Remuneration after-taxes + overhead of Family Physicians?

[nowiveseen]

There've been quite a few threads discussing this.

 

However, I think the numbers may have changed quite a bit over the years.

 

Anybody have any ideas of the Remuneration after-taxes + overhead of Family Physicians in Canada and the USA?

 

I can't find any reliable statistic sheets or information online for this year. (especially for the USA)

 

Thanks.

[justletmein]

wrong forum.

and this topic has been discussed in many, many, threads.

[cheech10]

A reasonable estimate for Ontario:

 

$250,000 to 300,000 gross billings

- 80,000 to 100,000 overhead

=170,000 to 200,000 profit

- 60,000 to 70,000 income tax

=110,000 to 130,000 after-tax income

 

The possibility of making much more exists by working longer hours, or tailoring your practice toward high remuneration activities, but this is a starting point.

[thebouque]

On est ou ici? La cour du roi pétaud!

[nowiveseen]

A reasonable estimate for Ontario:

 

$250,000 to 300,000 gross billings

- 80,000 to 100,000 overhead

=170,000 to 200,000 profit

- 60,000 to 70,000 income tax

=110,000 to 130,000 after-tax income

 

The possibility of making much more exists by working longer hours, or tailoring your practice toward high remuneration activities, but this is a starting point.

 

I love you. Thank you. haha

 

Wow, 130k is only the starting point. I imagine the average could be like 160k, 180k after-tax income.

[RickRick]

Rural/Northern GPs work very hard do Emerg and hospital work - avg 500k billings some up to 750k. Here they are given 2k/mo for being up north plus 20-30k relocation fee to move up here. They work very hard for this kind of $ and their practice is VERY VERY different from an urban family doc.

[Real Beef]

Rural/Northern GPs work very hard do Emerg and hospital work - avg 500k billings some up to 750k. Here they are given 2k/mo for being up north plus 20-30k relocation fee to move up here. They work very hard for this kind of $ and their practice is VERY VERY different from an urban family doc.

 

I met with my family doctor to arrange for my immunizations for med school. I expressed some concern for the eventual accumulation of 100-150 k of LOC debt. He said dont worry I billed half-million last year .... you will be fine once you start working. He is a rural GP, does emerg, family practice, etc.

 

Beef

[cheech10]

Just to be clear, the numbers I posted above were for a Toronto practice, 8am-5pm ish hours, 5 days a week. Rural practices are significantly busier, as many have mentioned in this thread.

[HycrestJIT]

What's practice like for a rural general practitioner?(I try not to say "family doctor" because I think it sounds stupid, but that's just me)

 

Depends on the community and its current hospital amenities, the catchment area and demographics thereof, proximity to referral centers and their capabilities, and the group of coworkers you have.

 

It's highly variable based on all of the above, but I can outline what it's like in my old home community (for which I also have an ROS contract to start working in 2013).

 

The town is 500km from an academic tertiary center, though there is a 60,000 person city 280km away that we can refer to as well. The town itself is 6500 peeps with a catchment area of almost 20,000, made up largely of a surrounding aboriginal reserve population.

 

The town is short docs, so it's pretty hectic. The group covers 24h call in the ER, which requires 2 on-site physicians during the day and 1 providing overnight coverage (usually getting to leave around midnight). This means you usually do 2-3 day ER shifts + 1-2 evening/weekend shifts/week. This site does have a CT scanner and is located as an air ambulance hub, so it gets all the peripheral rural trauma, MIs, strokes, etc.

 

Otherwise, the town does ~500 deliveries a year - all by GPs. 2 GP surgeons and 2 GP anesthetists provide 24h c-section and anesthesia/epidural coverage. Their call is 1 in 2. Some docs deliver their own patients, so they're on call every night but deliver 5-10/month. There is a call group of 2 docs who do 1 in 2 call, and their group averages 30-40/month.

 

There are 30 inpatient beds and 2 special-care monitoring beds for acutely ill people requiring 24h monitoring. Usually you'll have a few inpatients on the go at any time.

 

You also have nursing home and LTC patients who you round on once/week and provide coverage for.

 

Finally, there's the regular family practice (the same practice you'd have anywhere else) that you'll do 2-3 days/week.

