Canada vs USA working conditions - any differences?

[dushash]

In terms of workstyle, workflow are there any significant differences? I would imagine it's mainly same, but then again I'm just a nobody yet to know it from within.

A couple of additional questions.
So is the consensus such that US=more $$$ while Canada=? (not sure what to put here)

and

with all being said and done - is it really better to pursue a specialty that you like the most, rather than settling for something of a second or third choice even if it means extra years and extra relocations (or some other hardships)?

Thank you.

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[laserzpewpew]

Having spoken to an ENT who studied in Canada but is working in the US, I'm surprised to have learned that income potential is higher in Canada than the States. You can also look forward to a lot of headaches arguing with insurance companies for reimbursement if you manage your own practice.

 

[UBC2014]

In Canada, once you get the specialist position your set.

The U.S. is terrible with respect to dealign with insurance and all the administrative bureaucracy that is shrouding HCPs. Wouldn't want to touch that with a 10 foot pole.

Also, while some specialities have higher income potentials in the U.S., it also comes with the above headaches - and that not everyone will actually be hitting those potentials.

Primary care in general is much better reimbursed in Canada. It is the devil in the U.S. amongst my peers(unless they ultimately want to return to Canada). Few want to go into primary care when they have 300-400k in debt.

Generalizations of course.

 

[Old_Mil]

Having just made the switch...

...Money is about the same (excluding the vagaries of foreign exchange).
...If you are practicing in a place with a state income tax of 7%+, tax burden (excluding GST) is similar.
...If you are a Canadian citizen who forms a professional corporation the tax burden for you in Canada is less than in the US where you will always be a W2 or 1099 wage worker.

Having addressed that, Canada offers

1. A much better malpractice climate.
2. Much better charting systems, with less bureaucracy.
3. No ICD 10, which means no spending 10 minutes sorting through this (http://www.healthcaredive.com/news/the-16-most-absurd-icd-10-codes/285737/) looking for right ankle sprain.
4. No need to cough up 1000, 1500 or more a month for private health insurance if you are a 1099 worker.
5. Beautiful tropical weather.

Ok, I'm kidding about that last one.

 

[docta9]

Canada does things that would be considered illegal in the U.S. Reimbursement is lower so Canadians make up by restricting other doctors. For example, if you are in ENT and want to go to Vancouver, forget about it. You can go there but you will be prohibited from doing surgery in a hospital.

Email pays well. Some provinces pay $20 to answer an email, which is really good compared to an office visit. 5 emails x 300 days = $30,000.

There is an artificial shortage of doctors in Canada so you can practice assembly line medicine.

 

[bearintraining]

Canada does things that would be considered illegal in the U.S. Reimbursement is lower so Canadians make up by restricting other doctors. For example, if you are in ENT and want to go to Vancouver, forget about it. You can go there but you will be prohibited from doing surgery in a hospital.

Email pays well. Some provinces pay $20 to answer an email, which is really good compared to an office visit. 5 emails x 300 days = $30,000.

There is an artificial shortage of doctors in Canada so you can practice assembly line medicine.

curious about this - what exactly is the issue with ENT in Vancouver?

 

[Stim4me]

Canada does things that would be considered illegal in the U.S. Reimbursement is lower so Canadians make up by restricting other doctors. For example, if you are in ENT and want to go to Vancouver, forget about it. You can go there but you will be prohibited from doing surgery in a hospital.

Email pays well. Some provinces pay $20 to answer an email, which is really good compared to an office visit. 5 emails x 300 days = $30,000.

There is an artificial shortage of doctors in Canada so you can practice assembly line medicine.

Why is there a doctor shortage? Money? Debt? From above it seems like it would be a desirable profession... I doubt it though, governmental health care is not autonomous enough for smart physicians...
I personally think specialists with private practices and small business savvy do very very well in the USA....

 

[dushash]

Why is there a doctor shortage? Money? Debt? From above it seems like it would be a desirable profession... I doubt it though, governmental health care is not autonomous enough for smart physicians...
I personally think specialists with private practices and small business savvy do very very well in the USA....

