Massive physician shortage coming?

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TiradeFaction
Massive physician shortage coming?

Hi everyone.

I'm an American, and I've posted before about Canadian healthcare, since I feel this community can seperate the fact from the bullshit.

A canadian just told me this about the health system in Canada.

"Nobody sane or competent is going to go through all the effort and time to acquire medical licensing just so they can deal with the utterly insane and fucktarded bullshit that is the heath care system. Especially when they can earn 5-20 times as much (or more) down south.

> (especially on it's health system) are greatly exaggerated.

Hardly. If anything it's underreported. Ottawa goes to great lengths to hide just how colossal a failed fiasco the Canadian health care system is. And just wait as the current generation of 60yo+ docs start to retire en-mass in the next decade with nobody coming up to replace them. It's going to be brutal."

Any truth to this matter? Or right wing BS?

 

Fidel

It's rigthwing bs. Sure we lose professionals to the US. And there will be some who are attracted to higher pay in America. But most people who go into medicine do so because it is a genuine calling for them. These special people want to help other people because that is what they have chosen to do. No one breezes through medical school. It's hard work and a lot of dedication. Most people who want to earn a lot of money go into banking and finance, business etc. But treating sick people all day  is not the easiest way to make a lot of money. Doctors are on call a lot and must be extremely dedicated to helping people. Cuban doctors, for instance, earn very little pay compared to North American doctors. And some are recruited from Central America and around the developing world where they've chosen to help desperately poor people to have medical care, and many who receive medical attention for first time in their lives. Not everyone is motivated by money rewards, and doctors really are very people oriented as are most any health care worker.

The problem here in Canada is that we have a shortage of general practitioners or family physicians. Medical students here in Canada typically earn a four-year undergrad degree before attending medical school, another three to four years depending on the school. Most students by that time have a student loan debt ball and chain. Canadian students pay highest interest rates in the world on student loans. And at this point some have to take out lines of credit just to pay interest on anywhere from $100,000 to $170,000 dollar student loan debts, and perhaps more. Then, graduates must do a period of intern work of two or three years at a hospital where they earn about $40,000 a year on average. By this point medical students may have families and paying on mortgages besides student loans. And so there is little incentive for becoming family physicians at this point as GP's are generally the lowest paid doctors. The trend, it's said, is for medical students to continue studies for higher paid medical professions,  specialized degrees etc. Our post-secondary education system was defunded by billions of dollars in the 1990's and resulted in soaring tuition fees across the country ever since. Add to that the professional medical associations here under-estimated the number of doctors needed in future some time in the early 1990's or so, and that also contributed to fewer family doctors across Canada.

TiradeFaction

The same individual also said this,

"Spend 23 hours in an emergency waiting room with a shattered pelvis and femur because there are no doctors and you'll know why. Then, when a doctor (with a medical degree from India and who barely speaks English) finally shows up, have them misread the X-ray while telling you that you can't have your hip properly checked with the MRI they have sitting idle at the end of the hall because its use quota has already been filled for the week. Then you'll know why.

Then have the crown corporation monopoly insurance company almost double your already ridiculously high car insurance rates even though all the police reports say the other driver was a DUI and 100% at fault and hit you while you were parked and your engine was off just because they're a government monopoly and they can and you can't take your business anywhere else. Then you'll know why Want more?"

Is there any truth to the above statement at all, or more bullshit? Personally I'm skeptical, but I'm not Canadian..

Also, thanks to Fidel and ElizaQ for your detailed responses. I always laugh when people claim the doctor shortages of "SOCIALIZED MEDICINE", when in fact, we have a massive one here....

 

ElizaQ ElizaQ's picture

Well the potential 'earning potential' argument tied to people either taking the time and money to go through school or immigrate to the US starts to fall flat when one takes a hard look at the fact that just like Canada the US is also experiencing a potential shortage of doctors and already has to deal with maldistribution of doctors, especially in rural areas. The US is also facing an impending shortage and just like Canada servicing and aging demographic is also a big issue and potential problem. If becoming a doctor in the US is such a great potential earner and worth the time and effort then why the the shortage of US citizens becoming doctors? The quick answer is that just like Canada the lack of doctor numbers and the problems with the distribution of doctors has very little to do with the money doctors make.

Similar to Canada it's general practitioners numbers are and issue. If large numbers that of Canadian doctors are indeed flocking with dollar signs in their eyes then it's not apparently helping that much and/or the doctors that aren't flocking to the needed practices (primary care) and the needed places.

