Applications are usually available for download here in April of your graduating year.
Practice U (HealthForceOntario): Information on transition to practice, finding work etc.
CMA Practice Management tools: Step-by-step guides to practice management separated into high yield modules.
CMA Practice Management Modules: Practice modules discussing common personal and professional issues in practice.
Since 2009, the First Five Years in Family Practice (FFYFP) Committee has been working to address the interests and concerns of residents and new family doctors who, at the end of their training program, experience an “off-the-cliff” feeling. Like many others, you will have lots of questions about starting to practice and being out on your own as an independent practitioner in the ever- changing world of family practice.
Last year, we asked the FFYFP Committee members what they needed from us, and where they wanted the committee to dedicate its efforts. They told us that they want more practice management and leadership training in residency, and more support in these areas during the early years of practice. With that information, we are now developing new programs to best meet your needs. We’re excited to be establishing FFYFP provincial chapters that will provide province-specific programs for you at the CFPC’s Annual Scientific Assemblies.
The full membership of the FFYFP Committee is our most valuable resource. Together, we work to support one another. Our Facebook group has over 1,100 members, including many residents and medical students. We have lots of active discussions on a number of practical topics.
Here are a few examples:
Our Facebook page is a great way to get quick answers to your questions from someone who has been through it before.
Search “First 5 Years in Family Practice – Canada” and join the discussion today!
Our webpage includes some great resources for starting up your practice, as well as links to clinical practice tools and guidelines. Think about making First Five Years your browser homepage in clinic for easy access to these tools!
We hope to hear from you!
Scott MacLean, MD, CCFP
Chair, First Five Years in Family Practice Committee
Similar to applying for residency, the prospect of finding a job, or jobs, may be daunting. Thankfully, there is help!
Fee-for-service + some incentives and bonuses
Designed for solo primary care physicians
Fee-for-service + some incentives for patient enrollment and bonuses
Three or more physicians practicing together
Regular office hours plus three to five sessions of extended hours (at least three hours in duration) based on number of physicians in group
Sign agreement to join
FHOs can apply to the MOHLTC for funding to add allied health professionals if they are successful in their application for a FHT
Interdisciplinary teams serve hard-to-serve communities and populations that may have trouble securing health services
Focus on addressing the underlying conditions that affect people’s health, such as social determinants of health, poor diet and literacy
Regular extended hours
In recent years, physicians have been allowed to incorporate, meaning they create a distinct legal entity. There are many advantages to incorporating in the right circumstances. The two main advantages are that you can 1) defer taxes (and lower total tax paid) by leaving money in the corporation and taking it out when you are in a lower tax bracket, and 2) split income between family members (significantly decreasing amount paid in taxes). An additional advantage is the option to pay yourself in dividends as opposed to a salary. The main advantage of dividends is that you are taxed at a lower rate. However, the disadvantage is that, because it is not a salary, you will not build up RRSP room.
As an example to illustrate both income splitting and dividends, once incorporated you can give your 18-year-old son a $40,000 dividend as a shareholder of the corporation. He is taxed minimally or not at all, both because he is in a low tax bracket and because he is being paid dividends. He can then gift the money back to you such that you have paid significantly less taxes than if you weren’t incorporated.
References and Resources
As you move forward in your career, you’ll need to continue to repay your debts while keeping in mind the tax and investment opportunities now available to you. Your MD Advisor can help you develop a total wealth management plan that includes a well-diversified investment portfolio.
You may want to consider contributing to a RRSP or a Tax Free Savings Account (TFSA) or both. Contributions to your RRSP grow tax free and reduce your taxable income. TFSAs allow Canadian residents to contribute up to $5,500 annually. Although the contributions are not tax deductible, the investment income earned within a TFSA, as well as any dividends or capital gains, are tax free.
If children are part of your family, you’ll want to consider a Registered Education Savings Plan (RESP). An RESP offers generous government grants and tax-deferred growth to help maximize education savings.
A financial advisor can help you identify your financial goals, risk tolerance and capacity and determine your financial priorities. Together, you can decide how much you should be allocating to debt repayment, building an investment portfolio and planning for life events such as purchasing a home or starting a family.
