booking 4 patients an hour when you're out. Like I said, I spend time with patients IF NEEDED. I let patients speak so they feel like they've said all they've said. Seeing 6-7 patients an hour does not mean not letting the patient speak.

 

What makes a patient satisfied? In my experience it's several things:

 

1) you let the patient speak and you don't cut them off.

 

2) you examine the patient. You also do a review of systems while doing the physicall--two birds with one stone, save more time. Doing a physical reminds you to do a quick review of systems. For example, the 50 year old man with a cough tells his story. You fill in the blanks. I'll listen to his lungs--and ask you smoke, chest pain, short of breath? I'll ask about his meds, his history, all the while examining the ears, throat, neck nodes, etc.

 

3) you are efficient and waiting time is limited for them. (chart while you're speaking with the patient--NEVER leave the charting til the end of the day or after you've seen more than one other patient. You will waste time thinking about what the patient said, what your exam was, etc. I see many docs leave the charting until after seeing 3-4 patients and they spend forever, thinking about what the patient said and you've just wasted more time)

 

4) you explain things to the patient. What they have, what causes it, etc.

 

5) and most important, you ask the patient if there's anything else you can do for them today before you leave. This makes them feel NOT rushed.

 

I do all of this, all the time and each visit lasts 10 minutes or less ON AVERAGE. When you're explaining what eczema is for the millionth time or why the patient needs to get his blood pressure under control, or what the danger signs for a mole are, or what to do to treat BPPV, it becomes easy and you learn to do it efficiently.

[bones]

Awesome post!!

[future_doc]

Awesome post!!

 

moo is the hidden treasure of this forum.

 

All his posts should be required reading.

[bloh]

First, I see 6 patients an hour (bookings). In walk-in I average 7-8. Unfortunately, this is the reality of the situation when you have a waiting room full of folks. It is possible to give good care and see patients quickly. First, you know your own patients (don't have to take a full history every time). Second, some patients just want in and out (prescriptions, etc.). These make up for those that take longer. For isntance, in walk in I often do spend a lot of time with some patients that need it... the 20 year old woman with abdominal pain is typical. You get them to give a urine, while you go see someone else, come back in, get them to change, go see another patient, then go in and do a vaginal exam, with swabs, etc. I will have spent 20+ minutes on this woman all the while also being quick with the ones that only need a prescription or have the sniffles. More time does not equal better care. I also do counsel patients. Just the other day I had to tell a woman that her ultrasound likely shows ovarian cancer. I spent half an hour with her. By the time I was done 15 people had arrived in my waiting room. The other ones were all quick, easy prescriptions or skin things that take 1 minute each and I was caught up within 2 hours.

 

The other thing as I said is you get a lot of private billings. I typically get at least 3-4 privates a day. We bill 65-110 bucks per patient for these private patients. Driver's medicals--very lucrative, we bill 120 bucks each and each takes no more than 10 minutes to do because they're usually young and healthy. WSBC also adds way more. With form fees, it's 80 bucks per visit. Also there are form fees, etc that I listed above. Oh and I forgot chronic disease management fees. 125 bucks per patient per year with CHF, COPD, Diabetes. 50 bucks per patient with hypertension. 315 bucks per patient per year for patients with multiple chronic diseases. 100 bucks per male in 40s or females in 50s for doing cardiovascular assessment (framingham), etc etc. 100 bucks per patient per year for patients with mental health issues (depression, etc.) It all adds up. People think being a family doc = billing 30 bucks per patient and that is how much you make. Not so anymore. All these extra billings add another 30 percent to my take home. And if you do hospital and nursing homes like I do, it's even more lucrative (no overhead).

