When people look up physician pay, they see one number. But a doctor’s salary by specialty in Canada isn’t one number — it’s the result of what happens to that number before it reaches them. The amount that lands in a physician's account depends on what they have to cover first, not the size of the top line.
Three factors to take into consideration when looking at a physician's income: how long training lasts, how the work gets paid, and how much overhead the practice carries. Two doctors can bill similar amounts and still keep very different sums after costs and taxes.
This article walks through what physician payment data covers and what it doesn’t account for. You will find a comparison table across several specialties, plus the single most misunderstood point in the whole topic: gross billings are not the same as take-home pay.
Why billings alone don't tell the whole story
The same gross billing figure can lead to very different take-home pay, depending on what has to be paid out of it first.
Consider three factors. Training length determines how many years pass before full earning begins, which affects overall lifetime earnings. The payment model determines how and when money arrives. Overhead determines how much of each billed dollar goes to rent, staff, and equipment before anything reaches the physician.
Keep these three in mind as you read the numbers below. They explain why a larger billing figure does not always mean a larger income.
Average physician payments by specialty in Canada
The table below shows CIHI per-full-time-equivalent (per-FTE) gross clinical payments for 2023–2024. These are gross figures, before overhead and taxes. Per-FTE is a workload-adjusted metric: physicians who bill less than a full-time load count as a fraction of a full-time physician. That's why these figures run higher than CIHI's simple per-physician averages (for example, $324,000 for family medicine), and the two shouldn't be compared directly.
Specialty | Typical training after medical school (years) | Average gross clinical payment, per-FTE (2023–2024) | Typical overhead | Rough sense of net (estimate) |
|---|---|---|---|---|
| Family medicine | 2 | $368,895 | Lower to moderate | Moderate share retained |
| Psychiatry | 5 | $345,129 | Lower — often hospital or clinic based | Higher share retained |
| Dermatology | 5 | $520,427 | Higher — office-based procedural | Lower share retained |
| Orthopaedic surgery | 5 | $538,172 | Lower — hospital based | Higher share retained |
| General surgery | 5 | $571,042 | Lower — hospital based | Higher share retained |
| Cardiology | 6–7 | $566,810 | Moderate | Moderate share retained |
| Ophthalmology | 5 | $907,381 | Higher — office-based procedural | Lower share retained |
These figures come from the Canadian Institute for Health Information (CIHI) National Physician Database (NPDB) for the 2023–2024 fiscal year. The overhead and net columns are qualitative on purpose. There is no current national dataset that reports precise net income by specialty, so the last two columns show direction, not dollars.
Two specialties are missing here for methodological reasons. Diagnostic radiology and other imaging and laboratory specialists are excluded from CIHI's average payment indicator. Anesthesiology is excluded from the per-FTE specialty indicator, because its payments are calculated using service counts rather than the standard method.
Why gross billings are not take-home pay
This is the point that many people overlook. The payment figures above are gross clinical payments. As CIHI states in its methodology, average payment calculations are based on gross payments to physicians and do not represent physicians' net incomes.
Gross billings flow to the practice, not the person. Before a physician keeps anything, the practice pays overhead: office rent, administrative staff, equipment, supplies, insurance, and software. What remains is professional income, and that will still need to be taxed.
How doctors get paid — fee-for-service, salary, and alternate funding
Payment models change both the size and the timing of income. In Canada, there are three broad approaches.
Fee-for-service: the physician bills a set fee for each service delivered, so income scales with volume.
Salary or contract: the physician earns a fixed amount, often through a hospital or health authority.
Alternate or blended funding: payment combines base amounts, per-patient (capitated) funding, and some fee-for-service.
The model matters because it changes how predictable income is and how closely it tracks patient volume.
How training length changes the math
Every extra year of training is a year before full practice income begins. That timing affects lifetime finances as much as the annual figure does.
Family medicine requires two years of residency after medical school, certified through the College of Family Physicians of Canada (CFPC). Many Royal College specialties — including psychiatry, general surgery, dermatology, ophthalmology, orthopaedic surgery, diagnostic radiology, and anesthesiology — require five years each. Cardiology typically takes six to seven years in total, combining internal medicine core training with subspecialty years.
A longer path can delay earning, saving, and paying down education costs. A higher annual figure later does not automatically offset those earlier years, so training length belongs in any honest comparison.
Why the same specialty can pay very differently
Two physicians in the same specialty can report very different figures. Several factors drive the gap.
Hours and workload: per-FTE figures adjust for this, but real schedules still vary widely.
Setting: office-based practices carry different overhead than hospital-based work.
Province and payment schedule: fee schedules and funding models differ across the country.
Procedural mix: some work within a specialty bills at higher rates than other work.
Overhead can reorder this list entirely.
How to read a physician pay figure
When you see a physician’s pay number, run through this checklist before drawing conclusions.
Gross or net: confirm whether the figure is before or after overhead and taxes. Most published numbers are gross.
Per-physician or per-FTE: these are different metrics and should not be compared directly.
Fiscal year: check the year, since payments shift over time.
Source and coverage: note who published it and which specialties are included or excluded.
Payment model: fee-for-service, salary, and blended funding behave differently.
Overhead context: office-based work often carries higher overhead than hospital-based work.
For context on the overall scale, CIHI reported total clinical payments of $34.6 billion in 2023–2024, up 6.5%, with the average payment per physician up 3.9% to $383,000.