How U.S.-Trained Doctors Can Move to Ontario and Build a Thriving Practice
Welcome to the Ultimate 5-Part Series for U.S. Physicians Coming to Ontario
Whether you’re just thinking about moving or you’re already CPSO-licensed, this 5-part guide series will show you every step of the journey—from immigration to income growth.
Bookmark this page and use it as your command center.
Quick Links to the Full Guides:
Blog 1: Immigration, Mindset & Strategy
How to legally immigrate and prepare your documents before applying for licensure.
Blog 2: CPSO Licensure Step-by-Step
Full breakdown of Ontario’s licensing pathways and how to avoid common mistakes.
Blog 3: OHIP Billing Setup & Payment Systems
How to register for your OHIP number, MCEDT, and start receiving government reimbursements.
Blog 4: Finding Jobs, Locums & Building Your Practice
How to choose the right practice, what to watch for, and how to build your career wisely.
Blog 5: Scaling Your Practice and Protecting Profitability
Growth, profitability, burnout prevention, and long-term success strategies in Ontario healthcare.
Practical Differences Between U.S. and Ontario Medical Practice Cultures
If you’ve trained and worked in the U.S., transitioning to Ontario means adjusting to some key operational and cultural differences:
Billing & Payment Differences
In the U.S.:
You deal with dozens of private insurance companies ("ribbons") with different rates and forms.
Physicians often negotiate rates with insurers or directly with patients.
In Ontario:
There’s one main payer: OHIP (Ontario Health Insurance Plan).
You cannot negotiate rates. Every service has a government-set fee.
Claims are submitted electronically and paid monthly based on OHIP’s Schedule of Benefits.
Patient Access & Referrals
In the U.S.:
Patients can often self-refer to specialists directly or based on insurance plan rules.
In Ontario:
Patients must first see a primary care doctor (family physician) to get a referral to most specialists.
Without a valid referral, OHIP often won't cover specialist consultations.
Family physicians act as "gatekeepers" to ensure system navigation and cost control.
Practice Operations and Ownership
In the U.S.:
Clinics can be owned by corporations, hospitals, or private equity groups.
Heavy marketing, brand competition, and private-pay services are normal.
In Ontario:
Physicians typically own and run their clinics individually or in small partnerships.
Clinics can't aggressively advertise for OHIP-insured services (ethical guidelines apply).
Focus is more on community relationships and referral networks than pure marketing.
Insurance & Liability
In the U.S.:
Malpractice insurance premiums are often very high ($30K–$150K+ per year depending on specialty and location).
In Ontario:
Malpractice insurance is much cheaper (often $2K–$10K/year), heavily subsidized by provincial programs through CMPA.
Legal claims frequency is lower because of the Canadian healthcare litigation environment.
Regulatory Environment
In the U.S.:
Physicians deal with a mix of federal, state, and insurer regulations.
In Ontario:
Regulation is centralized through:
CPSO (licensure and discipline)
Ministry of Health (billing and payments)
CMPA (malpractice defense)
Pro Tips to Adapt Faster
Build relationships with local family doctors—they are key to getting specialist referrals.
Keep close tabs on your billing accuracy—no negotiation means no margin for error.
Plan for a longer average visit time: Ontario encourages thorough patient assessments over rushed volume.
Use admin support or billing services early—self-billing eats into clinical time fast.
Learn about virtual care rules—telemedicine is growing, but billing structures differ from U.S. platforms.
F.A.Q’s
1. Can U.S. doctors negotiate billing rates in Ontario?
No. OHIP sets standardized fees, and negotiation is not permitted for insured services. The best way to improve compensation is careful billing optimization, where we see paid collections rise between 20% - 50% with proper charting and coding.
2. How do specialist referrals work in Ontario?
Patients must be referred by a family physician to see most specialists and have the visit covered by OHIP.
3. What malpractice coverage do Ontario physicians need?
Physicians need CMPA coverage, which is subsidized and significantly less expensive than U.S. malpractice insurance.
4. Are clinic ownership rules different in Ontario?
Yes. Physicians must own clinics themselves or work in physician-run partnerships; large corporate ownership is limited.
5. How is billing handled for Ontario doctors?
Billing is handled through one payer (OHIP) using electronic submission via MCEDT.
6. Can Ontario physicians advertise their clinics heavily?
Advertising of insured services is restricted to protect patient trust; marketing focuses more on patient education and referral relationships.
7. Is Ontario healthcare more centralized than U.S. healthcare?
Yes. Regulation and payments are centralized under provincial bodies like CPSO and the Ministry of Health.
8. How do OHIP billing cycles work?
Claims submitted by the 18th of the month are processed and paid by the 15th of the following month.
9. How long does it take to establish a specialist practice in Ontario?
Typically, 6–18 months depending on referral patterns, location, and niche specialty demand.
10. Who can help me grow my medical career in Ontario?
PFF offers practice setup, billing support, growth strategy, and concierge services tailored to U.S.-trained physicians.