Just google 'United states physician shortage' for lots of info about it.

The brain drain to the US is largely a myth anyway and was hyped and still gets hyped when it's suits a political argument. http://www.chsrf.ca/mythbusters/html/myth29_e.php
There's no flocking, just some trickling. Right now it's estimated that over time it's been between half to one percent of total doctors when the numbers of doctors that come back are calculated in as well. In recent years the numbers are even showing a reverse drain. Doctors trickling north rather then south. Interesting that of the few doctors that do leave Canada 50% do go to the US but the other 50 go somewhere else.

Fidel addressed a couple of the issue related to the cost of schooling, funding and the type of doctors people choose to become. The US has the same sort of problems.

He mentioned the under-estimation of the numbers of doctors needed. This under-estimation contributed to the lack of real physical space and the numbers of students going through medical schools. In recognition of this problem many schools increased the size of their programs and some set up new medical schools. This was done a few years ago and there is a lag time of about ten years before we see the results in terms of numbers. Similarly as you'll find in the numerous links that turn up in the google search the US has or is working on the same issue. Last time checked the increase in actual spaces are filled and there are still people who would like to become doctors who can't get in. This indicates that the problem isn't that people don't want to be doctors because being a doctor in Canada stinks because of health system bladdity blah. It's just another disengenuous talking point based on a 'wishful' reality rather then reality.

One of the biggest problems which again is similar between our two countries is the distribution of doctors. More doctors tend to want to work and live in larger populated and urban areas rather then rural areas. This trend isn't necessarily just about the jobs or the money that can be made but about where people want to actually live and mirrors the general trending of population movement from rural to urban that's occured over the past century or so. The question then becomes well how do you get doctors to work where they're needed.

remind remind's picture

Quote:
Getting into medical school is extremely competitive. In 2007, UBC's Faculty of Medicine received over 1,800 applications for the 256 positions available in the undergraduate program. Of the 256 students selected, 32 will enter the Northern Medical Program at UNBC.

~

It all started in June 2000 when 6,000 Northern BC residents packed the Prince George Multiplex to express their concerns about the state of health care in the North. Four years later, the Northern Medical Program welcomed its first students and in May 2008, graduated twenty-three medical students.  The Northern Medical Program is a partnership between UBC and the University of Northern British Columbia and is an integral part of the expansion of UBC's Faculty of Medicine. The goal of the Program is to train physicians in the north for rural and northern practice.

The program is vital to meeting the critical need of northern communities for health care professionals. The curriculum is being delivered through a combination of cutting-edge videoconference and internet technology, face-to-face instruction, and learning from local doctors in various health care settings throughout northern BC.



http://www.unbc.ca/nmp/prospective/

http://www.unbc.ca/nmp/

 

Most likely the rascist guy whining about government insurance, votes for the dudes who turned it into that nasty scheme...and for those who created the world wide isotope shortage that has limited MRI use around the world...too

Personally I would rather wait 23 hrs for a diagnosis, than not be able to get one at all... but you know in this instant privileged white man's world, one can see how waiting 23 hrs is a real issue for some.

 

skdadl

Huh? Where in Canada are there emergency rooms with 23-hr waits for injuries like that? Can we have some specifics?

 

Emergency rooms everywhere I know in Canada have access to MRIs that run more or less non-stop because the people who need them could be dying right now, not tomorrow. The MRIs that people are scheduled for work differently, and are "rationed" only because we have a shortage of technicians, as does the U.S. But if you arrive in emerg and need an MRI, you will get one immediately.

TiradeFaction

skdadl wrote:

Huh? Where in Canada are there emergency rooms with 23-hr waits for injuries like that? Can we have some specifics?

 

Emergency rooms everywhere I know in Canada have access to MRIs that run more or less non-stop because the people who need them could be dying right now, not tomorrow. The MRIs that people are scheduled for work differently, and are "rationed" only because we have a shortage of technicians, as does the U.S. But if you arrive in emerg and need an MRI, you will get one immediately.

I wasn't given any specifics, just a blasted tirade (ha ha). I figured they were mostly right wing hyberbole, but I wanted to make sure.

ElizaQ ElizaQ's picture

Well there's some 'truth' and then there's reality. Wait times are a problem in some places and in some areas. There is no doubt about that and it is a recognized problem.

