Why aren't more GPs making 400k+

[NLengr]

well that sucks,

 

40% of med students have a dark future

 

Academic family med did a pretty good job of helping to dig it's own grave.

[jerkoutnow2]

Agreed re: FFS model rewarding speed over quality.

I see 40 patients in my 7-hour clinic day, but I know many older docs (and also some younger GP's who's out of residency for < 3 years) who see 50 pts in <5 hours. Granted many of them work in Walk-in clinics which often deal with minor issues/ Rx refills, while sending the patients back to their regular GPs for f/up of more complex problems.

 

However, WICs certainly plays an important role to provide service when the patient's regular GP is away or too fully-booked. WICs also commonly provide after-hours service which most family docs don't, offering convenience for patients and relief for ER.

 

I'm not sure how patient-rostering works in Ontario (extra lump-sum/pt/year?). As many (if not most) patients are "double-/triple-doctoring" (either via having >1 GPs concurrently or via visiting walk-ins), it might be difficult to work out a fair fee for the non-primary physician. That would also discourage GPs from working in walk-in clinics (some may say it's a good thing), which as mentioned above, do play an important role in primary care.

 

family health networks, family health organizations

 

capitation models

 

http://www.healthforceontario.ca/HealthcareInOntario/PrimaryCare.aspx

 

in order for GPs to get $$ per patient, the patient usually signs this form stating that he's the only FM. but this doesn't prevent them from using walk-ins

[Alastriss]

Disagree with you here bro.

 

Due to the family doctors' relative ubiquity, coupled with the recent lower-level encroachment de-valuing the worth of the family doctor, their bargaining power is limited. Since they are hoi polloi of the medical profession any cut to them will have a larger net savings than cuts to smaller subspecialties like ophthalmology.

 

I tell the students I teach that family medicine will be in for a future that's more challenging than ever before. Not only will the "not-so-hidden curriculum" paint every patient and specialist encounter with the brush of regret as it does now, but the ability to work and be remunerated fairly will be compromised by pharmacists, NPs and naturopaths doing the duties that used to be those of doctors.

 

Family med has a dark future. There will be cuts. The government will drink the milkshake of the family doc.

 

What I tell my students is that if income is a factor in specialty selection, I'd stick with imaging. It's interesting, intellectual work, and even with cuts, the relative lack of overhead and fee-for-service billing model is the most financially rewarding in medicine. Lots of students understand matching to imaging is difficult, so they ask about pathology too. I tell them that pathology, imaging's ugly cousin, is no less intellectual and is a similar job but the salary model eliminates any incentives to work more and provide higher quality service, and also limits one's autonomy.

 

renumerations towards family doctors have been improving. There isn't this low-level "encroachment" as you mention it really, so what naturopaths can now prescribe antibiotics and Nurse practitioners are expanding their scope.

 

You'll be hard-pressed to find families actively choosing to see a ND or an NP over a family doctor when they essentially have access to either at the "same price". It's the demand for family doctors that will determine their price, and people will always choose a family doctor over a naturopathic doctor or a nurse practitioner.

 

Secondly, NPs are not a substitute for family doctors. They aren't trained to the same degree and are still, by and large, lacking that clinical judgement you get through your training. There's more to medicine than using an algorithmic approach.

 

We can all sit here and talk about how each specialty is going down in it's own way if we choose to.

 

Even if this isn't enough, family medicine has a "way too diverse" scope to be phased out so easily.

 

Not sure why but around where I am most docs operate as part of a FHO. They are much happier and by and large feel they make more money this way.

[kemeno]

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

 

 

What is income for Community Doc ? Thanks !

[youngdad]

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

 

 

We are some lucky human beings...

I'm not playing the same old tune of "money doesn't buy happiness" because it sure doesn't hurt. I'm not naive. Certainly poverty sucks, and fighting your whole life (like most hard working people) just to crack the middle class and all it affords doesn't sound like fun after a decade+ of school.

However I have one question: Does anybody see a salary on here that would prevent happiness or exclude one from a deeply satisfying life?

I sure don't. Just pick an area you enjoy.

[jerkoutnow2]

What is income for Community Doc ? Thanks !

 

community wasnt listed sorry..

 

but typically salary for a MOH is from $170k to $250k depending on seniority (e.g. regional assistant MOH vs. provincial MOH)

[jerkoutnow2]

We are some lucky human beings...

I'm not playing the same old tune of "money doesn't buy happiness" because it sure doesn't hurt. I'm not naive. Certainly poverty sucks, and fighting your whole life (like most hard working people) just to crack the middle class and all it affords doesn't sound like fun after a decade+ of school.

However I have one question: Does anybody see a salary on here that would prevent happiness or exclude one from a deeply satisfying life?

I sure don't. Just pick an area you enjoy.

 

well

 

except that i'd say most physicians are high-income

 

http://www.progressive-economics.ca/2011/07/20/what-is-a-middle-class-income-these-days/

 

Look at some data here.

