US vs Canada: A Doctor Compares working in Universal Healthcare, Pay & Lifestyle (Ft. Dr. P. Hertz)
Thinking About Moving to Canada as a Physician? Here’s Everything You Need to Know
Hi, I’m Dr. Rob Beck, host of The Interesting MD podcast, and over the past few years, I’ve fielded countless questions from physicians across the United States who are curious (or actively considering!) about what it’s really like to move north and practice medicine in Canada. So, I put together this two-part series—and this blog post—to answer the most pressing questions, share my personal experience, and add insights from local experts like Dr. Paul Hertz, an internal medicine leader in British Columbia.
Whether you’re considering a leap for personal, professional, or socioeconomic reasons (and trust me—it’s not always about politics!), there are real structural and lifestyle differences between the two countries’ healthcare systems and what it means to be a doctor in Canada. If you’re looking for honest insights and actionable advice, you’re in the right place.
The Canadian Healthcare System: How It Works for Physicians
One of the first big differences I noticed after moving is that Canada operates under a single-payer healthcare model. What does that mean for you as a physician? Essentially, all physicians bill their provincial government for services provided—no private insurance companies, no patient co-pays, and no separate back-office battles for reimbursement.
Here’s how it works: Every specialty has a standardized list of fee items you can bill, depending on the type of service—think consults, follow-ups (in the clinic or hospital), procedures, and so on. You track your work using a simple app, submit the day’s claims directly to the government, and get paid like clockwork every two weeks. Done. There’s no messy insurance paperwork, no collection calls, and your patient doesn’t get a surprise bill after their visit.
From a patient perspective, it’s even simpler: They show their health card, get the care, and walk away. Period.
Portability and Practice Freedom: Become a True Free Agent
I’ll be honest—Canadian licensing and job structure offer an independence I never fully appreciated until I was here. If you’re licensed to practice in one province (like BC), getting licensed in another (Nova Scotia, Ontario, Saskatchewan, you name it) is mostly a matter of paperwork. No extra exams, no additional hoops—just a single, national standard.
And as a physician, you’re considered an independent contractor. Hospitals grant “privileges” to practice, not employment contracts. That means you can set your own schedule, work in multiple hospitals, or move to a different city or province with far less bureaucracy compared to the US system. I’ve held licenses in several places, including Washington after moving to BC, and the process was straightforward once I met the criteria.
Hospital Life and Organization: Goodbye Multi-System Competition
Canadian hospitals are organized under regional health authorities, each overseeing multiple institutions in a geographic zone, rather than a patchwork of competing private health systems. For example, Vancouver Coastal Health runs several sites in the lower mainland, and Vancouver Island Health Authority covers most of the island’s population.
As physicians, we’re not hired by the hospitals but granted privileges. When internal medicine departments need to recruit, it’s typically physician-driven: post a job, interview, vote on candidates, and then get the hospital’s approval for privileges. Surgeons or proceduralists may have more hospital/health authority involvement—especially when it comes to operating time and resources—but for cognitive specialties, it’s pretty streamlined.
Most hospitals run independently, but regional systems help share large capital expenditures, technology, and specialty resources. There’s virtually no competition for patients between hospital systems the way there is in the US; patients just go to the closest center.
Medical Records: Provincial Integration
Many provinces have integrated systems for lab results, imaging, and op reports. I can pull up a CT report from a hospital in Kelowna for a patient who’s traveled to Vancouver Island. This helps avoid duplication, streamlines care, and honestly makes day-to-day work that much easier.
What About Compensation?
Let’s get real: Everyone wants to know about salary. Here’s the answer—fee schedules are negotiated by specialty, province by province, and everyone gets the same reimbursement for the same service, regardless of geography. If you’re working in a remote or rural area, there are additional incentives—sometimes 20-30% on top of regular billing—to help offset those challenges.
Most internists in Canada are making in the range of $500–600K CAD per year (and yes, your effective tax rate is only about 10% higher than the US, especially if you incorporate). My own income and quality of life—less hours, more flexibility, and far less administrative stress—have both improved since I moved.
