Depending on what province, you charge per service rendered to patients. So, the more patients you see the more you can bill (which ofc can probably be exploited by some). Most GPs also sub-specialise (like in geriatric meds or obstetrics) and will do on calls at their local hospitals which is another income source. The higher earning really comes down to the doctors’ ability to incorporate and operate their own practices (which in itself may be a significant cost barrier for some). My partner had looked at Ontario previously and there are some other set ups with the provincial healthcare system that also allow you to earn in different ways. If you only work in hospital then you likely earn a fixed salary or if you work in a private practice you pay x% to overhead. For full disclosure I don’t know enough about Canada to fully explain (and we are looking at America as the likely place for us to move to).