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Salaries of specialists adjusted for overhead expenses


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There is a lot of misinformation out there about just how much each specialist makes, and the CMA data is so generic as to be mostly useless. Overall, it is all very province-dependent, but across all provinces, there are some that always stand out. The following are two of the best sources I have found, that are specific to Ontario and Alberta. For BC, you can look up individual salaries for each MD, but without information on the overhead, and the "laboratory" specialties are not included in this (e.g. path, rad, etc.)

 

2012 Study of Ontario physician salaries:

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3517870/

2017 study of Alberta physician salaries:

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Source: http://c2-preview.prosites.com/213099/wy/docs/Attachment 01 - Fee and Income Relativity 101 for Spring 2017 RF FINAL 2017-02-10.pdf

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As a non-radiologist (and maybe Rmorelan can chime in here), it's completely justified based on how hard they work.

Everyone is sending stuff down and expecting radiology to find something, and according to everyone, everything is urgent.

In the ER, CT PE protocols in some centers are way overused. It's almost calling on a friend to help you practice some form of defensive medicine. 

I don't understand sometimes - if you want to pay them less but send more scans down expecting immediate results, especially complicated modalities like MRI and thoracic CT,  then I'm sorry but there needs to be some incentives to keep that in place.  

 

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Something that also gets lost in the talk of income comparison between specialties is hours and whether or not those hours can scale. There's a big difference in work hours between, say, vascular surgery and radiation oncology, despite both having high incomes. Likewise, if an FP is willing to work a typical surgeon's hours they can increase their income quite a bit - probably not to the same level as a surgeon in most cases, but the gap closes significantly. Also, a note of caution when looking at billing data only - many physicians get a not-insignificant portion of their salary through private billings. Even a 10% increase is pre-overhead income, which is far from uncommon, increases total take-home by quite a bit.

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17 hours ago, BeentheredonetheDAT said:

Is there any chance that radiology will remain lucrative as it has been given all the changes to the profession in terms of AI and the government going after radiologist pay? Plus, how good is radiology for a new grad?

A good question for @rmorelan !

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16 hours ago, ralk said:

Something that also gets lost in the talk of income comparison between specialties is hours and whether or not those hours can scale. There's a big difference in work hours between, say, vascular surgery and radiation oncology, despite both having high incomes. Likewise, if an FP is willing to work a typical surgeon's hours they can increase their income quite a bit - probably not to the same level as a surgeon in most cases, but the gap closes significantly. Also, a note of caution when looking at billing data only - many physicians get a not-insignificant portion of their salary through private billings. Even a 10% increase is pre-overhead income, which is far from uncommon, increases total take-home by quite a bit.

Very true. If you scale a general surgeon's hours to that of the typical GP, their earnings are on par. And surgeons can't scale up their practice because of OR time limitations, while office-based practices can be scaled up and and down on a whim. 

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9 minutes ago, humhum said:

Very true. If you scale a general surgeon's hours to that of the typical GP, their earnings are on par. And surgeons can't scale up their practice because of OR time limitations, while office-based practices can be scaled up and and down on a whim. 

But you also run into caps as a FM doc, and you cant necessarily easily cherry pick your appointments(at least not as easily). If you are seeing 50 patients a day, working 6 days a week, 50 weeks a year, you will make very very good money, but there are way too many extra variables with FM.  

All the extra work and managing you have to do for that type of patient panel, all the forms, all the follow ups, all the  continuity of care.  Sure you can do walk-ins and that will help minimize the "extras", but then that usually means lower billing codes per patient too. 

You can only scale up so much with FM, given the inherent variability of the practice and patients you will see.  

A unit of time in surgery is still generally greater than a unit of time in FP clinic, so i still think if you scaled gen surgeries hours down, they would make more.  If you assume the intangibles are equal.  If you're super efficient, doing walk-in style FP, then you can definitely get it close to par, but you're still working very hard.

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1 hour ago, humhum said:

Very true. If you scale a general surgeon's hours to that of the typical GP, their earnings are on par. And surgeons can't scale up their practice because of OR time limitations, while office-based practices can be scaled up and and down on a whim. 

