Doctor fees

[Guest macdaddyeh]

Hi all. I had to go to the doctor today, and I wondered just how much do doctors receive considering that typically doctors in ontario clinics receive fee-for-service payment. Does anyone have a link or website to which Ontario citizens can refer to see how much docs get paid per visit? I have seen websites that list average annual salaries, but I would like per visit information...

 

Hope everyone is enjoying the holidays by now:D

[Guest aneliz]

There is a huge PDF file that is available somewhere on the Ontario ministry of health website that gives you all of the billing codes (by specialty and procedure) and the $$ amount attached to it. I don't have a URL, just go to the ministry of health site and search for OHIP BILLINGS and you should get some results. We had to look some of this stuff up for a PCL objective a few weeks ago....

[Guest Kirsteen]

Hi macdaddyeh,

 

There's a blue book (probably the book form of the website to which aneliz is referring) which lists the same: chapters for each type of specialty, then the billing codes and billable fees for each procedure. It can be pretty shocking to see how little doctors collect for certain services. For example, my fear of needles seems extreme given that each one delivered in the arm is worth less than $3 (I think it was), not including the vaccine! Cardiac surgical procedures however, now that's a whole other set of digits...

 

Cheers,

Kirsteen

[Guest macdaddyeh]

Hi everyone:

 

I managed to poke around and I found the website and the list of fees is very comprehensive. I am surprised, as Kirsteen said, to see how little docs get paid in some areas (ie. family medicine) but the $$$$$ one can get paid in obstetrics is phenomenal...anyways happy reading...

 

www.gov.on.ca/MOH/english...rv_mn.html

[Guest MayFlower1]

macdaddyeh,

 

You are so right with respect to how little family docs get for various procedures and types of visits...that's where an extremely well oiled office machine is critical. My wife's office (family practice in Ontario) is extremely efficient...however, even given that...the clinic bills about 450K per year...after staff, overhead, taxes, equipment, insurance, etc., we're down to about 100K...a great salary...but tons of work to get it.

 

Don't let the obstetrics numbers fool you...for the amount of work you do to get it it's really a pitance...I guess it depends on how much you value your non-work time, weekends and sleep :\

 

If anybody is interested in specifics about billing, income from family medicine, the business side or anything else about opening up a new clinic (ours has been running for about 6 months now) please just ask and I'll do whatever I can to answer your questions...

 

Peter

[Guest macdaddyeh]

Hey Mayflower (Peter):

 

I concur with your observations; it must be a lot of work. Doctors often put in a lot of work to receive little back (relatively speaking of course). When my wife and I have used midwives in the past to have our daughter they live the same reality. They get a flat fee and do not get fee-for-service like doctors do. Midwives are a dedicated bunch and just like doctors you have to be in it for the passion. I REALLY want to be a family doctor as crazy as that sounds; to me it would be the most grounded and well-rounded decision according to my lifestlye and "family" values. I really want to serve the community at large and ultimately I am really interested in community medicine.

 

Does your wife have a partner in her practice? What type of hours does she put in to receive that type of salary? Is she rural or urban practicing?

 

BTW...Where did you apply to?

 

Thanks,

macdaddyeh

[Guest MayFlower1]

macdaddyeh,

 

Although it is much work, there are also upsides to it, of course. For one, we have a very professional office...all staff get along...all patients are nice to the staff...and best of all we have a brand new facility which we built to specification...time and motion reduced...separate nursing area...makes the environment really nice too.

