Opening a Medical Practice in Canada vs USA: Insights from Dr. Khashayar Farzam
Returning Home: Medicine, Muscles, & Moving North with Dr. Kashiyar Farzam
By Dr. Rob Beck
Welcome back to the Interesting MD blog, where we take you beyond the white coat and into the real lives, choices, and sometimes wild hobbies of fascinating physicians. This week’s conversation is a treat, especially for anyone eyeing a move north of the border (or just looking for bench press inspiration!). I sat down with Dr. Kashiyar Farzam, a dual-trained ER and family medicine physician who brought his US training back to Ontario—not to mention, he’s a bona fide powerlifting beast.
Why Come Back to Canada?
So, why would anyone pack up after US training, leave behind dollar signs, and return to Canadian soil?
Family ties: For many, this is the anchor—and Dr. Farzam is no different!
Freedom in Practice: In Canada, especially in family medicine, there are more options to mix and match your ideal practice style. Want to work ER, run a clinic, do travel medicine or minor procedures? You can do all that without getting locked into one corporate role.
Credential Flexibility: With Canadian certification, you can work in emergency medicine—a flexibility rarely offered to non-EM-trained MDs in the US.
No Non-Compete Headaches: Forget the tight contracts, non-competes, and administrative chains. Here, you can move between roles and locations without lawyer headaches.
The Practical Side: Setting Up Shop
Physicians from the US will appreciate how much simpler it can be to strike out on your own in Canada:
Starting a Clinic: You can, quite literally, rent a building and start seeing patients. There’s no complicated web of insurance contracts, billing offices, or coding gurus necessary.
Billing System: Submit your billing code, and you’re done. Yes, there are billing nuances, but nothing on the scale of US insurance bureaucracy. Most of us do our own billing in ten seconds flat, and some payers like Dr. Bill make it even easier.
No Negotiating with Insurers: Every doctor gets the same rate. The government sets the fee schedule, and the doctor’s association handles negotiations—so, no more getting crushed in individual contract talks.
Financial Realities: The Numbers Game
Let's bust a myth: moving to Canada doesn’t always mean a pay cut.
Family Docs: Many Canadian family doctors make as much as or more than their US counterparts, especially when you look at cost of living and practice flexibility.
Specialties: For procedural or surgical specialties, US pay can be higher—but for paediatrics and generalists, Canada's system can actually come out ahead.
No Location-Based Salary Gaps: Whether you're in downtown Toronto or 10 minutes outside of it, your billing rate stays the same. Geography matters more for lifestyle than your actual paycheck.
Unique Opportunities in Canadian Practice
Telemedicine & Consultation: In Ontario, there’s a strong consultation system (like eConsults), making it easier to reach and support rural communities.
Rural & Remote Bonuses: Some provinces offer significant financial incentives for communities in need—think sign-on bonuses, higher billing percentages, and a chance to truly be a community pillar.
Publicly Funded Niche Clinics: You can run focused practices within the public system—weight loss, men’s health, hormone replacement—with the right billing codes and medical necessity.
Dr. Farzam: Not Just a Doctor…a Powerlifter!
I can't write about Dr. Kashiyar Farzam without mentioning his world-class side hustle: smashing powerlifting records.
Guinness World Records: Most weight benched in 30 seconds, most bodyweight reps… the list is growing.
Competition Results: Top 10 in the world at an international bench press competition—and that was with an injury.
Strength Feats: 555lb bench press at 200lb body weight. Yes, you read that correctly. At this point, I feel like I should either hit the gym harder or just keep interviewing amazing guests like this!
Want to Connect or Move North Yourself?
Dr. Kashiyar Farzam practices at True North Metabolic. His work focuses on obesity medicine, evidence-based hormone therapies, and men’s health.
If you’re a US healthcare provider thinking of making the jump, feel free to reach out at rob@interestingmd.com or through the Interesting MD website.
Thanks for tuning in (and reading!). Whether you’re dreaming of Canadian practice, fascinated by the business of medicine, or just want an excuse to lift heavier at the gym, this episode was for you. Don’t forget to share, comment, and subscribe—see you on the next round!
— Rob