Pay is same as in US, even better for some specialties. Loans are available for ridiculously low rates 2.7% prime rate not only for med.school, but after that for starting small business. Problems are in limited number of med.schools - only 17 and limited seats in each of them. In addition there is always a flow of physicians from Canada to US (opposite is also true, but less so). Add to that a "free" healthcare that makes lots of people come to emergency often for simple flue or cold, thus contributing to abysmal waiting times. All this quickly creates a situation when physicians are in shortage. Government can't simply build more med.schools and flood country with more doctors, because each of them is expensive to afford. And I think budget is already at it's max and money is limited. This is just some minuses of "free" healthcare. It still has to be balanced somehow and I think sooner or later they will allow more physicians and probably pay each one less to split the increased cost - there is no other choice IMHO. So as in US we are possibly looking a decrease in pay. However, as in US, I hope this decrease will be gradual and within reasonable limit as no mater how you cut it, you have to pay for doctors.

 

[Stim4me]

Pay is same as in US, even better for some specialties. Loans are available for ridiculously low rates 2.7% prime rate not only for med.school, but after that for starting small business. Problems are in limited number of med.schools - only 17 and limited seats in each of them. In addition there is always a flow of physicians from Canada to US (opposite is also true, but less so). Add to that a "free" healthcare that makes lots of people come to emergency often for simple flue or cold, thus contributing to abysmal waiting times. All this quickly creates a situation when physicians are in shortage. Government can't simply build more med.schools and flood country with more doctors, because each of them is expensive to afford. And I think budget is already at it's max and money is limited. This is just some minuses of "free" healthcare. It still has to be balanced somehow and I think sooner or later they will allow more physicians and probably pay each one less to split the increased cost - there is no other choice IMHO. So as in US we are possibly looking a decrease in pay. However, as in US, I hope this decrease will be gradual and within reasonable limit as no mater how you cut it, you have to pay for doctors.

Seems like a very regulate governmental experiment.... Why would Canadians accept these limitations to access of healthcare and specialists? Americans want a shot in their spine yesterday..... Can't wait months here, golf season is around the corner....

Plus your corporate tax rate is way less, makes a difference. I pay 50% of every dollar I make. Thanks for the info...

 

[ConfusedChemist]

Seems like a very regulate governmental experiment.... Why would Canadians accept these limitations to access of healthcare and specialists? Americans want a shot in their spine yesterday..... Can't wait months here, golf season is around the corner....

Plus your corporate tax rate is way less, makes a difference. I pay 50% of every dollar I make. Thanks for the info...

Because of universal health care. There are too few people on waitlists compared to the general population who is happy not paying

 

[jayceee]

Pay is same as in US, even better for some specialties. Loans are available for ridiculously low rates 2.7% prime rate not only for med.school, but after that for starting small business. Problems are in limited number of med.schools - only 17 and limited seats in each of them. In addition there is always a flow of physicians from Canada to US (opposite is also true, but less so). Add to that a "free" healthcare that makes lots of people come to emergency often for simple flue or cold, thus contributing to abysmal waiting times. All this quickly creates a situation when physicians are in shortage. Government can't simply build more med.schools and flood country with more doctors, because each of them is expensive to afford. And I think budget is already at it's max and money is limited. This is just some minuses of "free" healthcare. It still has to be balanced somehow and I think sooner or later they will allow more physicians and probably pay each one less to split the increased cost - there is no other choice IMHO. So as in US we are possibly looking a decrease in pay. However, as in US, I hope this decrease will be gradual and within reasonable limit as no mater how you cut it, you have to pay for doctors.

Canada doesn't have a shortage of medical schools.

17 schools for 1/10 the US population would be equivalent to 170 medical schools if they had the same population as the US.

Class sizes are also pretty large. UBC has about 260 seats for their first year class.

Are you Canadian? You don't seem to know that you're talking about. There's no shortage of MDs in the big cities. The problem is with distribution, just like it is in the US. No one wants to work in small towns.

Also, what are you talking about in terms of the emergency room visits? There are walk-in clinics all over cities like Vancouver where you can go and get seen by a family physician with thought having to make an appointment. Google map "walk-in clinic" in Vancouver, or any Canadian city and you can see for yourself.

