Why aren't more GPs making 400k+

[da_birdie]

Now to the numbers:

 

The first year out, having the burning desire to get rid of remaining student loans (~50k), I worked "relatively hard" at approx 40-42 hrs/week (~5.5 days/week) in clinic+hospital+locum settings and in the process became debt-free. The second and third years, I decided to take it easier, so worked approx 32-36 hrs/week (~4.5 days/week). Also got myself incorporated.

 

The past 1-2 years, I switched clinic and landed a ~15% overhead reduction (from a 62.5/37.5 split to something much better), boosting my take-home pay. I've been working quite hard since then, working 6 days a week (42-43hrs) in a clinic+hospital mixed practice (I don't think I can stand being in clinic >4.5 days a week.)

 

If I had spent all 43 hours in clinic, seeing patients at my upper tolerable pace, I suppose I could've billed >$400k. However, for my peace of mind I work a couple days at the hospital, which pays a bit less at BCMA-negotiated sessional rate at ~115/hr). The GP who owns the clinic billed >$450k last year (for MSP BILLINGs, check out http://www.health.gov.bc.ca/msp/legislation/pdf/bluebook2012.pdf )

 

I take on avg 5 weeks vacay/year.

 

My take home (pre-tax) pay over the years was highly variable depending on my lifestyle, from 180k to mid/high 200s)

 

Planning to tone it down a bit next year for a bit more quality of life - want to have some more fun while still in my early 30s and without kids!

So far I have yet to regret picking family med : )

[Gametime24]

Now to the numbers:

 

The first year out, having the burning desire to get rid of remaining student loans (~50k), I worked "relatively hard" at approx 40-42 hrs/week (~5.5 days/week) in clinic+hospital+locum settings and in the process became debt-free. The second and third years, I decided to take it easier, so worked approx 32-36 hrs/week (~4.5 days/week). Also got myself incorporated.

 

The past 1-2 years, I switched clinic and landed a ~15% overhead reduction (from a 62.5/37.5 split to something much better), boosting my take-home pay. I've been working quite hard since then, working 6 days a week (42-43hrs) in a clinic+hospital mixed practice (I don't think I can stand being in clinic >4.5 days a week.)

 

If I had spent all 43 hours in clinic, seeing patients at my upper tolerable pace, I suppose I could've billed >$400k. However, for my peace of mind I work a couple days at the hospital, which pays a bit less at BCMA-negotiated sessional rate at ~115/hr). The GP who owns the clinic billed >$450k last year (for MSP BILLINGs, check out http://www.health.gov.bc.ca/msp/legislation/pdf/bluebook2012.pdf )

 

I take on avg 5 weeks vacay/year.

 

My take home (pre-tax) pay over the years was highly variable depending on my lifestyle, from 180k to mid/high 200s)

 

Planning to tone it down a bit next year for a bit more quality of life - want to have some more fun while still in my early 30s and without kids!

So far I have yet to regret picking family med : )

 

So, for the weeks that you were working roughly 40 hrs per week (in between your lighter and harder years) you were looking at low 200s? Like 225ish?

 

You say this was your take home (pre-tax) pay, so I'm guessing this meant after you paid your overhead n such so tax was the only thing left to come off of it? (and rrsp contributions, etc).

 

I ask cause I'm legitimately considering family practice and maybe the +1 for EM or something depending on how I feel when I get to that point and good, first-hand info like this is hard to come by a lot of the time. Thanks!

[apache]

i totally agree, although i lack your economic pedigree... people who try and squeeze money out of billing waste so much time anyways... like... do forensic psych, leaves rads in the dust... anything medico-legal can subsidize your income greatly... my view on that is that it means i can give more to patients, take emergency calls, fill in same day appointments for urgent things...

 

there's a lot of other ways to make more money in 10 hours than your other 30... but to me, that just means i don't have to rush ppl, can really be able to make a difference without having money as a concern

 

ha - a fellow economist Preference curves, and Pareto efficiency for the win.

 

I think a lot of people on the forum over value the money aspect - probably because we aren't sitting on piles of money etc. Natural probably, but ultimately I haven't run into many doctors that think that way. Sure they are all concerned at least to some degree about maximizing their income for the time the do spend , but not ridiculously obsessed with squeezing every last nickle out of the system. That just sounds exhausting

[da_birdie]

So, for the weeks that you were working roughly 40 hrs per week (in between your lighter and harder years) you were looking at low 200s? Like 225ish?

 

You say this was your take home (pre-tax) pay, so I'm guessing this meant after you paid your overhead n such so tax was the only thing left to come off of it? (and rrsp contributions, etc).