There’s no “salary cap” anymore. That’s an old myth; if you’re willing to work longer hours and see more patients, you can absolutely increase your income.
Taxation and Running Your Medical Practice
Taxes come up a lot. As a Canadian physician, you’re self-employed (or incorporated) and there are a LOT of legitimate business-expense write-offs—home office, travel, staff, equipment, and more. Health insurance is handled by the government, so you’ll never see a surprise bill for your kid’s ER visit, diagnostic studies, or surgery. These costs add up fast in the US, even with good insurance.
If you’re a US-trained physician with American student loans, you’ll want to plan around currency conversion and tax implications, but in most cases, you come out ahead after adjusting for lifestyle and overhead.
Training and Practice Patterns: Internal Medicine in Canada vs. the US
This one’s really important for internists thinking about relocating:
In Canada: Internal medicine is a strictly referral-based specialty. After medical school (3-4 years), you must do three years of “core” internal medicine residency, then either subspecialize, do a two-year general internal medicine residency, or one extra year if practicing general internal medicine. Most internists have done four or five years of training. You’re not the primary care doctor—family medicine/family practitioners fill that role, typically after two years of residency.
In the US: Internal medicine residency is three years, and you’re board-eligible for primary care after that. You can do primary care, hospitalist work, or further subspecialize. Most hospitalists are internists, whereas in Canada, most hospitalists are family practitioners.
It’s a different system—and the BC College is actively working to ensure US-trained internists are able to bill and certify as full internists as long as they meet the criteria (either four clinical years or a chief year).
Outpatient Practice: Greater Control, Greater Flexibility
Unlike US hospital-based clinics, most Canadian physician offices are privately operated. As an internist, I rent office space, hire my own staff, and set my own schedule. Outpatient billing codes are slightly higher to offset overhead, and in my experience, outpatient medicine can be more lucrative than inpatient.
And yes—I take full advantage of my autonomy. I rarely schedule clinics on Friday afternoons. That flexibility is priceless.
Work-Life Balance: The Real Game Changer
Here’s the best part: My average work year is 35–38 weeks, with 12–14 weeks off for travel, family, or whatever I want. Even on busy call days, I’m rarely at the hospital overnight, and I set my own outpatient schedule. This is not a “grind until you drop” system; you can scale up or down, and opportunities exist in every region—especially British Columbia, where demand is high and recruiting is ongoing.
Lifestyle Perks: Living in British Columbia
If you love the outdoors, arts, culture, or want urban amenities within minutes of mountains, ocean, world-class skiing, and hiking—British Columbia is unbeatable. I walk to work every day, spend weekends on my bike, and get to explore the natural beauty in all seasons. North Vancouver was recently ranked the most “livable city” in Canada, and with our new hospital tower opening, we’re actively recruiting.
Safety, Stress, and Everyday Life Differences
One unexpected change moving to Canada: Safety. Day-to-day life here is just less stressful. Gun violence is minimal; shootings make local news because they’re so rare. People are friendly, and politics—while present—don’t dominate professional or personal discussions. You’d be hard-pressed to know who anyone votes for, and elections are short, snappy affairs.
Most importantly, I don’t worry about my kids outside, don’t walk into public spaces plotting my exit strategy, and don’t see anxiety or anger nearly as often as I did back home.
Final Thoughts: Advice for US-Trained Physicians Considering the Move
Make sure the provincial college/health authority credentials and billing rules line up with your training (watch for updates if you have only three years of IM residency).
Know your preferred practice style (inpatient/outpatient/mixed), and explore regions that fit your lifestyle interests.
Reach out to local physicians, like myself or
Dr. Paul Hertz
, to understand current openings and billing nuances.
Prepare to see an improvement in quality of life, work flexibility, and compensation—without sacrificing career growth or personal fulfillment.
If you’re looking for a new chapter in your medical career, I can wholeheartedly say: Canada is an incredible place to live and work.
Ready to learn more or connect with a local practice leader in British Columbia? Feel free to check out Dr. Paul Hertz’s website (drpaulhertz.com) or contact me directly via social channels at @InterestingMD.
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