Many financial advisors are available to guide your investments, including those from MD Management. Find out more about what services MD Management offers residents here
Find out about the next CMA PMC session at your school. Click here and go to Schedule of Events. These sessions are an introduction to practice management issues you will face as you navigate through job opportunities and transition to practice.
Calculating the average physician salary is very complex and is influenced by many factors. Although there is no clear data on physician salaries, some studies have attempted to estimate average salaries.
A study by Petch et al. (2012) used data from the 2010 National Physician Survey as well as public data from the Institute for Clinical Evaluative Sciences (ICES) Report on Payments to Ontario Physicians from the Ministry of Health and Long-term Care Sources 1992/93 to 2009/10 (CFPC et al., 2010; Henry et al., 2012).
Petch et al. estimated that “Family physicians and general practitioners had a mean net income of $207,600. The means that family physicians made on average $207,600 after accounting for overhead costs, but before taxation. The mean net income from public payments for all physicians in Ontario, after adjusting for overhead, was $240,400.” The authors cautioned that “self-reported overhead varies substantially both within and between specialties, and has a substantial effect on physician income. Mean net income from public payments varies more than twofold between specialties. Given the lack of comprehensive data, it is difficult to construct a complete account of physician income in Ontario.”
A second available estimate published by the CMA used Canadian Institute for Health Information (CIHI) data (Buske 2004; CIHI 2004). This study estimates net average physician income (all specialties) nationally at $148,700 in 2004, which is much lower than the $240,400 estimated by Petch et al. in 2010. There are several methodological reasons for this discrepancy, as outlined by Petch et al. in their study. A third source includes data from the CIHI Average gross fee-for-service payment per family physician in Ontario for 2011–11.” This data suggests that the average gross fee-for-service payment per family physician in Ontario for 2011–12 was $240,615, which represented 47.3% Database Table A.5.A: “ of total physician clinical payments. It should be noted that this data did not include alternative forms of reimbursement, such as salary and capitation.
The past few years have seen the emergence of novel compensation models, such as the blended salary model or blended capitation model, where payment can vary greatly based on the number of patients, complexity of patients and ability of a physician to meet a wide variety of applicable bonus incentive payments. Information on these types of payment models is available through the Ontario government here.
Additional information is available through HealthForceOntario
Given the variability and limitations on currently available data regarding physician compensation, it is clear that it is difficult to calculate a true physician salary. Factors that influence physician income include, but are not limited to:
The proportion of total income derived from clinical work (e.g., funds for teaching and administrative work). These include:
“Physician Billing Highest in Ontario, Lowest in Quebec.” CMAJ 170(5):776.
Canadian Institute for Health Information. Analytical Bulletin Physician Expenditures 2004. http://www.cihi.ca/CIHI-ext- portal/pdf/internet/PDF_BUL_NPDB_28MAY2004_EN
Canadian Institute for Health Information. National Physician Database Table A.5.A: Average Gross Fee-for-Service Payment per Family Physician in Ontario from 2010– 11. https://secure.cihi.ca/estore/productSeries.htm?pc=PCC476
College of Family Physicians of Canada, Canadian Medical Association and Royal College of Physicians and Surgeons of Canada. 2010 National Physician Survey. Accessed Sept 2012. http://www.nationalphysiciansurvey.ca/nps/2010_Survey/methods/weights-e.asp
D.A. Henry, S.E. Schultz, R.H. Glazier, S. Bhatia, I.A. Dhalla, A. Laupacis. Payments to Ontario Physicians from Ministry of Health and Long-Term Care Sources 1992/93 to 2009/10. Toronto: Institute for Clinical Evaluative Sciences. Accessed Sept 2012. http://www.ices.on.ca/Publications/Atlases-and-Reports/2012/Payments-to- Ontario-Physicians
J. Petch, I.A. Dhalla, D.A. Henry, S.E. Schultz, R.H. Glazier, S. Bhatia, et al. “Public Payments to Physicians in Ontario Adjusted for Overhead Costs.” Healthc Policy 2012;8(2):30–6.
