Lactic Folly Posted December 5, 2012 Report Share Posted December 5, 2012 Well, community medicine does include a family medicine residency. Not sure how feasible/common in other fields, or if you would be spreading yourself thin trying to maintain competency/volume in two separate areas. I can more easily come up with examples of FPs picking up shifts in other areas (sports medicine, surgical assisting) than specialists doing the converse. Link to comment Share on other sites More sharing options...
rmorelan Posted December 5, 2012 Report Share Posted December 5, 2012 Well, community medicine does include a family medicine residency. Not sure how feasible/common in other fields, or if you would be spreading yourself thin trying to maintain competency/volume in two separate areas. I can more easily come up with examples of FPs picking up shifts in other areas (sports medicine, surgical assisting) than specialists doing the converse. Sure, although in some ways there may be reinforcement - I mean if you read msk all as a rads and then actually work at a sports clinic one day a week there is some synergy going on there. Plus variety is actually interesting. I mean with a FM you can make your practise pretty restrictive. side note there is a pathologist I know who regularly surgically assists. That is kind of fun to watch - he will assist and then if there is pass that is required right away for biopsying he will then go to do that. Says he did it just because it was fun. Link to comment Share on other sites More sharing options...
Lactic Folly Posted December 5, 2012 Report Share Posted December 5, 2012 Sure, although in some ways there may be reinforcement - I mean if you read msk all as a rads and then actually work at a sports clinic one day a week there is some synergy going on there. Plus variety is actually interesting. If you are an MSK rad, your main clientele will be orthopedic surgeons, and I imagine you would get more out of high-level discussion of cases and current management with them (as at multidisciplinary tumour boards, etc.) than seeing routine cases yourself as a GP-sports med. As for variety, it would be uncommon to have an exclusively subspecialty practice except as part of a very large, likely academic practice - most people are going to be covering other areas from time to time (pretty much essential to being able to take call, not to mention the occasional vacation). Those wanting more variety / maintenance of general skills are more apt to do locums in general radiology - there is *huge* variety due to the range of studies and procedures involving virtually every organ system and field in medicine - it would be all you can do to just keep up from a CME perspective Link to comment Share on other sites More sharing options...
rmorelan Posted December 5, 2012 Report Share Posted December 5, 2012 If you are an MSK rad, your main clientele will be orthopedic surgeons, and I imagine you would get more out of high-level discussion of cases and current management with them (as at multidisciplinary tumour boards, etc.) than seeing routine cases yourself as a GP-sports med. As for variety, it would be uncommon to have an exclusively subspecialty practice except as part of a very large, likely academic practice - most people are going to be covering other areas from time to time (pretty much essential to being able to take call, not to mention the occasional vacation). Those wanting more variety / maintenance of general skills are more apt to do locums in general radiology - there is *huge* variety due to the range of studies and procedures involving virtually every organ system and field in medicine - it would be all you can do to just keep up from a CME perspective Makes perfect sense! Still I am curious about this, I will have to look at it a bit further. Provides some interesting options for later on. Link to comment Share on other sites More sharing options...
Legume Posted December 5, 2012 Author Report Share Posted December 5, 2012 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. I think the FP residency still requires full time commitment. So if you were to take 1.5 years off work to do this extra residency, you'd be losing out on $600-750k of income. Averaged over a 30 year career that's quite substantial ($20-25k per year). Another thing why family medicine is so appealing: I don't have to stay in residency/fellowship(s) till 2020-2023 (cardiology anybody?) and I would've made 2-3 million dollars MINIMUM before these specialists graduate with 250k+ debts. And don't expect your starting salary as a new attending in any IM subspecialties, path, psyc, peds, rad onc to exceed 150-250k. Also, don't expect anything more than 250-300 as a newly grad anes/rad/surgery fellow (if you are lucky enough to find a job). How many more years on top of residency/fellowship(s) would it take for you just to break even? All this bs just to serve "The Man" (shout out to Panda Bear MD ) and to fulfill your moral ego? -Legume Link to comment Share on other sites More sharing options...