That isn't true. Also the image you provided isn't the most appropriate; the one below is. It's from the same document you drew yours form and it standardizes to training time and overhead.

In order for a GP to "catch up to a surgeon's 5 day/week pay", he or she would have to work 8.4 days/week.

 

income.gif

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1 hour ago, bloh said:

That isn't true. Also the image you provided isn't the most appropriate; the one below is. It's from the same document you drew yours form and it standardizes to training time and overhead.

In order for a GP to "catch up to a surgeon's 5 day/week pay", he or she would have to work 8.4 days/week.

 

income.gif

Why isn't it true? And how are you calculating the family docs income? What practice model are they in? How efficient are they? What bonus billings do they get? Private billings/cash? 

 

Someone who has a large FHO roster and is efficient will absolutely topple every specialist's average income. Likewise a specialist who's on the ball can do the same. 

There's been a couple provincial top 20-25 billings list and family med has had 4 doctors on those I believe. 

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6 hours ago, JohnGrisham said:

But you also run into caps as a FM doc, and you cant necessarily easily cherry pick your appointments(at least not as easily). If you are seeing 50 patients a day, working 6 days a week, 50 weeks a year, you will make very very good money, but there are way too many extra variables with FM.  

All the extra work and managing you have to do for that type of patient panel, all the forms, all the follow ups, all the  continuity of care.  Sure you can do walk-ins and that will help minimize the "extras", but then that usually means lower billing codes per patient too. 

You can only scale up so much with FM, given the inherent variability of the practice and patients you will see.  

A unit of time in surgery is still generally greater than a unit of time in FP clinic, so i still think if you scaled gen surgeries hours down, they would make more.  If you assume the intangibles are equal.  If you're super efficient, doing walk-in style FP, then you can definitely get it close to par, but you're still working very hard.

If you're only doing straight clinic FM, the scaling factor is pretty low. However, FM can comprise a lot more than that and it's the extras that tend to be lucrative. Rural docs work longer, more inconsistent hours and have earnings fairly close to if not beyond an average surgeon's. Even in larger cities, if you add lots of home care, urgent care, nursing home work, inpatient coverage, and/or OB work, all of which add to the length and inconsistency of your hours, you can increase your income pretty significantly. Probably not to surgeon-levels in these cases, but certainly more than a typical FP in clinic practice.

Likewise, a surgeon sticking to more of a lifestyle practice - that is, trying to work mostly days, minimizing or eliminating call, doing more clinic-based work - will typically see their income fall (there are some notable exceptions in sub-specialty fields).

It's more than just taking the reported stats and adjusting them by a "worked hours" factor. The nature and consistency of the work play a big role. The point I was trying to make is that reported income stats are rarely and apples-to-apples comparison. Once you look at practitioners with more similar workloads and time demands, many of the major specialties' earnings tend to even out a bit.

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12 hours ago, medigeek said:

Why isn't it true? And how are you calculating the family docs income? What practice model are they in? How efficient are they? What bonus billings do they get? Private billings/cash? 

 

Someone who has a large FHO roster and is efficient will absolutely topple every specialist's average income. Likewise a specialist who's on the ball can do the same. 

There's been a couple provincial top 20-25 billings list and family med has had 4 doctors on those I believe. 

It's not true because it's based purely on billing statistics for Alberta physicians. They're all non-part time physicians, billing at least 100k+ and working a set minimum number of days. Are you suggesting the data I provided is faulty in some way?

"How efficient are they?"

Do you understand averages? Or are you stipulating that the data is representing non-efficient GPs or overly-efficient surgeons?

"Bonus private billings?"

This stuff (insurance letters, other notes, etc) makes up less than 5% of a GPs income and trust me when I say that it's more tedious work and it doesn't make more than FFS billings would take. It's also shit That's regularly done outside business hours

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Derm, ophtho and rads I can understand why their billing’s are so high - lots of patients per day, procedural, easy to scale up hours of you wish, plus some cash business not shown in these graphs. But what’s the deal with nephro and resp? For resp is it mostly PFTs that bill so much? I can’t imagine interventional resps making up the majority of those numbers. Nephro I have no idea. 

