pathology vs general internal med

[Knovecc]

...which one has better salaries?

sorry to be so direct...

[ubcredfox]

Very difficult to answer. Let me give you a B.C. example where there is a functioning private laboratory system.

 

In the community, the IM docs I knew were doing 1:5-6 call, covering ER and an ICU. They were either respirology or cardiology trained so extra bacon was coming in from ECHO's, bronchs etc. They were billing ~$640,000 to MSP. I'm not sure what they had for overhead.

 

In the community, the pathologists I know are doing no call per-se i.e. they might come in for a frozen very rarely and do call for a week straight. There are about 20 of them in a group so your call is one week out of twenty. In the two cases of which I'm most familiar, each of the pathologists has a stake in the laboratory facilities of the hospital from which they derive a "professional" fee i.e. every time a CBC is run, you get a couple cents...this is split between all partners. I'm not sure how equitable the splitting is between different path-docs. Long and short of it, you are looking at $450,000 - $750,000 depending on how much you get from your "professional fees" and private lab income i.e. outpatient cytology, bloods etc.

 

In academic centers the salaries tend to be much lower (in my experience), because people sign on to alternate funding agreements. In two cases pathologists are making approx. $320,000 per year. The internal medicine physicians are making slightly more $400,000.

 

Please remember that the lifestyles between the two are incomparable, as is the scope of practice. General pathology in the community touches all fields of medicine from neonate to geriatrics whereas general medicine is inexorably intertwined a magical beast known as the CTU special i.e. the BMI 45, 40 pack year, diabetic, self-entitled pleb). Further, pathologists generally have zero overhead. This is not the case for IM.

 

But you could outsource pathology to India, or consolidate it into larger and larger labs and refuse to hire more pathologists. You outsource IM, as the guy sticking a scope up your butt actually has to be in the same approx. vicinity +/- 2 feet.

 

Oh, and if you really want to know what anyone makes at your particular institution, find someone and ask them. That's how I got those numbers. And learned a helluvalot about billing and the various tax breaks that make sure that Oliver Twist remains a reality for many billions of people the world over.

[Knovecc]

ubcfox, are you sure the internal med you are talking about is general internist, excluding cardiologist, gastroent etc?

apparently here in Quebec the avg for general internist is 240k, and i dont know how much path is.

[DubZteR]

..... the norm gross for academic general internists is definitely NOT $400,000.

[GrouchoMarx]

Very difficult to answer. Let me give you a B.C. example where there is a functioning private laboratory system.

 

In the community, the IM docs I knew were doing 1:5-6 call, covering ER and an ICU. They were either respirology or cardiology trained so extra bacon was coming in from ECHO's, bronchs etc. They were billing ~$640,000 to MSP. I'm not sure what they had for overhead.

 

In the community, the pathologists I know are doing no call per-se i.e. they might come in for a frozen very rarely and do call for a week straight. There are about 20 of them in a group so your call is one week out of twenty. In the two cases of which I'm most familiar, each of the pathologists has a stake in the laboratory facilities of the hospital from which they derive a "professional" fee i.e. every time a CBC is run, you get a couple cents...this is split between all partners. I'm not sure how equitable the splitting is between different path-docs. Long and short of it, you are looking at $450,000 - $750,000 depending on how much you get from your "professional fees" and private lab income i.e. outpatient cytology, bloods etc.

 

In academic centers the salaries tend to be much lower (in my experience), because people sign on to alternate funding agreements. In two cases pathologists are making approx. $320,000 per year. The internal medicine physicians are making slightly more $400,000.

 

Please remember that the lifestyles between the two are incomparable, as is the scope of practice. General pathology in the community touches all fields of medicine from neonate to geriatrics whereas general medicine is inexorably intertwined a magical beast known as the CTU special i.e. the BMI 45, 40 pack year, diabetic, self-entitled pleb). Further, pathologists generally have zero overhead. This is not the case for IM.

 

But you could outsource pathology to India, or consolidate it into larger and larger labs and refuse to hire more pathologists. You outsource IM, as the guy sticking a scope up your butt actually has to be in the same approx. vicinity +/- 2 feet.

 

Oh, and if you really want to know what anyone makes at your particular institution, find someone and ask them. That's how I got those numbers. And learned a helluvalot about billing and the various tax breaks that make sure that Oliver Twist remains a reality for many billions of people the world over.

 

Are the community laboratory private fees exclusive to general pathologists, or are anatomic pathologists also able to partake in this? I'd rather be my own boss than work in an academic centre.

[Guest copacetic]

i agree that salaried pathologists have no overhead, or very little, but those in private practice would necessarily have overhead.

[ubcredfox]

Just so there is now confusion:

1. The IM salaries I posted, and clarified in my post, were for people who had some extra IM training like cardio, resp etc. That allowed them to work in an ICU setting and to do extra-money things like interpret ECHO's etc. You don't need a fellowship in cardiology per se to read ECHO's, but you do need to get some paper that says you can read them. So the were not "pure" general internists. I guess if you didn't do any of that, you'd be making around $250,000'ish. But I don't personally know of anyone who does just straight GIM without ICU etc.

