From Texas to Canada: Dr. Mariam Washington on Escaping US Healthcare Part I

Reflections on Student Debt, US Healthcare Realities, and My Conversation with Dr. Mariam Washington

Posted by Dr. Robert Beck

Welcome back, everyone. Every week, I’m continually humbled by the flood of emails, notes, and messages I get from all of you—your thoughts, support, and especially your suggestions keep Interesting MD growing and, honestly, make it a joy to keep coming back to the mic.

This episode was a special one for me. It’s the first of a two-part conversation with Dr. Miriam Washington, a physiatrist who has seen healthcare through both the US and Canadian systems. As so many of you know, making the transition from one country to another is more than a paperwork shuffle—it’s a complete overhaul of how you see medicine, money, and purpose.

Here’s a rundown of some of the key themes and my takeaways from our chat.

Dr. Miriam Washington: A Journey Across Borders

• Background Snapshot:

  • Born in Iran, raised in Southern California.

  • Trained and mainly worked in Texas as a physiatrist.

  • Specializes in physical medicine and rehabilitation, especially musculoskeletal and EMG medicine.

  • Moved, with her family, from the US to Edmonton, and then on to BC.

• Motivation to Leave the US:

  • Started discussions in 2015 around issues of safety, race, and long-term quality of life.

  • Inspired after seeing the documentary Where to Invade Next—the concept that healthcare and physician wellbeing could (and should) be better.

The Student Loan Reality Check

• The Weight of Debt:

  • American medical education comes with a jaw-dropping price tag. Dr. Washington left medical school with $380,000 in debt, which ballooned to $620,000 by the end of residency due to high interest rates and payment deferrals.

  • For those outside the US, those numbers seem surreal—but for thousands of American physicians, it’s a disheartening reality.

• Strategies for Survival:

  • Dr. Washington hustled—taking jobs in underserved areas, chasing higher-paying roles, and pouring everything extra into loans.

  • In her last three years in Texas, she was paying off $200,000 per year to get out from under the burden of debt, determined to arrive in Canada loan-free.

  • There are a lot of myths about Canadian doctor salaries—many Americans believe you’ll take a steep pay cut by moving north. Spoiler: it’s not true for everyone.

US Healthcare vs. Canadian Healthcare: My Perspective and Mariam’s Take

• The Business of Healthcare:

  • In the US, profit dictates care in ways that can be hard to stomach. Physicians are paid a fraction of what hospitals bill insurers, and private practice is dying as hospitals with facility fees crowd out smaller operations.

  • There’s an immense (and often unseen) cost to this system—layers and layers of administration, constant fights for insurance authorization, and a business-first, patient-second mentality that frustrates both doctors and patients.

• Impact on Patients and Providers:

  • Patients with public insurance routinely receive fewer options and less comprehensive treatment than those with private insurance.

  • Fragmentation is the reality—if you want a true sense of “two-tiered” care, look south of the border at what privatization actually means.

• Lessons from Canada:

  • Moving here comes with its own headaches, sure, but it’s a breath of fresh air to work in a system where care comes first, not billing.

  • Doctors here are treated as independent corporations, which brings more favorable tax rates and the freedom to build a sustainable life.

  • The overhead to bring new physicians into clinics is manageable—there are opportunities everywhere if you’re proactive.

A Message for Residents, Students, and Physicians on the Edge

• Don’t Buy Into Scarcity Mindsets:

  • You can move to Canada with a plan, and physician salaries here can support a family and allow for loan repayment (or even some vacation, imagine that).

  • If debt feels like it’s trapping you, know that you’re not the only one and there are avenues for change.

• Be Proactive, Seek Out Connections:

  • Dr. Washington didn’t wait for opportunity to knock—she networked, called clinics directly, and wasn’t afraid to put herself out there (sometimes in front of hundreds of colleagues at a conference).

• Understand the Real Tradeoffs:

  • The US system isn’t broken because its people are bad—it’s just a system with misaligned incentives. If you really want to prioritize health outcomes and work satisfaction, don’t overlook the benefits of a publicly funded system.

Looking Ahead

Next week, we’ll dig deeper into the nuts and bolts of immigration, licensing, and the lighter side of moving a family (and a whole career) across the border. Thank you for listening, sharing, and supporting—I hope you find these perspectives useful, wherever you are in your journey.

And as always, send in your questions, your stories, and your feedback. These conversations only get richer with your input.

Stay tuned,
Dr. Rob Beck