As told to Teagan Sliz.
If you ask most people who earns more, American doctors or Canadian doctors, they'll almost certainly say Americans – by a landslide. And by some measures, they’d be right. Doctors in the US are some of the highest paid physicians in the world; on the high end, specialized doctors like neurosurgeons can earn around C$1 million a year, depending on where they live and how many years of experience they’ve got. That’s nothing to scoff at, and for Canadian-trained doctors like myself, the move to the US can look very tempting on paper – lower debt coming out of school, and then a higher salary if you head south.
But the calculations change quickly once you factor in what American doctors have to spend in order to earn that salary, and Canadian doctors like myself aren’t as far behind as you might think. When you take things into account like malpractice insurance, business overhead, student debt, and other related costs, the pay gap between American and Canadian doctors actually shrinks, and in some cases, nearly closes.
"When you take things into account like malpractice insurance, business overhead, student debt, and other related costs, the pay gap between American and Canadian doctors actually shrinks, and in some cases, nearly closes."
A common misconception posits that most American doctors earn 50% more than, or even double, what their Canadian counterparts make. But the real-life gap is only about 10% to 20%. Canadian neurosurgeons, for example, earn C$850,000 or more on the high end, just 16% shy of a million. Experienced cardiac surgeons like me earn around C$650,000 in Canada, while a comparable American cardiologist would bring in a little over C$850,000. All things considered, we Canadian physicians average around 22% less than American ones.
Of course, Canadian doctors can also pay much higher income taxes, especially compared to doctors operating in states with no income tax, like Texas or Florida. But most of us are incorporated, meaning we’re taxed at the small business rate, which ranges from a more palatable 9% to 12.2%, depending on the province.
Malpractice insurance
One of the biggest out-of-pocket expenses for American doctors is malpractice insurance. Compared to Canada, the US is an incredibly litigious society, and doctors rely on third-party insurers to cover themselves when things go wrong. Costs range dramatically, from C$13,807 to upwards of C$276,180 each year, depending on location and specialization; a Miami-based OB/GYN, for example, could pay around C$336,935 per year. Hospitals will often cover it, but doctors in private practice have to pay out of pocket.
In Canada, though, doctors pay into the Canadian Medical Protective Association (CMPA), which protects all doctors against legal action; those fees range from just C$2,000 to C$5,000 and are largely reimbursed by the provinces.
Administrative overhead
Hospitals and clinics are expensive to run regardless of what country you’re in, but the biggest cost difference between the US and Canada comes down to paperwork. Canada’s single-payer system makes billing straightforward: one payer, predictable reimbursement, and less time spent on claims. But in the States, their multi-payer system works differently. Doctors and their staff spend significant time negotiating reimbursement rates with multiple insurers, handling claim denials, and navigating pre-authorizations.
American doctors employed by hospitals are largely shielded from these costs, since hospitals absorb them. But for the 48% of American physicians who work in private practice, overhead can run as much as 50% to 60% of total revenue. In Canada, most of us expect to lose only around 20% to 30% to overhead.
Student debt
Post-secondary education is infamously expensive in the States, and medical school is no exception. On average, American medical students graduate with nearly C$300,000 in debt, and that’s before factoring in debt from undergraduate degrees, master’s degrees, or PhDs.
In Canada, medical graduates carry an average of C$90,000 in debt, and only about a third of students report owing C$120,000 or more. That’s a difference of more than C$200,000 in some cases. For young doctors entering the workforce, especially those who live in expensive cities like New York City or Los Angeles, that extra debt, combined with malpractice insurance and overhead costs, makes the higher American salary a lot less impressive.
I feel I owe it to the country that raised, schooled, and trained me to stay and contribute, especially amid the current doctor shortage.
The bottom line
I choose to practise medicine in Canada for reasons that go beyond the numbers. I feel I owe it to the country that raised, schooled, and trained me to stay and contribute, especially amid the current doctor shortage. I also value working under a universal healthcare system – if my patient needs a CT scan or expensive surgery, I don’t have to worry about whether they can afford it or if I need to alter my care to fit their finances.
I’ll be honest: if I could actually make 100%–200% more by moving to the US, it would be tempting. But careers are about more than just the paycheque, and once you account for malpractice insurance, administrative overhead, and student debt, the gap between what Canadian and American doctors actually earn is a lot narrower than you’d expect. I’d rather stay here instead.