Here's the surgical wait times site for British Columbia.

https://swt.hlth.gov.bc.ca/

 

[jayceee]

Pay is same as in US, even better for some specialties. Loans are available for ridiculously low rates 2.7% prime rate not only for med.school, but after that for starting small business. Problems are in limited number of med.schools - only 17 and limited seats in each of them. In addition there is always a flow of physicians from Canada to US (opposite is also true, but less so). Add to that a "free" healthcare that makes lots of people come to emergency often for simple flue or cold, thus contributing to abysmal waiting times. All this quickly creates a situation when physicians are in shortage. Government can't simply build more med.schools and flood country with more doctors, because each of them is expensive to afford. And I think budget is already at it's max and money is limited. This is just some minuses of "free" healthcare. It still has to be balanced somehow and I think sooner or later they will allow more physicians and probably pay each one less to split the increased cost - there is no other choice IMHO. So as in US we are possibly looking a decrease in pay. However, as in US, I hope this decrease will be gradual and within reasonable limit as no mater how you cut it, you have to pay for doctors.

I just checked your profile. You didn't get into a Canadian med school, I can see how that would be upsetting, but please present factual information when you speak about Canada's health care system. I hope you didn't discuss it this way during you MMI interviews.

 

[UBC2014]

Canada doesn't have a shortage of medical schools.

17 schools for 1/10 the US population would be equivalent to 170 medical schools if they had the same population as the US.

Class sizes are also pretty large. UBC has about 260 seats for their first year class.

Are you Canadian? You don't seem to know that you're talking about. There's no shortage of MDs in the big cities. The problem is with distribution, just like it is in the US. No one wants to work in small towns.

Also, what are you talking about in terms of the emergency room visits? There are walk-in clinics all over cities like Vancouver where you can go and get seen by a family physician with thought having to make an appointment. Google map "walk-in clinic" in Vancouver, or any Canadian city and you can see for yourself.

Here's the surgical wait times site for British Columbia.

https://swt.hlth.gov.bc.ca/

I agree completely with your sentiments, but with one exception re: ER visits. The proportion of patients going to the ER that should be going to a FM doc in the community, is HUGE. It is a big problem, as you are aware an ER visit is much more expensive and costly to the system than a FM doc office visit. Low-acuity patients are heading to the ER, for many reasons, some personal preference (i.e. why not go to the ER? they got all the specialists and fancy tools there!!!) and others because they don't have access to a FM doc or walk-in clinic.

Many clinics in Vancouver, have abysmmal evening hours, and VERY few provide after-hours care. Again, i can only speak for BC, and Vancouver, but there's a few different on-going research projects that peers are involved with.

 

[dushash]

Jayceee what's with your attitude mate? I state things I see everyday. I have 2 kids and we live in Kitchener, ON. I'm not trying to lecture you, but I know how things work in our city and what kind of walk-in clinics we have and when we need to rush to ER because my daughter had vomited blood after tonsils surgery - you go to ER, not walk-in, especially in the middle of the night. I've been there too many times and waiting times are abysmal.
P.S. We all here on this forum share our opinion and that may not be a factual information - you should know that. And I for sure don't understand why you need to bring up the country where I got accepted? What it has to do with my everyday experience with ER and waiting times? Do you think your post about MMI and you lecturing me how I should be saying things is smart? I applied only to US and got accepted to US med.school. Part of my family is in US and I'm happy about it. I would like to have options open for coming back to Canada, but that has nothing to do with your "smart" comments or this topic. What you need to do is to stop judging people by little info you know about them and work on your attitude. I don't think I'll be happy (or anyone else) to be working with such a colleague.

 

[Stim4me]

Peace not hate....
Are there lucrative and productive private practices in Canada? Also why do busy pain management guys like me in the USA get affluent Canadian patients for injections regularly. I've been told by Canadian patients elective procedure, like an epidural , has a long wait time and in general Canadian docs don't "care" about pain.... Curious if this a societal issue more than a wait time issue...

