How much do family doctors actually earn? Right after residency?

[SansaStarkMD]

Don't get me wrong, you can work in the ER as an FM doc (I did it for 4 years). However, there is no way that you as an FM doc will have the same amount of trauma training as an EM doc. The ER's are getting away from having FP's running solo in certain locations (I found this true in Nevada) where admin wants an ER doc running the ER, the FP is the extra help, not the solo provider. The same was when I worked in a large (45 bed) ER in Texas, the FP's did the "step-down" section, but never the "big rooms" where traumas and the super sick patients were placed. If you work ER you will have to have PALS, ATLS, ACLS as a minimum. You need to know that. You will never make the same as an ER doc as an FP - isn't gonna happen. The training just isn't the same. You can make good money but not as much as them. Sorry to burst your bubble.

You will actually make more as a hospitalist at $165/hr doing locums vs ER locums that runs $115/hr.

Those numbers are not even close to accurate in my state. Double them.

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[cabinbuilder]

Those numbers are not even close to accurate in my state. Double them.

My numbers are what I have been paid as an FP loucms who doesn't do trauma or vents. Of course, the more you know, the more you can command. I don't know how you can say hospitalist locums is $330/hr? And ER is $230/hr? As an FP? And which state are you talking about? I would be glad to research the locums sites.

 

[deleted87716]

Hey Blue Dog, what would you say is a good base salary for a new grad working 40hrs/wk out pt ~1hr outside a major metro area in the mid west? Seeing ~25 patients a day, could you give me a reasonable range that one should expect is the position is salary only (no RVUs)?

The 50% percentile is in the $180K range. Salary with no RVUs...? I'll bet they're measuring something...

 

[cabinbuilder]

I guess I'll be ok no matter what then. Like so many of my colleagues, I'm prone to freaking out about nothing every now and again. As long as I can control how much I work, I'll be happy. I just want the option to take 2-3 months off on a whim and go on safari in Australia.

Yes, you can take 2-3 months off if you want.

 

[SansaStarkMD]

My numbers are what I have been paid as an FP loucms who doesn't do trauma or vents. Of course, the more you know, the more you can command. I don't know how you can say hospitalist locums is $330/hr? And ER is $230/hr? As an FP? And which state are you talking about? I would be glad to research the locums sites.

Sent you a PM.

 

[VHADOC]

The 50% percentile is in the $180K range. Salary with no RVUs...? I'll bet they're measuring something...

~180K is 50th percentile in the Midwest? I appreciate that Merritt Hawkins is to be taken with a grain of salt, but in 2015 nationally they said average starting was 199k and now 225k in their 2016 report. I assume that this is up-front base teaser salary but not including loan repayment, 401k, etc...but starting salaries always are. Besides, someone BC out of residency probably can beat 180K from the feds.

All this said, with respect to the thread topic, I'd only encourage someone to go DPC out of residency (unless there was a compelling reason not to). If you can figure out how to provide comprehensive care to 20-25 people per day while feeling comfortable financially supporting a cadre of ancillary staff, then you certainly have the intellectual capacity to create a DPC that sees <10 patients per day (and should feel comfortable keeping the fruits of your labor in your own pocket).

 

[deleted87716]

~180K is 50th percentile in the Midwest?

"The Midwest" is a pretty big area, encompassing over-saturated urban and suburban locations as well as underserved rural areas. You're not going to find any salary/income data much more specific than that without looking at specific job opportunities.

 

[deano5709]

Don't get me wrong, you can work in the ER as an FM doc (I did it for 4 years). However, there is no way that you as an FM doc will have the same amount of trauma training as an EM doc. The ER's are getting away from having FP's running solo in certain locations (I found this true in Nevada) where admin wants an ER doc running the ER, the FP is the extra help, not the solo provider. The same was when I worked in a large (45 bed) ER in Texas, the FP's did the "step-down" section, but never the "big rooms" where traumas and the super sick patients were placed. If you work ER you will have to have PALS, ATLS, ACLS as a minimum. You need to know that. You will never make the same as an ER doc as an FP - isn't gonna happen. The training just isn't the same. You can make good money but not as much as them. Sorry to burst your bubble.

You will actually make more as a hospitalist at $165/hr doing locums vs ER locums that runs $115/hr.