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3 hours ago, bloh said:

It's not true because it's based purely on billing statistics for Alberta physicians. They're all non-part time physicians, billing at least 100k+ and working a set minimum number of days. Are you suggesting the data I provided is faulty in some way?

"How efficient are they?"

Do you understand averages? Or are you stipulating that the data is representing non-efficient GPs or overly-efficient surgeons?

"Bonus private billings?"

This stuff (insurance letters, other notes, etc) makes up less than 5% of a GPs income and trust me when I say that it's more tedious work and it doesn't make more than FFS billings would take. It's also shit That's regularly done outside business hours

Youre totally right.  

Not to be rude, but it seems sometimes when this gets brought up that people feel the need to "justify" being a GP by saying "some make a ton" etc.  Its not true!  Of course a GP can make more by working longer hours and being more efficient, but so can every specialty!!  Ya you could do well working 12 hour days 6 days a week as a GP...but you would make more as a specialist working those hours, and typically by a large margin.  Disputing averages makes no sense.  Its not like someone can easily make a ton more by being more efficient...if that were true, everyone would do it.  Its not like most people don't like money.

Also "bonus private billings" is, if anything, rarer for GPs than almost any other specialty, so bringing that up makes no sense.  No one is sending medicolegal work or "private corporate clinic" work to GPs.  So if anything, these extra billings increase the disparity between GPs and (most) specialists.  

And a large patient roster is not nearly enough to increase a GPs income anywhere close to the level of most specialists.  That is just not true haha.

 

Edit: and I'm not just trying to slam the above posters who are trying to "talk up" GP income for whatever reason.  I just don't want readers in med school to get the wrong information.  Also the regular caveat: they still make good money, as we all know, theyre not doing POORLY, they are just not able to make specialist wages, regardless of the tricks other people seem to think they can employ

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5 hours ago, ZBL said:

Derm, ophtho and rads I can understand why their billing’s are so high - lots of patients per day, procedural, easy to scale up hours of you wish, plus some cash business not shown in these graphs. But what’s the deal with nephro and resp? For resp is it mostly PFTs that bill so much? I can’t imagine interventional resps making up the majority of those numbers. Nephro I have no idea. 

Once that dialysis line is in, $$$$$

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4 hours ago, goleafsgochris said:

Youre totally right.  

Not to be rude, but it seems sometimes when this gets brought up that people feel the need to "justify" being a GP by saying "some make a ton" etc.  Its not true!  Of course a GP can make more by working longer hours and being more efficient, but so can every specialty!!  Ya you could do well working 12 hour days 6 days a week as a GP...but you would make more as a specialist working those hours, and typically by a large margin.  Disputing averages makes no sense.  Its not like someone can easily make a ton more by being more efficient...if that were true, everyone would do it.  Its not like most people don't like money.

Also "bonus private billings" is, if anything, rarer for GPs than almost any other specialty, so bringing that up makes no sense.  No one is sending medicolegal work or "private corporate clinic" work to GPs.  So if anything, these extra billings increase the disparity between GPs and (most) specialists.  

And a large patient roster is not nearly enough to increase a GPs income anywhere close to the level of most specialists.  That is just not true haha.

 

Edit: and I'm not just trying to slam the above posters who are trying to "talk up" GP income for whatever reason.  I just don't want readers in med school to get the wrong information.  Also the regular caveat: they still make good money, as we all know, theyre not doing POORLY, they are just not able to make specialist wages, regardless of the tricks other people seem to think they can employ

i think something to take into consideration is training time tho. the efficient gp, that did his residency wisely (learing how to be efficient, and what routes to go), will be making income for 4-5 years before most specialists..considering atleast one fellowship is the norm now a days. 

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24 minutes ago, #YOLO said:

i think something to take into consideration is training time tho. the efficient gp, that did his residency wisely (learing how to be efficient, and what routes to go), will be making income for 4-5 years before most specialists..considering atleast one fellowship is the norm now a days. 

Residents and fellows also earn income, although much less than staff.  When the net income differential is a factor of 2 or more, the additional training time doesn't really matter for a typical 30 year career or so.  In the graphic above, the net differential goes up to 3x between GP and some specialties.  

In any case, focussing too much on perceived earnings risks backfiring, both from a career satisfaction point of view and also since there's a large spread in the income in highly-paid specialities too.  