 

ALL physicians will have gross income in the upper quintile and are considered "high-class" or well-off. EVEN in BC

 

http://www2.macleans.ca/2011/10/25/rank-your-income-where-do-you-stand-compared-to-the-rest-of-canada/

 

$100 000 is at top 5.56%

$300 000 is at top 0.71%

 

all physicians are in the high-income class.

 

and this is actually the truth. and it's hard to believe for someone who's grown up in a suburban middle-high class neighbourhood all their life, went to university (where most are from middle to middle-high class) and went into medicine (most from doctor-families, professional families)

 

get outside of GTA in Ontario and most people live very poorly indeed...

[mavrik13]

We are some lucky human beings...

I'm not playing the same old tune of "money doesn't buy happiness" because it sure doesn't hurt. I'm not naive. Certainly poverty sucks, and fighting your whole life (like most hard working people) just to crack the middle class and all it affords doesn't sound like fun after a decade+ of school.

However I have one question: Does anybody see a salary on here that would prevent happiness or exclude one from a deeply satisfying life?

I sure don't. Just pick an area you enjoy.

 

I completely agree - but it would suck to be paying back 150k in student loans while netting the ~180k that Peds gets paid compared to many others netting over 400k. I find the pay disparity between different specialties to be quite shocking sometimes.

[Legume]

I completely agree - but it would suck to be paying back 150k in student loans while netting the ~180k that Peds gets paid compared to many others netting over 400k. I find the pay disparity between different specialties to be quite shocking sometimes.

 

Well said my friend. One of the main reasons why I started this thread. If I can bank 500 grand a year as a GP coming off 2 years of residency, there is very little reason to do anything else. And from the responses I've seen so far, it is quite possible to make that amount (or more) as a GP.

[Legume]

We are some lucky human beings...

I'm not playing the same old tune of "money doesn't buy happiness" because it sure doesn't hurt. I'm not naive. Certainly poverty sucks, and fighting your whole life (like most hard working people) just to crack the middle class and all it affords doesn't sound like fun after a decade+ of school.

However I have one question: Does anybody see a salary on here that would prevent happiness or exclude one from a deeply satisfying life?

I sure don't. Just pick an area you enjoy.

 

These are all deeply satisfying incomes for sure. However, many specialties have deeply unsatisfying workload and lifestyle. I sure as hell don't want to spend the majority of my waking life in the OR, on the wards, or in the dark room. Personal opinion.

 

You are awake for ~110 hours a week, do you really want to spend 60-80 of those hours working?

[rmorelan]

These are all deeply satisfying incomes for sure. However, many specialties have deeply unsatisfying workload and lifestyle. I sure as hell don't want to spend the majority of my waking life in the OR, on the wards, or in the dark room. Personal opinion.

 

You are awake for ~110 hours a week, do you really want to spend 60-80 of those hours working?

 

well actually on some level yeah I kind of do, I just want that work to be actually interesting.

 

When I was a software engineer I worked 80+ routinely for years. The why behind that was it was a lot of fun. People actually paid me to solve interesting problems, and paid me well. It was like I had an awesome hobby I got to do as much as I wanted. For me I see some areas of medicine being exactly the same way.

 

I know many doctors that think the same way. Just try and tear away some of the surgeons out of the OR. Some internal docs will round for seemly an endless amount of time because they enjoy it and think it helps. They aren't just there for the money.

 

I also know a whole lot of other doctors for which it is just a job. I know which group seems to be happier but I cannot really say which group make a better doctor.

[Gametime24]

well actually on some level yeah I kind of do, I just want that work to be actually interesting.

 

When I was a software engineer I worked 80+ routinely for years. The why behind that was it was a lot of fun. People actually paid me to solve interesting problems, and paid me well. It was like I had an awesome hobby I got to do as much as I wanted. For me I see some areas of medicine being exactly the same way.

 

I know many doctors that think the same way. Just try and tear away some of the surgeons out of the OR. Some internal docs will round for seemly an endless amount of time because they enjoy it and think it helps. They aren't just there for the money.

 

I also know a whole lot of other doctors for which it is just a job. I know which group seems to be happier but I cannot really say which group make a better doctor.

 

Mhmm, and there is also those who are extremely passionate about their work, but equally passionate about their family, etc.

 

Just adding another point to rmorelans reply, there are an infinite number of reasons why someone may want to work more hours per week or less hours per week that are unrelated to the financial stability.

 

Everyone just needs to find the area that best fills their overall wants and needs. For me, it would be really any specialty that I find interesting and can work roughly 40 hour weeks, so FP might be it, or private practice in another area. For example, one of my profs introduced me to a radiologist who has a pretty nice lifestyle, only works about 45 hours a week and has a salary that is much more than the typical family doc makes in those hours (but that won't be the determining factor for me, how interesting I find radiology as an elective someday will decide if I will take a run at it).

