I am in Canada and why are family med docs making more than surgeons.

Discussion in 'Family Medicine' started by KingScrubs, Jan 5, 2019.

  1. KingScrubs

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    I live in a small Canadian city of about 45,000. Also, in my province, it is mandatory for all health professions to post their salaries online. And almost all the family med docs in my city are making between 300K - 600K. And the ones who own their own single practice are making more than a million. And the surgeons who are working in hospitals are only making 200,000 - 500,000. Why is this?
     
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  2. sb247

    sb247 Doer of things
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    Link?
     
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  3. RadsWFA1900

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    I believe it. They have an excess of specialists overall like (cards, ortho, Rad Onc) and can’t find work. I happened on a salary survey from health Canada years ago and of course now I can’t find it. internists were making around 500.
     
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  4. Blue Dog

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    $300-600K Canadian equates to roughly $230-470K US, FWIW. Not that much different than here, and Canada has higher taxes.

    As for the guys who own their own practices making >$1M, I'm betting that's gross billings before overhead, not salary. Lots of us bill >$1M/year, too. Keep in mind that overhead in primary care is something like 60%. It's not much different in Canada. Those hospital-based specialists have relatively low overhead compared to primary care docs.

    Link --> How much are Canadian doctors paid?
     
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    #4 Blue Dog, Jan 5, 2019
    Last edited: Jan 5, 2019
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  5. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    Let's not forget the "cold as hell winter" tax on one's soul...
     
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  6. OP
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    KingScrubs

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  7. OP
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    I am still a premed, but I always hoped to go into a surgical subspecialty. Do you know if Canadian trained doctors are easily able to find work in USA or not? Cause the last thing I need is to do a 5-year surgical residency and not be able to find a job afterwards.
     
  8. sb247

    sb247 Doer of things
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    can you post your link
     
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  9. OP
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  10. MedicineZ0Z

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    Overhead in Canada is more like 20-25%, max 30%. And those overhead rates are generally for lower 6 figures. As you climb up, your absolute costs remain the same hence the % drops, so realistically you're pushing 20% only if billing upper 6 figs.
    There's also incorportation and paying far less taxes than the standard income tax rates.

    I don't think it's a secret that Canadian FM out earns USA FM, it's become a somewhat competitive field there.
     
    #10 MedicineZ0Z, Jan 5, 2019
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  11. OP
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    No doubt about it. I have heard from rumorus sources that being a FM doc in Canada is way better than the States. FM docs are treated much better and they have to deal with less bureaucracy. The pay is better here too from what I have seen, but this is not true for specialists/surgeons.

    But getting a FM residency is not that competitive. You can see here on the 12th page that the number of FM residencies spots available far out number any other speciality: http://www.carms.ca/pdfs/2018-R-1-data-snapshot-EN.pdf
     
  12. Blue Dog

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    This article is a few years old, but things probably haven't changed dramatically.

    "Mean self-reported overhead ranged from 12.5% in emergency medicine to 42.5% in ophthalmology ... After subtracting estimated overhead ... Family physicians/general practitioners had a mean net income of $207,600. The mean net income from public payments for all physicians in Ontario after adjusting for overhead was $240,400." That's in Canadian dollars.

    Link --> Public Payments to Physicians in Ontario Adjusted for Overhead Costs
     
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    #12 Blue Dog, Jan 6, 2019
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  13. musicman89

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    This is definitely province dependent. In Quebec salaries are not as high as they are in Ontario, and it's a challenge to practice where you want to because of PREM.

    Also, there isn't necessarily an excess of specialists... Current specialists aren't retiring and the government doesn't see the point in adding more positions, so jobs in specialties other than FM are strained.
     
  14. MedicineZ0Z

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    A lot of FM work less hours or do a lot of ER work, so those averages get dragged down by those guys. Also there's the FFS vs capitation models. At least in Ontario, capitation is how those guys shot up the high 6 figs and even past 1 mil.
     
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  15. QueenJames

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    I'm moving to Canada..


    EH.
     
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  16. septoplasty

    septoplasty Exceptional
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    So I did some research on this as a former canadian, american trained/working stateside, who was considering moving back. Gross pay per patient in the urgent care or "walk in clinic" is about $13 (this was minus overhead, etc.). If you subtract tax of about 35%, that's $8.50 CAD/patient (again this is for a visit thats equivalent to a 99213). So those guys end up seeing way more in that setting.

    OTOH, straight primary care makes more as well, minus bureaucracy, as does hospital medicine. Which a lot of traditional FM docs do (Outpatient-Inpatient-ED Coverage). Just the cost of living is very high.. and people don't know how to drive
     
  17. VA Hopeful Dr

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    $13/patient? That nuts. Our urgent care guys get roughly $36/patient gross (assuming a 99213 visit, most are coded as 99214 which is worth $60 gross).
     