The next few paragraphs highlight the practice profiles of four different Ontario family physicians. There is incredible diversity amongst these featured practices. Family physicians are in a fortunate position to evolve their skills and experiences to cover a wide variety of medicine. We hope that in reading on, you feel inspired and start to envision the practice you hope to have one day!
The four featured practices are located, as shown below, throughout Ontario:
Residency: University of Ottawa
Practicing since: 2006
Practice description: Full-time emergency medicine — three to four shifts per week — seeing patients as well as working with and teaching students and residents. Additionally spending about 4-8 hours/week on administrative duties and the same on teaching outside of the department.
What you love most about your work: The challenge of acute care medicine - it is mentally stimulating so you don't get bored of what you do.
What you love least about your work: Working "antisocial" hours (evenings, nights and weekends).
Advice to residents: Seek to get the most learning out of every rotation you do - You realize, in retrospect, how valuable it can be. Enjoy your time establishing rapport with patients, no matter how brief that interaction may be.
Personal interests: I'm one of those crazy busy people - I play in a concert band and love to get out cycling (road and mountain) and running. I love to read and belong to a great book club that has expanded my network of women physician friends (who are not in emerg). I travel as much as possible.
Typical salary range: About $300,000 per year.
Residency: University of Ottawa
Practicing since: 2007
Practice description: It depends on where I am. In Ottawa, I do a fair bit of medical education as well as hospitalist work on our inpatient family medicine hospital service. In Sioux Lookout, I practice both Family and Emergency Medicine as well as hospital work. In Haiti, I work mostly in HIV care and Tropical Medicine.
What you love most about your work: I thoroughly enjoy working with the patients. They are all truly inspiring. Also, I love the fact that my clinical practice is flexibility and diverse.
What you love least about your work: The least pleasant part of my work is the times I have spent away from my family. The time I spend away from them is usually as a result of the traveling I do. As such, traveling can be very taxing at times.
Advice to residents: First, family medicine is a great field of medicine and I can think of few others that offer the diversity of clinical practice that family medicine does. Second, enjoy your residency experience and relax. Third, don’t forget to spend as much time as possible with your family and friends during residency. It will set the right tone for your personal life and work after residency.
Personal interests: I most enjoy spending time with my family. Additionally, I am a huge football fan. Being able to watch a game now and then is always nice.
Typical salary range: Here In Ontario, a Family Physician can typically make a salary within the range of 220,000 - 300,000 annually depending on scope of practice.
Résidence: Hôpital Montfort à l’Université d’Ottawa
Pratique depuis: 2002
Description de la pratique: Le lundi matin, je m’occupe des tâches administratives et je travaille l’après-midi et en soirée. La journée de mardi est dédiée à l’administration académique. Les mercredis et vendredis matins, je vois les patients et j’applique les procédures en après-midi (mes patients et ceux en consultation). Le jeudi est réservé aux soins cliniques de routine. Je suis sur appel pour le département psychiatrique de mon hôpital tous les autres jeudis.
Votre aspect favori du métier: J’aime le fait que nous jouions un rôle important dans la vie des gens dans les moments critiques. J’aime également le fait que nous ayons le droit d’entretenir un lien longitudinal avec les patients. J’aime voir un nouveau-né dans le cadre de ma pratique et je crois qu’il s’agit de mon devoir (même si cela m’effraie parfois) d’être aux côtés d’un patient en soins palliatifs au moment de son décès.
La responsabilité qui nous incombe en tant que médecins de famille de conseiller nos patients est plus importante que ce qu’on peut croire durant notre résidence. À un grand nombre de reprises, j’ai dirigé quelqu’un vers un autre spécialiste qui est revenu pour me dire: « Voici ce que l’autre médecin a dit, qu’est-ce que ça signifie et quel est votre avis à ce sujet? »
Votre aspect le moins favori du métier: Je n’apprécie pas qu’on m’incite à être « efficace » ou rentable quitte à passer moins de temps avec mes patients. Il existe des personnes qui aiment savoir que leur médecin prendra le temps de les rencontrer. Je crois qu’un grand nombre d’entre eux cherchent à recevoir des soins par des médecins qui vont prendre plus de temps pour rencontrer leurs patients en plus de fournir d’excellents soins. Je ne connais pas la réponse à cette question. Il semblerait que l’efficacité et la rentabilité soient la voie de l’avenir.