youngdad Posted December 5, 2012 Report Share Posted December 5, 2012 Why all the hatin'? There is nothing worse for the great field of medicine than doctors pointing out everything negative about other specialties and specialists. "Do what you love, the money will follow." -Stephen R. Covey Do what you love and let everyone else do what they love. -Me Link to comment Share on other sites More sharing options...
futureGP Posted December 5, 2012 Report Share Posted December 5, 2012 I think the FP residency still requires full time commitment. So if you were to take 1.5 years off work to do this extra residency, you'd be losing out on $600-750k of income. Averaged over a 30 year career that's quite substantial ($20-25k per year). Another thing why family medicine is so appealing: I don't have to stay in residency/fellowship(s) till 2020-2023 (cardiology anybody?) and I would've made 2-3 million dollars MINIMUM before these specialists graduate with 250k+ debts. And don't expect your starting salary as a new attending in any IM subspecialties, path, psyc, peds, rad onc to exceed 150-250k. Also, don't expect anything more than 250-300 as a newly grad anes/rad/surgery fellow (if you are lucky enough to find a job). How many more years on top of residency/fellowship(s) would it take for you just to break even? All this bs just to serve "The Man" (shout out to Panda Bear MD ) and to fulfill your moral ego? -Legume except nephrology is absolutely awesome, same with respirology, cardiology... i think i would've loved being an american IM Link to comment Share on other sites More sharing options...
bloh Posted December 5, 2012 Report Share Posted December 5, 2012 Depends on how far from residency you were. If you are going back fairly soon, a lot of directors would probably be able to accept some of your previous training. But a radiologist of 20 years going back? You're repeating all of it for sure. Link to comment Share on other sites More sharing options...
rmorelan Posted December 5, 2012 Report Share Posted December 5, 2012 Depends on how far from residency you were. If you are going back fairly soon, a lot of directors would probably be able to accept some of your previous training. But a radiologist of 20 years going back? You're repeating all of it for sure. I guess that is the part that still confuses this - I always thought the time length was mandated etc without flexibility. This is all a bit of news to me Link to comment Share on other sites More sharing options...
Alastriss Posted December 5, 2012 Report Share Posted December 5, 2012 I think the FP residency still requires full time commitment. So if you were to take 1.5 years off work to do this extra residency, you'd be losing out on $600-750k of income. Averaged over a 30 year career that's quite substantial ($20-25k per year). Another thing why family medicine is so appealing: I don't have to stay in residency/fellowship(s) till 2020-2023 (cardiology anybody?) and I would've made 2-3 million dollars MINIMUM before these specialists graduate with 250k+ debts. And don't expect your starting salary as a new attending in any IM subspecialties, path, psyc, peds, rad onc to exceed 150-250k. Also, don't expect anything more than 250-300 as a newly grad anes/rad/surgery fellow (if you are lucky enough to find a job). How many more years on top of residency/fellowship(s) would it take for you just to break even? All this bs just to serve "The Man" (shout out to Panda Bear MD ) and to fulfill your moral ego? -Legume Read the mother flipping post. Some of us LIKE THIS STUFF. Some of us in fact, LOVE IT. It has nothing about being "the man" and fulfilling the moral ego. I loved cardiology, I woke up every morning happy to go to work and learn. I feel sorry that you don't share in my passion in medicine. However I think you've found your source of happiness. Link to comment Share on other sites More sharing options...
