Can you open a walk in clinic/work in a family practice as an EM doc?

[Karma]

Thank you for clearing that up!

 

So I guess I was insulted by Kaymcee for no good reason...

[future_doc]

I do not want to personally insult you, but there are many things wrong with your post, evidence of someone who is not in medicine commenting on something they have no knowledge of:

 

In Canada, a physician bills—that is, charges one of the provincial health care plans—based on what he does, which has nothing to do with his certification. A specialist gets paid more for a consultation, yes, but a CCFP, CCFP(EM), and FRCPC emergency physician can bill the same codes.

 

Another example of a false assumption (about you) and ignorance of Quebec billing codes (based on a false assumption again) leading to a misdiagnosis or misinformation.

 

We all have utmost faith in you Karma, eveb if you are from that strange land called Quebec.

[crockett]

This is assuming that you would call a doctor who has the 2+1 ER certificate a generalist. Not sure if this is the case, as in rural areas you often get family doc's with no +1 working in the ER, so they could be the generalists you are referring to. That being said, I have no personal knowledge of the Quebec health care system, so maybe the 5 year guys actually do make more than 2+1's. On another note, the 5 year EM program does allow you to do things that the 2+1 doesn't such as Critical Care/ICU through the R4 match, which I guess would be a possible option for those worried about burning out in strictly emerg work.

[Maxime]

Here in rural areas, as much as everywhere in Canada, the majority of ER docs are FM only (2 years). A few have 2+1, haven't yet seen an R5 doc working in rural Quebec yet, but they probably exist. When I say GP, I mean 2 year, and ER 2+1, but the Quebec government doesn't make a distinction on these grounds. For remuneration, they are CCFP certified, that's it.

 

The ER docs make more, but they can't bill for the same things as the family docs. They bill per consultation (as does the specialist in other fields), as opposed to the family doc (or 2+1) that bills for specific things he does (ex: a complete physical exam done on someone who's short of breath will pay more than let's say a skin exam for eczema. In this case, he cannot bill a complete physical exam). There are also differences with complex cases (those he has to transfer to the next doc or ask the internal medicine to evaluate). The specialist ER (r5) cannot bill for this. Of course, this can create problems between the R3 and R5s, the R3s complaining on the grounds that they do the same work, but get paid less.

 

Edit: I wanted to add that when I said that you can land an ER job with only FM training, I meant with only FM training (2 years). People say it doesn't change much in the long run, but probably gives you more confidence when you start. Some of the best ER docs I've met were 2 year family docs. However it's true that with the ongoing trend for subspecialization in medicine, there is more and more emphasis on a 3rd year of EM.

 

Other Edit: True, R5 does open more doors, but I don't know if you get your EM FRCPC if you complete training in CCM/ICU (if you don't, you could be obliged to do CCU/ICU all the time, which also has a high rate of people leaving, at least here in Quebec). Probably, since there are residents in anesthesia/surgery that also do it, but it could be worth it to look into before signing up

[leviathan]

All I know is that I hope they keep the 2+1 option open for me.

[leviathan]

This is assuming that you would call a doctor who has the 2+1 ER certificate a generalist. Not sure if this is the case, as in rural areas you often get family doc's with no +1 working in the ER, so they could be the generalists you are referring to. That being said, I have no personal knowledge of the Quebec health care system, so maybe the 5 year guys actually do make more than 2+1's. On another note, the 5 year EM program does allow you to do things that the 2+1 doesn't such as Critical Care/ICU through the R4 match, which I guess would be a possible option for those worried about burning out in strictly emerg work.

 

The pay is definitely the same. If you bill for a procedure, it doesn't matter whether you're a GP or a surgeon or an intensivist; there is only one billing code for one procedure for all doctors. Again I guess this might be different if you're in Quebec, which is news to me.

 

Only the 5 year guys/girls can then proceed to do more years of ICU training if they wish/if they're crazy enough.

[Satsuma]

To the OP: Though you cannot open a family medicine practice (which would be the walk in clinic you are refering to) you can work in urgent care centres as an FRCPC - so if you want to slow down a bit, that is an option.

