Salaries of specialists adjusted for overhead expenses

[rmorelan]

10 hours ago, Aconitase said:

I think most of higher paying g medical specialists (ICU/cardio/nephro) are closer to 600k-1mill as well. Also rads is 750-1mill

we are not 750K-1 million on average. 

and keep in mind since we are future planning they all of those high paying specialties are enemy number one right now for the government. The governments position in the next step of bargaining is pretty clear on that - even more cuts after 6 straight years of cuts exactly those areas - and we are talking some big cuts as well.  All that will continue I am sure until ultimately they are knocked off of their position. 

[rogerroger]

On 3/4/2018 at 10:04 PM, humhum said:

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:

 

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

 

I don't know if this WAS accurate historically.

But I can spot huge differences from the reality of what I know first and second hand.

Another thing, huge variations occur. What you take home can swing by +200K within a province and between provinces within some given specialties depending on location.

So big caution on using averages...

But I strongly believe that regardless of your specialty, if you want to figure out ways to crush "the average" you can do it. Just need to be creative. You can also decide to work a minimal amount and live comfortably as well but be well below the average. Take home point, take such numbers with a big grain of salt. 

[A-Stark]

22 hours ago, Aconitase said:

In Ontario you get 100 bucks per patient seen after midnight bonus. No maximum  

 

GIMs often do a number of things to “exploit” this

 

-reasses admissions from before midnight

-walking around to wards and signing orders for Tylenol and stuff they ordered over phone before midnight 

-rush to jot a quick note down after reviewing am labs before 7am

 

It’s a way to make a quick bonus of 1-2k per shift 

I can't comment on the Ontario fee schedule specifically, but I don't know what you mean by "reassessing" admissions. You don't get to bill just for dropping by to see a patient on the same day of admission. You bill for the consult and any bonuses based on the documented time you saw the patient. That's it. You also don't get to bill for walking around signing orders. A patient being "seen" means a consult or follow-up has been completed and you can only bill for that. So in the dictation you say something like "I was called in from home to assess Mrs B at 2am..." and then bill the consult fee and any modifiers for after midnight, age, comorbidities, etc. 

Now some places will have call day "minimums" so that if you're billings fall below that level you will still get a guaranteed minimum. 

[rmorelan]

20 minutes ago, A-Stark said:

I can't comment on the Ontario fee schedule specifically, but I don't know what you mean by "reassessing" admissions. You don't get to bill just for dropping by to see a patient on the same day of admission. You bill for the consult and any bonuses based on the documented time you saw the patient. That's it. You also don't get to bill for walking around signing orders. A patient being "seen" means a consult or follow-up has been completed and you can only bill for that. So in the dictation you say something like "I was called in from home to assess Mrs B at 2am..." and then bill the consult fee and any modifiers for after midnight, age, comorbidities, etc. 

Now some places will have call day "minimums" so that if you're billings fall below that level you will still get a guaranteed minimum. 

and you have to be careful with that sort of stuff as well - clearly they are tracking and targeting doctors that are over the average. If you are a doctor that somehow is generating notably more than others with the same patient number it automatically screams red flag. Those government audits aren't exactly a lot of fun.

we should get paid a fair fee for what we do, and there are way of increasing things (like as the poster mentioned actually seeing an emergency consult in the proper time periods - but you actually have to see that patient, have an indication to do so, and do the work. The fee is there for a reason - after hours consults are sporadic and often complex).

 

 

[Let'sGo1990]

1 hour ago, rmorelan said:

we are not 750K-1 million on average. 

and keep in mind since we are future planning they all of those high paying specialties are enemy number one right now for the government. The governments position in the next step of bargaining is pretty clear on that - even more cuts after 6 straight years of cuts exactly those areas - and we are talking some big cuts as well.  All that will continue I am sure until ultimately they are knocked off of their position. 

Pardon my ignorance, but I thought the cuts were pretty uniform across the board, no? I remember seeing that opthal. billings actually went up while the cuts were ongoing (they probably just worked more, but other specialties certainly did decrease). I was actually under the impression that family medicine was targeted the most because the government figured they could save more $ just by the sheer number of general practitioners.