 

It's a busy life, but it's that way because in a place like that, you are THE doc. There is no backup. There is no specialist help aside from what you get over the phone. And in the winter during a snowstorm, you're the one who gets to sit on everyone.

 

As a student while rotating there, we delivered and resuscitated 26 week old neonates with no prenatal care, thrombolyzed STEMIs, did home visits to help palliative patients die at home, manage full-blown DKA, place central lines/chest tubes/suture scalp lacs following multi-trauma MVAs and much more. The GP surgeon there not only gets his fill of sections, but has performed numerous laparotomies for unstable patients with ruptured ectopics or massive intraperitoneal hemorrhaging who would have never lived through a transport. This community is lucky, it has 10 units of blood. There are others nearby that have 2 units of O+ only.

 

Heck, in one of the rural sites a few hundred km from this place, one of my fellow residents a few weeks ago ran 3 codes in a single night with only the small complement of nursing night staff. It's also not uncommon to be the first physician a person has seen in decades.

 

This is why rural docs make more. They also work 80-100 hours per week, which is a far cry from a stable 9-5 practice where call doesn't involve you wondering how many times you'll end up changing your undergarments over the course of the night.

 

Again, this is a contextual example of a single location, and numerous factors play into what a practice would be like, but the bottom-line for a rural doc is this: You are the responsible person for anything that walks through the door at any time in a place with limited staff and limited resources.

 

If you're looking for a personal and professional challenge, I'm not sure that there is any other specialty that comes close. But I'm evidently quite biased.

[Med0123]

oh god, and how long does the average GP last in this kind of setting? 3-5 years?

[HycrestJIT]

oh god, and how long does the average GP last in this kind of setting? 3-5 years?

 

That seems to be the trend for new grads within the last 3-5 years. Most attendings I've met who graduated 5-10 years ago have set up shop and have stayed where they are.

 

Just gotta be smart about taking time off. The docs in said community take 2 months vacation per year on average (not including CME).

 

Rural life is also hectic because there's a global shortage of rural family docs. Add a couple into a community and that 80-100 hours/week easily becomes 60-80.

 

You'd be amazed at how long docs who end up rurally stay in a single place, usually because of the community ties they form. Then again, our generation is a whole lot different than the ones prior.

[Med0123]

I am myself maybe contemplating small community practice and I was wondering wondering: are their wives/husband satisfied with living in such a small town? and were there concerns about education for kids?

[Lactic Folly]

Well, it's always helpful if spouse is from said small town.

[HycrestJIT]

I am myself maybe contemplating small community practice and I was wondering wondering: are their wives/husband satisfied with living in such a small town? and were there concerns about education for kids?

 

Depends on what their spouse wants, just like it depends on what you would want. What amenities are important to you, and which can you live without? Same goes for a spouse.

 

I've seen spouses who were completely happy with it and others who weren't. I've seen spouses (both male and female) who understood their partner's hectic life and those who wanted nothing more than for their spouse to stop.

 

It certainly helps, as Lactic said, if said spouse is from the region, or from a similar community.

 

Best way to find out: do some community and rural rotations and ask the spouses of your attendings.

 

Practice wise, communities are awesome. For a General Surgeon, imagine doing all the breast, bowel, thyroid, etc you can get your hands on. If you can get a community with an ICU, you end up seeing some amazingly awesome pathology. My residency program is based in a town of 60,000 with 6 general surgeons - I sat through multiple whipples (though one really is enough for a family resident), not to mention the late night thoracotomies for penetrating chest trauma. All the surgeons here do this stuff when required, and the group is good enough that if backup is needed, one is almost always able to come in. They too work hard.

 

School-wise: ask any of your classmates who grew up rurally, see what insight they can give you. I went to a school in the same northern community I already spoke of and had every opportunity I looked for afterwards. One of my medical school classmates was also from the same community (we played hockey together), and now he's an Ortho resident. Many medical school graduates do very well having come from small, rural backgrounds. My personal opinion is that a rural high-school vs an IB high-school confers no benefit once you're into the thick of post-secondary. Again, highly biased, and horribly not based on any solid stats.

[Real Beef]

I have a lot of respect for med people who grew up in rural communities. There are far fewer opportunities there than in an urban center, so those that managed to thrive took what little opportunity they had and made something of it.