Depends on what program you go to and where you end up working. There have been a number of folks from my program in just the last few years graduate and work full time ER with no restrictions, (i.e. sickest patients, trauma 1s, etc...) A couple of these people have been in the ER where my residency is and a few out of state out west.

 

[VenusinFurs]

I am a recent grad, in a not v affluent/ underserved part of Ca, and my base is $195k.

However, bonuses are based on numbers alone (probably due to the whole fqhc thing) and are not so easy to come by. If I average more than the average schedule (which is 21/8 hr) I get paid extra for however much more I average.

I am doing newborn rounds for my practice which is extra income and a v cute time as well.

 

[drcrispmd]

I am doing urgent care. Base is $114/hr with rvu bonus and other bonuses. Doing 15 12-hr shift a month (minimum required is 10 a month). Our urgent care is more like a level 3 ED than an urgent care. Other docs working there are ED physicians. This is in MO.

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[cabinbuilder]

Depends on what program you go to and where you end up working. There have been a number of folks from my program in just the last few years graduate and work full time ER with no restrictions, (i.e. sickest patients, trauma 1s, etc...) A couple of these people have been in the ER where my residency is and a few out of state out west.

Like I have said before, it comes down to the training and what you are qualified to take care of to be safe for the patient.

 

[skeptastic]

Thank you to all who contributed to this thread. It has been an excellent read with a wealth of information.

 

[shaggybill]

I was talking to a third year in my program and she was offered a position with a large system along the I85 corridor in NC for a guarantee of 230k for two years. This is for OB. 220k without OB. A new-graduated attending who is in this same system says her two year contract ends this year and she expects to bring in $305-315k with the RVUs she's been generating with her new contract.

 

[smq123]

I was talking to a third year in my program and she was offered a position with a large system along the I85 corridor in NC for a guarantee of 230k for two years. This is for OB. 220k without OB. A new-graduated attending who is in this same system says her two year contract ends this year and she expects to bring in $305-315k with the RVUs she's been generating with her new contract.

Doing OB only earns you $10K more? They must not be hurting for OBs.

 

[shaggybill]

Definitely not hurting for OB providers in our FM program. She also said they get a 0.5 RVU increase over non-OB docs on all RVUs whether OB related or not. I don't fully understand it and didn't get into the details. I'm assuming she means the pay rate is 1.5x as much, as I don't know that RVUs can actually be adjusted (or can they?). And for doing OB, they are only on call one night q2wks.

 

[Ericslv]

Make FM residency 5-6 years, increase reimbursement as you get more rural, decrease dependence on specialists. Fewer fellowships are needed, not more.


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That would be a disaster. Make the one of the lowest paid specialties 5-6 yrs? That would bring in lots of candidates. Said no one.
What needs to be changed is med school. You don't need a 4 year BS to get into med school. Med school needs to be about 5 to 6 years. Fellowship spots need to be opened up to all family physicians that are interested.
If we create more PCP spots we won't need the NP's or PAs as much. At least no on primary care. Specialty is another thing all together. So shaving off two years of school on the front end would motivate many to do another 2-3 on the back end and get fellowship trained in something. Even if they don't that's 2 years of life they get back and thousands of dollars they save in loans. In the event they don't like being a doctor that buys them time to go and do something else before they get so deep they can't get out.
None of this will happen because the education system is set up to milk the student loans to the end. Why would a university shoot themselves in the foot and eliminate a 4 year degree and create a 5 year or 6 year medical school program when they can take in money for 8 to 9 years instead?

 

[VA Hopeful Dr]

That would be a disaster. Make the one of the lowest paid specialties 5-6 yrs? That would bring in lots of candidates. Said no one.
What needs to be changed is med school. You don't need a 4 year BS to get into med school. Med school needs to be about 5 to 6 years. Fellowship spots need to be opened up to all family physicians that are interested.
If we create more PCP spots we won't need the NP's or PAs as much. At least no on primary care. Specialty is another thing all together. So shaving off two years of school on the front end would motivate many to do another 2-3 on the back end and get fellowship trained in something. Even if they don't that's 2 years of life they get back and thousands of dollars they save in loans. In the event they don't like being a doctor that buys them time to go and do something else before they get so deep they can't get out.
None of this will happen because the education system is set up to milk the student loans to the end. Why would a university shoot themselves in the foot and eliminate a 4 year degree and create a 5 year or 6 year medical school program when they can take in money for 8 to 9 years instead?

