Fam Med Pay + Future

[GrouchoMarx]

Couple of my friends are investment bankers. One with a major US firm. Neither are math whizzes. What they are good at is salesmanship.

[rmorelan]

 

ha - that is a stockbroker though rather than an investment banker

 

that was such an unexpectedly amazing scene - just didn't see it coming.

[Birdy]

Not to get too philosophical here, but I think a very large portion of the "math divide" between the two groups is how we deal with math culturally.

We decide if kids are good at math super early on and then continually tell them whether they are or aren't good at it. Then we talk about how hard it is and portray it not as a challenge to be mastered but as a innate character trait. Self fufilling prophecy really. It doesn't work this way else where in the world.

So yah, I think most people who could be doctors have at least the academic potential to be investment bankers, somewhere in there.

That bugs me so much, especially because kids internalize it so early and then just check out of math. I'm really big on math skills in my house - it's as important to me as literacy and I put lots of effort into working on math with the kids because it's so easy to tell when they have a teacher who hates teaching math. We teach our kids that math is about approach, not innate ability. Building math skills is as natural a progression as going from the alphabet to reading, and we're very careful how we talk about it.

 

ha - that is a stockbroker though rather than an investment banker

 

that was such an unexpectedly amazing scene - just didn't see it coming.

Funny thing is that it wasn't really acting. He actually does that to psych himself up for a scene; Leonardo DiCaprio saw it and said they absolutely had to include it.

[amichel]

That bugs me so much, especially because kids internalize it so early and then just check out of math. I'm really big on math skills in my house - it's as important to me as literacy and I put lots of effort into working on math with the kids because it's so easy to tell when they have a teacher who hates teaching math. We teach our kids that math is about approach, not innate ability. Building math skills is as natural a progression as going from the alphabet to reading, and we're very careful how we talk about it.

 

 

Funny thing is that it wasn't really acting. He actually does that to psych himself up for a scene; Leonardo DiCaprio saw it and said they absolutely had to include it.

My mom used to give me mental math questions and to help me sleep, haha.

 

The amount of adults who have zero strategies for doing math without a calculator (round to an easier number then add/subtract after, use 10s, splitting things up, etc) is baffling to me. It makes me sad.

 

These are usually the same people complaining about how new math curriculums are stupid and illogical, when in reality they are trying to teach kids to use logic and work through problems when they get stuck - not get out a calculator.

[Birdy]

My mom used to give me mental math questions and to help me sleep, haha.

The amount of adults who have zero strategies for doing math without a calculator (round to an easier number then add/subtract after, use 10s, splitting things up, etc) is baffling to me. It makes me sad.

These are usually the same people complaining about how new math curriculums are stupid and illogical, when in reality they are trying to teach kids to use logic and work through problems when they get stuck - not get out a calculator.

Yeah, I agree that's definitely the intent - mental math skills - but the execution of these curricula is spotty at best, though. That's true of every subject to a degree but I think it's particularly difficult with math which builds so rapidly on foundational skills.

 

My son asked me once why he can't just pull out a calculator to do his math homework. He only asked me the once because I gave him a very lengthy answer, hah. I do mental math all the time just to keep in the habit; it's just fun.

[amichel]

Yeah, I agree that's definitely the intent - mental math skills - but the execution of these curricula is spotty at best, though. That's true of every subject to a degree but I think it's particularly difficult with math which builds so rapidly on foundational skills.

 

My son asked me once why he can't just pull out a calculator to do his math homework. He only asked me the once because I gave him a very lengthy answer, hah. I do mental math all the time just to keep in the habit; it's just fun.

True, but that doesn't mean the old way is better! And as you said, a lot of the time it's because lots of elementary teachers hate math. Kind of self perpetuating, really.

[NLengr]

valid point sure they aren't idiots at it either. What was their background prior to going into it?

 

My uncle is an investment banker (?was, I don't know it is a tough market - he seems to do more of the educational side of things now. It is hard to be a front line investment banker for a long time - long hours, big stress etc). Chartered accountant, MBA - you know the usual stuff it seems you need. Guess it depends on what type of banker you are at as well because he didn't do too much selling - just management large corporate accounts (someone has to manage those 100+million loans big, big corporations ask for).  

 

There was actually a point when I was finishing my economics degree and applying to medicine where there was recruitment for banking zipping around the campus at Waterloo meeting with all the students that won some sort of award in the program that year (if you are getting the GPA for medical school you probably are getting the sort of grades that would attract attention). There was a surreal day when I realized I could if I wanted to go down that route despite not aiming for it at all. I wonder how that would have turned out ha!