However the reality is that in the US there are also problems with wait times, in some places and in some areas. I've gone through this sort of argument before and run into a couple of issue. The big one being that the tracking of how long people actually do wait for treatment is either not done, is really piecemail or is only done for particular ailments like the wait for knee surgaries. Which by the way are apparently more similar to Canada wait times for similar surgeries when all of the different factors and regions are taken into consideration. It is actually really hard to get direct comparisons of wait times in Canada because of the lack of tracking them in the US. However through discussion boards like this and through reading about cases there is a whole lot of anecdotal evidence of people experience long waits in the emergencies and long waits for operations. Here's the thing though. Since wait times are tracked here there is a wider spread recognition that they are a problem, people get pissed at them, we then have actual stats to back up anecdotal evidence and that creates the political will to actually do something about them.

So yeah lack of good stats leads to a lot of anecdotal evidence about how I or my relative in Canada had to godamn wait and the care sucked. Well logs in eyes and all that. For some reason and I know it's strange but I can't somehow believe that there haven't at least been a few people in the US who godamn had to wait and ended up with sucky care. :D

So here's my anecdotal evidence. My late Grandfather had heart pain, went to his HMO, waited 7 hours with chest pain and was sent home with a couple of pills for indigestion. Ended up he needed a heart valve replacement. He had insurance too but still ended up paying over ten thousand dollars in the costs that his insurance didn't cover when it was all said and done. Luckily he could afford it. So sucky care on both sides of the border. Check the box. The big difference is that on this side of the border someone like him would likely get to spend that ten thousand dollars on a big screen tv or a cruise to the Bahamas.

I also can't believe that no one in the US has been subject to the horrors of a doctor who can't speak english very well.(sarcasm) Why because just like Canada the US in order to deal with our mutual shortage is enacting programs and policies to try to attract said doctors. :D So yeah it's just BS with possibly a dose of sheer prejudice thrown in to make the story sound better and more horrible.

The whole monopoly insurance costs more then car insurance is just a complete load of crap. Canadians don't pay monthly insurance premiums in order to get coverage. It's not like car insurance at all. It differs between provinces and some do have small fees but they are based on incomes. If you don't have any income you pay nothing. The most I ever paid was forty bucks. Now I pay nothing. My monthly car insurance is around two hundred bucks. I'll pay more if I end up in an accident. If I get sick, get better and get sick again I will still pay nothing.

Canadians however can choose to supplement the basic care through a private insurance company but it's entirely voluntary. Basic coverage which everyone gets is done through taxes not a separate payment. The main difference between Canada and the US is that although some of all of our tax dollars go into the health care pot, everyone is covered no matter what. The care you get is also not related to whatever your individual insurance company decides to cover and there is no such thing as a 'pre-exisiting condition' that will deny you getting the insurance you need to just be able to afford to see a doctor. We also don't have to worry about changing or losing a jobs and losing access to the medical insurance it provides. In Canada someone might lose the extended benefits that some employers provide through private insurance but isn't in a position of losing access altogether. The fear of going bankrupt because one gets something horrible like cancer is also virtually non-existent.

Is the system perfect? Nope. It does have it's problems. However when you look at per capita numbers Canada spends about half the amount of money for universial coverage that the US spends per capita within it's system. You guys pay more through your taxes already but for some reason end up getting less if you look at society as a whole.

G. Muffin

skdadl wrote:
But if you arrive in emerg and need an MRI, you will get one immediately.

Don't know about that, skdadl.  My cousin, brain cancer X 2 survivor, was suddenly struck with vision and balance problems.  Vancouver made her wait (weeks not days) for a CAT scan.  In the triage hierarchy, she was at the top yet she wasn't made a priority.

On the flip side, my father gets test after unnecessary test done (all of which merely confirm that he should stop treating whiskey like a food group).  No waiting for him.

I suspect the problem here is just a massively bloated and inefficient bureaucracy. 

ElizaQ ElizaQ's picture

Yeah skdall. The whole 'rationing' argument is just so bogus. As if insurance companies don't ration their care. They depend on it. Reams of policy statements on whats covered and whats not. Many insurance companies 'ration' people right out of getting any care at all. That's the irony. We'll give you insurance but not if you have this and this or had that or that, or we will give you insurance but you have to pay way more money. Oh and hey if you do get really sick, we'll comb your past and make sure that you weren't lying to us and if we discover you did then DENY. You're on your own buddy. Of course from the companies perspective this is all quite 'rational'. It's just numbers and good business.

remind remind's picture

wow your monthly car insurance is 200.00 bucks Eliza?  Mine is 800.00 per year....of course should I lose my 40% discount by having an accident.