Agree about not lengthening FM residency.

Not sure I agree with opening up all specialties to us. We don't have enough family docs as is. That would just reduce the numbers in primary care even more.

 

[jm192]

I went to 2-3 informal primary care offer sessions where they would talk about their packages. And the gist across the board was that they wanted more primary care which they felt would lead to increased specialist referrals. Specialists can bill higher/do more. They don't want to rely on them less.

 

[Ericslv]

Agree about not lengthening FM residency.

Not sure I agree with opening up all specialties to us. We don't have enough family docs as is. That would just reduce the numbers in primary care even more.

Stop shooting yourself in the foot. Give yourself choices, then choose.

 

[VA Hopeful Dr]

Stop shooting yourself in the foot. Give yourself choices, then choose.

That choice is called an IM residency...

 

[deleted87716]

That choice is called an IM residency...

Yup. Practically nobody goes into IM if they want to do primary care, and practically nobody goes into FM if they want to specialize. The only people who seem to complain are those who chose...poorly.

 

[Ericslv]

I went to 2-3 informal primary care offer sessions where they would talk about their packages. And the gist across the board was that they wanted more primary care which they felt would lead to increased specialist referrals. Specialists can bill higher/do more. They don't want to rely on them less.[/QUOTE

That choice is called an IM residency...

OK. Good luck.

 

[jm192]

I agree that no one shoots themselves in the foot by not lobbying for an FM to Cardiology pathway.

At the point I was applying for Residency--I couldn't wait to be out and working. I knew I wouldn't go into fellowship. And I soul-searched on that for a few months prior to choosing FM over IM. I was very comfortable when I submitted my applications/rank lists/etc that I did not want to do a fellowship.

Now 3.5 years later, I don't regret that.

I also wouldn't cut years of school. I guess there's an argument that the 4th year is redundant and some places are going towards 3 year programs--but I feel that we're putting out good, quality doctors now. If it aint broke...

 

[Ericslv]

I agree that no one shoots themselves in the foot by not lobbying for an FM to Cardiology pathway.

At the point I was applying for Residency--I couldn't wait to be out and working. I knew I wouldn't go into fellowship. And I soul-searched on that for a few months prior to choosing FM over IM. I was very comfortable when I submitted my applications/rank lists/etc that I did not want to do a fellowship.

Now 3.5 years later, I don't regret that.

I also wouldn't cut years of school. I guess there's an argument that the 4th year is redundant and some places are going towards 3 year programs--but I feel that we're putting out good, quality doctors now. If it aint broke...

Why is it that a country like Enland, France, Germany, Australia can create doctors in a 5 or 6 year program and the quality is the same? I would argue our system is very broken.

 

[Prehealth1011]

Why is it that a country like Enland, France, Germany, Australia can create doctors in a 5 or 6 year program and the quality is the same? I would argue our system is very broken.

The years are made up by their length of residency training. From what i remember, it takes ~5 years to become a GP in Australia/UK.
Not that i disagree with what you're saying. May be shortening pre-med and increasing the length of residency is the answer?

 

[VA Hopeful Dr]

Why is it that a country like Enland, France, Germany, Australia can create doctors in a 5 or 6 year program and the quality is the same? I would argue our system is very broken.

Our system is broken? Are we producing bad doctors?

 

[VA Hopeful Dr]

The years are made up by their length of residency training. From what i remember, it takes ~5 years to become a GP in Australia/UK.
Not that i disagree with what you're saying. May be shortening pre-med and increasing the length of residency is the answer?

You are correct. Post high school training is the same between us and them.

 

[TorMed]

In Canada family med is two years after 4 years of medical school. You can subspecialize for an additional year after that if you want. Some people specialize with a year in the ED after that and community hospitals accept their credentials for the ED.

Yet we survive.

 

[deleted87716]

In Canada family med is two years after 4 years of medical school. You can subspecialize for an additional year after that if you want. Some people specialize with a year in the ED after that and community hospitals accept their credentials for the ED.

Yet we survive.

http://healthydebate.ca/2017/03/topic/family-medicine-residency-expand-rural

 

[W19]

I like what the last commenter says:

'Residency’s purpose is to train doctors to competency, not mastery.'