[kemeno]

community wasnt listed sorry..

 

but typically salary for a MOH is from $170k to $250k depending on seniority (e.g. regional assistant MOH vs. provincial MOH)

 

Many thanks Jerkoutnow2 ! It is not bad at all for a job 9-5 I found.

[jerkoutnow2]

Many thanks Jerkoutnow2 ! It is not bad at all for a job 9-5 I found.

 

plus, you can work as a FP so you can always take up locum/walk-in shifts

[kemeno]

plus, you can work as a FP so you can always take up locum/walk-in shifts

 

We can do that by combine an employee income and incorporation as GP ? that is interesting if we can keep some clinical activities ! Do you have any idea about job market of this specialty ? Thanks again !

[rmorelan]

We can do that by combine an employee income and incorporation as GP ? that is interesting if we can keep some clinical activities ! Do you have any idea about job market of this specialty ? Thanks again !

 

You can be both incorporated and command a salary at another position. Actually happens quite a bit for the higher ups in academy.

[futureGP]

We can do that by combine an employee income and incorporation as GP ? that is interesting if we can keep some clinical activities ! Do you have any idea about job market of this specialty ? Thanks again !

 

job market isn't that good apparently. look around for posts by 'moo' he did the 5-year comm med and is also a practising FP. he talks a lot about what he does etc but from what i remember he couldn't find a job in his specialty in the big cities, you might have to go elsewhere (rurally)

[AtomSmasher19]

Alright, let's say a GP works in his clinic, booked solid. How much does he make per hour on average, minus overhead?

[Amadeus89]

How much does he make per hour on average, minus overhead?

 

[futureGP]

Alright, let's say a GP works in his clinic, booked solid. How much does he make per hour on average, minus overhead?

 

how do you define booked solid...

 

1 patient/5 min?

1 patient/10 min?

1 patient/15 min?

 

if you're fast, you can probably get $200~$300 after overhead

on average probably $120~150

 

as a reference, hospitalists are paid from $110~130/hr depending on location

[youngdad]

Boy if you can take a resident on it sure beefs up the income.

I worked with a family doc who did 9-5 with an hour for lunch. He still has hospital privileges and he has 2-5 patients in the hospital at any one time, and he does a few deliveries every month. He has a great resident and often has students. He's busy, but from my vantage point, not as busy as any surgeon or internal specialist. He billed over 650+ in 2012.

[apache]

you know, it still shocks me after years that attendings can bill for residents, that's ridiculous, then again, it going back to a non traditional modeli was discussing about psychologists hiring gp's as consultants and paying a salary, i wonder what the laws are about dividing formal space for seperate businesses in an office, since the ability for the guy to supervise residents payed by the gov to see patients, and running a parallel boutique service for psychological well being, nutrition, physio etc. consulting and only seeing people in your llc from the consulting service could be very profitable for boutique med and health, especially with those residents.

then you run 50 patients and charge 25 g each, plus billings to gov... i'm gonna think of a legal way around this somehow... lol

 

Boy if you can take a resident on it sure beefs up the income.

I worked with a family doc who did 9-5 with an hour for lunch. He still has hospital privileges and he has 2-5 patients in the hospital at any one time, and he does a few deliveries every month. He has a great resident and often has students. He's busy, but from my vantage point, not as busy as any surgeon or internal specialist. He billed over 650+ in 2012.

[apache]

yeah, my psych makes close to 400 on 9 months a year, she sais 700 is very doable, but shes very creative...consider her overhead is like 45 k

 

and she writes off conferences almost biweekly... pads the legal stuff... you gotta work smart, not more (sounds like this gp does)

 

Boy if you can take a resident on it sure beefs up the income.

I worked with a family doc who did 9-5 with an hour for lunch. He still has hospital privileges and he has 2-5 patients in the hospital at any one time, and he does a few deliveries every month. He has a great resident and often has students. He's busy, but from my vantage point, not as busy as any surgeon or internal specialist. He billed over 650+ in 2012.

[apache]

problem is some patients don't stay 10 minutes, i remember a buddy hassling for oxy who took 50 minutes... oi

 

Alright, let's say a GP works in his clinic, booked solid. How much does he make per hour on average, minus overhead?

[AK81]

You will be disappointed if you go into FM for the money. Every study has shown GP earnings per hour is less than most specialists'. The statistics for average billings and hours worked for Ontario anyways is easy to find on the OMA website and it is current to 2011. GPs work long hours in Ontario. However, different studies give different values so don't look at the specific numbers but rather the trends between studies. The best way to get an estimate is just ask doctors IN THE LOCATION YOU WANT TO PRACTICE and inquire about their billings and hours.

 

At this stage, I'm sure we all have friends who are family doctors. You will work hard to clear 300K gross as a GP (but doable). Factor in overhead and taxes on top of that. Compare that to say general internal medicine which can range 350K to 1 million with comparable variety of hours to a GP.