The Taboo of $$$

[Guest tantastic]

I appreciate your answer

 

 

I guess the confusion arose for me because I was under the impression that those doctors on hospital staff (ie such as the ones found in the salary disclosure) were paid salary rather than through billings. But I guess I was mistaken in my assumption. Thanks again though, what you said makes the whole thing make total sense now.

 

Take care UWOMEDS

 

 

PS. Perfect moment are you in med school already?

[Guest wileycoyote]

I think it's pretty obvious that many med students have $$$ in the eyes through this whole process....just take a look at the competition for specialties on the carms site...the more lucrative specialties are crazy competitive, and ones like psych. where the money is insulting, its nothing but tumbleweeds....

[Guest statementofclaim]

Tantastic

 

The salary disclosure report I posted cannot be said to necessarily represent the actual incomes of those physicians listed. One has no idea whether or not the physician is part time or full time, whether they have a university appointment, whether they have a private practice, work in a private clinic (rads, paths, etc.), do medicolegal work, on retainer for companies, WCB, insurance carries, do fee for service seminars, etc., etc., etc..

 

You see a pathologist for example making $130K and another making over $200K, and you really wonder what the deal is. It really depends on the above.

 

I don't know of any ophthalmologists that are on alternative payment systems. As you will see from list, very very few specialists outside of lab and psych are there. Notice how few Rads are there.... Rads and opthalmologists can simply make too much money doing procedures on a fee for service, that it is simply not attractive for them to look at a salary. I had a buddy over on Friday who will start interventional radiology practice this spring after his fellowship. He and his classmates will start in the $350-400 range for first year guaranteed, and then up from there. The doctors you see listed in these salary lists are specialists who's work is generally tied to some type of institution, and in many cases a tertiary care centre. There are also regional difference. For example, Paths in BC are among the highest paid specialists in that they have the market sewn up with groups that contract with the regional health authorities. You don't see very many salaried paths in BC. This is partly why paths in Ontario make $100-150 less than their colleagues in BC.

 

It is really market and specialty driven when it comes to compensation. If you want to do the exciting work in a large centre (aka teaching hospital) and their is competition to go there, salaries and income are generally going to be less (less OR time for example than in a smaller centre). For eacmple, Halifax is a popular place to live right now. A specialist going there is going to take a pay cut. A specialist working an hour or two outside the city is going to make more. A specialist at Mt. Sinai at the top of his field may not give a rats ass about his salary. The Toronto General has many world renowned doctors. Dr. Tirone David for example is a famous Heart cutter thas has been offered seven figure salaries to go to the US, but he has chosen to make a half or a third of that to stay in our system. www.utmj.org/issues/78.3/NVDavid.pdf

 

 

 

The answer is... it depends.

 

If you want to make money is medicine, I think you would have to be DD&B not to make that happen.

 

To answer Tantastic's question...

The salareis of Law school grads as first year associates.... DEPENDS. In Canada it can range from $30K in some small town to $100K on Bay Street with the right firm. In the US it can be $130KUSD to start. A Bay street Partner is going to make a multiple six figure or even a seven figure salary (for the select few). That being said, a sucessful and established personal injury or mass tort lawyer is going to as well or better.

 

It depends on the goal and ability of the individual. I hope this helps. Speaking of docs, I have to call a specialist about an expert report on a file.

 

Later...

[Guest PDSP]

Monksters:

 

I'm not so sure that I agree with your arguments that the cost increase will be short-term. You say that people will make more use of healthcare simply because it is available? I'm not sure if someone who was not feeling well would decide or not decide to seek medical treatment based upon the time it will take to be treated (short vs. long waiting lists). In the case of those seeking treatment for non-medically necessary procedures, their physician should be the custodian of public money. But, I do concede, the physician is in a conflict of interest here - by not referring the patient for a procedure he might save tax-payer dollars, but he is also cutting-in to his income. I guess this is where the over-sight committee would be needed. An alternative to this committee would be partial patient payments to discourage unnecessary procedures. But, there goes the public-funded, accessibility of our system. Gee, what a mess. :x

 

Well monksters, what would you suggest for a way to reduce waiting lists and provide better care to the people of Canada? I know you mentioned the idea of efficiency, but that will only go so far. Your idea of accountability is similar to my suggestion of an over-sight committee to evaluate the spending of public money by physicians.

 

One final note - I don't think the prospect of a Canadian physician paying higher taxes while receiving a much higher salary will force them to be more inclined to go south. At the end of the day, their take-home pay will still be higher with the caps removed, regardless of even a moderate tax hike. Like the rest of Canada, they're choice to remain here based upon an idea of better quality of life, including a better healthcare system, must be supported by a willingness to pay for this quality.

