I have been looking for information on what the net income for a Canadian outpatient FM doc who sees an average number of patients would look like. I haven't seen much solid information on the internet about it. I know family docs are frequently quoted as having 20-25% overhead and the numbers I see most often seems to be 275,000 (gross pay, before taxes and overhead).
I'm not sure how the tax works after that, and I know physicians frequently "incorporate" themselves to reduce taxes but it seems like you'd end up with somewhere around $130,000 net pay after overhead and taxes are taken care of (without factoring in "incorporation"
In the US, it seems like Family Docs make somewhere around $220,000 for an average patient load (which I am told is lower than in Canada, but there are also quite a few hurdles due to insurance and billing stuff). It also seems like American docs don't have any overhead somehow?
Would really appreciate some info on this (especially from Canadian docs who are practicing). Money isn't everything but I do think it has to be taken into account when making career decisions, especially considering medical debt.
It's a hard question to answer because it varies so widely and family docs in Canada are very much self employed, meaning they decide how they want to work rather than being employed by a medical organization in the US.
A very rough estimate for looking at pure outpatient practice with a panel in Ontario is about $250/pt/year before overhead and taxes. Then all the variation comes in - are you in a fee for service model or FHT? As a family doc in Ontario, you don't have a contract with anyone so you can practice how you want. Some docs take 3000 patients and do clinic 3 days a week. Others take 1500 and do 5 days a week. What number of patients per hour are you comfortable seeing? How many days a week do you want to work? Will you work with nurses or NPs to increase your patient volumes and billings?
In terms of overhead, essentially family docs in Ontario are all in private practice models. You will be in an office and you and your office colleagues have to make sure rent on your building is paid, you staff are hired and paid and the clinic is stocked with equipment and necessities like toilet paper. There's different ways of doing this too, there's the true solo practice where you are responsible for all of these costs, no matter how much you make - but if you run a tight, lean ship you can get your total costs of all this to less than 20% of your income in some cases. In other styles of practice, such as a "managed practice" or "turnkey practice" you pay 30% of whatever your income is and someone else does all the hiring of staff and stocking the equipment. If your income goes down, so does your overhead cost. Great if you're with a young family and will be needing parental leave.
If you're a savy biller, you will learn how to maximize outpatient opportunities to max income. When do you roster or deroster a patient to max your income? How often should you see your diabetics? Are you willing to do things like palliative consults or medical abortions which bill highly?
This is just pure clinic - don't forget there are a ton of opportunities to supplement your income, and 5 days of clinic can get a little monotonous. Many docs combine 3-4 days of clinic with long term care patients, palliative home consults, low risk OB, inpatient medicine etc. You can pick and choose and add in what you like. To give you an example, I work in a managed practice 3 days a week and the practice takes 30% of whatever I earn in clinic, (so less if I earn less that month) and they manage all the staff payments, running the building, getting equipment etc. I also do walk in shifts, I'm in an FM-OB call group so I do deliveries, CS assist and newborn rounding plus I round on my own patients when they are admitted inpatient. All that extra income I keep, no overhead to the clinic. My husband is at the same managed practice, 2-3 days a week and then does hospitalist, inpatient and outpatient palliative. Again, that's all no overhead and a lot of opportunities pay very well compared to clinic.
In the states, the bottom line difference is less flexibility. Usually the modus operandi in the states are that outpatient FM clinics are owned by some type of medical corporation. That corporation hires you to be a family doc in their clinic. This may be an organization like Kaiser or Tufts. They own the building and pay for the other staff and all that, so you don't shoulder those costs as overhead. You get a fixed salary, but that comes with a fixed contract. They usually dictate how many patients they want you to see in a day, how many days of the week etc. so you maximize billing for the organization. Billing usually goes to them. Fixed vacation time. If you want to make changes, you need to negotiate with the big dogs. Speaking very generally, I have seen in the US there's less flexibility to participate in multiple locations of care. Usually family docs were clinic only, or inpatient only. Very few crossed those boundaries.
There's other models for outpatient primary care that exist in the states - there are private practices with overhead. There's direct primary care where you charge the patient a monthly membership fee and others.
The US has much more strict documentation requirements too - think of what your note has to look like to even meet level III billing. Those documentation requirements don't apply in Canada, a brief SOAP note is all that's required, so easier to see more patients and not drown in paperwork in Canada.
Don't forget about US taxes in your calculations and cost of living which can vary widely between cities.
If you are in the US on anything like a J1 waiver, that will significantly restrict what you can and can't do - usually requires full time work which is generally considered 4 days a week in clinic and restricts you to one work location.
At the end of the day, you are comparing a fixed salary in the states at the cost of documentation requirements and a fixed contract vs. a more potentially variable salary in Canada in both directions with more flexibility in how many patients you take on/see, how many days a week you work and what you do aside from clinic. Keep in mind personal factors - geographically where do you want to be? Is being close to family important? If you have a partner, where do they want to be? Money can't buy happiness at the end of the day, but family and job flexibility can bring happiness.