 

The FRCPC program is not going away, I don`t know where the person who got that information heard that from. It may down the road go to a 4 year program. It was a 4 year program in the past keep in mind.

 

 

Regarding flexibility of the FRCPC vs EM. It all depends on what you want to do. Sure with EM you can do family and ER shifts - but that doesn`t really mean a whole lot if you don`t want to do family. With the FRCPC program you have fellowships open to you that are not possible with family med, for example, critical care. So there is still flexibility with FRCPC, just the options are different.

[ploughboy]

As far as I know, CAEP is yet again looking at the notion of a single training track for emergency physicians, or maybe just thinking about looking at it again. As far as I know, any time in the past that this has been mooted, the CCFP and the RCPSC didn't see eye-eye and it was dropped. There are arguments in favour of keeping two separate streams, and arguments in favour of a unified, probably 4-year, program.

 

As for clinics - I know of FRCPC docs who hold methadone licenses and do that a half-day or a day a week for variety. I also know of an FRCPC staff whose exit out of shiftwork is a cosmo clinic that he and a business partner are starting. A little bit of botox here, a little bit of filler there and eventually no more ED shifts for him some day.

 

But ya, traditional "family medicine" wouldn't be an option if you go the 5-year route.

[Byrne]

I've always wondered this...

 

Because, I'm starting to really get interested in EM, but I don't know if I can do it for the rest of my life...and it doesn't sound like the 2+1 FM+EM is going to be around much longer...

 

I might have totally misheard or misunderstood a FRCPC ER doc I worked with over the holidays, but I could have sworn I heard him talking about how busy he was in the 'clinic' the prior week. It seemed like he was talking about a walk-in clinic ...

[leviathan]

I might have totally misheard or misunderstood a FRCPC ER doc I worked with over the holidays, but I could have sworn I heard him talking about how busy he was in the 'clinic' the prior week. It seemed like he was talking about a walk-in clinic ...

Could have been any variety of clinics, just not a family clinic.

[cheech10]

Some EDs have Urgent Care Clinics, similar to Minor/Fast-Track, associated with them. Maybe this is what they were talking about.

[Knovecc]

An ER (FM 2+1) doc was invited to talk about his job in my university (Quebec), he confirmed that there is a income difference between those 5yr (EM) and 2+1 (FM) trainees, the latter being between 180k and 280k, with average of 220k here in Quebec

[Knovecc]

so in Québec they bill and there IS a difference between the 5yr and 2+1 huh? I was wondering about NB (or anywheres in the Maritimes really), but I heard a doc say something about ER docs getting payed roughly 180$/hour in Moncton ... sounds kinda high! anybody have some insight on this?

 

And could a 2+1 do some ICU in smaller centres?

 

180$/h... hmmm thats 320k /yr if you work 40h/wk, 45wk/yr, sounds not bad:p

as for ICU, i dont think so though, you should be at least a general internist...well but im not sure:rolleyes:

[thebouque]

180$/h... hmmm thats 320k /yr if you work 40h/wk, 45wk/yr, sounds not bad:p

as for ICU, i dont think so though, you should be at least a general internist...well but im not sure:rolleyes:

 

Do ER docs really work 40 hours a week? I thought they needed 12-15 8 hours shifts per month to be full time...

And in some places, family docs are in charge of the ICU.

[ploughboy]

so in Québec they bill and there IS a difference between the 5yr and 2+1 huh? I was wondering about NB (or anywheres in the Maritimes really), but I heard a doc say something about ER docs getting payed roughly 180$/hour in Moncton ... sounds kinda high! anybody have some insight on this?

 

And could a 2+1 do some ICU in smaller centres?

 

$180/hr sounds about right, maybe a touch on the high side but not outrageous. $150-$160 is not uncommon, often with additional compensation for procedures, WSIB notes etc.

 

I know of 2+1s who work in small ICUs, or at least cover the unit overnight and then sign over to the the unit doc in the morning.

 

And ya, a full line is 12-14 shifts per month.