 

I don't know where you are in your stage of training but in med school and even first year of residency when you're doing clinics in a university/academic setting and are seeing 2-3 patients an hour, it's not realistic. If you work walk-in you almost HAVE TO see 50-60 per shift (what else are you going to do, turn them away when no other walk in is open in your vicinity? send them to emerg to wait 10 hours for a prescription/cold/wart/etc?), or even if you don't, patients get frustrated if they have to wait 3 days or more to see you. I guess another option is to institute user fees to stop those with useless things from coming in, but I'm not going to open that can of worms. In a typical day, about half of those 50 patients I see in walk in are for things that you probably didn't need to see a doctor for (the typical 20 year old girl... oh doctor, I have this spot on my face, can you laser it off for me, or the 30 year old man who complains he's losing hair, or the 25 year old who twisted his back lifting boxes). You can't expect to be booking 4 patients an hour when you're out. Like I said, I spend time with patients IF NEEDED. I let patients speak so they feel like they've said all they've said. Seeing 6-7 patients an hour does not mean not letting the patient speak.

 

What makes a patient satisfied? In my experience it's several things:

 

1) you let the patient speak and you don't cut them off.

 

2) you examine the patient. You also do a review of systems while doing the physicall--two birds with one stone, save more time. Doing a physical reminds you to do a quick review of systems. For example, the 50 year old man with a cough tells his story. You fill in the blanks. I'll listen to his lungs--and ask you smoke, chest pain, short of breath? I'll ask about his meds, his history, all the while examining the ears, throat, neck nodes, etc.

 

3) you are efficient and waiting time is limited for them. (chart while you're speaking with the patient--NEVER leave the charting til the end of the day or after you've seen more than one other patient. You will waste time thinking about what the patient said, what your exam was, etc. I see many docs leave the charting until after seeing 3-4 patients and they spend forever, thinking about what the patient said and you've just wasted more time)

 

4) you explain things to the patient. What they have, what causes it, etc.

 

5) and most important, you ask the patient if there's anything else you can do for them today before you leave. This makes them feel NOT rushed.

 

I do all of this, all the time and each visit lasts 10 minutes or less ON AVERAGE. When you're explaining what eczema is for the millionth time or why the patient needs to get his blood pressure under control, or what the danger signs for a mole are, or what to do to treat BPPV, it becomes easy and you learn to do it efficiently.

 

Awesome post moo. Thanks very much. Is there anything else you could divulge about billing? I presume the private stuff is not something you could bill the province for (and thus wouldn't come into the totals I outlined).

 

~30$ - 6/hr - 8 hours/day - 7days a week - 52 weeks = 525,000

 

 

Even with a super busy, hard-working schedule with no vacation, it still doesn't add up. I realize that you can bill more for some things (full physical) and such but it's still crazy.

 

Did this guy really work such a schedule for 10 years?

 

 

574k (2009)

549k

454k

401k

434k

409k

471k

363k

333k (2001)

 

And lastly, if family med is able to hit such salaries why are people fleeing to specialize? Isn't FM then the perfect lifestyle specialty? I'm largely confused and I'm sure the truth is somewhere in the middle.

[olecranon]

I think FM is the perfect lifestyle specialty if you don't mind interacting with patients and enjoy variety and enjoy being able to work anywhere in the country you want. otherwise do gas or rads. Unfortunately med students are obsessed with prestige and status and will gun for other roads specialties just to create a better image of themselves. Well good for them i guess but too bad nobody here in canada really cares and they can look forward to being on call still after 20 years.

 

There's also hospitalist billings and and nursing home billings i suppose?

[cardiomegaly]

If FM didn't have so many spots people would pick it more. Kinda that whole supply and demand thing. Med students get caught up - it's the me too me too!! I'm just as smart and talented as the guy who wants to do plastics maybe I shouldn't "settle" for family medicine. Plus you get taught by specialists constantly. Which is sad, really - being a generalist is no easy feat. It's comforting when you meet someone who you respect in med school that wants to do family medicine and says it confidently.