[rmorelan]

9 minutes ago, Let'sGo1990 said:

Pardon my ignorance, but I thought the cuts were pretty uniform across the board, no? I remember seeing that opthal. billings actually went up while the cuts were ongoing (they probably just worked more, but other specialties certainly did decrease). I was actually under the impression that family medicine was targeted the most because the government figured they could save more $ just by the sheer number of general practitioners.

there was a proposed (by the ontario government) specific reduction to radiology in the double digits in their current proposal (as of 3 days ago) spread over 2 years. Now they won't get that because of arbitration - but it is the starting point. That is again after no increase in 6-7 years even to cover the costs related to inflation, and no increase to the technical fees portion (which is used to pay for equipment etc) in almost 30 years (we have been using the professional fees to subsidize the operations costs - which means you cannot look at the fee and think that is what you get as there is quite a bit of overhead in some practices). This is why I keep saying that you cannot look at the high earning fields and think that will even be there when you are done (10 years from now). If you are going into field X for the money, and reach the end (for me that would be 11 years after getting accepted to medical school) how are you going to feel when you get there and you just get average doctor pay (which is the goal I think - equalize things and cut them overall as well)? Would you do the job and do it well if you don't happen to really have any interest in it, all while getting paid the same as every other doctor?

It is another blunt tool and again assumes all radiologists read the same mix of cases (completely wrong). I don't honestly know how some practices would stay in business on those models.  Others would just be taking a hit that would hurt but keep going. 

[JohnGrisham]

On 3/13/2018 at 0:47 PM, uwopremed said:

Because our transcripts are absolutely useless - getting into competitive specialties is not actually as reflective of how smart students are (in relative to the USA - where grades are on transcripts, and board exams results are required (Step 1 at least).  

There are a few dummies in my class that are gunning for some high paying specialties - and because they can present themselves reasonably well for short periods of time on a focused subject , and have some research, they will have a great shot of matching next year.  I'm talking plastics and ENT and urology as specialties.

Oh well...

I've seen this quite often in the last few years. You see person X matched to some competitive specialty... and i just think to myself "but how?".  Not saying its a better or worse system than the US though...where you score a 250 on Step 1 and you're automatically in the running for competitive specialties... Pros' and Cons.

[Aconitase]

2 hours ago, rmorelan said:

we are not 750K-1 million on average. 

and keep in mind since we are future planning they all of those high paying specialties are enemy number one right now for the government. The governments position in the next step of bargaining is pretty clear on that - even more cuts after 6 straight years of cuts exactly those areas - and we are talking some big cuts as well.  All that will continue I am sure until ultimately they are knocked off of their position. 

Most of the rads I know are all 750-1mill 

 

they are lower bc of the academic guys making less. Don’t kid yourself - busy community rads make this much. Average is misleading 

 

Ask the the guys in the west GTA (Trillum/William Osler/Waterloo even) and this is the range 

[Aconitase]

1 hour ago, A-Stark said:

I can't comment on the Ontario fee schedule specifically, but I don't know what you mean by "reassessing" admissions. You don't get to bill just for dropping by to see a patient on the same day of admission. You bill for the consult and any bonuses based on the documented time you saw the patient. That's it. You also don't get to bill for walking around signing orders. A patient being "seen" means a consult or follow-up has been completed and you can only bill for that. So in the dictation you say something like "I was called in from home to assess Mrs B at 2am..." and then bill the consult fee and any modifiers for after midnight, age, comorbidities, etc. 

Now some places will have call day "minimums" so that if you're billings fall below that level you will still get a guaranteed minimum. 

You admit someone at 1030pm and you bill a consult and Speical visit and E premium. 

 

You “reasses” then at 1am. It’s a new day for billing so you can bill an assessment and special visit for this day as well. 

 

After modnight you you can bill A138 (minor asses) and the SVP for 100 bucks for anything you do as long as you see the patient 

[humhum]

On 3/14/2018 at 9:25 PM, Aconitase said:

Most of the rads I know are all 750-1mill 

 

they are lower bc of the academic guys making less. Don’t kid yourself - busy community rads make this much. Average is misleading 

 

Ask the the guys in the west GTA (Trillum/William Osler/Waterloo even) and this is the range 

This is what it comes down to. The top earners are NOT the ones in the academic centres actually teaching. Volume is king.

