snoopdawg

It's quite different really
First of all patients- its hard for them to get a doc so are much more appreciative of you, I think I've a better relationship here.I know so much more about the whole family- even extended family. A "family doctor" is considered important, so they will even just bring in their kids just to meet you which is nice and easy cash for a quick check up although I would bill a visit not a physical ( CPX here) !!!
Remember, you are paid differently. Per visit- look at
http://www.health.gov.bc.ca/msp/info...l-practice.pdf
before you arrive.
People expect "full physicals' one a year but generally hard to justify unless older or chronic illness.
Take note of the "chronic disease management" and "complex care" bits of the billings- these add massively to your income- these are the patients you really want!!! But you cannot cherry pick and anyway, you need younger/lighter stuff to ease the pressure.
Can bill extra for counselling- see link above- useful for the depressed /anxious people you need to spend time with.
Medication- lots of different drugs/names- we have a great little book we found at UBC book store- Canadian Drug Pocket- get one early on.
Another fantastic book is Bugs and Drugs- 2012 edition just out
Written by an amazing local microbiologist- it is so useful and you may be able to get free when you arrive via health authority but buy one if not- UTis, staph infections seem to need different antibiotics here, and they still use the equivalent of septrin- why- no idea but you'll get half your patients telling you they are "allergic" to sulfa ' drugs.
Be prepared for a million times more opiate/benzo prescribing- be shocked!!! Be very careful taking on some of these people- you can meet and greet patients and decline to take them if you feel you could not have a working relationship. I had no probs with those who indicated they would work with me on appropriate pain management and declined those who said they could only take percocet- look it up- awful drug!
Hard to get LA opiates covered- crazy ruling
Expect lots of medical marijuana requests- avoid - the CPSBC /CMA do not approve due to lack of decent medical evidence-even though Health Canada are pushing.
Medication- cost- patients pay- some have "extended health care " paid for by employers normally- pay 50-100% of drug costs, but some are really picky about drugs- and refuse to cover some great ones. People on benefits get coverage from MSP and everyone should be enrolled on fair pharmacare-
http://www.health.gov.bc.ca/pharmaca...laniindex.html
But its tough at first thinking about costs.
One thing you must know about is Special authority- it will drive you mad-
look at
http://www.health.gov.bc.ca/pharmacare/prescribe.html
Really important- you could save your patients huge amounts
Physio- generally people pay or their extended health care.
Home visits- rare as hens teeth!!!
people expect to come to you- I have some from 2 hours away!
Nursing homes- we get faxes from the nurses and deal with people that way- very rarely you might need to visit.
Repeat prescriptions- only do via fax with pharmacy if patients blister packed- our office policy- all others must see us.Repeats= refills here
Out of hours- walk in clinics until about about 9pm, after that ER ( Emerg)
Patients pay for ambulances- odd how its not abused like the UK
DNA's- no shows here- can warn pt then bill- amount depending on length of appointment-
If persists can then fire patient
DO NOT be pushed into hospital- you should find in Vancouver that most GPs do not cover
Specialists- all docs are physicians- Physicians as you know are Internal medicine physicians
And- you write to them , not a hospital- their offices are usually in the community, and they can refuse to see your patients- if busy etc
Equally , you learn who is good/bad, nice /rude and can direct your patients to the good/nice specialists
Blood tests- = blood work- in the Okanagan , we cannot order LFTs, or U&Es, has to be written individually but our EMR has templates to quicken this. Forget U&Es- not a term- just renal bloods/panel, or in hospital shortened to E5 or 7 depending on what you want.
Some levels are different- FBC= CBC,, HB 10.2= HB 102
paps-smears- you do- very few "practice nurses"- cannot bill for them so not financially viable for most- forget the team you work with in the UK
A few nurse practitioners around- mainly employed by health authority in their own clinics- seem excellent- here anyway
You need to find out about ICBC- make great notes about all car accidents- MVAs here- you will most likely need them- a lot need legal reports later and you are usually treated as an expert witness
WCB- look it up- your EMR should have the forms loaded to fill out each time you see the patient- billing complicated for ICBC/WCB- get advice when you arrive

Financially- get advice ASAP re incorporating- its a must really- get a great accountant/book keeper- Dr Medix Inc- you then employ yourself.
Watch your overheads- make a hefty dent in your billings if you aren't careful!

Which is better- NHS/MSP- both have pros and cons for docs and patients! I would love someone to see this and eliminate the cons.