Wachaa Posted December 5, 2012 Report Share Posted December 5, 2012 One argument to make about the likability of the job, for me at least, is that I think I enjoy doing things outside of medicine just as much, if not more. I like being able to set a time to myself and enjoy life doing sports, leisure activities, having a family, and hobbies. Having variety in life is more important to me when one day I'm thinking..."what did I do with my life?" With a good income and very light hours, I'm not going to be jealous of what anybody else is doing in the OR/ ward. Link to comment Share on other sites More sharing options...
cheech10 Posted December 5, 2012 Report Share Posted December 5, 2012 Legume, where do you get your numbers from? I agree that finding a job in some specialties is difficult, but if you find one, the starting remuneration is significantly higher than what you quote (for personal experience for IM and subspecialties, new grads are making twice as much as you suggest). In fact, in a fee for service environment the remuneration at the start one's career is similar to that of an established physician, as long as you are efficient at seeing patients. Also, in the 3-4 years of longer residency for a specialist, a FP *might* bill 1.5 million, but certainly won't take home anywhere near that after expenses. Specialist training programs won't put one that far behind that they can't catch up in a few years. Link to comment Share on other sites More sharing options...
NLengr Posted December 5, 2012 Report Share Posted December 5, 2012 Legume, where do you get your numbers from? I agree that finding a job in some specialties is difficult, but if you find one, the starting remuneration is significantly higher than what you quote (for personal experience for IM and subspecialties, new grads are making twice as much as you suggest). In fact, in a fee for service environment the remuneration at the start one's career is similar to that of an established physician, as long as you are efficient at seeing patients. Also, in the 3-4 years of longer residency for a specialist, a FP *might* bill 1.5 million, but certainly won't take home anywhere near that after expenses. Specialist training programs won't put one that far behind that they can't catch up in a few years. I half think at this point he's just trolling to stir up arguments. Link to comment Share on other sites More sharing options...
Laika Posted December 5, 2012 Report Share Posted December 5, 2012 A timely article: Public Payments to Physicians in Ontario Adjusted for Overhead Costs, Healthcare Policy, 8(2) 2012: 30-36. Link to comment Share on other sites More sharing options...
apache Posted December 5, 2012 Report Share Posted December 5, 2012 i've always wondered about this if i decide to work i canada... could you do fm and then the 4 years psych wth year credit from fm... i don't see why not... in the states... you can double residencies in 6... both specialties... psych can jump into sleep med, pain management (honestly... while i welcome a doubling in salary... this seems pretty sketch... anesthesia should get most) isn't their some policy that states that you can't practise FM and another specialty at the same time? Link to comment Share on other sites More sharing options...
cheech10 Posted December 5, 2012 Report Share Posted December 5, 2012 Two specialties does not imply a doubling of remuneration. The large majority of physicians are under fee for service plans, and there is a finite amount of time you can work in a year, so any time spent in one field lessens the time available for the other. Link to comment Share on other sites More sharing options...
nauru Posted December 5, 2012 Report Share Posted December 5, 2012 A timely article: Public Payments to Physicians in Ontario Adjusted for Overhead Costs, Healthcare Policy, 8(2) 2012: 30-36. I would very much like to read this, if anyone has access to a non-paywalled version. Or at least a detailed summary of the key table would be great. Thanks. Link to comment Share on other sites More sharing options...
jerkoutnow2 Posted December 5, 2012 Report Share Posted December 5, 2012 i've always wondered about this if i decide to work i canada... could you do fm and then the 4 years psych wth year credit from fm... i don't see why not... in the states... you can double residencies in 6... both specialties... psych can jump into sleep med, pain management (honestly... while i welcome a doubling in salary... this seems pretty sketch... anesthesia should get most) we need something like this in Canada, seriously Link to comment Share on other sites More sharing options...
