Family medicine is a failing business model

I’ve been a family doctor for 30 years.I bought my family medicine practice in 1993 in Toronto. I paid $75,000 for 1,300 patients which took me three years to pay off. I earned $25,000/month from OHIP and was able to pay staff, rent, utilities, phone, business loan, and supplies (or roughly 40% expense rate for a solo practice), which left $15,000/month as my personal income. I paid tax of $6,900/month (46% tax bracket) and lived off $8,100/month. Fortunately, I had no debt when I graduated. Rent and utilities were $3,000/month for a nice Harbourfront two-bedroom, two-bath apartment and groceries were $1,100/month for a family of three. We had $4,000/month left over for savings, trips, clothes, events, and to enjoy life. That’s when I did my charts on paper. That’s when I was able to get patients seen by specialists, or tests done in a timely manner, or patients had limited comorbidities. I worked 50-60 hours/week doing ER shifts, house calls, surgical assists, office care and in-patient care but I still had over 50 hours/week with my family when I was not sleeping. Life was simple and family medicine was a good business model. When I graduated half of the medical students went into family medicine. We got to work independently after two years postgraduate training. You had the ability to do full scope (just look at the variety of what I was doing above), you were appreciated by your specialist colleagues, you were friends with specialists as you worked with them in the hospital and saw them in the doctor’s lounge, they gave you advice or took your consult requests and helped you manage your patients on your own (without hospital admission and without ER visits).Now medical students choose anything but family medicine and there are many reasons.The typical new medical school graduate has $160,000 in debt when graduating. Why would they pick family medicine which is one of the lowest paid specialties? You now make $332,000/year on average as family doctor, but compared to 1993 dollars that is $180,000/year. So lower than my 1993 income. A family doctor in 2023 is worth less than one in 1993! The average family doctor in 2023 works in a group and pays on average 35% expense rate (so less than I did) and ends up with $18,150/month (taxable) and $8,800/month (tax deducted). More than I did in 1993. But rent and utilities ($5,000 est.), food ($2,500 est.), and servicing debt ($1,590 est.) in 2023 means they won’t be anything left over for starting a family, trips, savings or enjoying life for 10 more years. Remember $160,000 at 5% over 10 years will cost you $1,590/month in debt service.Financially, it makes no sense to be a family doctor.Besides money, there is no job satisfaction because there is a long list of obstacles and detractors to being a good family doctor. The average family doctor spends 35-40 hours/week seeing fewer patients per hour since they are more complex. It takes a long time to get tests done, specialists decline your referrals, surgery is years away, patients are more demanding due to frustration, and on top of your clinical work you need to add 19 hours/week doing administrative work. Every family doctor I know is more worried about patients’ illnesses and delays in the system. They are impotent to get their patients timely care, and this grinds them down. There are higher expectations from patients. There are more complaints to the College of Physicians and Surgeons, more lawsuits of delays in care, more angry patients, more insurance forms, and more obstacles that prevent you from looking after your patients as you want. This is causing family doctors to burn out.Good new,s though. No one buys family practices anymore. There are so many orphan patients you could be filled within the first day of opening your practice.And still no one wants to be a family doctor. Can you blame them?Family medicine is a failing business model. The only solution is a 100% increase in income and 100% increase in new family medicine residents and elimination of all administrative work, you can expect no family doctors in 10 years.Don't say I didn't warn you.Dr. Alykhan Abdulla is a comprehensive family doctor working in Manotick, Ont. and Director for Longitudinal Leadership Curriculum at the University of Ottawa Undergraduate Medical Education.

Family medicine is a failing business model

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