There's probably so much more- but I've just come to accept them as the norm!!!You'll feel like a fish out of water initially but it quickly gets better! Patients are generally tolerant and won't mind whilst you look up/ask someone about something.
Post or PM if you want!
HTH

Medix

OMG Snoopdawg you are a star! That's enough to get me started. I knew there was more to to it than the glossy brochures I got from Healthmatch BC and the BCMA!

Even urban practice will come as quite a shock it seems. I've been allocated an in-house supervisor who I've yet to meet (hopefully this will ease the impact).

As I head into work, have to say the lack of home visits seems like a nice welcome and the lack of abuse re: ambulances/DNA's

ann m

If there are GP's still reading this thread, and not put off () and would consider Alberta - even Cochrane - for work, I have an excellent contact. British-trained GP - has been here about five years, and like snoopdawg, can explain the non-glossy warts-and-all version of working here. Can also point you in the right direction re hoops that need to be jumped. LMO's might even be available. Send me a message.

JonboyE

Oi! Stop trying to poach our potential GPs.

To Medix: there is a general shortage of GPs in many areas of Canada. Less so in urban areas but unless you kill off more than 10% of your first year patients you should not have too much trouble establishing a practice.

British and South African doctors seem to be respected by patients.

Yes, you should incorporate so find a lawyer and accountant with experience in this area. (I have no experience with medics and so am not touting for business.)

cjones

10% ... I think it's fair to say that if old Harold Shipman was still with us his indiscretions would be overlooked if he was willing to establishing a practice up this way.

charlottyb

As a nurse, I hope I am allowed to add something here. I worked as a Practice Nurse in the UK before moving here. Now I work in the Canadian equivalent of the Family Planning/GU clinic.
Alas, it is true...no Practice Nurses here, because of billing.
I work alongside many Family Practice Drs that do shifts for us at the clinic. They do it as an add-on to their normal hours. They like the ease and convenience, no overheads, no admin, no paperwork. Turn up see the patients and then get paid. It keeps their skills up, and most of them enjoy the work and the seeing the patients.

Medix

Thank you all for the insights, very useful since when you are recruited from the UK they never tell you about the cons of practice.

In my particular circumstances, I did my homework 3-4 years in advance to ensure I met BC requirements (they are far pickier than some of the other provinces) and I have several GP/medic friends who are considering Alberta or SK instead because getting registered is less of an issue as other people have noticed. If you play your cards right, you can get exemption from the MCCEE as well (one less hurdle).

Snoopdawg: I may continue to pick your brain as I work my way through your info, a lot of Canadian practice seems more closely aligned with our American colleagues (eg Hb readings, CBC/panels) - I did some of my rotations as a med student in the US and it all sounds suspiciously familiar. Most of the docs recruited are placed into fee-for-service practice which seems to be the way to go. Your wisdom is most appreciated . I am actually pulling some extra shifts in A&E just to make sure I'm thick skinned to cope with any unexpected surprises in BC practice...

ann m: I may have people interested in Alberta, the trick is getting the college to recognise your training. Getting the LMO isn't too bad for physicians in most provinces - it seems to be quick since they seem to be very short staffed (then again, you lose the advantage when applying for TWP since you need a medical and additional blood tests)

JonboyE: rest assured, BC was (and remains my first choice) primarily due to climate and my liking for Vancouver (despite the incredible flak it seems to get on this forum)! Vancouver was not always on the 'demand' area list but now the entire province is considered 'area of need' for physicians. I am trying to stay positive about it all! I am moving by myself and want to live downtown/west end, and have picked a job that allows Skytrain commuting. I know Vancouver isn't everyone's cup of tea, but I really enjoyed my research trips partying away and people seem laid back (or maybe I have been misled?!). Incorporation as both you and snoopdawg have said seems a good idea, I need to get professional advice with this since it doesn't always make sense if you need to extract the money from the corporation immediately.

charlottyb: I like the idea of additional shifts (not sure I'd be allowed in the early stages). Nothing like a shift in FP/GUM to broaden one's horizons and something to think about for the future.