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9 hours ago, bloh said:

It's not true because it's based purely on billing statistics for Alberta physicians. They're all non-part time physicians, billing at least 100k+ and working a set minimum number of days. Are you suggesting the data I provided is faulty in some way?

"How efficient are they?"

Do you understand averages? Or are you stipulating that the data is representing non-efficient GPs or overly-efficient surgeons?

"Bonus private billings?"

This stuff (insurance letters, other notes, etc) makes up less than 5% of a GPs income and trust me when I say that it's more tedious work and it doesn't make more than FFS billings would take. It's also shit That's regularly done outside business hours

Using averages is fine but it's important to have additional data such as 75th and 90th percentile incomes. Not everyone is working on the ball to make more money. 

 

5 hours ago, goleafsgochris said:

Youre totally right.  

Not to be rude, but it seems sometimes when this gets brought up that people feel the need to "justify" being a GP by saying "some make a ton" etc.  Its not true!  Of course a GP can make more by working longer hours and being more efficient, but so can every specialty!!  Ya you could do well working 12 hour days 6 days a week as a GP...but you would make more as a specialist working those hours, and typically by a large margin.  Disputing averages makes no sense.  Its not like someone can easily make a ton more by being more efficient...if that were true, everyone would do it.  Its not like most people don't like money.

Also "bonus private billings" is, if anything, rarer for GPs than almost any other specialty, so bringing that up makes no sense.  No one is sending medicolegal work or "private corporate clinic" work to GPs.  So if anything, these extra billings increase the disparity between GPs and (most) specialists.  

And a large patient roster is not nearly enough to increase a GPs income anywhere close to the level of most specialists.  That is just not true haha.

 

Edit: and I'm not just trying to slam the above posters who are trying to "talk up" GP income for whatever reason.  I just don't want readers in med school to get the wrong information.  Also the regular caveat: they still make good money, as we all know, theyre not doing POORLY, they are just not able to make specialist wages, regardless of the tricks other people seem to think they can employ

There's been a couple provincial lists released of top 20-25 billings and family doctors had 4 spots on those lists. If they can't keep up financially with specialists then they wouldn't have the same broad range of incomes. 

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11 hours ago, medigeek said:

Using averages is fine but it's important to have additional data such as 75th and 90th percentile incomes. Not everyone is working on the ball to make more money. 

 

There's been a couple provincial lists released of top 20-25 billings and family doctors had 4 spots on those lists. If they can't keep up financially with specialists then they wouldn't have the same broad range of incomes. 

It's not as if most physicians wouldn't like to make more money.  Half will be below the median and half will be above.  Only looking at the highest earners misses an important part of the picture, especially before even beginning residency.  

FM also has the most specialists - and more likely to have outliers.  The relative proportion of high earning FM docs is much lower compared to high earning specialists.  

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1 hour ago, marrakech said:

It's not as if most physicians wouldn't like to make more money.  Half will be below the median and half will be above.  Only looking at the highest earners misses an important part of the picture, especially before even beginning residency.  

FM also has the most specialists - and more likely to have outliers.  The relative proportion of high earning FM docs is much lower compared to high earning specialists.  

I was commenting on this exact issue the other day in a different thread. Copy/pasting here to emphasize your post above. 

 

See this report from BC:

https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/medical-services-plan/irm_complete.pdf

 

For 2016/2017 across 65 dermatologists, 9 billed over 600K in MEDICAL fees. That's 13.8% of dermatologists in BC making over 600K in medical fees. And, 33 derms (51%) billed over 300K in medical fees. None of this accounts for private cash billings. 

For 2016/2017 across 5929 FMs, 21 billed over 600K in MEDICAL fees. That is 0.35% of family doctors in BC making over 600K in medical fees. Just 767 (12.9%) of FMs billed over 300K in medical fees. Again, none of this accounts for private cash billings. 

 

For fun, the odds ratio for billing over 600K from the data in the above report is 47. You are 47 times more likely to bill over 600K in BC as a dermatologist than as a FM. 

 

This doesn't account for who's working full time and who's not, but this alone would not explain the differences above. 

