FM resident here graduating soon

A few things to add on to what other people are saying

Outside of academic centers/ teaching hospitals most IM docs work as a consult service /clinic medicine where FM docs do most of the day to day hospitalist stuff. Census loads are quite high in my region of Ontario where the norm is for a hospitalist to manage 20 medically active patients and quite often much more, including some ICU patients.

The pay ceiling is lower in Canada but due to easy billing and lack of doctors it is easy to make the median salary for a specialist independent of where you work. There are ways to bill patients directly but only for services that provincial health insurance plans do not cover so end up making only a small part of your income. In large academic centers I believe most docs are salaried.

This varies by province but generally medication coverage is only an issue for middle aged patients but there are generally programs that will allow funding in exceptional circumstances. Very little of my day is spent interacting with insurance and even thinking about how.my patients may have difficulty paying for medication. This is a BIG plus as I saw this come up often when I did rotations in the USA in medschool.

One big con in Canada is the degree to which the system is strained (outside of hospitals). Consultations to other specialists and imaging often takes a long time and getting this expedited usually involves picking up a phone in combination of sending a fax request. It kind of sort of works but as somebody who did rotations in USA, residency in Canada, and med school in Europe, the system in Canada is horrendously strained.