 

I ask cause I'm legitimately considering family practice and maybe the +1 for EM or something depending on how I feel when I get to that point and good, first-hand info like this is hard to come by a lot of the time. Thanks!

 

You need to take into consideration improvement in your efficiency as you gain experience, know your patients, and/or change practice style. For example, I was working 40-42 hour weeks both now and in my first year, but in my first year I was mainly doing community clinics/hospital/locum/walk-in work, seeing 5-5.5pts per hour (most are new patients, which requires taking full pHx on first encounters) while rarely bill any complex care fees.

 

Nowadays I see 6-7/hour, and since they are mostly my regular patients, I can bill all the complex care codes, complete physicals and am frequently asked to do driver's physicals ($125-$150), attending physician statements ($60-$120), sick notes ($20), auto-insurer physicals ("CL-19" >$100) and sometimes medicolegal reports ($800+). With the reduced overhead from mid-high 30%'s to low 20%'s, despite working the same hours, I took home low 200s in 1st year while high-200s in 4th year.

 

It's worth noting that working in salary/sessional fee structures (eg in hospital/community clinics), you only get 1-2% gain/year (depending on the physician/government negotiated agreement). Experience/efficiency does not reward you financially. However, in FFS private practice, an increase in working hours and/or efficiency directly translate to income growth.

 

And yes, this is take home pay (pre-tax). Prior to incorporation it's really "take-home" (while paying 35% average tax rate), after incorporation it's "corporation earnings" (taxed at low teens %) while it pays me the dividend/salary of my choosing (which will also be taxed).

 

I can futher improve my efficiency and also take on additional work (eg 2x/week nursing home rounds after clinic for another ~$30k+/year), but at this point in life I still prefer to keep more free time for my own well-being : )

[futureGP]

Now to the numbers:

 

The first year out, having the burning desire to get rid of remaining student loans (~50k), I worked "relatively hard" at approx 40-42 hrs/week (~5.5 days/week) in clinic+hospital+locum settings and in the process became debt-free. The second and third years, I decided to take it easier, so worked approx 32-36 hrs/week (~4.5 days/week). Also got myself incorporated.

 

The past 1-2 years, I switched clinic and landed a ~15% overhead reduction (from a 62.5/37.5 split to something much better), boosting my take-home pay. I've been working quite hard since then, working 6 days a week (42-43hrs) in a clinic+hospital mixed practice (I don't think I can stand being in clinic >4.5 days a week.)

 

If I had spent all 43 hours in clinic, seeing patients at my upper tolerable pace, I suppose I could've billed >$400k. However, for my peace of mind I work a couple days at the hospital, which pays a bit less at BCMA-negotiated sessional rate at ~115/hr). The GP who owns the clinic billed >$450k last year (for MSP BILLINGs, check out http://www.health.gov.bc.ca/msp/legislation/pdf/bluebook2012.pdf )

 

I take on avg 5 weeks vacay/year.

 

My take home (pre-tax) pay over the years was highly variable depending on my lifestyle, from 180k to mid/high 200s)

 

Planning to tone it down a bit next year for a bit more quality of life - want to have some more fun while still in my early 30s and without kids!

So far I have yet to regret picking family med : )

 

this

 

is why im choosing FM

 

just 1 question, how common is it for a new FM grad to start off with 37.5% split? that seems pretty high compared to #s that are being thrown around in this forum. was it because you were locuming for a part-time that you had to pay higher split?

[da_birdie]

this

 

is why im choosing FM

 

just 1 question, how common is it for a new FM grad to start off with 37.5% split? that seems pretty high compared to #s that are being thrown around in this forum. was it because you were locuming for a part-time that you had to pay higher split?

 

I started out working at a couple different clinics, getting 67/33 split from the main clinic (and 70/30 from another). Then the clinic decided to lower physician's cut by 5%, triggering my relocation to another clinic. Now I get to keep 75%-80% of what I bill. To phrase it another way, seeing 40 patients in my current clinic earns me the same take-home pay as seeing 50 patients in the previous clinic.

 

In terms of 'industry averages', I'd say 70/30 is not uncommon outside of core Vancouver, even for new grads.

When you get to Burnaby East / Surrey / New West, you can expect upwards of 75/25. Downtown Vancouver ~ 65/35.

[NLengr]

I don't know man. I'm in western Canada actually. Many gen surg teams start rounding at 545am in this city and OR can go till 11pm quite often. Call teams go straight through to the AM and have a normal work day (till 6pm) after. One in 2-4 call.

 

I said that gen surg 'can' make 500-700 but that's on 70-80 hour weeks (11-14 hour days a day, 7 days a week). They average more like 450 because they tap out at lower hours (10-11hrs a day x 5-6 days a week?). And if they average 450, I question why don't one just be nice to himself and his family and just work 40 hr/wk as a GP?