When I see 2nd year IM residents taking care of patients with very little input from attendings; it hard for me to say a 2-year IM/FM residency training would be detrimental (for lack of a better word) to the system. I think getting cheap labor plays a big role into that whole residency scheme.

 

[VA Hopeful Dr]

I like what the last commenter says:

'Residency’s purpose is to train doctors to competency, not mastery.'

When I see 2nd year IM residents taking care of patients with very little input from attendings; it hard for me to say a 2-year IM/FM residency training would be detrimental (for lack of a better word) to the system. I think getting cheap labor plays a big role into that whole residency scheme.

Maybe. But I have never met a doctor who said they came out of residency too prepared for practice...

 

[deleted87716]

My take on the 3-yr. FM residency experience:

Year 1: You're dangerous at first, but learning (while supervised almost constantly) takes place exponentially.
Year 2: Learning continues, and you reach the point where you can work without direct supervision most of the time.
Year 3: This is when you learn to put it all together, and to hone your skills in the clinic. You also learn to think like an attending.

I've worked with enough third-year residents to see what a difference that third year makes.

 

[DoubleBogey]

Maybe. But I have never met a doctor who said they came out of residency too prepared for practice...

This this this this....you have no idea what gaps need to be filled once you’re sitting in front of pt presenting with a complaint/situation/problem that you haven’t dealt with in residency/healthcare system/resources you were used to in residency.

I scored the highest on my ITE, got awards in 3rd year and scored top 3rd on ABIM exam in my class, and I still feel like I’m missing things/over working things up. You learn A LOT after residency from how things pan-out with your workup, to what consultants do and what your partners do. Good luck !

 

[Ericslv]

My take on the 3-yr. FM residency experience:

Year 1: You're dangerous at first, but learning (while supervised almost constantly) takes place exponentially.
Year 2: Learning continues, and you reach the point where you can work without direct supervision most of the time.
Year 3: This is when you learn to put it all together, and to hone your skills in the clinic. You also learn to think like an attending.

I've worked with enough third-year residents to see what a difference that third year makes.

True, but you don't need an undergrad degree to be a doctor. You can do an extra year or two of medical school rather than 4 years of undergrad to get the basic science.

 

[Ericslv]

Our system is broken? Are we producing bad doctors?

I was referring to the healthcare system.

 

[W19]

Maybe they should make IM/FM residents board eligible after 2 years then; and if they pass the board, let them 'graduate'...

 

[DoubleBogey]

True, but you don't need an undergrad degree to be a doctor. You can do an extra year or two of medical school rather than 4 years of undergrad to get the basic science.

Isn’t that why they have accelerated undergrad/med school programs, as well as accelerated med school/residency programs with FM and IM now

 

[VA Hopeful Dr]

I was referring to the healthcare system.

And the length of our training has what to do with that?

 

[deleted87716]

True, but you don't need an undergrad degree to be a doctor.

If that's your thing, there are some combined BS/MD programs out there: Medical Schools Offering Combined Undergraduate/MD Programs

 

[Ericslv]

Isn’t that why they have accelerated undergrad/med school programs, as well as accelerated med school/residency programs with FM and IM now

We have some of those but the entire system needs to be like that. Getting a BS degree and then getting an MD not needed. 5 year med school, 3 years FM residency. done. Fellowship from there is you want.

 

[Ericslv]

And the length of our training has what to do with that?

debt, shortage of doctors, burnout just to name a few.

 

[Ericslv]

Maybe they should make IM/FM residents board eligible after 2 years then; and if they pass the board, let them 'graduate'...

So if they are Board certified they are qualified to practice? Just taking a multiple choice exam is good? What if you can pass six months into your intern year.

 

[W19]

So if they are Board certified they are qualified to practice? Just taking a multiple choice exam is good? What if you can pass six months into your intern year.

Give me another metric then... not something arbitrary (3 vs. 4 yrs EM residency)

Aren't we being judged mostly by multiple choice exams throughout that whole endeavor?

 

[DoubleBogey]

Give me another metric then... not something arbitrary (3 vs. 4 yrs EM residency)

Aren't we being judged mostly by multiple choice exams throughout that whole endeavor?

That’s part of it, and probably necessary as the board (insert whatever specialty) uses for the last step in obtaining your medical license in addition to successfully completing training.

