Many readers may recite this title in deepest disbelief, but Canadian nephrologists collect, by far, much higher revenues than their U.S. counterparts. How on Earth is it possible that a country with socialist medicine provides higher income to its nephrologists than the capitalist U.S.?   

Many Canadians had a good chuckle during the debates on Obamacare, when the word “socialist” was bandied about to describe underpaid doctors and long waiting lists for surgeries. Maybe there are such health care debacles in Canada, but definitely there is no long waiting period if you need to start dialysis treatment and to find a dedicated nephrologist.

Indeed, you will get more intensive care with frequent nephrology visits for transition to dialysis in this arctic place than in its Southern neighbor. This higher level of dialysis care in Canada is partly owed to substantially higher reimbursement fees for nephrologists for providing care to a Canadian dialysis patient, often resulting in at least $7,000 a year of physician fees per each dialysis patient compared to approximately $3,000 a year for providing care to a Medicare dialysis patient in the U.S.

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If a hardworking nephrologist provides care to 100 dialysis outpatients in Canada, he or she will collect at least $700,000 a year in addition to inpatients rounds and other outpatient clinics. This enormous dialysis fee collection may explain why a Canadian nephrologist has on average a two- to threefold greater income than their American counterparts. 

I asked some of my Canadian colleagues why physician reimbursement for dialysis patient care is so high in Canada. The frequent answer is that the reimbursement is not high compared with other subspecialties there. Indeed, very few medical students in Canada opt for nephrology fellowship training because they can have even higher income in other subspecialties.

Some Canadian nephrologists tell me that they feel deeply sorry for their vastly underpaid American colleagues. Additionally, you may be surprised to learn that Canadian physicians are allowed to incorporate themselves so they a corporate income tax of 16% instead of personal income tax of 45%.

In case you’re interested in practicing in Canada, don’t yet pack your bag for a one-way ticket to Toronto. There is practically no vacant nephrologist position in Canada, and if there were a few openings a year, only Canadian-trained nephrologists with a Canadian citizenship are qualified for such a position.

Nevertheless, there are plenty of nephrology fellowship spots in Canada, with an average stipend of $80,000 to over $100,000 a year to work as a renal fellow in Toronto, Vancouver, Edmonton, and other cities. So, we have finally figured out why Canadians—or at least Canadian nephrologists—do not mind the cold climate.