 

Your observations about midwives is interesting, although, when you do the calculation they actually get equivalent or more money than doctors do on a per patient/time basis. The fees they receive are comparable, however, they don't have to see 40 patients in a morning...they have no overhead expenses and I believe they also receive benefits now too. A significant portion of our family income goes towards these "benefits" (e.g., dentist, malpractice insurance, disability insurance and saving for the future in lieu of a pension that docs also don't get, etc., etc.)...and, you also have to include the 40% overhead we pay right now (staff, building renovation, new equipment and supplies, nursing, telecommunications, computers, network...the list goes on...). The midwives actually have a pretty sweet deal in many ways...but any way you cut it...obstetrics is just plain tiring. My wife started out in obs/gyne...did two years of the residency...was often on call 1 in 2 or 1 in 3 days...sure the money is decent but you never see the light of day to enjoy it. My wife and I both found the lifestyle way unbalanced...she ended up going the family route and is so happy she made that decision. I'm really happy about it to as I now get to see her when she is awake too

 

With respect to having a business partner...yes, my wife was fortunate enough to do a family medicine rotation, and subsequently several locums, with this guy that's been in the business for over 20 years. Essentially, we have one big family business together. My wife's business partner is extremely knowledgeable on the business side. My wife and her business partner run the medicine and myself and his wife run the front end of the "machine" (i.e., accounting, scheduling, telephones, billing, staffing, etc.). It works out really well as the docs can do what they do best and not have to worry about the business side of things.

 

Hours...hours are great and they're getting better. We have room for two more docs in the facility...we are currently interviewing docs to find someone compatible and if everything goes well we will have a third doc in by february or march and a fourth doc in by april, may or june. When we have four full-time docs working we will start to see the return on investment as our overhead will be reduced significantly (i.e., right now two docs pay all overhead). Sorry...back to hours...my wife runs clinics from 1-4pm on mondays, 8am-4pm on tuesdays, 1pm-8pm on wednesdays, 8am-4pm on thursdays and 8am to 12pm on fridays. Of course, there is also about 1 hour of dictating/charting at the end of each day. The practice is downtown Ottawa...we're right near the Civic Hospital.

 

I applied to Ottawa again this year. I applied last year and received an interview but, as best as I can tell, I didn't talk enough about the "non-academic me". As I've been out of school for about 12 years, I felt I needed to justify my academic capabilities more than I in fact should have. Anyway, that's my story and I'm sticking to it...we'll have to see what happens this year. I also really want to go into Family Medicine, however, I have done much research in ophthalmology and enjoy it too. If I should be lucky enough to get in this year I'm sure electives and rotations will throw another few curves at my potential direction as well.

 

Talk to you soon...

 

Peter

[Guest aneliz]

Hey Peter,

 

Just wondering, did your wife kept obstetrics as part of her family practice or drop it altogether?

 

Have a great holiday!

[Guest MayFlower1]

Aneliz,

 

My wife has always been interested in women's health...she is quite well known for this. Many of the new patients are young women who will eventually have families. My wife looks forward to the day when she will deliver more babies, however, she is still very hapy with her decision to leave obstetrics as a specialty. I believe while obstetrics will always be part of her practice she enjoys the diversity and challenge of family practice.

 

Peter

[Guest QM6]

Just on a side note, in Ontario (and elsewhere too) there's a move to get more family docs grouped into Family Health Networks, where you're basically paid a flat rate for each patient signed up ("rostered") in your clinic - $96.85 - that covers the "57 commonly-billed primary care FFS billing codes". You'd still bill for services outside that set of 57. That's in addition to some other bonuses based on in-hospital work, health promotion, prevention measures (eg meeting a target number for giving flu shots), etc.

[Guest PerfectMoment]

will doctors be getting more or less than they already do now?

[Guest UWOMED2005]

My understanding is that this sort of alternative payment plan is fairly popular as for many docs, it means more. But I think it depends on how you run your practice.

 

It's also my understanding a revision to the billing codes is coming. One of our PCL leaders was a consultant on that. But I'm not sure of the specifics.

[Guest Ian Wong]

I think it is the exact opposite. This new system, which is capitation in disguise, introduces a lot of complexities as far as patient selection and physician co-operation goes. It also means that most physicians should end up making less than they would via fee-for-service. It does, however, make governments much more happy because it becomes more feasible to plan out health care costs as far as physician remuneration.