 

My main question and main point of making this thread is to ask the you other smart beings out there why GPs only average in the low 200s, when the billing schedule clearly allows them to make much more than that?

 

They have staff rounding at 545?

 

Gen Surg staff at my center show up 7-730 on OR days. Maybe a bit later on clinic days.

[futureGP]

I started out working at a couple different clinics, getting 67/33 split from the main clinic (and 70/30 from another). Then the clinic decided to lower physician's cut by 5%, triggering my relocation to another clinic. Now I get to keep 75%-80% of what I bill. To phrase it another way, seeing 40 patients in my current clinic earns me the same take-home pay as seeing 50 patients in the previous clinic.

 

In terms of 'industry averages', I'd say 70/30 is not uncommon outside of core Vancouver, even for new grads.

When you get to Burnaby East / Surrey / New West, you can expect upwards of 75/25. Downtown Vancouver ~ 65/35.

 

interesting, but i guess it makes sense that average split changes based on location,

[da_birdie]

interesting, but i guess it makes sense that average split changes based on location,

 

This site is especially good for family med jobs

http://locums.ca/search/jobs

 

most postings mention the % split

should be fun to browse around even if you're not yet in the job market.

[da_birdie]

And if GPs can theoretically hit 400-500K on 40 hour work weeks, I want to put forth the question of why would one -ever- want to specialize?

 

First of all, to Bill $450-$500k routinely as a GP will put you several standard deviations above the GP norm, which will trigger red flags at MSP monitoring algorithms, significantly increase the chance of an audit - which can be extremely unpleasant (MSP is known to set a strict cap of ~25pts/day as disciplinary action vs high-billing GPs who are found to provide substandard care)

 

Also, to "Take Home" $400-$500k (after subtracting overhead) would mean Billing $550-$600k, very difficult/tiresome/audit-prone to achieve unless you do niche practices (eg cosmetic), even that requires building reputation and client base, which can take several years.

 

Generally, to generate the highest income with the least on-call and hours-worked, you need to look at specialties that provide services to satisfy people's vanity.

[Real Beef]

In a placement I am attending my Family Med trained MD preceptor works 3 days a week in her small family medicine practice and works 2 days a week in the cancer clinic in a Well visit clinic where she sees oncology patients in follow up who are stable. She is able to bill as a specialist at this clinic. This constitutes full time practice but she also works 2-3 evenings a week at a walk in clinic from 5-9 pm to further jam up her income .... so she is getting paid like a specialist 2 days a week, like a fam med doc 3 days a week but cushioning those Family Med days with additional walk-in clinic work 2-3 evenings a week which she stated was 'very lucrative' so I anticipate she is getting paid 'like a specialist' working all that she is.

 

Not sure how she arranged or got into the 'family medicine oncology specialist' role .... likely just by interest and being a part of a new pilot project at the cancer clinic that freed up more time for oncologists with their higher acuity patients.

 

Beef

[futureGP]

Could one do a specialty residency in something that's pretty low on hours worked like rad onc or part-time radiology (without call and the hard stuff) and supplement this with a family med residency to do some clinic or office work on the side?

 

isn't their some policy that states that you can't practise FM and another specialty at the same time?

[futureGP]

In a placement I am attending my Family Med trained MD preceptor works 3 days a week in her small family medicine practice and works 2 days a week in the cancer clinic in a Well visit clinic where she sees oncology patients in follow up who are stable. She is able to bill as a specialist at this clinic. This constitutes full time practice but she also works 2-3 evenings a week at a walk in clinic from 5-9 pm to further jam up her income .... so she is getting paid like a specialist 2 days a week, like a fam med doc 3 days a week but cushioning those Family Med days with additional walk-in clinic work 2-3 evenings a week which she stated was 'very lucrative' so I anticipate she is getting paid 'like a specialist' working all that she is.

 

Not sure how she arranged or got into the 'family medicine oncology specialist' role .... likely just by interest and being a part of a new pilot project at the cancer clinic that freed up more time for oncologists with their higher acuity patients.

 

Beef

 

it happens a lot in rural areas but i doubt it does in the big cities

[rmorelan]

Could one do a specialty residency in something that's pretty low on hours worked like rad onc or part-time radiology (without call and the hard stuff) and supplement this with a family med residency to do some clinic or office work on the side?

 

wouldn't you need a double specialization for that (or am I missing something)? That is a lot of work (not well paid work either).

[da_birdie]

Could one do a specialty residency in something that's pretty low on hours worked like rad onc or part-time radiology (without call and the hard stuff) and supplement this with a family med residency to do some clinic or office work on the side?