I would say test taking during residency is a very small part of it. Where the real training is pt contact with management of common and critical patients in inpt and outpt settings under supervised conditions. The ITE/morning report/afternoon conferences allow for updating your knowledge base, learning workup of common/uncommon dx and staying up to date.

A resident who struggles with pt management vs the resident who is a poor test taker - the resident with poor clinical management acumen/skills is under the microscope more...because, well, we tx pts after residency instead of taking multiple choice questions where I can read the question first and answer the question without reading through the stem.

5 yr medical school would be too long, shortening medical school more would make the match process more difficult, esp those who require research. Yes, certainly specialities can accelerate the process (hence the combined med school-FM residency and IM residency programs). But med schools shoot themselves in the foot - you lose a year of tuition which helps subsidize professors during 1 and 2nd year of med school (don’t agree with it).

In short, this is not the UK/Europe system for education, and never will be - too much money to be made in tuition.

 

[Ericslv]

Give me another metric then... not something arbitrary (3 vs. 4 yrs EM residency)

Aren't we being judged mostly by multiple choice exams throughout that whole endeavor?

Is the way we are being judged accurate? By board exams determine competence, we should allow anyone to take the test after 6 months of internship and they pass they are competent.

My point is that board exams don't test beyond some arbitrary level of knowledge. They are good for basic science because you can present more concrete questions. It's starts to get murky when you start to work with abstract questions about complicated medical problems. The test writer wants a specific answer and that answer may not really matter in the real world of treating patients. The answer may be a small part of the solution to a medical problems and a doctor may be able to manage a patient very well but on that day not realize that the test questions is asking the to give that specific answer.

There are brilliant doctors who have never taken a board exam or who refuse to take it. Their practices are full of patients doing well by any standard of care.

 

[Ericslv]

That’s part of it, and probably necessary as the board (insert whatever specialty) uses for the last step in obtaining your medical license in addition to successfully completing training.

I would say test taking during residency is a very small part of it. Where the real training is pt contact with management of common and critical patients in inpt and outpt settings under supervised conditions. The ITE/morning report/afternoon conferences allow for updating your knowledge base, learning workup of common/uncommon dx and staying up to date.

A resident who struggles with pt management vs the resident who is a poor test taker - the resident with poor clinical management acumen/skills is under the microscope more...because, well, we tx pts after residency instead of taking multiple choice questions where I can read the question first and answer the question without reading through the stem.

5 yr medical school would be too long, shortening medical school more would make the match process more difficult, esp those who require research. Yes, certainly specialities can accelerate the process (hence the combined med school-FM residency and IM residency programs). But med schools shoot themselves in the foot - you lose a year of tuition which helps subsidize professors during 1 and 2nd year of med school (don’t agree with it).

In short, this is not the UK/Europe system for education, and never will be - too much money to be made in tuition.

So because we live in the US we get the honor being screwed by some the education system. Great.

 

[VA Hopeful Dr]

Give me another metric then... not something arbitrary (3 vs. 4 yrs EM residency)

Aren't we being judged mostly by multiple choice exams throughout that whole endeavor?

Not once you finish school, no.

 

[deleted87716]

Not once you finish school, no.

Well, except for MOC and Board recerts...

 

[W19]

Is the way we are being judged accurate?

I wish I knew... I just think the system need to be 'streamlined'... Med school should not be that long. We can have a 3-year prereq and a 3-year med school (Not a 6-year combined)... Also, if a 2 yr IM/FM residency will have grave consequence to the system, I will definitely be against it. But I think it's worth asking these kind of questions.

 

[DoubleBogey]

I wish I knew... I just think the system need to be 'streamlined'... Med school should not be that long. We can have a 3-year prereq and a 3-year med school (Not a 6-year combined)... Also, if a 2 yr IM/FM residency will have grave consequence to the system, I will definitely be against it. But I think it's worth asking these kind of questions.

2yr residency would be too short. Sure, pass your boards within 6months of being in residency, but you’re certainly not competent to take care of pts, which I think everyone here would agree with.

Yes, boards do not always represent reality - on wards you’ll commonly hear “the board answer is such and such, but practically speaking we do such and such”. The boards do test common scenarios seen in practice and make sure you don’t miss conditions that can be fatal if not dx early.

Changes are being made with “expediting” undergrad/med school, which addresses the current lengthy process. Some argue that current length of residency is too short given more duty hour restrictions with more hand-offs taking place.