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  18. MedicineZ0Z

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    That's not actually true at all. Everyone bills 33$ (Ontario) and bit higher in some other province for low level visits. 13$ is for the 1 minute visits.
    But they do push high volumes (50-60+ patients/day, up to 70-90) in urgent care/walk in.
     
  19. septoplasty

    septoplasty Exceptional
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    So the number I was provided by a friend who works at is for after practice cost.
    Billing =/= collections =/= take home pay.
     
  20. MedicineZ0Z

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    Maximum overhead is 30%, and that's a stretch. Typical is 20%. So 80% of 33$ is not 13$. Maybe they were in the Atlantic where fees are much lower and have exceptionally high overhead/a bad practice model?
    Anywhere west of Quebec, you're easily billing 400k+ if you have a decent practice - at 20% overhead, and you're incorporated so you dodge a lot of the income tax (ex. paying dividends to family members from your corp). Capitation models in Ontario make 400k+ the norm for those docs and put quite a few in the upper 6 figure range.

    Medicine pays quite well in Canada. A lot of specialties make way more than in the states.. IM docs can bill upwards of 600k, critical care can bill more than that. General surgery is well above 400k. Community radios approach and exceed 1 mil (last few years). Cardio/GI also have quite a few 1+ mil guys.
    The biggest difference is in some of the surgical specialties, like neurosurgery etc. where USA is well ahead in terms of pay.

    And of mention, there are family docs in every province that bill above 1 million. And some of them even publish the actual names and exact billing amount online. I think the highest I've seen was 1.3 million.
    None of these numbers include cash billings etc.
     
  21. septoplasty

    septoplasty Exceptional
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    I'm not too sure about their practice model/incorp status. They're actually in the GTA (where I could see costs being higher), but still overall quite good numbers.

    So I know you used the words 'billing' alot. Are we suggesting 80% of it is take home? So around $320k CAD? Minus taxes so around $208k CAD.. Thats around $158k USD. So is actually less than the US average (depending on where you practice).

    Surprising though..
     
  22. Qester

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    Just entering Residency but my understanding is;
    Overhead at a lot of the walk-in places are 20-30%, so yes 80% is take home
    A lot of Family Docs incorporate so they get tax benefits and their overall tax is much lower
    I have heard of FM docs bringing in high 6 figures post-tax and overhead
     
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  23. septoplasty

    septoplasty Exceptional
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    This must be it, although I wonder what the work-type mix is..
     
  24. MedicineZ0Z

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    Yeah but I think the net income is difficult to calculate. Many have private billings and do random forms of work on top of the public billings. Corp taxes and benefits are also very tricky. But I think the system is wayyyyyy better than the American salaried model. At the end of the day, an independent contractor usually wins the net income race versus a someone who is salaried (regardless of benefits).

    I also don't know if currency exchanges are fair.
    Lifestyle wise, USA family docs tend to look more upper-middle class whereas some Canadian ones go full blown upper class lifestyle (ex. mansion, ultra expensive sports car etc.).
     
  25. Blue Dog

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    Salaries are for suckers.

    Huh...?

    Some US docs do that, too. Quite a few, in fact. Most of them are probably in debt up to their eyeballs, regardless of which country they're in. You should never assume someone's net worth based on their toys.
     
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  26. septoplasty

    septoplasty Exceptional
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    I think they might be suggesting all this based on cost of living which is much much higher in Canada currency wise. As in it should be inverse as costs of goods is much higher in general vs. state side.
     
  27. Blue Dog

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    :shrug:
     
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  28. MedicineZ0Z

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    Well when you know someone (far more than one person) and they're somewhat wealthy, consistently bill upper 6 figs andd have a lot of toys - I don't see the issue. I don't assume someone's net worth is high from their toys. I just never see that lifestyle among primary care in USA. Essentially seems like you cap out hard in the 300k range.
     
  29. Blue Dog

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    So, is that Canadian or US dollars...?

    :shrug:
     
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  30. MedicineZ0Z

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    What if.. a highly efficient USA family doc in a suburban area is working as an independent contractor? Billing insurance companies as a solo practice? Small group practice?
    And to make a fair comparison to Canada, seeing ~40 patients daily.

    What would he/she be billing annually? Any approx. projections? And based on those parameters (ex. practice of that size), what is the overhead? Again, assuming suburbs by a decent city.

    ^^^ I'm genuinely curious.
     
  31. Blue Dog

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    About what...? You clearly want us to believe that Canadian FPs are living large, but aside from your anecdotes, what evidence do you have? You like to discount conversion rates and COL, but that's reality.
     
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  32. MedicineZ0Z

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    I asked about USA numbers, what total billings/overhead would be for a busy FM.
     