 

Good conversation.

 

PD

[Guest MDWannabe]

Getting back to the premise of this thread, I should say that I would think long and hard about bringing money up as a factor for the career choice of medicine for the following important reason. If you really think about it, purely on the basis of the hours you will put in to get there and the hours you will put in when practicing, there are MUCH better ways for a smart person to earn money (as has been pointed out so many times in this thread alone). Sure, we all need some money to deal with the necessities and amenities of life - but if money is higher than #30 on your 'factors for applying' list, I'd have to think you are really misguided and haven't really checked out your alternatives.

 

My 2.6 cents.

[Guest monksters]

Hi PD

 

I did not think that the availablility of medical services would have such a strong force on seeking medical care either until a few years ago when I worked for a PhD student on her study. She looked at the effect of Direct-to-Consumer Advertising (Drug Companies) on patient doctor relationships. It was found that the exposure to advertisments not only increased requests from patients for particular drugs but it also increased the doctor's likelyhood to prescribe it. Furthermore, the patients of today are not like those of yesterday. With the emergence of internet and other sources of information, the patient is armed with a plethora of information and sometimes their own diagnosis even before the step into the doctors office. My grandfather fortunately or unfortunately is one of those curious bugs....

 

I also have been involved with an evidence based medicine group in BC called Therapeutics Initiative. You would be suprised at how many drugs actually have no therapeutic advantage over existing drugs, yet pharmacare (BC drug subsidy program) in the past has funded many of these. Every 3-4 days there is a new medication with a claim that it is better. Quite often the evidence is scanty and the marketing is bountiful. Not to say that there are not drugs that prove themselves better or worthwhile to fund but this is the exception. Drug costs are one of the fastest growing money suckers of our health care.

 

So to make a long story short, by efficiency I mean that we should be looking at more technology assessment, health care assessment groups that determine where the fat is in the health care service. Woops gotta go.. late..maybe i'll add more later

[Guest statementofclaim]

MDWannabe

 

I agree with staying away from the money discussion in any admissions interview. No good can come from that topic in that context.

 

...but when it comes to:

 

"...if money is higher than #30 on your 'factors for applying' list, I'd have to think you are really misguided and haven't really checked out your alternatives."

 

Come-on! That's just not realistic. Pretend the "reasonable" medical school applicant is explaining to a friend or family member why they want to go into medicine... say at a party. Now start listing them off. Are you having trouble getting past ten reasons before mentioning income? twenty reasons?

 

I can see that you may be able to say that for yourself, but do you think that is being honest with respect to the applicant pool at large?

 

Are you saying someone is misguided because they want to go into medicine for a list like the follow...

 

1. to help people

2. for the love of science

3. for status

4. for a good income

 

???

 

I doubt you are.

 

As for there being other careers to make lots of cash in, that is true, but like it or not, getting into medicine is next best thing to a sure thing for at a minimum, a a six figure salary.

 

There is a reason why banks extend credit to medical students using ratios that are not available to the rest of Jane and Joe public. The loans officers get the authority for those kinds of loans from the bank's actuaries that say the future salaries of doctors is going to be able to sustain that debt, and that the incidence of default is next to non-existent.

 

Law students and MBA students outside the Top programs are not entitled to these lines of credit. The fact of the matter is it is less of sure thing for someone in Law or business to make that kind of money. Ask any law or business student that is not in the top 10-20%.

 

Later...

[Guest tantastic]

statementofclaim

 

I totally agree with everything you say!

 

Medicine is the only profession that offers high reward with low risk. No where else is this observed. The higher the reward in other fields, the higher the risk of losing it. For example Investment Banking (risk of layoffs is huge). Law (risk of making partner is based on risk of not finishing in the top 2% of your class, then the risk of not being the top associate etc.)

 

Where else can the dumbest kid in the class still with almost 100% absolute surety end up making 6 figures....nowhere but Med school!

 

Sure the hours are bad, but hours are alot more horrendous in investment banking and law. Ask the cab driver who has to work three shifts a day to feed his family how his hours are. Ask the firefighter how his stress level/hours are, oh yeah and he is saving lives while worrying about his mortgage payments and how he will make a 35,000 income stretch.

 

Everyone interested in medicine outside of people on this board who seem to want to be a politically correct and cryptic about there true feelings mention money within their first two reasons. Actions don't lie. How many docs actually do work for charity, doctors without borders? Maybe less than 1%. How many stop volunteering etc. once accepted to med school I would say 95%. So yeah cash is king, if you got the gift of sciences, a sweet tongue for interviews and a good system to memorize information, welcome to the land of milk and honey.