snoopdawg

No problems re brain picking!
I've never worked in the USA but I think most of Canadian levels are similar to UK with the exception of HB, I know lipids are different from the States. Its more the terminology which may be similar to them. And I would love to just write LFTs!
There are some rules re what you can order- I've never seen a list of them, but it may exist but for e.g. MSP will only pay for PSAs/lipids if medically indicated, otherwise patients pay.
Incorporation- you can get your money, you just have to pay tax!!- It makes sense, whatever you don't need , stays in the Inc and you pay business tax- 13ish% ??
If you take it out- either as wages or as a dividend you pay much higher tax. I don't know any docs here who aren't incorporated. It helped from a banking point of view also- a line of credit on a business account will be at a better rate than a personal account- I think! Our business credit card given to us on arrival in Canada had twice the credit limit than our personal one and was a pretty gold colour.
You're right about Vancouver being in need now. When we looked at moving we were told to forget Vancouver, Victoria, and probably Kelowna as they were not areas of need. Healthmatch had been set up to serve rural areas.This was fine for us as we had no desire to live in any of those places- although I love visiting both Vancouver and Victoria.
By the time we moved, over 3 years ago, Healthmatch had started to recruit for Vancouver also, so I presume everywhere is now in need. Using nurses ( esp nurse practitioners) would be the answer, they are excellent at chronic disease management, freeing our time so we can take on more patients.

Dhillstaines

[amazing power of forums

I am so thankful for this answer, i was lacking in surgery which i did on an honorary contract and I have worked my butt off doing this job for free. my supervising consultant wrote a letter and the college accepted it. but now they want t to be source verified. i have my CCT and MRCGP verifed already and I do not know if ECFMG will source verfy ths letter. Please can you advise if they would?

i am keeping my fingers crossed that you will visit the forum soon

Thanks
UOTE=snoopdawg;10451103]You called!!
Amazing the power of forums!
Amazing also that we had the exact same problem!
One of us needed paeds, the other paeds and A&E.
We were focused on BC and Healthmatch BC were the ones to help us.
The A&E was easy as OH had done orthopaedics, ENT, some maxillofacial surgery, plus medicine /surgery so we successfully had that approved but we did get a letter from his orthopaedic consultant saying how much emergency involvement there was in that job- so you would struggle.
Paediatrics!! Basically we had to do!
So for several months on any day off and one day each weekend, we would head down to our local teaching hospital ( an hour from home) and sit in clinics, do consultant ward rounds and see kids sent in by GPs just like ourselves. It was useful at times ( clinics) and useless the rest of the time- as GPs for many years, we knew far more than the junior docs but had fun with the consultants who would roll their eyes at us frequently when some over keen junior doc would suggest something.
It was very different from our training days as the consultants treated us quite differently and often asked for our opinion rather than just as a "test".
We decided we would need something in writing in case ,so kept a log of all kids seen with learning points etc.We also printed off useful information to attach to show we had done the work.
At the end we sat down with the head of the department and went through it all, he then wrote a nice letter which was accepted by the College here.
What you will need to do,is decide which Province you want to go to and negotiate with them, make it clear you already have a full time job, so what will they accept.
I'm guessing you'll get a different answer from each College- I hear Saskatchewan really needs docs!!!!
It will be a pain and will delay you a bit but you are very young and time is on your side which we didn't have. It depends how much you want to move![/QUOTE]

snoopdawg

Hi
Are you applying to Canada- do you not have to use PCRC? May be things have changed but have just checked PCRC as so long ago, but yes we did submit our letter from the paediatric consultant and yes they did source verify and it was passed.

Dhillstaines

Hi

I have all the other documents verified but was not sure how to classify it. It is not a certificate and was not part of the GPVTS. And also I was concerned about HR being obstructive. If they write to the lead consultant, it should be straightforward.
I am so grateful for your help. Any advice would help.

snoopdawg

Hi
We submitted it under Postgrad training ( after year 1)- I can't open the history- ? my mac- but looks like I put it under the hospital name. I would think that they would write to the consultant who did the letter for you.

Dhillstaines

Hi

Thank you so much. I am much relieved and reassured now.
Your replies meant a lot. Thanks

jem1

hi all,

Im new here but will be qualifying as a GP this year and considering BC. Im missing a paeds rotation - does anyone know if healthmatch BC/college of BC are still allowing you to make up a rotation? And can this rotation be made up outside a training post ie: arranged b/w yourself and a consultant, working for free for x amount of time, like the way snoopdawg did theirs?

Thanks in advance!

snoopdawg

Healthmatch are the people who help to get you over here and they really do try hard.They are incredibly helpful, email or phone them, they will tell you the CPSBC's current rules, I can't see why it should have changed.