Both are B. Comm/MBA guys. Both are pretty bright overall.

[older]

In every professional group there are bad apples -  lawyers lying, investment bankers cheating, doctors so focused on money  that they do not give a  thought to quality of patient's care.  

 

The point is not to be one of them. 

 

Discussing "theoretical" patient's  production line is as bad (or as innocent - depending on your point of view) as "theoretical" planning for supression of evidence in court, "theoretical" scheme for fixing LIBOR etc.  All starts with ideas.

[Edict]

For arguments sake, if the aforementioned practitioner did see 35 patients a day working for 6 days a week, that would amount to around 9 hours a day. 

 

In the short term, it may seem plausible, however, as the years count by, the mental strain would take its toll. I would believe that if someone did work those hours (with only a 15 min lunch break..), that person may have to take 12 weeks off every year to recuperate. That or retire at the age of 40. Strenuous work, more like it. Besides, there are other things FPs do other than seeing patients such as going through lab work and such.

 

My 2 cents..

 

Why do people say that when attending surgeons and specialists regularly work 60-80 hours and are perfectly healthy?

[ralk]

Why do people say that when attending surgeons and specialists regularly work 60-80 hours and are perfectly healthy?

 

Who says they're perfectly healthy? Some are, some most certainly aren't.

[Beacon]

Why do people say that when attending surgeons and specialists regularly work 60-80 hours and are perfectly healthy?

 

Do those who work 60-80 hour work weeks throughout their career have a life outside of medicine? Assuming they are perfectly healthy, it still isn't ideal.

[katakari]

_{God save patients  from doctors who see 35 patients per day for 15 minutes each, in clinic for 9 hours a day, 6 days a week. Aren't  we nuts discussing such scenario in  pure monetary terms? What about quality of patient care, nobody has a comment?  The only concern seems to be that the poor greedy doctor will get overworked. And that sounds almost like some kind of a virtue. Hard working, eh?}

 

_{That's one of the things that is wrong with the current system of payment for service - encouraging money-makers to assemble patient production lines.}

 

_{OP, what about becoming investment broker instead of FM doc. At least they do no harm.}

 

Of course there is always one person upset about the unthinkable prospect that a doctor be the least bit concerned about money.

 

An ophthalmologist I worked with got me thinking about non-OHIP procedures -- cosmetics, etc. He was telling me how it would be a good way to regain some of the control the government seems to be exerting over FMs right now. He works with another ophthalmologist who has transitioned almost purely to cosmetics (and I don't mean blepharoplasty, I mean botox). I was always curious as to whether it was due to it being more lucrative, or less stressful. Of course, this brings its own challenge in finding the patients, dealing with this patient population etc. Interestingly, if you pull in some good money from this you could also "afford" to spend extra time with those patients who need it,  without having to rush them through the door.

[Edict]

Do those who work 60-80 hour work weeks throughout their career have a life outside of medicine? Assuming they are perfectly healthy, it still isn't ideal.

 

It definitely isn't ideal but I don't think these people would have to take 12 weeks off a year to recuperate or retire at the age of 40. I mean, we have perfect examples already in people who work such hours in the form of surgeons. If you look at their polled averages surgeons work https://www.cma.ca/Assets/assets-library/document/en/advocacy/Cardiothoracic-Surgery-e.pdf about 70 hours a week for cardiac and 54 for general https://www.cma.ca/Assets/assets-library/document/en/advocacy/General-Surgery-e.pdf and around there for most of the other surgical specialties. 

 

These people regularly work until they are 60 years of age or even older in some cases.

 

I think my point isn't that its ideal and maybe i exaggerated in "perfectly healthy" but these surgeons are not dying early deaths or retiring early they are generally able to live fulfilling and normal lives even though they work longer hours.  

[Beacon]

It definitely isn't ideal but I don't think these people would have to take 12 weeks off a year to recuperate or retire at the age of 40. I mean, we have perfect examples already in people who work such hours in the form of surgeons. If you look at their polled averages surgeons work https://www.cma.ca/Assets/assets-library/document/en/advocacy/Cardiothoracic-Surgery-e.pdf about 70 hours a week for cardiac and 54 for general https://www.cma.ca/Assets/assets-library/document/en/advocacy/General-Surgery-e.pdf and around there for most of the other surgical specialties. 