 

Drs do not  ask for MRI's if another diagnostic tool can do the job, equally as well, or better.

 

No matter what country you reside in...

G. Muffin

Health care and capitalism don't mix.

Boom Boom Boom Boom's picture

My car insurance is $50./month, but I'm 60 and haven't made an insurance claim since 1992, and that was for a new windshield. My only claim before that was in 1968 for a minor front end collision that totalled I think $2,000.00.

skdadl

I promise you, if you arrive in emerg after vomiting bile for two days (as I have), you will be into an MRI immediately, as I was -- and I observed the way that department was working as they wheeled me along. It was 1 or 2 a.m., and patients from emerg were being streamed into it continuously.

\

Now, that's downtown Toronto. I realize that that won't happen in some parts of Canada where there isn't a hospital, maybe not even a resident doctor, although I know people who live in circs like that, and they usually have arrangements that get them flown out quite quickly to hospitals that can cope. I believe the provinces are required to set up such arrangements.

 

My doctor friends tell me that emergency departments here are nowhere near the horrorshows they've seen in the U.S., mainly because of the preventative aspect of our public healthcare. We don't have many young women turning up in the middle of the night, eg, suddenly bleeding from advanced cervical cancer, and we all know why that is. Uninsured victims of their system crowd U.S. emerg departments, put incredible pressure on them that we don't mainly have.

 

Emerg departments are for emergencies, though. I've done a lot of time in them, and they really do have to see to those in immediate danger of dying first.

Boom Boom Boom Boom's picture

I waited three months for an endoscopy last month (under anaesthesia as requisitioned by my ENT specialist) in Sept-Iles, only to be told that the surgeon doing the procedure would not be using anaesthesia. Like the first endoscopy in Blanc Sablon last spring, I could not swallow the tube, so it had to be cancelled. Now I'm waiting for my third  endoscopy this year, this time the ENT specialist is sending me to Quebec City to have it done by a specialist, and, yes, this time under anaesthesia. Each time the health service is billed for not only for the hospital time and for  the physician doing the procedure, but also my transport and also that of my escort (I am hearing impaired). Such a wasteful system! Not to mention that I have lived with throat spasms since last summer - and should have had an endoscopy a that time. Almost a year and a half later, after thousands of dollars in meds, I finally am going to be sent out (hopefully soon, but I don't know yet) for the procedure under anaesthesia. Ridiculous.

ElizaQ ElizaQ's picture

remind wrote:

wow your monthly car insurance is 200.00 bucks Eliza?  Mine is 800.00 per year....of course should I lose my 40% discount by having an accident.

 

Drs do not  ask for MRI's if another diagnostic tool can do the job, equally as well, or better.

 

No matter what country you reside in...

Yep, that's about what I paid when I lived in BC. One of the joys to moving to another province that uses private insurance. I miss BC car insurance. :) It's so much easier to get too. You just go into one place, for one appointment and get everything done.

triciamarie

The problem is the Canadian Medical Association. Open up more spots in medical schools -- including cheap, short-term training for experienced doctors already qualified in other countries -- and the shortage disappears. Of course, that will make it more difficult for doctors to build the outrageous patient loads they so often prefer in a system that pays by the visit.

Unionist

TM, what control would the CMA have over such matters? Isn't it up to the provincial bodies? And any GPs I know are horrified at their patient loads. They should pay them more and leave them more time per patient. They should be on salary. If they let GPs vote, I'll bet they'd pass that overwhelmingly. Don't know about the specialists.

triciamarie

As I have been told, the relationship between the CMA and the regulators is akin to a hand in a glove. GP's have full control to accept fewer patients so protestations of overwork ring hollow to me; the exception is in underserviced remote rural areas, where it can be pretty overwhelming to be the only doctor in town.

Unionist

Well, TM, I'll stick with my statement about provincial control - I could be wrong, but if so, why are there different qualifying standards in different provinces?

And yes, GPs are "free" to spend more quality time with fewer patients. Trouble is, two things then happen: 1. They have to refuse new patients, including family members of existing patients. 2. They are punished by earning less for doing better medicine.