 

This in large part is why so few family doctors in Ontario are going for it. There's been several articles in the Globe and Mail over the last few months regarding this re-organization of physicians into small health groups/health networks. Here's one:

 

pub125.ezboard.com/fpremed101frm31.showMessage?topicID=165.topic

 

This particular article quotes a statement that while the Ontario Ministry of Health had forecast converting 80% of family doctors by 2004, and at this point have only recruited 4%.

 

Ian

UBC, Med 4

[Guest MayFlower1]

I totally agree with Ian's analysis of this ploy...

 

The first point is really only one of many that is bad about this policy, namely, significantly less money. Sure, if you run an inefficient practice this would actually be an increase but my guess is that you'd have to be pretty inefficient to take advantage of this.

 

Woven into this policy or at least one of the many ways it has been talked about is also the notion that somebody else picks your patients. The idea of 24-hour responsibility for these patients has also been discussed. I can tell you that while all patients are welcome at our new practice, those who are abusive to our support staff, residents, docs and those who continually miss scheduled appointments, etc., are fired from our practice...I don't believe this is that simple in the health network model.

 

Believe it or not, it's already a significant amount of work to make a decent living as a family doc. If the government isn't careful they will find themselves with an even more serious shortage of family physicians. At this point in time you can still make a decent living but it's not as easy as everyone thinks it is.

 

Peter

[Guest PerfectMoment]

100k for that few amount of hours is pretty good, granted, i know your wife's clinic is probably run more efficiently than many practices. i always thought that GPs would have to work like, a 60 hr week in order to be getting paid that much. btw, what exactly is factored in for overhead after inital capital investments when starting up? is it paying for medical equipment, nurses, receptionists, bills (hydro, etc), the lease, etc? and will working in a hospital, rather than a clinic, significantly reduce overhead? and if so, by how much approximately? btw, i'm referring to that post u made in that thread that Ian linked to.

[Guest MayFlower1]

Hey PerfectMoment,

 

100k for that few amount of hours is pretty good, granted, i know your wife's clinic is probably run more efficiently than many practices. i always thought that GPs would have to work like, a 60 hr week in order to be getting paid that much.

 

It's not really that "little" work. Remember...while the hours are relatively short, they are extremely intense. In a "4-hour" shift, my wife typically sees between 30 and 50 patients. The record to date is 53 in a 4-hour shift. Obviously the 4 hours went a bit longer on this day... We have regularly scheduled appointments, however, there are also blocks reserved for same-day appointments, flu and allergy shots. Also, remember that while approximately 32 hours is being spent seeing patients there is also about 1.5 hours of dictating/charting and other miscellaneous paperwork at the end of each 4-hour shift. On a typical day, my wife charts/does paperwork for about 2 hours. So, add 10 hours a week for this sort of thing... 32 hours plus 10 is about 42 hours of intense work a week. Then, of course, there are staff meetings and times we are just at the clinic to fix things, organize things or plan things.

 

btw, what exactly is factored in for overhead after inital capital investments when starting up? is it paying for medical equipment, nurses, receptionists, bills (hydro, etc), the lease, etc?

 

I'll see if I can remember most of the overhead sources and a few of the figures. Just to put it in perspective, we renovated an 1800 square foot facility...it has 6 exam rooms (we're using 4 right now, two per doc), a nursing area for weighing babies, giving injections, taking samples of various kinds, drug storage area, reception area, patient waiting room , chart storage area, kitchen, 2 doc charting areas, and a dictation station. We have three computers networked, a high-end telephone system with about 23 telephones (including two mobile phones for nursing and reception to maximize efficiency; two patient telephone lines; one private line for docs and labs; a fax line; and a high-speed internet connection peeled off of the fax line).

