archer Posted June 21, 2012 Report Share Posted June 21, 2012 This may present as a stupid question, however I'd like the input of the more experienced premeders on this one: As a family medicine + 1 (ER) doc, could you opt to incorporate in your own clinic as a FP and also take 1 wk per month to work as an ER physician in the local hospital? How do you get paid as an ER doc, is it through the government (aka massively taxed and capped off)? How exactly is the capping system working now for specialists who are under government control (aka those who cannot incorporate)? What about those docs that do incorporate... are they somehow capped? Lastly, what about doing a rural family medicine residency? it's 2 years and qualifies you for ER and other things as well... how small does the community need to be to qualify as rural? and if you change your mind and want to go to a bigger city later could you go open a clinic in say Ottawa with your rural family medicine training? Like I said, I am young... just accepted after 3rd year undergrad, and I'm anxious to figure all this out! Thanks in advance guys Link to comment Share on other sites More sharing options...
Real Beef Posted June 21, 2012 Report Share Posted June 21, 2012 Archer! Congratulaions on getting accepted after 3rd year undergrad! Thats great ... as an old timer entering medicine I take off my hat to you for being on top of the game from the start. From the wisdom I have gathered over the years I will tell you this "Just breathe, relax .... you got in! ... you will have plenty of time to figure all of those things out once you start medical school and start talking with medical students." You have obviously got into medical school because of you great ambition, do it attitude but you are jumping the gun with your questions. Some of those questions you are asking may not be applicable in 6-7 years time once you have done 3-4 years of medical school + a 2+1 residency so dont worry about those things at the moment. In all truth I dont have the answers you are seeking but even if I did I would still tell you to relax and breath and not be 'anxious' about those questions ... LOL. Good luck! I hope others can answer your questions but please realize that tax law changes, government policy and funding changes so the information you get now may be useless by the time you practice so better to concentrate on medical school related questions. Beef Link to comment Share on other sites More sharing options...
nikki dale Posted June 21, 2012 Report Share Posted June 21, 2012 I'm interested in this too Link to comment Share on other sites More sharing options...
Real Beef Posted June 21, 2012 Report Share Posted June 21, 2012 I'm interested in this too Well maybe it is worth gathering the information then. I will try and answer the questions I know about and leave the information blank that I dont know. This may present as a stupid question, however I'd like the input of the more experienced premeders on this one: As a family medicine + 1 (ER) doc, could you opt to incorporate in your own clinic as a FP and also take 1 wk per month to work as an ER physician in the local hospital? Yes you could How do you get paid as an ER doc, is it through the government (aka massively taxed and capped off)? There are various payment schemes. 1) You can be paid an hourly wage. I have seen in the range of $125-210/hr, 2) fee for service model, and 3) blended models (i.e. fee for serivce plus top up rates, etc.) How exactly is the capping system working now for specialists who are under government control (aka those who cannot incorporate)? What about those docs that do incorporate... are they somehow capped? Lastly, what about doing a rural family medicine residency? it's 2 years and qualifies you for ER and other things as well... rural emergency rooms will staff with CCFPs without a +1 EM specialization though they would prefer +1 I am sure. Therefore you could do a EM in smaller communities with a non-rural FM residency as well, though a rural FM residency may arguably better prepare you for the realities of that practice environment. Some postings I have seen for some rural EDs do request only CCFP (EM) or FRCPC so you would be out of luck with those postings. So it may be worthwhile pursuing the +1 if you want to be mobile as an ER doc and not be as limited. There is always the option of challenging the exam after ~4 yrs of practice as a FM doing the requisite number of ER hours and getting the +1 EM designation that route. how small does the community need to be to qualify as rural? and if you change your mind and want to go to a bigger city later could you go open a clinic in say Ottawa with your rural family medicine training? There is no reason you couldnt set up practice in an urban setting after doing rural FM practice, you just may not be used to passing off so many interesting cases to specialists and using more modern diagnostics Like I said, I am young... just accepted after 3rd year undergrad, and I'm anxious to figure all this out! Thanks in advance guys Thats the best I could do with the knowledge I currently have. Hopefully others can add to the discussion. Beef Link to comment Share on other sites More sharing options...