 

Either way, even in BC where dermatologists argue they are underpaid, they are relatively more likely to be billing over 300K and 600K than FM. We already established that derm probably has a higher cash billing potential than FM, so I'm not sure where you are getting the idea that FM=derm in terms of money. Is it possible for a FM to make as much or more? Sure, but not as likely. Again, there's a reason derm is a competitive residency. 

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11 hours ago, ZBL said:

I was commenting on this exact issue the other day in a different thread. Copy/pasting here to emphasize your post above. 

See this report from BC:

https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/medical-services-plan/irm_complete.pdf

For 2016/2017 across 65 dermatologists, 9 billed over 600K in MEDICAL fees. That's 13.8% of dermatologists in BC making over 600K in medical fees. And, 33 derms (51%) billed over 300K in medical fees. None of this accounts for private cash billings. 

For 2016/2017 across 5929 FMs, 21 billed over 600K in MEDICAL fees. That is 0.35% of family doctors in BC making over 600K in medical fees. Just 767 (12.9%) of FMs billed over 300K in medical fees. Again, none of this accounts for private cash billings. 

For fun, the odds ratio for billing over 600K from the data in the above report is 47. You are 47 times more likely to bill over 600K in BC as a dermatologist than as a FM. 

This doesn't account for who's working full time and who's not, but this alone would not explain the differences above. 

Either way, even in BC where dermatologists argue they are underpaid, they are relatively more likely to be billing over 300K and 600K than FM. We already established that derm probably has a higher cash billing potential than FM, so I'm not sure where you are getting the idea that FM=derm in terms of money. Is it possible for a FM to make as much or more? Sure, but not as likely. Again, there's a reason derm is a competitive residency. 

Thanks for the detailed stats.  My only quibble would be interpretation - 300K was the median income for a full time FM doc in Ontario in 2010, so half the BC dermatologists are under this value, despite much longer residency (but private billings may make up part of this difference).

 In Ontario, median=mean=300K for FM (source p.22-3) in 2010, and from what I've seen the mean is 270K for FM in BC (source) more recently.  It could be that in BC, the median is much less than the mean, but I wonder if working full time does play a role. 

In any case, unquestionably, there is higher income potential in derm than FM, and that definitely could be motivation for some.  However, given that about half the dermatologists aren't earning that much more than most FPs I'm not sure if that's the major motivation (which correlates with the attitude of albeit small sample size of the dermatologists that I've come across).   

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On 3/6/2018 at 4:20 AM, ralk said:

If you're only doing straight clinic FM, the scaling factor is pretty low. However, FM can comprise a lot more than that and it's the extras that tend to be lucrative. Rural docs work longer, more inconsistent hours and have earnings fairly close to if not beyond an average surgeon's. Even in larger cities, if you add lots of home care, urgent care, nursing home work, inpatient coverage, and/or OB work, all of which add to the length and inconsistency of your hours, you can increase your income pretty significantly. Probably not to surgeon-levels in these cases, but certainly more than a typical FP in clinic practice.

Likewise, a surgeon sticking to more of a lifestyle practice - that is, trying to work mostly days, minimizing or eliminating call, doing more clinic-based work - will typically see their income fall (there are some notable exceptions in sub-specialty fields).

It's more than just taking the reported stats and adjusting them by a "worked hours" factor. The nature and consistency of the work play a big role. The point I was trying to make is that reported income stats are rarely and apples-to-apples comparison. Once you look at practitioners with more similar workloads and time demands, many of the major specialties' earnings tend to even out a bit.

Most of what you said is incorrect and I wish people with no real work experience would stand on the sidelines and just listen in.
I do comprehensive family medicine in a large city. On a weekly basis I have my family practice, a few walk in shifts and a half day in nursing home. On weekends I do hospitalist and emergency room work.

I keep detailed track of what I earn and where it comes from.

In the order of earning capacity, it goes like this:

1. Emergency room work - strictly because it's weekend work in a remote location. You get stipends for being on call, you get afterhour premiums and all your procedures are boosted.  If you do a daytime shift in the city, you will be making less than clinic work. Not only do you miss out on all the premiums but there are also inefficiencies in the triage system, having to clean the room, prepare the chart, etc.