 

The initial equipment and supply costs can be taken out of day-to-day overhead as you typically pay cash for these or take out a personal loan to get this stuff. Renovation costs can't really be taken out of overhead realistically as you pay a percentage of this each month to the building owners...in our case, over 5 years. In overhead you also have space rent...ours is about 8K per month...nursing staff are about 20 bucks an hour...in our case we have two half-time nurses (i.e., they job share) and we bring in an additional nurse during flu and allergy seasons to help out. You also have a receptionist at about 14 buck an hour...a medical dictation person to type dictations in order to have a hard copy of doctors notes for the charts...she's paid 20 bucks an hour...you also have to calculate that you have to contribute to taxes and CPP for all employees as well (a significant amount of money). Other things include...accountant...paper supplies, medical forms printing (medical forms printing alone is about 4-5K a year)...telephone bill...our is about 700/month (no or little long distance in a typical month...the charges are for several lines with roll-over, call display, internet connectivity)...day-to-day medical supplies (e.g., new instruments to replace worn or broken ones; k-y jelly; "deli" paper; otoscope/rhinoscope tips; paper cups for samples; test strips; syringes; cotton; bandaids; emergency kit maintenance (i.e., some stuff expires); liquid nitrogen for procedures; various test kits; tongue depressors; novocaine; non-latex gloves)...you also have other costs like electricity (we run our autoclave every day...lights...computers humming...phones...vaccine fridge...kitchen fridge), water (we have a washer and dryer for washing sheets that patients wear as gowns (patients like our cotton sheets that they wrap around themselves much better than the paper or "bum exposing" hospital gowns)...heating/air conditioning...service charges for bell telephone and our telephone switch provider (minitel) to maintain our system. Then there's billing software and server maintenance...billing is the heart of the business...if you miss a billing date you have to wait a whole month to submit...that's a whole month of interest lost...we pay to have 1-hour service (which typically translates into a few hours to get a response and fix) on our hardware and software...we pay about 10K a year for this maintenance contract...I maintain the computer and telephone networks on a day-to-day basis so that's a "freebie". Then you have disability insurance...big bucks if you want to start receiving money within 30 days of being injured to the point you are unable to work...I believe it's about 1200 a month but it could easily be more...I can't remember the exact figure...oh yea, and then there's overhead insurance...if you become disabled...your disability insurance covers your average income...however, you've still got all your staff and all your other overhead to cover while you're not working or in the event of your death...that's big bucks...I believe we pay about 3K per month...

 

I've got to go start getting breakfast ready for the kids...I'll edit this post in a while...there's a bunch more...

 

Peter

 

EDIT:

 

...then there's rental on the interac machine...we have this to ensure we get paid when people come in for privately billed procedures/visits or when they don't present a valid health card...photocopier leasing and maintenance...we have an older one which we purchased but now we realize it doesn't make sense to buy them...when you lease you always have a top-end functioning photocopier. Yet other expenses include miscellaneous office supplies...several hundred dollars a month for paper, pencils, pens, stamps, sticky note pads. We also support two family medicine residents a year...while this really isn't overhead, and the residents are generating some income seeing patients, teaching definitely reduces income for the clinic as you have two docs seeing each patient (i.e., resident and staff) and debriefng after each patient to ensure the resident learns and grows. Oh, and then there's parking...while we just live a few blocks from our clinic we often have to cart charts, supplies back and forth...we pay 80 bucks a month for one parking spot at the building. Another thing that isn't overhead but is a monthly "expense" is putting money aside for the future...since docs don't get benefits or a pension you have to have savings from some source...we max out RRSP room every month. Ahhh, and the last source of monthly expenses that aren't overhead are those nasty student loans and lines of credit which were essential to get my wife through medical school. At the end of school and residency, the debt was about 100K...the interest at prime was about 500 bucks a month...without touching the principle amount. Over the past year and a bit we've managed to chisle it down by about 40K...we still owe about 60K from the line of credit...it would have been paid off by now if we didn't build the clinic...but, again, it's a long-term investment.