[moo]

I don't know why FM gets such a bad rap. Maybe it's because when you're on the wards doing IM, or surgery or subspecialties, you always get the stupid consults from family docs. So med students strive not to be a family doc. But what specialists don't realize is that it's no easy feat to see 50 patients a day, deal with multiple complaints and DEMANDS from patients. A lot of patients just demand to see a "specialist" because they want a 2nd opinion. I've trained a lot of my patients that a lot of times it's not necessary to see a specialist if I don't think they need to and a lot of them end up trusting me. I think it has to do with the fact that 1) I am also a specialist-in-training, albeit in public health and epidemiology, and 2) I act very confident and I give them reasons why someone should or shouldn't see a specialist. Many times, you say to patients, look, you have these options and spell it out to them. I tell them, why and when it's necessary to get a consult (for instance, the specialist does a procedure that I don't do, they treat a disease that I don't do, or I myself just don't know what the hell is going on). Most patients are fine with that.

 

As for the lifestyle thing, FM is great. You can work as much or as little as you want. Do what you are comfortable with. I know some family docs end up just doing vasectomies for instance. They make a lot of money doing so and they act as a specialist of sorts. Look up Dr Barry Rich, MSP blue book. He made 310K off MSP last year, minus expenses that's still well over 200k with no call and probably working only 3-4 days a week. I'm pretty sure that's all he does is vasectomies day in day out.

 

That's why I get annoyed when family docs or residents or students say that you are going to be poor when you do family med. Yes, you will be poor if you have no idea how to bill (no, we don't just bill 30 bucks per patient, like I said there are so many other fees, including chronic disease management fees, hospital/long term care phone calls, WSBC phone calls, etc. on top of that that add 30-40% on top of you base billings) or are too lazy and work 1 day a week. (Yes, I have friends who work 1-2 days a week and wonder why they can't afford to move to Vancouver.) Does family med have its annoyances? Yes, it does. Patients can get annoying. Specialists can be annoying when you're talked down to. But in the end I think it's still rewarding. That's why I still plan on doing some clinical work even after I'm done my CM residency. I will plan on doing probably HIV, cancer or infectious disease epidemiology with a faculty position, and then maintaining a small private practice.

[silverjelly]

I am not at all interested in family medicine, but your posts are incredibly informative and a great read.

 

Thanks, moo.

 

 

-silverjelly (Meds 2011)

[olecranon]

just wondering, i've heard expenses for running a clinic from 20-40%. In practice, is it more towards the 20% side of 40% side?

[JewelLeigh]

just wondering, i've heard expenses for running a clinic from 20-40%. In practice, is it more towards the 20% side of 40% side?

I'm sure it depends on the location, group, number of docs, etc.

 

As an example, mine (starting Wednesday - yay done residency!) will be 30% for in-office work, 5% for out-of-office work billed through my office (eg. hospital, nursing home visits, etc.) to start. Likely after a year or so, the in-office portion will decrease to about 20-25% as I join as a partner.

 

I know of a local group in which the associates pay 35% and another where they pay 25%.

[olecranon]

Interesting.

 

Would you agree with the charts and tables created by a group of physicians here in Vancouver? Its one of the UBC family practice sites that i rotated through....

 

http://bayswatermd.ca/clinic-info/how-your-doctor-is-paid-by-the-medical-services-plan

[olecranon]

i should also mention that there is a high level of satisfaction among patients at this practice and physicians here bill avg 150K. This is on the low end of the spectrum in vancouver for full service GPs. There are walk in GPs who work only a few days (2-3) a week who bill twice as much as this.

 

I am pretty sure I already know the answer, but I wonder if someone did a study on patient satisfaction and physician billings if the obvious result would hold true.

[osmosis]

I think FM is the perfect lifestyle specialty if you don't mind interacting with patients and enjoy variety and enjoy being able to work anywhere in the country you want. otherwise do gas or rads. Unfortunately med students are obsessed with prestige and status and will gun for other roads specialties just to create a better image of themselves. Well good for them i guess but too bad nobody here in canada really cares and they can look forward to being on call still after 20 years.

 

There's also hospitalist billings and and nursing home billings i suppose?

 

+1.

 

i've always wanted to do FM. i knew this after spending a year shadowing my GP. the elments mentioned above is why i think it is the best area of medicine.

 

i am just hoping for an interview.