There are retinologists in BC that bill > $2.5 million per year, and they sure as hell aren't running clinical trials and teaching medical students.

[humhum]

On 3/14/2018 at 8:30 PM, rmorelan said:

This is why I keep saying that you cannot look at the high earning fields and think that will even be there when you are done (10 years from now). If you are going into field X for the money, and reach the end (for me that would be 11 years after getting accepted to medical school) how are you going to feel when you get there and you just get average doctor pay (which is the goal I think - equalize things and cut them overall as well)? Would you do the job and do it well if you don't happen to really have any interest in it, all while getting paid the same as every other doctor?

A rising or fall tide affects all boats. While the top earning specialties are seemingly the lowest hanging fruit, let's not be naive. The cuts will affect everyone. If the government is going after doctor's salaries, they will cut them across the board. The rhetoric right now is that they want to cut the tallest blades of grass and even the playing field. However, 0.5% less pay to all family doctors will save the system more money than 20% cut from all dermatologists. There are just that many more GPs.

There is no crystal ball for the future, but a historical track record is the only means to make appropriate decisions. The top earning specialties have been more or less top earning for the past few decades. People feel they should be apologetic for going to specialty X or Y for their earning potential, and I for one disagree.  Giving the benefit of the doubt, every medical student wants to help people with their ailments. And every specialty in medicine does exactly that. Beyond that it is just personal factors detached from the patient. Maybe someone has a hilariously amazing time watching a prostate get shredded into a paste with TURP, and that is why they fell in love with urology. That is no more noble of a reason than going into that specialty for its somewhat higher earning potential.

[humhum]

On 3/14/2018 at 7:00 PM, rogerroger said:

I don't know if this WAS accurate historically.

But I can spot huge differences from the reality of what I know first and second hand.

Another thing, huge variations occur. What you take home can swing by +200K within a province and between provinces within some given specialties depending on location.

So big caution on using averages...

But I strongly believe that regardless of your specialty, if you want to figure out ways to crush "the average" you can do it. Just need to be creative. You can also decide to work a minimal amount and live comfortably as well but be well below the average. Take home point, take such numbers with a big grain of salt. 

Statistics don't tell you what dice you will roll, but they will tell you your chances of landing it big. In our province, there is a pediatrician that makes more than the average dermatologist. And there is also a neurosurgeon that makes more $1.5 million a year. Not sure how they do it, but they stand out exactly because 99% of their colleagues in their field aren't able to pull it off, and I'm sure many would want to.

Data is important, but not just about the money. Many other things, such as burn out rates, average work hours, average call frequency, unemployment rates, etc. Med students ignore them at their own peril.

[rmorelan]

8 hours ago, humhum said:

A rising or fall tide affects all boats. While the top earning specialties are seemingly the lowest hanging fruit, let's not be naive. The cuts will affect everyone. If the government is going after doctor's salaries, they will cut them across the board. The rhetoric right now is that they want to cut the tallest blades of grass and even the playing field. However, 0.5% less pay to all family doctors will save the system more money than 20% cut from all dermatologists. There are just that many more GPs.

There is no crystal ball for the future, but a historical track record is the only means to make appropriate decisions. The top earning specialties have been more or less top earning for the past few decades. People feel they should be apologetic for going to specialty X or Y for their earning potential, and I for one disagree.  Giving the benefit of the doubt, every medical student wants to help people with their ailments. And every specialty in medicine does exactly that. Beyond that it is just personal factors detached from the patient. Maybe someone has a hilariously amazing time watching a prostate get shredded into a paste with TURP, and that is why they fell in love with urology. That is no more noble of a reason than going into that specialty for its somewhat higher earning potential.

cuts will for sure - but I am not trying to use a crystal ball here I mean the Ontario government has just published its position in the next round of negotiations for the coming contract. Their starting position is a large targeted cut  to specifically to most radiology fees, and similar cuts to the "tall blades of grass". That has been a similar pattern of targeted cuts over the past 8 yeas. My point is the government is absolutely trying to remove specific high paying fields off the board and been so for awhile. There is no where near that sort of cut to other areas. 