 

I think that's the bulk of the stuff that goes into overhead...I may be missing a few things as my head is a bit cloudy from "christmas spirits". If I think of anything else I'll post again. If you have any other questions please let me know.

 

and will working in a hospital, rather than a clinic, significantly reduce overhead? and if so, by how much approximately? btw, i'm referring to that post u made in that thread that Ian linked to.

 

Hospital work is essentially no overhead...that's one of the nice things about hospital work...however, you have to put up with the antics of hospitals! Another option (i.e., as opposed to opening up your own clinic) is to do locums for docs who want vacation, etc. In Ottawa, you typically pay 30-35% overhead, depending on how desparate the doc is to have a fill-in. That means, for every buck you bill you pay the doc whose clinic you're at 30-35 cents...but that's it...no other worries. The downside of doing locums is that the patient population is what it is...the clinic is run the way the doc likes it (may be quite different than how you'd like to be working). There are also walk-in clinics...the pay is good because you're mostly seeing lumps, bumps, coughs, etc. (i.e., quick and easy) however, patients in typical walk-ins are quite demanding (quite unreasonable often actually...e.g., "demanding" antibiotics", for arguing incessantly with the docs, for example)...they are not committed to good health care (i.e., they don't have a regular family doc who does pro-active health care)...they come in with multiple problems they've saved up for a long time...so the overhead is about 30-35% typically...less efficient...but no worries when you leave the clinic. The locums and walk-in clinics are great insofar as you will never be out of work...when my wife was doing locums she was turning away work every day...not enough people around to cover for docs when they want a break...however, that's if you have a good reputation in town as nobody wants to hire a "crappy" doc to take care of their patients...well, almost nobody...there are always exceptions. Another downside of locums and walk-in clinics is keeping track of billing and patient follow-up for bad cards, bounced cheques, failure to pay, etc...you essentially do it all yourself.

 

In the end...for us...the investment of starting a new clinic far outweighed the alternatives. Sure, it's tough for the first 5 years (financially, physically and psychologically), however it does pay off in the long run...you get to do GOOD medicine...make a decent living...put money in your own pocket rather than someone else's (like a mortgage vs. renting)...creating a positive work atmostphere and a positive atmosphere for the patients...etc.

 

If you have any other questions please do not hesitate to ask.

 

Peter

[Guest Kirsteen]

Hi there,

 

Regarding overhead costs for fully-qualified doctors who are hired by hospitals, it is not exactly nil. No, they themselves do not have to worry about all of the minutiae such as ordering medical supplies, but they do have to worry about a lot of other minutiae some of which, since working within one such office within one of Toronto's largest hospitals for the past eight months, surprised me. In total, I've had my eyes opened in terms of the business model applied to doctors within hospitals. At times, it's been a bit shocking.

 

I don't know if this model is applied to most large hospitals in the province, but doctors at this hospital are paid a flat salary. Although they are not compensated on a fee-for-service basis, their administrative assistants still need to keep track of all billing codes used during all patient procedures and are required to submit these on a regular basis to the hospital accounting department. Akin to doctors within private practices, these doctors also spend umpteen hours dictating, reviewing and signing documentation related to patient care: referral letters, insurance forms, worker's compensation forms... (It seems, the profession which we all desire to enter has paperwork as a ubiquitous bane.) With respect to a shopping list of overhead costs incurred by hospital-based doctors, at this facility they include (but are not restricted to): salaries and bonuses for all non-medical, office personnel (including research assistants) required by the doctor; all office equipment desired/used by the doctors' office, e.g., computers, scanners, printers, photocopiers; all non-medical office supplies (if he/she or their staff requires anything that you can purchase from Business Depot, then it comes out of their own pocket); any other item required within the doctor's office such as filtered water, etc; parking (which at this hospital, costs ~$10/day and perhaps more if the doctor manages to pop off the waiting list for a luxurious, spot in the physicians' parking lot).