  33. Blue Dog

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    ColorlessGeneralAmericanwarmblood-size_restricted.gif

    Not kidding. I've billed >$1M for years. Overhead in FM is around 60%. Do the math. However, I don't consider myself particularly "busy," although I'm as busy as I want to be. I work four 8-hour days/week, and see 20-25 patients/day. The devil is in the details, and the details include fee schedules, payer mix, and coding, as well as ancillary income if you're in a group practice.
     
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    #33 Blue Dog, Jan 11, 2019 at 7:48 PM
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  34. MedicineZ0Z

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    How do you get up over 1 mil? Bread and butter family med?
    And why is overhead 60%? You pay your lease, equipment, couple MAs and couple staff to do billing. How does it reach >600k?
     
  35. Blue Dog

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    http://www.physicianspractice.com/p...survey/keeping-medical-practice-overhead-down

    I'm in a three-doctor practice with ten staff (which is less than the MGMA average of four FTEs per physician), and am part of a large multispecialty group with ancillary services (imaging, lab, etc.), care coordination, billing, IT support, marketing, etc.
     
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    #35 Blue Dog, Jan 11, 2019 at 8:07 PM
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  36. MedicineZ0Z

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    Why the need for so many staff? Is it all billing? Lot of solo doc offices in Canada have just 1 person doing everything. Large practices (2500-3000+ patients) do have 1-2 MAs and 1-2 person at the desk.

    And so, is the high overhead why most FMs are employed in USA? Whereas virtually every doc in Canada is an independent contractor.
     
  37. Blue Dog

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    We do more than y'all, I guess. Plus, socialized medicine isn't exactly known for being customer-oriented.
     
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  38. MedicineZ0Z

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    Socialized medicine in europe or around the world certainly is not customer oriented. The Canadian version is no different than the US version of medicine though.

    Why don't more FMs set up shop, run the billings up and keep overhead as close to 50% as possible. If the potential to make 350+ is there while still being your own boss, why aren't more doing it?
     
  39. Blue Dog

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    Not exactly. Google "wait lists in Canada."

    It's a PITA, frankly, and most people doing direct pay earn less than I do. I'm already the boss.
     
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  40. MedicineZ0Z

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    I was just referring to outpatient FM. Specialist/procedure wait times are a different ballgame.

    How much do you bill for a standard visit?
     
  41. Blue Dog

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    My bell curve is typically 2/3 99214, 1/3 99213, with a smattering of 99215 and 99212. In addition to that, we'll perform Medicare AWVs and Medicare Advantage/commercial payer CPEs (which have no patient co-pay) during routine visits. I do minor office procedures, as well. Our nurses do walk-in visits for INR management, vaccines, etc. It adds up.
     
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  42. MedicineZ0Z

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    Interesting. Don't understand why so many FMs settle for a 250k salary then.
     
  43. Blue Dog

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    FTFY.
     
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  44. septoplasty

    septoplasty Exceptional
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    This is a GREAT thing imo. Because you aren't having to practice based on having to Rx something or test something that has no basis..
     
  45. septoplasty

    septoplasty Exceptional
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    This doesn't exist as much as now in the USA larger hospital systems are buying up the local docs, and local docs don't want to deal with the headaches that come with competing against multi-billion dollar health systems. This also comes as they lose privileges (outpatient doc being able to admit/see his own patients in inpatient setting etc.) as the hospital won't privilege you.
     
  46. MedicineZ0Z

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    So if I set up shop, I won't have patients knocking my door down to get in? Unlike Canada where a sign that says "accepting new patients" has your waiting room stacked.
    Didn't realize an FM needs to market themselves. Isn't there a long wait time to see your doctor, hence midlevels expediting themselves?
     
  47. Reboa

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    • [​IMG]

    Here's the graphic from the 2018 compensation report from physicians practice for reference. The majority definitely have high overheads or absurdly high overheads. Although 42% of practices having an overhead below 40% isn't something to scoff at either.
     
  48. Blue Dog

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    Not sure what you're referring to.
     
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  49. septoplasty

    septoplasty Exceptional
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    Oh you will fill forsure. The difference maybe in overheads being lower as a larger group vs. independent. Also the costs associated w/ billing, etc. are already accounted for if you're in a hospital system, so its cheaper.

    The way the trend is headed, being a part of a large system is seen as appealing to patients, vs. being an independent doc. I.e. marketing yourself as a "Cleveland Clinic Doc" vs. "Rose Medical Clinic", guess who will attract more patients? Even if the doc in the latter clinic was trained at CC?
     
  50. septoplasty

    septoplasty Exceptional
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    Practicing evidence based medicine, its much easier when the patients don't complain about having to pay their $10 copay. As in the McDonalds scenario is prevented (i.e. going to doc, paying $xx, getting a Rx), which eventually leads to pressure on the physicians, bad reviews etc.
     

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