rmorelan Posted June 21, 2012 Report Share Posted June 21, 2012 This may present as a stupid question, however I'd like the input of the more experienced premeders on this one:As a family medicine + 1 (ER) doc, could you opt to incorporate in your own clinic as a FP and also take 1 wk per month to work as an ER physician in the local hospital? How do you get paid as an ER doc, is it through the government (aka massively taxed and capped off)? How exactly is the capping system working now for specialists who are under government control (aka those who cannot incorporate)? What about those docs that do incorporate... are they somehow capped? Lastly, what about doing a rural family medicine residency? it's 2 years and qualifies you for ER and other things as well... how small does the community need to be to qualify as rural? and if you change your mind and want to go to a bigger city later could you go open a clinic in say Ottawa with your rural family medicine training? Like I said, I am young... just accepted after 3rd year undergrad, and I'm anxious to figure all this out! Thanks in advance guys as others point out don't forget to relax This is all my understanding of things - Yes you can still incorporate and work in the ER on hourly rates for whatever period of time you would like. It even makes more sense than normal to do so as a tax shelter etc. There are all kinds of combinations possible - particularly in rural areas. Ultimately we all get paid by the government - usually it is an hourly rate or salary as an ER doc. Ultimately we all pay tax - and potentially at a high rate but we have many options to structure things to defer it to the future and minimize it as well. Incorporation is one way of doing that. one trouble I will point out is the rules change all the time - knowing what happens now isn't as useful as you think - it will be 6-7 years before you are in practise and clearly the governments are changing things currently. However I don't think capping directly is currently done (it is more you have restricted access to things that would generate money - OR time, ER shifts etc). It did use to occur, and some do want it back to control costs. There is no such thing as a rural family specialization. There is simply family medicine that would allow you to potentially work anywhere anyone else can. You would simply have to work to your comfort level and of course keep up with your skills Some smaller rural ERs do have family doctors staffing them of course and that is not common in larger centres but that is not directly because of the location of their training. Link to comment Share on other sites More sharing options...
future_doc Posted June 21, 2012 Report Share Posted June 21, 2012 Yes, don't expect to be able to get the ER shift in the hospital you would prefer, it is highly unlikely. So, you would have to factor in lifestyle tradeoffs and determine if it is truly worth it to you (and your family). For everything in life, the devil is in the details. Link to comment Share on other sites More sharing options...
rmorelan Posted June 21, 2012 Report Share Posted June 21, 2012 Yes, don't expect to be able to get the ER shift in the hospital you would prefer, it is highly unlikely. So, you would have to factor in lifestyle tradeoffs and determine if it is truly worth it to you (and your family). For everything in life, the devil is in the details. there is some give and take - but if you pop yourself done in most rural areas in short order you will be able to get something worked out I would think Maybe not one full week a month all at once, but rather say every Monday and every 4th weekend or something. Some docs actually cover both at the same time - the ER load is so low they simply run their clinic and if something pops up they just go over and deal with it ( I have seen situations where their clinic is simply in the hospital). Link to comment Share on other sites More sharing options...
tooty Posted June 21, 2012 Report Share Posted June 21, 2012 It depends on the catchment area of your town. Rob's example sounds really small, like <5,000 population. Some rural EDs have a dedicated schedule of 1 doc per shift, 2 shifts per day. The doc group(s) in that town would share the ED responsibility equally. Docs within these groups take/give shifts depending on their preference. You won't have to do a 2+1 for a rural town, but you will for a medium-sized city. It's uncommon for big metropolitan hospitals to take 2+1s regularly but it happens. "Lastly, what about doing a rural family medicine residency? it's 2 years and qualifies you for ER and other things as well... how small does the community need to be to qualify as rural? " that definition changes depending on who you ask. i guess use the 10,000 mark as a rule of thumb. you also have to be far enough away from an urban center. "and if you change your mind and want to go to a bigger city later could you go open a clinic in say Ottawa with your rural family medicine training?" yes. canadian post-graduate training is recognized throughout canada period. rural folk ain't no different than urban ones. Link to comment Share on other sites More sharing options...
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