jerkoutnow2 Posted December 5, 2012 Report Share Posted December 5, 2012 I would very much like to read this, if anyone has access to a non-paywalled version. Or at least a detailed summary of the key table would be great. Thanks. k i dont want to go into copyright issues but an essential summary is this Self-reported gross/net from NPS 2010 + public payment data in Ontario All physicians gross ~$320k, net $230k Radiology: Gross ~$600k, net ~$480k Nephro: Gross ~$550k, net ~$470k Vascular surg, Cardiac surg: Gross ~$520k, net ~$420k GI: Gross ~$520k, net ~$420k Ophthal: gross ~$600k, net ~$350k Anes: Gross ~$400k, net ~$340k Urology: Gross ~$420k, net ~$310k Obs/gyn: Gross ~$440k, net ~$300k Gen Surg: Gross ~$410k, net ~$300k Medonc/Respiro: Gross ~$320k, net ~$290k Ortho/ENT: Gross ~$410k, net ~$280k Derm: Gross ~$390k, net ~$230k Plastic: Gross ~$350k, net ~$230k Family: Gross ~$300k, net ~$210k (family actually has higher net than emerg...apparently) Emerg: Gross ~$230k, net ~$200k IM, endocrin, rheuma: Gross ~$280-300k, net ~$200k Physiatry: Gross ~$250k, net ~190k Neurology: Gross ~$270k, net ~$180k Peds: Gross ~$270k, net ~$170k Overhead info: Anesthesia: ~56% of them have <10% overhead, 10% have >30% overhead radiology: ~41% have <10% overhead, 31% have >30% overhead Cardiology: 13% have <10% overhead, 48% have >30% overhead Family: 5% have <10% overhead, 68% have >30% overhead Ophthal: 2% have <10% overhead, 88% have >30% overhead EDIT: remember to tax! $480k for radiology would get 42% taxed to $278k in ontario (considered no incorp) $210k for family --> $133k Link to comment Share on other sites More sharing options...
NLengr Posted December 6, 2012 Report Share Posted December 6, 2012 k i dont want to go into copyright issues but an essential summary is this Self-reported gross/net from NPS 2010 + public payment data in Ontario All physicians gross ~$320k, net $230k Radiology: Gross ~$600k, net ~$480k Nephro: Gross ~$550k, net ~$470k Vascular surg, Cardiac surg: Gross ~$520k, net ~$420k GI: Gross ~$520k, net ~$420k Ophthal: gross ~$600k, net ~$350k Anes: Gross ~$400k, net ~$340k Urology: Gross ~$420k, net ~$310k Obs/gyn: Gross ~$440k, net ~$300k Gen Surg: Gross ~$410k, net ~$300k Medonc/Respiro: Gross ~$320k, net ~$290k Ortho/ENT: Gross ~$410k, net ~$280k Derm: Gross ~$390k, net ~$230k Plastic: Gross ~$350k, net ~$230k Family: Gross ~$300k, net ~$210k (family actually has higher net than emerg...apparently) Emerg: Gross ~$230k, net ~$200k IM, endocrin, rheuma: Gross ~$280-300k, net ~$200k Physiatry: Gross ~$250k, net ~190k Neurology: Gross ~$270k, net ~$180k Peds: Gross ~$270k, net ~$170k Overhead info: Anesthesia: ~56% of them have <10% overhead, 10% have >30% overhead radiology: ~41% have <10% overhead, 31% have >30% overhead Cardiology: 13% have <10% overhead, 48% have >30% overhead Family: 5% have <10% overhead, 68% have >30% overhead Ophthal: 2% have <10% overhead, 88% have >30% overhead EDIT: remember to tax! $480k for radiology would get 42% taxed to $278k in ontario (considered no incorp) $210k for family --> $133k Your taxation losses are wrong. You only pay 42% on the fraction of your income in the highest bracket. Income in lower brackets is taxed at a lower rate. Link to comment Share on other sites More sharing options...
Gametime24 Posted December 6, 2012 Report Share Posted December 6, 2012 Your taxation losses are wrong. You only pay 42% on the fraction of your income in the highest bracket. Income in lower brackets is taxed at a lower rate. 42% is the average tax rate for that salary in Ontario, 46% is the marginal tax rate. His taxation losses were correct. Throw the value of $480 000 into here and look at the column for Ontario and you'll see a take-home income of roughly $278 000. http://lsminsurance.ca/calculators/canada/income-tax/taxes-2012 Link to comment Share on other sites More sharing options...
nauru Posted December 6, 2012 Report Share Posted December 6, 2012 Thanks for the table. What is GI? (4th from the top) Link to comment Share on other sites More sharing options...