 

One of the large drawbacks of setting up shop within a hospital seems to be that many hospitals seem to have quite tightly administered requirements for resources from which you can draw to support your office. For example, my boss was looking to expand his offices and engulf the adjacent space measuring ~100 sq. ft. In doing so, he wished to paint the walls and provide carpet for this little antechamber using the same materials used in his own office so that it had a uniform feel and no longer resembled a kitchenette, for the person who had to happily work there. He also wished to add two phone and data lines to this new space to provide some means of communication to the world exterior to the hospital. He had no choice but to use the hospital interior design team who quoted ~ 350% the average rate for a painter, a flabbergasting amount for a patch of institutional-style carpet, and a grotesque sum for electrical/phone line installation (something on the order of $300 was quoted for the "installation" of each call display service alone--as such, neither phone is furnished with it). Subsequent to receipt of the skyscraping quotes, a few joke suggestions were shared that surrounded subterfuge, and office painting parties.

 

Sure, I can understand that punching some holes in hospital walls requires some special considerations, e.g., infection control procedures to capture all the nefarious little bacilli which may have set up shop within the drywall or styrofoam ceiling tiles, but in all, doctors in hospitals appear to represent luscious, lucrative, captive markets.

 

Cheers,

Kirsteen

[Guest MayFlower1]

Kirsteen,

 

I most graciously apologize...I was not assuming actually setting up a practice in a hospital, but rather, I was talking about my wife's experiences doing Emergency shifts or obs/gyne shifts...until now, I have had little or no experience with actually setting up shop in a hospital...thanks for the valuable information.

 

Peter

[Guest Kirsteen]

Hey there Peter,

 

Take those apologies back! I wasn't trying to rebut your comments; I was merely trying to add some anecdotes re: hospital-based practice to complement your commentary on private practice.

 

Cheers,

Kirsteen

[Guest MayFlower1]

Kirsteen,

 

I didn't take your post as a rebuttal...the apologies were for ASSuming the type of hospital practice that was being asked about...and completely being ignorant of another type of practice which we've never considered. Thanks again for the info...your posts are always extremely helpful and informative.

 

Hey, although we've only interacted online, I feel as if I've known you for a while...it's nice to have friends around...perhaps we'll actually get to meet this year at interviews should we be fortunate enough to be extended some?!

 

Peter

[Guest wileycoyote]

Hi Peter,

That's 100k after taxes right?

 

Just trying to put the whole loan thing in perspective

for my future (since, if I get in, I will be leaving a job which pays around 90k [before tax])

 

thx

-w

[Guest MayFlower1]

wileycoyote,

 

Yup...about 100k after tax...

 

I would also be leaving a 100K/year job to go back to medical school :\

 

For myself, even if I break even...or don't lose too much over my re-training it will be worth it...my primary aim is to do what I love to do...and to love it every day...that is, to help people in whatever way, shape or form I can...I've earned the big bucks...they're not very satisfying...

 

Peter

[Guest TimmyMax]

Hey Mayflower,

 

I tried to drop you a quick holiday greeting this past week, but none of the accounts I have for you seem to be functional. Obviously, you have changed them since last year's incident with a certain unsavory, but I was wondering if you could perhaps drop me a quick private email (click my user profile) so I could get a working address for you? Thanks a lot!

 

Timmy

[Guest MayFlower1]

TimmyMax...

 

Nice to hear from you...yup...I changed my email address...I'll drop you a note in a minute...

 

Peter

[Guest steak]

It will be interesting to see how the influence of the private sector (and I'm thinking, as a source of employment for MDs, primarily) will affect compensation over the next several years..

 

A few acquaintances (opth's in the SW Ont. area) have left (partially or wholly) public appointments for private sector practice, and suffice it to say that while opth. tends to be a well paying specialty to start, they are very well (pronounced: horrendously well) compensated..

 

(perhaps more importantly, they actually enjoy what they're doing, and recognize their families too!)