 

Statementofclaim knowing all that you know about Medicine and how lucrative it is, what the heck were you thinking when you went into law? I know a ton of people who haven't found articling jobs and are doing personal injury for peanuts.

 

BTW How much do neurosurgeons make? I think if I get in it will be that or Radiology...Bling Bling:hat

[Guest peachy]

Well, I've been reading this discussion and not commenting. I don't particularly see anything wrong with a good income and high job security being part of your criteria for medical school. Obviously not the only criteria - I'm totally confident that I could get both of those things in jobs that would make my life lots easier. But I know me, and I know that I couldn't be happy (or at my best) in a job without good job security.

 

(rant ON) But the comment about docs stopping to volunteer once they get into med school just makes me INCREDIBLY ANGRY. I do NOT volunteer because I want to get into med school. I do NOT organize things on campus because I want to get into med school. And I will NOT stop doing these things when I get into med school!!! I do NOT think that most people who get into med school are like that, and if *I* could design a med school applications process then the number one task would be to get rid of people like that. There is absolutely NOTHING I hate more than having to deal with people in student organizations who are only doing things to add them to their resume.... I really, really hope that med school admissions committees can generally see though those people, and I choose to believe that they generally can. (rant OFF)

[Guest Biochem10]

Hey peachy, I hear you regarding people doing volunteer activities purely for the sake of their med school application. In fact, when we had elections for student council this was one of things I considered when choosing a candidate: "is this person running for this position because they would truly love it and be good at it or are they just doing it because it would be good for their resume?" Anyway, on that note, I volunteer at a children's hospital and as much as this activity might make me look like "one of those people", I can assure you that I'm doing it because I purely enjoy hanging out with kids. I used to be a swim instructor and tutor and when I came to Montreal I had to give that up for school, the best part about those jobs was just interacting with the kids. Anyway, If I got into an MD/PhD program, my volunteer work won't stop, actually I was considering starting a different kind of volunteer work (may be not in a hospital because I don't want to be there all the time!!) like big sisters. I also had a discussion in my interview (the MD/PhD one) about doing volunteer work at the hospital one day a week during my PhD because I wouldn't want to completely isolate myself from the clinical side of things. Anyway, that was an interesting point about volunteer work--if it's not sincere, I don't think one should be doing it.

[Guest statementofclaim]

Tantastic

 

You kill me! Rads or Neurosurg! That's quite a difference there big guy/gal! Very different. It is safe to say that neither of those cats will be eating generic KD anytime soon! But the NS will spend a whole lot more time on call. But then again, they get to use all those great, "but I am a brain surgeon" jokes!":rollin I'm sure you'll be great MD no matter what you do. Never say never until you get some time on the wards. My wife said she would never do a non-clinical specialty, until she hit General Medicine, Peds, etc.. I think she went running to be a doctor's doctor. Who knew.

 

I didn't go into medicine because I just didn't have the sciences in undergrad at the level needed. I'll leave the doctoring to my better half. She got the brains in the family. (I do have the bad handwriting though!)

 

I like the law. I'm good at it. I get to use my health care background all the time. Beside, knowing all your secrets will put me ahead of the curve if the MEDMAL bar ever gets one up on those CMPA stars you have looking out for your interests. !

 

Later...

[Guest strider2004]

Wow this thread has been taken over by money grubbers. Things to say:

 

Volunteering: You'll actually find that people who were very active in their community before med school will stay active in their community during med school. I didn't actually do much volunteering while i applied. Instead I worked part time 15h a week. I had to stop that because med school is just a little bit harder than undergrad. I don't agree with the statement that people stop doing things once they get into med school. Instead, I think the meds application process tries to bring in Type A personalities who like doing things in general. Sure you'll hear stories of people who 'beat the system' but they're the exception, not the norm. Keen people are still keen while in med school - active in student clubs and intramurals.

 

2) Specialties for the money - yes some specialties pay well. Don't you think that med students know that? Why don't all med students compete for them? Well...some just aren't appealing. Different specialties are for different personality types - neurosurgery - ya gotta be hardcore. They are a very intense bunch and they also work crazy hours. Radiologists...I personally consider them to be glorified technicians unless they do interventional work. It also takes a certain type of personality to do that sort of work. Could you spend all your life counselling people and then go into radiology? Probably not.

 

There is a myth that people are not choosing family medicine because it doesn't pay as well. I don't agree with that. I think those who don't choose family do so because they prefer to work in a specific area. For lifestyle, FM is awesome.

[Guest PhantomPhoenix]

now if someone was after the money...why would they be a doctor in Canada....when they can make the short trip south...in that case the salary is probably comparable to someone in the business field

 

 

Students going into med have other things on their mind besides the salary although it is nice.