 

These people regularly work until they are 60 years of age or even older in some cases.

 

I think my point isn't that its ideal and maybe i exaggerated in "perfectly healthy" but these surgeons are not dying early deaths or retiring early they are generally able to live fulfilling and normal lives even though they work longer hours.  

 

Even then, surgeons (cardiac especially) are a minority in medicine. Most practitioners do not work those hours (70 hours). 

 

Anyhow, I'm not trying to say that they are not happy with their lives or that they retire/die early. It was just an added consideration to the OPs original speculation about FPs. The point is that work/life balance can be very difficult when you're working 70 hour weeks all the time (as evident in the CMA statistics you posted).

 

But again, this is not to say surgery isn't good for achieving an optimal life. Just to bring up the work/life balance aspect. 

[Nachoolibre]

My cousin is an oral and maxillofacial surgeon with a DDS, MD, MSc. He finished school at 34 and runs his clinic in Toronto now at the age of 38. He's on call at North York Hospital one week every month and works at his clinic 3 days a week. He averages 24 hour weeks and 40 hours when he's on call. He makes around $1.5 million after taxes and overhead and goes to Vegas every 3rd weekend. To me, I think you can make a real good living and live a great social life if you combine the field of dentistry and medicine. All the other fields (FM, etc.) seem dull compared to a specialty combining medicine and dentistry

[JohnGrisham]

My cousin is an oral and maxillofacial surgeon with a DDS, MD, MSc. He finished school at 34 and runs his clinic in Toronto now at the age of 38. He's on call at North York Hospital one week every month and works at his clinic 3 days a week. He averages 24 hour weeks and 40 hours when he's on call. He makes around $1.5 million after taxes and overhead and goes to Vegas every 3rd weekend. To me, I think you can make a real good living and live a great social life if you combine the field of dentistry and medicine. All the other fields (FM, etc.) seem dull compared to a specialty combining medicine and dentistry

Great first post

[ralk]

My cousin is an oral and maxillofacial surgeon with a DDS, MD, MSc. He finished school at 34 and runs his clinic in Toronto now at the age of 38. He's on call at North York Hospital one week every month and works at his clinic 3 days a week. He averages 24 hour weeks and 40 hours when he's on call. He makes around $1.5 million after taxes and overhead and goes to Vegas every 3rd weekend. To me, I think you can make a real good living and live a great social life if you combine the field of dentistry and medicine. All the other fields (FM, etc.) seem dull compared to a specialty combining medicine and dentistry

 

It's an interesting field for sure, but not an easy road. OMFS is a crazy-competitive program to get into and the people who do have years of very intense work ahead of them. I'm frankly in awe of the people in Western's OMFS program, they're insanely smart and hardworking.

 

Also, while OMFS practitioners do earn a good salary, your cousin is almost certainly an outlier, making quite a bit more for quite a bit less work than I've heard reported.

[DentHope2021]

My cousin is an oral and maxillofacial surgeon with a DDS, MD, MSc. He finished school at 34 and runs his clinic in Toronto now at the age of 38. He's on call at North York Hospital one week every month and works at his clinic 3 days a week. He averages 24 hour weeks and 40 hours when he's on call. He makes around $1.5 million after taxes and overhead and goes to Vegas every 3rd weekend. To me, I think you can make a real good living and live a great social life if you combine the field of dentistry and medicine. All the other fields (FM, etc.) seem dull compared to a specialty combining medicine and dentistry

I think you may be referring to Dr. Lam? I heard great things about him and sounds similar to what you said (parties in Vegas a lot)! 

[Beacon]

It's an interesting field for sure, but not an easy road. OMFS is a crazy-competitive program to get into and the people who do have years of very intense work ahead of them. I'm frankly in awe of the people in Western's OMFS program, they're insanely smart and hardworking.

 

Also, while OMFS practitioners do earn a good salary, your cousin is almost certainly an outlier, making quite a bit more for quite a bit less work than I've heard reported.

 

To add to this, Western takes 1 candidate per year for OMFS.  

[goleafsgochris]

My cousin is an oral and maxillofacial surgeon with a DDS, MD, MSc. He finished school at 34 and runs his clinic in Toronto now at the age of 38. He's on call at North York Hospital one week every month and works at his clinic 3 days a week. He averages 24 hour weeks and 40 hours when he's on call. He makes around $1.5 million after taxes and overhead and goes to Vegas every 3rd weekend. To me, I think you can make a real good living and live a great social life if you combine the field of dentistry and medicine. All the other fields (FM, etc.) seem dull compared to a specialty combining medicine and dentistry

 

This is so absurd lol not that this person exists, but because this is such an insane outlier.  Its like talking about the one guy in a med school class who does cosmetic plastics.  Of course they make an insane amount, but it is so hard to get to that position its barely worth mentioning.

