I'm a Canadian medical student and I'm deciding whether moving down to the states to practice medicine would be right for me. I know this sounds superficial, but one of the big reasons for moving is having better weather year round, in a place like California or Florida.
I know there are big differences in the healthcare systems between Canada and US, but I am wondering whether there is anyone who has trained or worked in both systems and would like to share their own personal stories and experiences. What are some aspects most people don't recognize? How bad is working with the insurance companies down in the States? I would love to hear your thoughts.
I practiced in the states as a resident and have been in Canada as an attending (FM). Overall I didn't find it too different in the day to day, I still practice the same way in both countries. The biggest day to day differences were access/resource differences and medications.
I could order scans and refer to specialists the same way in both countries, but how soon that would get done was very different. For example, if I had a patient with a hip issue and I wanted more complex imaging like an MRI and an ortho referral, in Canada I order the MRI myself (no insurance company to fight me on that one), it might get done in 4-6 months if non urgent, and if I refer to ortho the patient might get seen in 6-12 months. In the states there's MRI machines on every corner so I could order one and it would be done in two weeks, although I might get a kick back from the insurance company and have to sit on the phone to get it approved. They could see ortho within a week or two depending on the location/issue. I was in a medium sized town in the states, I imagine not all towns are as well resourced. Prior auths/insurance battles mainly happened over advanced imaging, not really part of day to day family med life. My work around was just refer to the specialists and let them order it in most cases.
Meds were a big day to day issue in the states, even when covered by medicare/medicaid the copays alone were enough to sink patients. A $4-$10 copay per medication can add up really quickly per month after 4-5 meds on patients with a very low income. Not an issue for those who can afford non government funded health insurance. If someone didn't have insurance? You can forget prescribing an inhaler, those are like $300 bucks with no insurance. Insulin was cheapest through Wal-Mart at $25 bucks a vial, but I had some patients on 4-5 vials per month. There were some helpful websites that provided coupons (ie. good rx) and of course I never would prescribe a brand name in the states (not that that matters).
Community resources can be different. My residency was a well resourced "FQHC" type centre (designed to help patients with low SES status with federal funding) and we had in house social workers, mental health therapists, even some dentists who could do some free work and extractions. I imagine many jobs/centres would not include this so patients are more on their own. In Ontario, there are some government funded nutritionists, therapists etc. so I think there's more widespread support for patients.
Overall, the main difference I think is job autonomy. I never worked as an attending in the states, but most jobs were such that you sign a deal with a clinic, get a salary, but of course with that you are beholden to them for x days per week or x patients per hour etc. You could of course open your own private clinic too. In Canada, most docs are self employed, so here I set my own hours, my own patient load to whatever I want it to be and can change that anytime I want.
Both systems have their pros and cons and there will be some daily administrative type frustrations of "this shouldn't be my problem", I don't think either is a deal breaker. Your time outside of work will make you more happy, so live where you want to live and fit work as best as you can around that.