Legume Posted December 6, 2012 Author Report Share Posted December 6, 2012 k i dont want to go into copyright issues but an essential summary is this Self-reported gross/net from NPS 2010 + public payment data in Ontario All physicians gross ~$320k, net $230k Radiology: Gross ~$600k, net ~$480k Nephro: Gross ~$550k, net ~$470k Vascular surg, Cardiac surg: Gross ~$520k, net ~$420k GI: Gross ~$520k, net ~$420k Ophthal: gross ~$600k, net ~$350k Anes: Gross ~$400k, net ~$340k Urology: Gross ~$420k, net ~$310k Obs/gyn: Gross ~$440k, net ~$300k Gen Surg: Gross ~$410k, net ~$300k Medonc/Respiro: Gross ~$320k, net ~$290k Ortho/ENT: Gross ~$410k, net ~$280k Derm: Gross ~$390k, net ~$230k Plastic: Gross ~$350k, net ~$230k Family: Gross ~$300k, net ~$210k (family actually has higher net than emerg...apparently) Emerg: Gross ~$230k, net ~$200k IM, endocrin, rheuma: Gross ~$280-300k, net ~$200k Physiatry: Gross ~$250k, net ~190k Neurology: Gross ~$270k, net ~$180k Peds: Gross ~$270k, net ~$170k Overhead info: Anesthesia: ~56% of them have <10% overhead, 10% have >30% overhead radiology: ~41% have <10% overhead, 31% have >30% overhead Cardiology: 13% have <10% overhead, 48% have >30% overhead Family: 5% have <10% overhead, 68% have >30% overhead Ophthal: 2% have <10% overhead, 88% have >30% overhead EDIT: remember to tax! $480k for radiology would get 42% taxed to $278k in ontario (considered no incorp) $210k for family --> $133k Thanks for pulling off the info for everybody! It would be important to know what are the average hours worked per week for each specialty too. I'm thinking GP/FP average 300k on 30-35 hour work weeks, while GI/cards/optho/surgery/rad do up 60 hours a week on average. Does anyone know how long attendings work on average in various specialties? Because that can change the rankings by quite a bit. Edit: Emerg seems to make little but their hours are really cupcake too. Many of them work 10-15 eight-hour shifts a month, which comes out to 80-120hrs a month. Some of the specialties work 80 hours a WEEK. -Legume Link to comment Share on other sites More sharing options...
jerkoutnow2 Posted December 6, 2012 Report Share Posted December 6, 2012 Thanks for the table. What is GI? (4th from the top) gastroenterology (IM subspecialty) Link to comment Share on other sites More sharing options...
jerkoutnow2 Posted December 6, 2012 Report Share Posted December 6, 2012 Thanks for pulling off the info for everybody! It would be important to know what are the average hours worked per week for each specialty too. I'm thinking GP/FP average 300k on 30-35 hour work weeks, while GI/cards/optho/surgery/rad do up 60 hours a week on average. Does anyone know how long attendings work on average in various specialties? Because that can change the rankings by quite a bit. Edit: Emerg seems to make little but their hours are really cupcake too. Many of them work 10-15 eight-hour shifts a month, which comes out to 80-120hrs a month. Some of the specialties work 80 hours a WEEK. -Legume nephro/GI/cardiology/resp all work pretty long hours and share call (unless they're in a private clinic) as attendings, GIM is pretty bad too - long work-hours + call cover Endo/rheum are much better and call is pretty light Med onc = probably similar to rad onc? 9-5 Rad onc = 9-5, no call Ophthal probably have pretty good lifestyle -- private clinics are usually day-time hours (lots of clinics with ophthal sharing office with optometrists -- clinic hours are pretty light), idk about call and if it's busy or not. -- but wow their overhead is HIGH 600k --> 350k Obs/gyn isn't bad either, i shadowed an obs/gyn once and they start at ~9 end at ~5. They cover off-shift deliveries for each other in the clinic (So if 9 ppl, it's 1/9 call). Derm is probably 9-5 (private clinic... idk what skin emergencies are there :s), but i'm surprised that derm net income is similar to FM/emerg Link to comment Share on other sites More sharing options...
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