 

[dushash]

Peace not hate....
Are there lucrative and productive private practices in Canada? Also why do busy pain management guys like me in the USA get affluent Canadian patients for injections regularly. I've been told by Canadian patients elective procedure, like an epidural , has a long wait time and in general Canadian docs don't "care" about pain.... Curious if this a societal issue more than a wait time issue...

I can only say what I've seen. Radiologists for example in Canada team up and open private imaging clinics. I won't name names and cities, but in one medium population city all 10 private imaging clinics are owned by same team of guys who work in Hospital. They do make a lot of money. From my little work experience in that Hospital, patients who came for spine, knee, hip etc pain injections had to wait at least 3-4 months, but besides that - a repeat injection is only scheduled after specific time have passed, often it's 4-6 months. I'm just saying that from my personal experience - my mom get a knee pain injection more often than that in US (Connecticut to be specific) and all she had to do is to go to local practice near her home. While in Canada you have to be first referred to a specialist by your FP. I know when my daughter was referred to a ENT for a basic tonsil removal, we waited 7 months in Kitchener, ON - just to be first seen by ENT. Surgery was scheduled another 3 months later after that. So you got an idea what it's like here. I'm not saying it's bad - many people would prefer to wait longer but have surgery for free. It's just I personally would have preferred to pay and get medical attention sooner. I guess that is why many folks from Canada (at least those who can afford) prefer to go across border to get their injections etc. faster. So in essence, in my opinion, this is waiting time issue for sure, but societal aspect may play a role too, since when you have "free" healthcare - priorities change and pain may not be priority #1.

 

[UBC2014]

I can only say what I've seen. Radiologists for example in Canada team up and open private imaging clinics. I won't name names and cities, but in one medium population city all 10 private imaging clinics are owned by same team of guys who work in Hospital. They do make a lot of money. From my little work experience in that Hospital, patients who came for spine, knee, hip etc pain injections had to wait at least 3-4 months, but besides that - a repeat injection is only scheduled after specific time have passed, often it's 4-6 months. I'm just saying that from my personal experience - my mom get a knee pain injection more often than that in US (Connecticut to be specific) and all she had to do is to go to local practice near her home. While in Canada you have to be first referred to a specialist by your FP. I know when my daughter was referred to a ENT for a basic tonsil removal, we waited 7 months in Kitchener, ON - just to be first seen by ENT. Surgery was scheduled another 3 months later after that. So you got an idea what it's like here. I'm not saying it's bad - many people would prefer to wait longer but have surgery for free. It's just I personally would have preferred to pay and get medical attention sooner. I guess that is why many folks from Canada (at least those who can afford) prefer to go across border to get their injections etc. faster. So in essence, in my opinion, this is waiting time issue for sure, but societal aspect may play a role too, since when you have "free" healthcare - priorities change and pain may not be priority #1.

It's not always black and white as well.

Just because you can hop over the border and pay for expediated care, doesn't automatically mean that care is warranted. Over-care is a real issue as well. For example, there are guidelines to pain injections set out, you don't want to overdo them as well, such that they lose efficacy or cause other hormonal/metabolic issues in the body due to prolonged usage.

There are two-sides to every situation.

I will agree though that FM after-hours care is abysmal and that is why many low-acuity patients end up in the ER, but also because its so hard to find out how to access after-hours care when you're in a rush.

 

[Stim4me]

It's not always black and white as well.

Just because you can hop over the border and pay for expediated care, doesn't automatically mean that care is warranted. Over-care is a real issue as well. For example, there are guidelines to pain injections set out, you don't want to overdo them as well, such that they lose efficacy or cause other hormonal/metabolic issues in the body due to prolonged usage.

There are two-sides to every situation.

I will agree though that FM after-hours care is abysmal and that is why many low-acuity patients end up in the ER, but also because its so hard to find out how to access after-hours care when you're in a rush.

So how is "overcame" decided in Canada, based on what medical literature? Is there a Medicare equivalent guideline? In the USA an advisory board of 15 people have oversite in cutting reimbursement and medical treatments. They have no congressional oversite, but would be subject to major public duress if they, for instance, prevent a total knee replacement in an 75yo...