So, I think the problem doesn't lie with GPs. Our politicians need to amend the system. It'll cost more money. Maybe the difference could be made up by reducing their fawning over Big Pharma.

G. Muffin

Unionist wrote:
2. They are punished by earning less for doing better medicine.

Not really.  They're earning the same but doing better medicine.  I know the mandated rate for an office visit doesn't look like much but in my experience we're talking about a six minute job.

Unionist

G. Pie, all I said was that GPs who take fewer patients in order to spend more time, earn less. Surely you would agree with that. I know GPs (connected with the unions and CSST claims) whose annual earnings are pathetic (relatively speaking) for that very reason.

G. Muffin

Unionist wrote:
G. Pie, all I said was that GPs who take fewer patients in order to spend more time, earn less. Surely you would agree with that.

Of course. 

Quote:
I know GPs (connected with the unions and CSST claims) whose annual earnings are pathetic (relatively speaking) for that very reason.

Really?  What kind of income are you talking about?

remind remind's picture

Was looking last year, at stats on GP's wages per year in BC, and  most made around 300,000 - 350,000.

 

And I agree with Tricia...the governments are not just at fault here, the  Royal College of Physicians and Surgeons of Canada and its provincial counterparts play a role too...

Unionist

G. Pie wrote:

Quote:
I know GPs (connected with the unions and CSST claims) whose annual earnings are pathetic (relatively speaking) for that very reason.

Really?  What kind of income are you talking about?

After business expenses, before income tax - $60,000. Sometimes less.

Fidel

triciamarie wrote:

The problem is the Canadian Medical Association. Open up more spots in medical schools -- including cheap, short-term training for experienced doctors already qualified in other countries -- and the shortage disappears. Of course, that will make it more difficult for doctors to build the outrageous patient loads they so often prefer in a system that pays by the visit.

 

[url=http://conservativenannystate.org]US economist Dean Baker[/url] says that in his country the health care system could save $80 billion a year by simply allowing free labour markets for medical doctors alone. Baker says this number exceeds any savings estimates cited in big business-friendly NAFTA agreements for trade in commodities. Imagine the savings potential for lowering PSE tuition fees, he suggests.

Jack Layton said a couple of years ago that the feds just aren't listening when it comes to foreign trained doctors needing to do practicums in Canadian hospitals before they can be licenced in Canada. Like Baker describes the US conservative nanny state, I think Canada is also guilty of protecting jobs for the upper middle class. Licencing exams and other expensive red tape bureaucratic hurdles are problems, too. Very many of these foreign trained doctors unemployed or underemployed in Canada are internationally recognized for their skills except for the odd country like Canada. I think racism is an issue as well.

Unionist

remind wrote:

Was looking last year, at stats on GP's wages per year in BC, and  most made around 300,000 - 350,000.

Really? GPs' earnings in B.C. quadrupled in the past 9 years?

 

[url=Source.[/url]">http://www.statcan.gc.ca/pub/75-001-x/01203/6699-eng.html][=red]Sou...

triciamarie

Quote:

Bill 37, adopted by the Quebec legislation on June 13, imposed a wage settlement and working conditions on medical specialists until 2010.

On Sept. 12, the Quebec Federation of Medical Specialists announced it will take the Charest government to court to contest the law's validity under the Quebec and Canadian charters of rights.

Under the imposed contract, Quebec's 8000 medical specialists receive a 2% wage increase in each of 4 years, leaving them on the bottom rung of the Canadian specialists' salary scale. The average gross annual income for a specialist in Quebec is $233 000 - $100 000 less than the national average.

The specialists' federation says the monetary package is disappointing, but it's what the federation calls the "extraordinary and punishing" nature of the decree that has pushed it to challenge the law's constitutionality. "It is an abuse of power and a breach of doctors' rights to freedom of association and freedom of expression," says Dr. Yves Dugré, the federation's president.  

(snip)

CMA's general council unanimously passed (with one abstention) a resolution in August, urging the association and its divisions to "staunchly oppose any form of coercive legislation in regard to the negotiation of working conditions and compensation of physicians."


CMAJ • October 10, 2006; 175 (8).
www.cmaj.ca

triciamarie

The figures quoted by CMAJ refer to gross income. The figures quoted by Unionist above indicate quite clearly how much MD's are able to claim in expenses to reduce their taxable income. To be fair, some of that money they are actually paying out for eg. office expenses and insurance. (Insurance rates are much lower here than in the US due to smaller malpractice awards.)