It isn't just about saving money - it is pure politics. They want to reduce health care costs overall and having a few high paying fields constantly in the news lets them give a chance to cut the spending overall by smaller amounts but requires them to lower particular areas more as well. 

Now they won't get their as much as they want because it is going to arbitration (at least that is now there) but the again the pattern is clear. Just because they have been top earners in the past doesn't mean that they will hold forever, and historically we haven't talked about doctors incomes publicly all that much which reduces any outside pressure to change anything. You talk about decades which is fair but I would suggest focusing on the past 10 years more than what happened beyond that.

Of course people should pay attention to income in selecting any sort of career. I am not sure how you could ignore it as a factor at least completely (or you are a very special sort of person if you do). My point was trying to be more practical than that - I strongly suspect as the pattern has shown that income specifically in high paying areas will fall over the coming 10 years. If you motivation is income you should also see if you think that is true by looking at the evidence and factor that in to your decision making process (and also factor in if people are working more as a substitute for falling income which some fields have done but has clear limits)

 

 

[ZBL]

Cutting the tall blades only is a joke though. Many of those specialties like rads and ophtho have massive overhead so the gross billing isn’t super reflective. Derm overall bills a lot due to volume, but their price per patient is already one of the lowest in medicine so I’m not sure where cuts will even come from. I agree fee codes should be corrected for things where technology has outpaced procedure time (like CT reading, cataracts etc) but that needs to be done more proactively, not 20 years after the fact. At the end of the day, every single med student knows what different specialties pay and what the lifestyle is like, and to a large degree they have high control over what specialty they pursue and are free to consider those factors as they wish. 

 

[Aconitase]

4 minutes ago, ZBL said:

Cutting the tall blades only is a joke though. Many of those specialties like rads and ophtho have massive overhead so the gross billing isn’t super reflective. Derm overall bills a lot due to volume, but their price per patient is already one of the lowest in medicine so I’m not sure where cuts will even come from. I agree fee codes should be corrected for things where technology has outpaced procedure time (like CT reading, cataracts etc) but that needs to be done more proactively, not 20 years after the fact. At the end of the day, every single med student knows what different specialties pay and what the lifestyle is like, and to a large degree they have high control over what specialty they pursue and are free to consider those factors as they wish. 

 

The other thing though is those high billing specialties also all seem to have significant private billing potential. My suspicion is that if the tall blades get cut in terms of typical medical billing, they will just increase their private billing ratio to maintain income as it was. The effect will be longer wait times for those specialties. 

What massive overhead does a rads working at large GTA hospital have? None? It’s 750-1mill take home for those rads. 

 

Med students don’t know about this since they don’t teach you and the averages are misleading. A lot of people still think rads Make 300k!

 

You really think med students know

 

-ICU docs make 30k a week? (No overhead)

-Busy ER shifts and busy GIM shifts make 5k a shift (No overhead)

 

they make cardiologists get a lot of money but they don’t know all of the details 

 

[ZBL]

14 minutes ago, Aconitase said:

What massive overhead does a rads working at large GTA hospital have? None? It’s 750-1mill take home for those rads. 

 

Med students don’t know about this since they don’t teach you and the averages are misleading. A lot of people still think rads Make 300k!

 

You really think med students know

 

-ICU docs make 30k a week? (No overhead)

-Busy ER shifts and busy GIM shifts make 5k a shift (No overhead)

 

they make cardiologists get a lot of money but they don’t know all of the details 

 

Except not all radiologists are academics at TGH. Those in community settings do have large overhead. Nonetheless, this is still where the point of tech advancement vs billing fee could be adjusted. 

 

I think many med students do know to some degree what is lucrative and what is not. And if they don’t, that’s their problem for not figuring out how they’re going to get paid before choosing a specialty. 

[Aconitase]

56 minutes ago, ZBL said:

Except not all radiologists are academics at TGH. Those in community settings do have large overhead. Nonetheless, this is still where the point of tech advancement vs billing fee could be adjusted. 

 

I think many med students do know to some degree what is lucrative and what is not. And if they don’t, that’s their problem for not figuring out how they’re going to get paid before choosing a specialty. 