 

IB only has value if it confers a greater chance at scholarships and awards for university. I know that this may be true for some universities. Otherwise it does nothing extra to prepare you for undergrad. Anecdotally, I was surrounded by a bunch of cocky IBs in my first year and I was also the only one not to lose my scholarship by the end.

 

IB high school? Sorry not familiar with the acronym, please explain.

[Lactic Folly]

IB only has value if it confers a greater chance at scholarships and awards for university.

 

There are also less tangible benefits of being in a competitive environment with teachers who support your academic ambitions.

[future_doc]

The IB program stands for "international baccalaureate." It's goal is to provide intelligent students with a more rigorous, universally recognized, university level education in high school.

 

And in the haste for more academic credentials, it messes up many students forced into 2nd year undergrad out of h.s., not really a good thing. I would not recommended to a loved one capable to enter such a program.

[PhoenixFlare500]

Can you not still start in first year after taking an IB? Then you'd know the material and would have a nice GPA cushion from first year, as well as an easier transition into university.

[bloh]

Of course you can, and probably should.

[future_doc]

not always

[Lactic Folly]

Even though I did full IB, only those subjects taken at Higher Level were eligible for credit according to my university.. so I only received credit for English and a half year of Biology in my first year, freeing up a bit of room for more interesting options. I also received credit for History, but this did not fit in my science-heavy degree, so it stayed on my transcript as 'extra to degree.' My other science IB subjects were taken at Standard Level, so I did not receive university credit.

 

I think that it was quite beneficial to be in a high school environment that pushed one to excel. People who transferred from IB to regular stream did not typically see their grades go up.

[NLengr]

Depends on what their spouse wants, just like it depends on what you would want. What amenities are important to you, and which can you live without? Same goes for a spouse.

 

I've seen spouses who were completely happy with it and others who weren't. I've seen spouses (both male and female) who understood their partner's hectic life and those who wanted nothing more than for their spouse to stop.

 

It certainly helps, as Lactic said, if said spouse is from the region, or from a similar community.

 

Best way to find out: do some community and rural rotations and ask the spouses of your attendings.

 

Practice wise, communities are awesome. For a General Surgeon, imagine doing all the breast, bowel, thyroid, etc you can get your hands on. If you can get a community with an ICU, you end up seeing some amazingly awesome pathology. My residency program is based in a town of 60,000 with 6 general surgeons - I sat through multiple whipples (though one really is enough for a family resident), not to mention the late night thoracotomies for penetrating chest trauma. All the surgeons here do this stuff when required, and the group is good enough that if backup is needed, one is almost always able to come in. They too work hard.

 

School-wise: ask any of your classmates who grew up rurally, see what insight they can give you. I went to a school in the same northern community I already spoke of and had every opportunity I looked for afterwards. One of my medical school classmates was also from the same community (we played hockey together), and now he's an Ortho resident. Many medical school graduates do very well having come from small, rural backgrounds. My personal opinion is that a rural high-school vs an IB high-school confers no benefit once you're into the thick of post-secondary. Again, highly biased, and horribly not based on any solid stats.

 

Where on earth where you that you saw multiple whipples PLUS multiple penetrating chest Traumas in a town of 60k all in a couple of months?

[HycrestJIT]

Where on earth where you that you saw multiple whipped PLUS multiple penetrating chest Traumas in a town of 60k all in a couple of months?

 

A northern city in western Ca that's an oil & gas hub. ie. Huge trucks with lift kits and quads in the back, young males with low education, drugs and copious amounts of booze.

 

While the city itself is only 60k, it's the only referral centre for the northwestern part of the province, including a large portion of the neighboring province. Its catchment area is over 200k.

[NLengr]

A northern city in western Ca that's an oil & gas hub. ie. Huge trucks with lift kits and quads in the back, young males with low education, drugs and copious amounts of booze.

 

While the city itself is only 60k, it's the only referral centre for the northwestern part of the province, including a large portion of the neighboring province. Its catchment area is over 200k.

 

I'll guess Fort Mac?

 

200k isn't that many people for trauma. Probably the booze fueled idiocy of youth driving up the numbers.

[Lactic Folly]

I'm going with GP (NW part of province).