 

I've come across general internists and pathologists working part-time in walk-in clinics, not sure if they had a CCFP certificate or not.

 

Here in BC, one of the main income sources as GP is complex disease management fees($125-$450/pt/year), which is only billable by MDs who has Not billed a specialist fee-code in the past year.

 

There is also a variety of higher-pay fee codes that are billable only if one did not bill a specialist fee code in the past year.

[ploughboy]

Any specialist would probably need at most 1.5 years of FP residency to certify themselves to prescribe abx for viral bronchitis at any walk-in.

 

LOL. I see what you did there...

[Legume]

Any specialist would probably need at most 1.5 years of FP residency to certify themselves to prescribe abx for viral bronchitis at any walk-in. The opportunity costs would be minimal.

 

Don't sound bitter man. People should know exactly what they are getting into when they signed up for it (IM/surgery especially). When they look back and regret it later it's too late cuz they already spent all of their 20s and majority of 30s huffing and puffing in residency/fellowship and come out to find that the attending work isn't much better and they are making lower than GPs.

[Alastriss]

Don't sound bitter man. People should know exactly what they are getting into when they signed up for it (IM/surgery especially). When they look back and regret it later it's too late cuz they already spent all of their 20s and majority of 30s huffing and puffing in residency/fellowship and come out to find that the attending work isn't much better and they are making lower than GPs.

 

No one's bitter. I get why you're so interested in family medicine; the autonomy and all around career prospects are attractive to me as well.

 

Yet some of us like what we do, so when you think we're spending the majority of our 20s and 30s 'huffing and puffing' think again. The family doctor will never take out that cancer in the OR, or will not make that rare medical diagnosis that the specialists nail. And for some of us, the thrill of medicine and our passion for it is enough to make the residency and the potential lack of jobs and autonomy bearable.

[rmorelan]

No one's bitter. I get why you're so interested in family medicine; the autonomy and all around career prospects are attractive to me as well.

 

Yet some of us like what we do, so when you think we're spending the majority of our 20s and 30s 'huffing and puffing' think again. The family doctor will never take out that cancer in the OR, or will not make that rare medical diagnosis that the specialists nail. And for some of us, the thrill of medicine and our passion for it is enough to make the residency and the potential lack of jobs and autonomy bearable.

 

and I love how everyone makes the entire medical school/residency thing out to be torture compared to what ever else you would be doing. I mean advanced research, law, business, engineering..... people who want to be successful in anything are "huffing and puffing" the majority of their 20s and 30s. You want a job sure it can be 40 hour weeks. You want a professional career and you are going to have to work for it

 

and medical school is actually fun. Just saying

[preppy038]

and I love how everyone makes the entire medical school/residency thing out to be torture compared to what ever else you would be doing. I mean advanced research, law, business, engineering..... people who want to be successful in anything are "huffing and puffing" the majority of their 20s and 30s. You want a job sure it can be 40 hour weeks. You want a professional career and you are going to have to work for it

 

and medical school is actually fun. Just saying

 

it's not torture if you enjoy it right?

[Lactic Folly]

Could one do a specialty residency in something that's pretty low on hours worked like rad onc or part-time radiology (without call and the hard stuff) and supplement this with a family med residency to do some clinic or office work on the side?

 

Yes, but if you are certified in both and just want to pick up some extra shifts here and there, I'm not sure if there is much incentive to choose family medicine shifts instead of extra radiology work, unless one really misses being a family doc.

[rmorelan]

it's not torture if you enjoy it right?

 

Exactly

[rmorelan]

Given what Legume and Da Birdie are saying, the pay isn't half bad given the minimal time commitment and relatively small liability risks. Granted its no radiology shift, not by a long shot, but its attainable by all specialists should the desire be there. Rad onc, as an example, appears to have a more flexible schedule that would allow for one to do that kind of work should they desire. It could supplement income by 100k if the numbers given by the aforementioned posters are any indication.

 

Any specialist would probably need at most 1.5 years of FP residency to certify themselves to prescribe abx for viral bronchitis at any walk-in. The opportunity costs would be minimal.

 

You know I have never actually looked into to that - I assumed you need to start the FM training completely from scratch again regardless of your prior training - is there actually some short cuts you can take?

[Lactic Folly]

You would likely receive credit for most, if not all of the basic clinical training year (PGY-1) due to the amount of overlap.

[rmorelan]

You would likely receive credit for most, if not all of the basic clinical training year (PGY-1) due to the amount of overlap.

 

Hmmm that is kind of interesting - I mean for community practise there might be a lot of things going for a some fields picking up a FM instead of a fellowship, no? That is a pretty flexible combination