2. Busy walk in shift

3. Family practice = nursing home

4. Slow walk in shift

The figure I posted that shows net DAILY payments between specialists is the most relevant statistic you can look at it. Looking at medians, averages, etc all of that is difficult to interpret because of variable practices.

But knowing that a surgeon makes $1400/day vs a GP at $800/day is all you need to know. It also tells you what you may be able to make depending on how much you work.  This is how everyone else in society compares jobs. They will all value a job that pays $14/hour than one that pays $8/hour. They realize that their friend may be making $2000/month but also appreciate they can make just as much by working 50% less shifts, since their hourly pay is 14$ and not 8$

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2 hours ago, bloh said:

Most of what you said is incorrect and I wish people with no real work experience would stand on the sidelines and just listen in.
I do comprehensive family medicine in a large city. On a weekly basis I have my family practice, a few walk in shifts and a half day in nursing home. On weekends I do hospitalist and emergency room work.

I keep detailed track of what I earn and where it comes from.

In the order of earning capacity, it goes like this:

1. Emergency room work - strictly because it's weekend work in a remote location. You get stipends for being on call, you get afterhour premiums and all your procedures are boosted.  If you do a daytime shift in the city, you will be making less than clinic work. Not only do you miss out on all the premiums but there are also inefficiencies in the triage system, having to clean the room, prepare the chart, etc.

2. Busy walk in shift

3. Family practice = nursing home

4. Slow walk in shift

The figure I posted that shows net DAILY payments between specialists is the most relevant statistic you can look at it. Looking at medians, averages, etc all of that is difficult to interpret because of variable practices.

But knowing that a surgeon makes $1400/day vs a GP at $800/day is all you need to know. It also tells you what you may be able to make depending on how much you work.  This is how everyone else in society compares jobs. They will all value a job that pays $14/hour than one that pays $8/hour. They realize that their friend may be making $2000/month but also appreciate they can make just as much by working 50% less shifts, since their hourly pay is 14$ and not 8$

Amazingly, I do listen in, but thank you for the condescending comment there. What I've described in a loose summary of the experiences, advice, and recommendations from many practitioners working in a variety of settings that I've encountered through my training thus far. It may not reflect your exact experiences, but even with what you've laid out, it doesn't contradict what I've said - you've supplemented your income by working longer hours than what most FPs work, largely by doing work beyond straight primary care clinic work, some of which pays more than that straight clinic work. I'd be rather shocked if you were earning at or below the typical amount for an FP - however you define that figure - working what you do.

The figures you quote are far from an apples-to-apples comparison. First, a day is not a unit of working time. Surgeons work more hours per day than FPs, on average, with more weekends and more call responsibilities on top of that. Knowing that a surgeon makes $1400/day vs a GP at $800/day says very little unless the hours worked per day is equivalent, which it isn't, and which the statistics you quote do not account for. In fact, what you've quoted is exactly what you immediately derided in your next sentence - an average of net billings. All it adds is a slight adjustment for training/opportunity costs and eliminates after-hours premiums.

Now, admittedly, accounting for hours worked does not equal out income disparities between FM and most higher-earning specialties, particularly in Alberta where the disparity seems to be especially large. That's not the point I'm trying to make. What I am trying to say is that the disparities are not nearly as pronounced as it appears in the raw numbers.  Looking through my previous post, I unintentionally implied that all non-clinic work is especially lucrative, which, you're right, is not universally true. Rural work, particularly because of long ER shifts, absolutely qualifies, which is what I was getting at more so than anything else. In cities the options are typically less lucrative, but do add to overall income by increasing hours and do so more efficiently than simply adding more patients and hours to a standard clinic practice. The exact benefits of doing so will depend on the set-up of this additional work - inpatient care in particular - and options may be limited based on the organization of local facilities, but these nevertheless provide opportunities to scale up the number of hours worked per day in exchange for additional income, just as you've done.

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On 3/5/2018 at 1:49 AM, distressedpremed said:

As a non-radiologist (and maybe Rmorelan can chime in here), it's completely justified based on how hard they work.

Everyone is sending stuff down and expecting radiology to find something, and according to everyone, everything is urgent.