Échelle de salaire: entre 200 000 et 300 000 $ par année.
Residency: North York General Hospital, University of Toronto
Practicing since: July 2009
Practice description: As a locum, I don't have a typical workweek! Some weeks are very routine (i.e., office 3-4 days a week). Others are filled with urgent care/walk-in shifts. When working in Northern Ontario, I have typically split my time between office, 24-hr ER shifts and in-patient care.
What you love most about your work: In terms of working as a locum, the freedom to choose where, when, and what I want to do. In terms of family medicine, I enjoy interacting with patients as well as the variety of clinical cases.
What you love least about your work: I have formed an intense dislike of paperwork over the past few months as an independent doctor. As a locum, it can be frustrating to have each patient be new to you. There is definitely something to be said for the doctor-patient relationship! I have also found it frustrating to find locums, which allow me to pursue my interests, such as OB, at least in the GTA.
Advice to residents: Don't sign up for the first staff position or locum available "just to have something". Take your time to find out details re: clinics/staff, what is expected of you and also what compensation is being offered. Soak up as much information as possible about practice management! Also, don't close the proverbial door too early on options within Family Medicine. Even if you dread a particular rotation in residency or can't envision yourself ever using those skills again, you never know what clinical pearls you may retain that might come in handy down the line. You also never know how your practice may change over the next fifty years.
Typical salary range: Working typically 3-4 days a week (and taking a couple of months off at a time once or twice a year) my annual salary would be in the range of $120K before tax, after overhead.
Introduced in October 2015, The Ministry of Health and Long-Term Care is offering a voluntary New Graduate Entry Program (NGEP) to new family medicine graduate physicians who wish to join a Family Health Network (FHN) or Family Health Organization (FHO) that is not located in a ministry identified high physician needs area. It is anticipated that there will be changes made to this program based on family medicine physician feedback thus far.
To join the NGEP program, eligible New Graduate Physicians must sign and deliver to the ministry:
• an “NGEP Application”
• an application to join an existing FHN/FHO group or form a new FHN/FHO group
• all other necessary documentation required to register in a FHN/FHO group.
The NGEP program requires a minimum of 3 years and candidates must performance expectations have been met/exceeded (“NGEP Period”). If a candidate has met those two criteria, they may transition to compensation under the FHN/FHO agreement. Physicians who do not meet noted conditions will continue in the NGEP until such time as the conditions are met, and will continue to be compensated at the Year 3 level.
New Graduate Physicians participating in the NGEP are required to adopt an approved Electronic Medical Record. The NGEP is available to both full time and part time physicians. A full time equivalent (FTE) position will be based on a 40 hours per week commitment to the FHN/FHO group. The New Graduate Physician must declare their FTE commitment as part of the application process (allowable commitments range from 0.5 to 1.0 FTE in 0.1 FTE increments. Changes in the FTE level will be approved during the NGEP period at the discretion of the ministry.
Annual Compensation: Annual compensation levels will be prorated based on the physician’s commitment (between 0.5 and 1.0), and are distributed on a monthly basis.
Annual compensation levels for a 1.0 FTE position are as follows:
• 1st Year – Maximum of $162,000
• 2nd Year – Maximum of $178,000
• 3rd Year – Maximum of $207,000
Monthly compensation amounts will be prorated based on based on the percentage of the monthly enrolment target achieved. This calculation will be conducted monthly. Exceeding monthly enrolment targets will not result in payment above the maximum monthly rate.
Suspension of agreement: Eligible New Graduate Physicians participating in the NGEP may request the NGEP Period to be temporarily suspended due to an absence from their practice as long as they provide 30 days notice. The ministry will consider such request on a case-by-case basis.
Termination of agreement: New Graduate Physicians participating in the NGEP must provide a minimum of 30 days prior written notice to the ministry of their intention to terminate their participation in the NGEP. New Graduate Physicians who end their participation in the NGEP prior to completing the minimum 3-year term and the exit requirements, will also terminate their affiliation as a signatory physician with the FHN/FHO group.