 

2. If you have a share in a private lab, then you are independant of the hospital system. But, in addition to monies coming from independent private lab work (if that exists in your province), a lot of pathologists also sign alternate funding agreements with the hospital in which they primarily work. Basically it's a contract that says that from time A to B, you the pathologists provide pathology services to the hospital for x dollars. X is usually in the 325,000-450,000 range. You are not employed by the hospital in this case. You are a contractor basically, and the terms of your employment are dictated in the alternate funding agreement. This also includes things like pensions, if they are a part of the deal you signed.

 

Remember though, funding can change in an instant. The government dictates how much the fee codes are worth, and though, in theory this is done with physician input via master agreement negotiations, the amount of disorganization and fragmentation within the physician lobby makes it rather ineffectual (say compared to any of the major nursing unions in the country).

[cheech10]

..... the norm gross for academic general internists is definitely NOT $400,000.

 

Not quite, but many are well over $300,000 in Toronto.

[davbrwn]

Not quite, but many are well over $300,000 in Toronto.

 

yes, quite a lot of academic general internists manage to get more than 300 000$

[Knovecc]

thanks guys

for those "academic GIM" as you mentionned, I assume that they work in hospital (not open up a private clinic), so there is no (or minimal) overhead?

 

in that case, can i assume that the take-home salary for an academic GIM in, say Toronto is 330k - income tax (~40%??)

 

some stats tell me the average IM income in Ontario is 380k in 2008-2009, before "overhead", i suppose, though I do wonder what the overhead is if you're just hospital based

 

thanks!

[rmorelan]

thanks guys

for those "academic GIM" as you mentionned, I assume that they work in hospital (not open up a private clinic), so there is no (or minimal) overhead?

 

in that case, can i assume that the take-home salary for an academic GIM in, say Toronto is 330k - income tax (~40%??)

 

some stats tell me the average IM income in Ontario is 380k in 2008-2009, before "overhead", i suppose, though I do wonder what the overhead is if you're just hospital based

 

thanks!

 

Are these guys actually on salary? makes a big difference in terms of how you can structure you business if it isn't - that 40% is way too high for some models.

[Knovecc]

40% is the tax rate, not overhead

there's not overhead for salary i think, correct me if im wrong

[cheech10]

Many different set-ups:

1 - community based hospitalist - no clinic, inpatient work has no overhead, may be fee-for-service or salaried

2 - community based with outpatient clinic (clinic may be inside or outside of a hospital) - clinic has overhead, usually fee-for-service (ie, if clinic is in a hospital, the hospital may bill you for expenses related to it, depending on your contract)

3 - academic - may be salaried or fee-for-service, usually pay back a portion of your earnings to the department to fund overhead/non-clinical activities (ie, you get to keep only 70% of your billings if fee-for-service, or your salary is lower)

[rmorelan]

40% is the tax rate, not overhead

there's not overhead for salary i think, correct me if im wrong

 

well that is my point - there are a lot of political tax freely ways to effectively beat that 40% if done properly but only if it is not a true salary

[seeking1]

http://www.payscale.com/research/CA/Job=Physician_%2F_Doctor,_Internal_Medicine/Salary

 

http://www.payscale.com/research/CA/Job=Pathologist_(Medical)/Salary

 

To me, it seems as though that pathology makes more money than general internal med. Are these Payscale graphs believable/accurate? Is my perception correct?

[cheech10]

These are way off. More realistic full time averages would be $300K for path, $350K for medicine, but with significant variability for each, and large variability within specialties.

[mavrik13]

These are way off. More realistic full time averages would be $300K for path, $350K for medicine, but with significant variability for each, and large variability within specialties.

 

+1 - I've heard internal med starts lower (~250k) but goes much higher depending on what you sub-specialize in. Those numbers don't make much sense compared to what I've heard.

[seeking1]

+1 - I've heard internal med starts lower (~250k) but goes much higher depending on what you sub-specialize in. Those numbers don't make much sense compared to what I've heard.

 

Well, they're just payscale, lol. Is there a way to go private and charge more for path?

[seeking1]

Mind you, $300K isn't too bad for path, given that there is no overhead and you're not paying other people's salaries.

[seeking1]

In pathology, not just the amount of pay, but also the structure of compensation varies depending on province.

 

Where there is compensation in the $300-$330K range (such as in Manitoba), the positions are usually true salaried positions -- with benefits (extended heath, life & disability insurance, paid vacation, pension, etc) coming on top of that amount.

 

In other provinces (such as Alberta), pathologists are generally contractual employees of the health authority, and the numbers tend to be higher ($340-$400K) but do not include a benefits package. However, pathologists under contract can incorporate, and reap all the tax savings, etc. that go along with the corporation.

 

Please excuse my ignorance on this topic, but I am not aware of the benefits accorded to pathologists who incorporate. Is there some document I can access somewhere to learn more about this? Do you have any knowledge about it? Thank you.

[japlanet]

Please excuse my ignorance on this topic, but I am not aware of the benefits accorded to pathologists who incorporate. Is there some document I can access somewhere to learn more about this? Do you have any knowledge about it? Thank you.

 

Any physician (or person for that matter) who bills fee-for-service (and thus basically a contract worker) can incorporate their practice.

 

Under this set up, the money you bill for is paid to your corporation and thus you pay corporate tax rates on these funds. You can use these funds for business expenses (which may include office overhead, educational events, transportation, etc) and pay yourself (as an employee of your own corporation) a salary - which can be whatever you decide.

 

You would then pay the higher personal income tax rate on the proportion of your billings which you pay yourself as salary.