Rads at TGH do not get paid as well. 

 

I am talking anout large community places. No residents. No teaching. No research. Just money. 

 

Trillium. William Olser. Markham Storyville. Scarbough. 

 

Legends paying no overhead and making a million

[Edict]

1 hour ago, ZBL said:

Cutting the tall blades only is a joke though. Many of those specialties like rads and ophtho have massive overhead so the gross billing isn’t super reflective. Derm overall bills a lot due to volume, but their price per patient is already one of the lowest in medicine so I’m not sure where cuts will even come from. I agree fee codes should be corrected for things where technology has outpaced procedure time (like CT reading, cataracts etc) but that needs to be done more proactively, not 20 years after the fact. At the end of the day, every single med student knows what different specialties pay and what the lifestyle is like, and to a large degree they have high control over what specialty they pursue and are free to consider those factors as they wish. 

 

The other thing though is those high billing specialties also all seem to have significant private billing potential. My suspicion is that if the tall blades get cut in terms of typical medical billing, they will just increase their private billing ratio to maintain income as it was. The effect will be longer wait times for those specialties. 

There is a reason why they cut it 20 years after the fact.. If they cut it proactively that would discourage innovation. Why improve reading speed or implement new technologies to do operations faster if the second you implement them the government cuts ur reimbursement? 

[ZBL]

2 hours ago, Edict said:

There is a reason why they cut it 20 years after the fact.. If they cut it proactively that would discourage innovation. Why improve reading speed or implement new technologies to do operations faster if the second you implement them the government cuts ur reimbursement? 

Haha the typical community doc that’s cashing in on faster procedure times and technology are not the ones doing the innovating.... not by a long shot. 

 

The innovators are the ones on some alternative pay plan through the university (or not even physicians at all) where they are dedicating time to research. From tech, they can patent it and make far more money than any community doc using that tech ever could. Their motivation is science, medical innovation and safety, or the idea of a patent - not scrapping 10 minutes off their procedure time. 

[Edict]

Just now, ZBL said:

Haha the typical community doc that’s cashing in on faster procedure times and technology are not the ones doing the innovating.... not by a long shot. 

 

The innovators are the ones on some alternative pay plan through the university (or not even physicians at all) where they are dedicating time to research. From tech, they can patent it and make far more money than any community doc using that tech ever could. Their motivation is science, medical innovation and safety, or the idea of a patent - not scrapping 10 minutes off their procedure time. 

They are still the ones buying the technology. For example, if ophthalmologists knew that the second they all bought the new Zenius 4000 to halve their surgical times the government would halve the reimbursement for a procedure, they wouldn't buy it. 

[DermJuly2018PGY1]

what you smoking? @Edict jeez...

[ZBL]

41 minutes ago, Edict said:

They are still the ones buying the technology. For example, if ophthalmologists knew that the second they all bought the new Zenius 4000 to halve their surgical times the government would halve the reimbursement for a procedure, they wouldn't buy it. 

Right, I forgot that patient safety/outcomes and keeping up with the standard of care doesnt matter. 

[Edict]

4 hours ago, ZBL said:

Right, I forgot that patient safety/outcomes and keeping up with the standard of care doesnt matter. 

Unfortunately for some physicians it doesn't... there are physicians out there who seem to prioritize their bottom line over other things. 

Again, maybe i'm wrong about this, maybe this is just the government being slow to respond to changes in the market. That wouldn't be unprecedented for sure.

 

[Aconitase]

1 hour ago, Edict said:

Unfortunately for some physicians it doesn't... there are physicians out there who seem to prioritize their bottom line over other things. 

Again, maybe i'm wrong about this, maybe this is just the government being slow to respond to changes in the market. That wouldn't be unprecedented for sure.

 

Is there something wrong with a physician wanting to get paid fairly for that they do? Especially after this Liberal governments all out assault on doctors ?

[ArchEnemy]

We should not be fighting amongst ourselves. 

The government is trying to sow discord between the various specialties so as to justify its cuts to ALL specialties. Additionally, they are not transferring the money from cuts to the higher paid specialties to the lower paid specialties, but rather it is used to fuel their own political agenda.