Either way, I'm not losing any sleep over MD's salaries in this country. This is a tremendously powerful group with a vested interest in keeping the supply of doctors at the lowest practicable level.

Unionist

TM, I'm talking about GPs and GPs only. That's where the urgent shortage is. Do you have earnings info for them that's different from mine? I do appreciate your disclaimer about gross earnings. They pay other people's salaries out of those, besides office expenses.

No one is talking about losing sleep. The fact remains that GPs are grossly overworked and underpaid. I know of no evidence that this is due to their own lobbying. In Québec, we are still feeling the effects of the late 1990s freeze on medical school entries and massive government financed early retirements of doctors and nurses - all aimed at budget cuts.

Canada must spend more on health care workers and less on drugs.

Unionist

TM, I think our stats are the same - once you convert yours into net taxable income. What I find really interesting is that "supply and demand" don't work neatly either. Even in the wake of the slash-and-burn of doctors and nurses under Lucien Bouchard's government and the consequent drastic shortages, the survivors were still dramatically underpaid by comparison with Ontario.

Anyway, the fact remains that under present conditions, a young medical student has to be either masochistic or saintly to become a GP rather than pick a specialty where they will work half and earn double or more.

triciamarie

In 2001/2002:

 

Quote:

When the overhead estimates

are applied to the CIHI gross

billings, estimated 2001/02 average

net incomes (before taxes)

from fee-for-service payments

were $124 103 for family physicians


http://www.cmaj.ca/cgi/reprint/170/5/776.pdf

Unionist

You seem to be saying that the doctors' shortage has been primarily created by medical associations. I guess we'll agree to disagree. I do wonder, though, how you would explain the equally chronic shortage of nurses. Not also self-inflicted, I trust? I like to look for fewer and simpler explanations for such phenomena.

triciamarie

Unionist, the issue I believe we are discussing is the shortage of physicians. I have suggested that doctors generally benefit from a certain shortage of providers, because this supports their income levels. It is your view that family doctors are actually underpaid, as well as overworked. I don't consider $125 - 150K to be underpayment for what is effectively a government employee. If overwork is a problem then doctors absolutely have the ability to reduce their patient load, and earn less money. As to your point that this would mean that doctors could not treat the family members of their patients, well, there is usually some natural attrition going on too eh.

In many countries it is still seen as a calling to practice medicine. There is some altruism in the decision to enter the field. It's unfortunate that here it's so often viewed as a meal ticket.

I'm going to look into the question you raise about MD's incomes in Quebec.

triciamarie

The nursing shortage is not comparable to the shortage of doctors, because nurses, unlike doctors, are not essentially self-employed. Nurse shortages don't financially benefit nurses who are already practicing; nurses get the same pay regardless of workload, they cannot control their workload and have to deal with whatever work is needing to be done on the ward regardless of short-staffing. They are completely dependent on the government allocating sufficient budget to hire enough nurses. This was a chronic problem in the 90's and as a consequence, many nurses left the profession or moved to the US, leaving us with a shortage.

In both cases, the shortage could be addressed by facilitating qualification of foreign-trained health professionals, as well as by improving access to schools. The Canadian Nurses' Association supports both of these measures outright, while the abstruse CMA policy on "Physician Resource Planning" discusses the complexity of the issue and the need to balance "population health needs and expectations, and the supply, mix, scope of professional activity, and distribution of physicians" through ongoing consultation and consensus among all stakeholders.

http://www.cna-aiic.ca/CNA/documents/pdf/publications/RN_Highlights_e.pdf

http://policybase.cma.ca/dbtw-wpd/PolicyPDF/PD04-02.pdf

remind remind's picture

Excellent summary tricia.....

 

Yes, unionist, most with established practices make in billing income around 300k, plus change in some cases, what they pay out in office/business expenses can vary greatly in respect to the practice parameters and where it is located. Should have worded it to show it was billing income, not personal income declared.

also the wage/billing amounts can vary greatly, thus making a skewed median income per year...

For example in BC, we have about 200 Drs entering the work force per year, with no established patient list to bill on. Most entering are taking the left overs from the other Drs in the office. Their expenses are high and their income is low in the first year, perhaps 2, unless they can, and want to, walk into an empty, but established practice.

The problem isn't the pay, lots want in but can't get in.....see my links above to the UBC/UNBC programs details

That nurses make so little is the shame here...