[rmorelan]

This is so absurd lol not that this person exists, but because this is such an insane outlier.  Its like talking about the one guy in a med school class who does cosmetic plastics.  Of course they make an insane amount, but it is so hard to get to that position its barely worth mentioning.

 

all other fields seem dull other than combining dentistry and medicine? so there is only one nonboring field then?

 

I get that some people are really into the money - although when ever I see someone trying to work as few hours as possible AND spending a huge amount of time in Vegas then exactly how interesting can their jobs be?

[Edict]

I think you may be referring to Dr. Lam? I heard great things about him and sounds similar to what you said (parties in Vegas a lot)! 

 

Hmm, it says online that Dr. Lam works at PMH though. 

[daftjustice]

No, actually, OMFS do tend to make that much. 

I know a family friend OMFS who retired at 55. Keeps flying somewhere around the world every other month. Put all three of his kids through private school and university, no loans. His partner doesn't work IIRC.

1.5 million a year sounds about right. That guy was making even more. What people don't realize it the amount of work in the private sector they can do....
10 wisdom tooth removals @ ~1600+ a go, at their own surgical clinics...

[medisforme]

Do OMFS and ENT do a lot of overlapping procedures or is their scope of practice quite distinct?

[uwopremed]

LOTS of doctors and dentists make over 1 million a year.  The following are the groups most likely to make 1 million (or way more) a year - often with great lifestyles and those monthly vegas trips, and several mega world trips a year.

 

MDS: 

 

1.  Ophthalmologists.  - absolute no brainer.  In addition to the crazy OHIP money is the multiple private pathways to making money as well.  LASIK, cosmetics, eyewear, private industry consulting work, special cataract lenses, etc.  INSANE money

2.  Plastic Surgeons.  Some will make 2 million plus with reasonable lifestyles.  You do have to be a business person to make the 2mil+ range - but it is doable.  Especially if you are willing to work in medium sized cities with large catchment areas.  But even the GTA is open to plenty of growth for cosmetics - whether it be nose jobs, boob jobs, vaginal rejuvenation, tummy tucks...demand is huge.

3.  Dermatology.  THE DREAM JOB for BIG money, and relatively easy lifestyle.  This is even further buttressed by he fact that dermatologists severely limit entry into royal college programs - making the monopoly dermatologists have probably the most remarkable of any specialty.  PRIVATE billings galore for quick relatively safe procedures.

4.  Radiology.  Community hospital radiologists routinely make 1 million plus with minimal expenses.  If you own your own equipment - the expenses can add up - but most such practices have a large pool of radiologists.  Many radiologists make money on the side with investments in baby 3D US clinics, and other private enterprise - though this is mostly through connections. 

5.  ENT.  - If one does facial plastics - similar to plastic surgery.

6.  Physiatrists.  ONLY if you do medico-legal work for insurance companies.  BUT the money here - all private - is insane.  Catching 'fakers' saves insurance companies millions - so they will pay top dollar for good rehab physicians to do evaluations.

7.  Anesthesia - IF YOU DO PAIN CLINICS and PROCEDURES - the world is your oyster. 

 

Urologists, Obstetricians, Thoracic Sx, Neuro Sx, all have decent potential to make 1 millions plus - BUT the amount of work to do it is pretty brutal.

 

Dentists:

 

1.  Own General Dental Practice - Yes - as hard as it is to believe, in the right location with the right marketing and the right number of money making hygienists - even general dentists can make 1 million + a year aventually after expenses.  YOU do need to have a good business sense though.

2.  Orthodontics:  relatively easy job to basically print money.  Easy way to make 2 million + a year with good lifestyle.  However, getting a residency is the hard part, and connections matter.

3.  MFS - maxilla-facial-surgery - long process, hard to get in, and also involves getting an MD in the end.  BUT THE MONEY is delicious.  It is insane. 

 

These are the guys often buying high end porsches and Ferraris in Toronto, livingin 3 million+ homes, and some of the younger single men are the guys partying in vegas ever 2 weeks.  These guys exist.  NOT MOST DOCTORS, mind you, but a lot of these guys exist.