In the UK, your practice receives a per-patient global sum from NHS England. You see patients, the money arrives, and you never think about billing individual encounters. In Canada, the default model is the opposite: you bill the provincial ministry of health for every patient interaction, using specific fee codes, and your income is directly proportional to your billing volume and accuracy.
UK doctors who move to Canada without understanding this transition systematically under-bill in their first year — often by CAD $50,000–$100,000. Here's the plain-English guide.
How fee-for-service works
In most Canadian provinces, the dominant payment model for family physicians is fee-for-service (FFS). You see a patient, you submit a claim to the provincial health insurance plan (OHIP in Ontario, MSP in BC, AHCIP in Alberta), and the plan pays you a set amount for each type of service.
Every service has a fee code — a numerical identifier that corresponds to a specific type of encounter. The provincial schedule of benefits lists thousands of codes, each with a defined dollar value.
Example (Ontario/OHIP): You see a patient for a standard office visit. You bill fee code A007 (general assessment by a GP) — currently valued at approximately CAD $36. If the same patient needs a comprehensive examination, you bill A003 (complete assessment) — approximately CAD $77. If you do a Pap smear during the visit, there's a separate procedural code. If you provide counselling that extends the visit beyond the standard time, there may be time-based premium codes.
The critical mindset shift: In the UK, you're paid for having patients. In Canadian FFS, you're paid for seeing patients and billing correctly. A UK GP who sees 25 patients a day but only bills for 20 (because they forgot to submit claims for phone calls, prescription renewals, or procedures) is losing 20% of their income.
What UK doctors get wrong
Under-coding. Billing the basic visit code when a more specific (and higher-value) code applies. If you did a complete physical examination, don't bill for a "minor assessment." If the visit involved chronic disease management exceeding 15 minutes, check whether a time-based premium applies. Every province has premium codes that UK doctors miss because they don't know they exist.
Not billing for non-face-to-face work. In many provinces, telephone consultations, prescription renewals, reviewing test results, and writing referral letters are billable — either directly or through time-based supplementary codes. UK GPs do this work for free (it's covered by the global sum). Canadian GPs bill for it. If you're doing the work but not billing, you're working for free.
Not understanding shadow billing. In capitation-based models (see below), you still submit claims to the provincial plan — not for payment, but for tracking ("shadow billing"). If you don't shadow bill, you don't get credit for the work, which affects bonus calculations and future capitation adjustments.
Not incorporating. Most Canadian GPs incorporate as a Canadian-Controlled Private Corporation (CCPC). This provides significant tax advantages (see our separate article on incorporation). UK doctors unfamiliar with the concept often practise as sole proprietors for years, paying substantially more tax than necessary.
Alternative payment models
Not all Canadian GPs are on pure fee-for-service. Alternative payment models include:
Capitation (e.g., Family Health Organisation/FHO in Ontario): Similar in concept to the UK's per-patient global sum. You receive a base payment per enrolled patient, adjusted for age and sex, plus bonuses for preventive care targets and after-hours access. You still bill FFS for some services on top. The income is more predictable but typically requires a group practice of 6+ physicians.
Salary/sessional: Some positions (academic, rural, hospital-based) pay a fixed salary or sessional rate. Simpler to understand but usually lower total income than FFS.
Blended models: Combinations of capitation, FFS, and bonuses. Ontario has the most complex blended models (FHO, FHN, FHG — each with slightly different rules). Alberta and BC are increasingly moving toward blended models as well.
For a UK GP arriving in Canada, FFS is the most likely initial model — particularly if you're in a rural or locum position. Understanding FFS billing from day one is essential.
Overhead: the number nobody warns you about
In the UK, your practice pays for premises, staff, IT, and supplies from the practice income — you see your salary after those costs are covered. In Canadian FFS, the gross billing amount is yours — but you're responsible for all practice expenses.
Typical GP overhead in Canada: 25–40% of gross billings. This covers: clinic space rental, medical office assistant (MOA) salary, EMR software fees, medical supplies, equipment, CMPA (indemnity), licensing fees, accounting, and insurance.
A GP who grosses CAD $400,000 in FFS billings and has 35% overhead takes home CAD $260,000 before tax. After personal income tax and CPP contributions, net take-home is approximately CAD $170,000–$190,000. This is still significantly more than most UK GP incomes — but it's not the $400K headline number.
The overhead trap for UK doctors: Signing a clinic association agreement without understanding the overhead split. Some clinics charge 30% overhead on all billings; others charge 40%+. The difference on $400K gross is $40,000/year. Negotiate this before you start.
Practical first steps
Before you start practising: Get a billing number from your provincial ministry. Without it, you can't bill. Apply as soon as you have your licence — processing takes 2–6 weeks.
In your first month: Find a billing mentor — a Canadian GP who can review your billing for the first few weeks and identify codes you're missing. Many clinics have experienced MOAs who handle billing; build a good relationship with yours.
Consider a billing service. Services like Dr.Bill (Ontario/BC) handle claim submission, rejection management, and reconciliation. The cost (typically 2–3% of billings) is worth it while you're learning the system.
Track your billings weekly. Compare your daily patient volume to your billing submissions. If there's a gap, you're leaving money on the table.
iatroX supports doctors moving to Canada with a MCCQE1 qbank and AI clinical search for evidence-based clinical decision-making. Built by a practising NHS GP.