In the ER, CT PE protocols in some centers are way overused. It's almost calling on a friend to help you practice some form of defensive medicine. 

I don't understand sometimes - if you want to pay them less but send more scans down expecting immediate results, especially complicated modalities like MRI and thoracic CT,  then I'm sorry but there needs to be some incentives to keep that in place.  

 

It is true - unlike say 20 years ago radiology now is much busier. We have had multiple fee cuts and mostly respond by just upping the work volume. Since people at the same time keep order more and more imaging we have been able to maintain a high income at the cost of lifestyle. Radiology now, particular as new staff, is kind of hellish (6 days a week 12 hour days). That is pure reporting time - not paperwork, keeping trained, and admin time etc. Simple ass in seat reading studies. One of the reason radiology programs have people dropping out is the realization of what is involved (some programs have higher drop out rates than gen surg ha. It is all about managing expectations).

You really want to factor in the amount of hours involved, and the intensity of work somehow in the calculation. I am not speaking in specifics here but in general I don't think every hour of work should be equal in pay regardless of what you are doing and what specialist is doing it. By the math being used here many of the specialists would be 1-1.2 million salary in the hole before starting as staff - with their say 4 years of extra training (including long resident style hours, call, more interest payments etc, etc). Using our traditional numbers of most specialties making around 350K and most family doctors making 200-250K it can take a bit of time just to get "caught up", and as with most other professional fields out there you would expect people with longer training to earn more in the end (otherwise the logic goes why would anyone actually do that - and as someone studying for my final year college exams that is the kind of logic that comes up - not a good time for all my family doc friends to be posting their vacation photos ha - I still have at least 2.5 years to go, and they were done 2.5 years ago).  Should the person standing in the OR doing delicate work for 7 hours straight get paid the same as someone sitting in a office for the same time where a lunch break is a real thing? There is a lot of room for debate on both sides. 

That doesn't mean that some of the fields are imbalanced, and gross income is a way of looking at that (although overhead for some fields, including radiology if you are running your own scanning clinic are quite high - more than family medicine as well the machines involved are a whole new class of expensive). Part of the problem is we never have an easy way of computing take home pay. Gross is a start but causes a lot of issue still - some people go into particular fields because they are reduced hours and more flexible (no 5:30 am surgery start times, and they haven't seen a pager in a decade). Some fields have low gross but actually very high hourly (nuclear medicine per hour beats radiology for example - they just only work 6-7 hours a day often). 

 

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On 3/6/2018 at 1:56 PM, ZBL said:

Derm, ophtho and rads I can understand why their billing’s are so high - lots of patients per day, procedural, easy to scale up hours of you wish, plus some cash business not shown in these graphs. But what’s the deal with nephro and resp? For resp is it mostly PFTs that bill so much? I can’t imagine interventional resps making up the majority of those numbers. Nephro I have no idea. 

These are good questions that I wondered as well. I think with nephrology, the big billings comes from the dialysis units. (and this is pure personal speculation). I think the amount they can bill for the "procedure" itself, and all the different complications that dialysis have bring in additional billing opportunities. But I really don't know for sure; interested to hear from someone with direct knowledge about this.

Thing to keep in mind, from what I do know, nephrology positions are very hard to come by these days. Many go years before stable employment after graduation.

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On 3/5/2018 at 10:46 PM, bloh said:

That isn't true. Also the image you provided isn't the most appropriate; the one below is. It's from the same document you drew yours form and it standardizes to training time and overhead.

In order for a GP to "catch up to a surgeon's 5 day/week pay", he or she would have to work 8.4 days/week.

 

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It is still true. The different figure you have changes nothing about the original point regarding scaling.

What you need to understand is the ability to scale up or not. An ENT can't scale up, no matter how badly he wants to - the hospital dictates when and where he can operate and how often. And once a surgeon has a full-time position with solid ER time, he is a slave to it. He can't scale down either. Hence the poor 65 year-old general surgeons still covering 1 in 3 call.

A GP can book his practice booked solid from 8am to 8am the next morning. The next week he can go to Hawaii.

That is called scaling. I don't think you have any idea what the work hours of a surgeon are like. The brutality of a 24 hour call shift is not equivalent to two 12 hour work days of a GP.

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