shimshim Posted November 4, 2014 Report Share Posted November 4, 2014 Hello all, I want to start a clinic and see adult patients on walk in basis based on both needed service and ancillary services. I have a 3 Year IM degree soon, I am trying to come back to the country I love and start this journey in about a year or so. I am creating the company profile, outline and website day by day trying to finish this year. My question is this, Can I start my own clinic and office and treat adult health and provide other services like I would be able to do in USA. Link to comment Share on other sites More sharing options...
Flow Cytometry Posted November 12, 2014 Report Share Posted November 12, 2014 Yes, if you have passed your royal college exam for Internal Med in Canada. Then you can have your clinic. Question then becomes if you will have enough referrals from just opening a clinic without hospital attachment. Link to comment Share on other sites More sharing options...
rmorelan Posted November 12, 2014 Report Share Posted November 12, 2014 I guess you are asking about the walk in aspect in part - short answer is I believe no, you can only operate with referrals from a primary service in Canada for the things (only exception is for private care but that is only services you cannot bill the government for - which does not include the vast majority of internal medicine services. Things like some elective cosmetic surgeries for a plastic surgeon are allowed as an example). Anyway this is why in canada the model is referral based for internal medicine. Unlike the US, internal med is not a primary intake service in Canada. You can of course open a clinic and provide those services which are under your scope of practice in Canada. You will have to be specific about the "other services" you mention to see if those are allowed. Link to comment Share on other sites More sharing options...
RadCdn Posted November 28, 2014 Report Share Posted November 28, 2014 I know internists tend to not work in primary care. My question is, can they? I do remember seeing some GP's in Canada with Internal Medicine training so I assume it is possible. Link to comment Share on other sites More sharing options...
justletmein Posted November 28, 2014 Report Share Posted November 28, 2014 I know internists tend to not work in primary care. My question is, can they? I do remember seeing some GP's in Canada with Internal Medicine training so I assume it is possible. Not really. In the old system, you did a year of internship after med school and were considered "GP" .. then you could go on to specialize. Nowadays, you choose either family doctor or specialist. The canadian health care model uses the family doctor as the "gatekeeper", so internists cannot just open a walk-in clinic. There are many internists (particularly older ones) who do primary care, but the patients they see tend to be recruited from hospitals or referred by GP's. Link to comment Share on other sites More sharing options...
ploughboy Posted November 28, 2014 Report Share Posted November 28, 2014 I know internists tend to not work in primary care. My question is, can they? I do remember seeing some GP's in Canada with Internal Medicine training so I assume it is possible. Two elements to this - will the provincial college of physicans licence you to practice with that scope, and will the provincial government accept your billings (and if so, will they let you bill FM or IM codes). 1 - College. In Ontario at least, everybody's licence comes with the following terms and conditions: "Dr. X may practise only in the areas of medicine in which Dr. X is educated and experienced." I have no idea how the college would feel about you doing some elements of what is traditionally viewed in Canada as the family physician's domain, but you should probably check with the relevant licensing body early on in the process. 2 - Government. Again, I don't know what fees the government would and wouldn't reimburse. Ontario example, I don't know whether you can bill x00x codes or x13x codes for what you want to do. You should probably find a good billing agent sooner rather than later and find out. Question back to you -- why would you do this? Internal Medicine consultation codes are generally more lucrative than Family Medicine codes. What you need is to figure out a way to get referrals from family docs. Maybe find a walk-in clinic and make them a pitch: "I'll bet there are a bunch of patients that your current docs would like to work up more fully but just don't have the time. I'll rent an exam room and a nurse from you if you send some of those patients to me". Then start cranking out the A135s Link to comment Share on other sites More sharing options...
spontaneouscombustion Posted November 30, 2014 Report Share Posted November 30, 2014 Unless you did gynecology and some pediatrics as part of your overseas IM training, I don't think you'd be able to. I've seen older IM docs run walk in clinics (hell, I just saw a Pediatrician the other day), but these guys were around when the rotating internship existed. Link to comment Share on other sites More sharing options...
RadCdn Posted December 2, 2014 Report Share Posted December 2, 2014 Thanks ploughboy for the great response. The thing is, I really enjoy clinic medicine more than hospital medicine. Now I'm wondering, how likely is it that I can get a good amount of referrals from Family Docs? Also, what is a A135? It sounds like a billing code. If so, how much more do General Internists bill per visit than a family doc does? Thanks for all your help. Link to comment Share on other sites More sharing options...
RadCdn Posted January 1, 2015 Report Share Posted January 1, 2015 Hey Guys, The reason I ask is that I find medicine in the hospital far less enjoyable than in the clinic. I would like to structure my career in the clinic setting, preferably in solo practice. I'm wondering if there are any General IM docs that do this in Canada? How feasible is it to do this? I have been out of Canada for so long that I have little idea of how it works up there. Link to comment Share on other sites More sharing options...
ploughboy Posted January 2, 2015 Report Share Posted January 2, 2015 Hey, For an Ontario-specific overview of the requirements for a specialist consultation, and general, intermediate and minor assessments start reading on page 5 of this link: http://www.health.gov.on.ca/english/providers/pub/ohip/physmanual/download/section_2.pdf Ontario billing codes are here: http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/a_consul.pdf I'm neither a family doc nor a billing guru, but I imagine most family doc visits are billed as A007s ($34) and A001s ($22) with some occasional A004s ($38) and A003s ($77) thrown in. Any family docs reading this, feel free to correct me. Now that's not money in your pocket, that's gross billing out of which you have to pay all your overhead. You make your money on volume, and being efficient. There's an argument to be made that patient care suffers if you're cranking through a bunch of patients in a fee-for-service model, so a lot of family docs are no longer straight fee-for-service but have some sort of capitation model, or a blended model or something else. I'm *definitely* not an internist, but afaik their basic consultation is the A135 ($157). In very rough terms it's equivalent to an A003, but pays twice as much. An A435 ($105) is a quicker version of the A135, and again speaking very broadly is kind of like an A007, A004 or A001, except it pays a lot more. Again, all before overhead. Now a terrible family doc who spends only 2 minutes with each patient but cranks through a ton of them every day will likely make more than a meticulous internist who only sees 4 patients a day and has memorized the lab values for each patient, but for normal billing patterns the internist is likely going to make more on a per hour basis than the family doc.. No idea how hard it would be to get referrals from family docs as a new-in-town internist with no connections. Might not be a bad idea to do a locum in the geographic area that you're interested in and figure out the lay of the land. Link to comment Share on other sites More sharing options...
rmorelan Posted January 2, 2015 Report Share Posted January 2, 2015 Hey Guys, The reason I ask is that I find medicine in the hospital far less enjoyable than in the clinic. I would like to structure my career in the clinic setting, preferably in solo practice. I'm wondering if there are any General IM docs that do this in Canada? How feasible is it to do this? I have been out of Canada for so long that I have little idea of how it works up there. well there are internal medicine docs that are mostly clinic for sure - it isn't the hospitals you require it is the referrals. Also it is very much common for them to do hospital work for a fixed period of time per year (say run a CTU unit for 8 weeks of the year all spread out ) and the rest is all their clinic work. Link to comment Share on other sites More sharing options...
Flow Cytometry Posted January 3, 2015 Report Share Posted January 3, 2015 It is more sustainable if your clinics as IM are hospital based due to overhead and referral reasons. Link to comment Share on other sites More sharing options...
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