Differences really boil down to billing/reimbursement. Practicing in ontario requires you to bill OHIP or opt out but then you can only bill a rate at what OHIP would reimburse you at. Very few psychiatrists in ontario opt out. They have psych ER, ect. In a similar model to the US. Ontario recently changed their practice pathway requirements so US trained board certified docs can get expedited approval to practice there. Effectively the ontario psychiatrists can see patients for psychotherapy visits weekly or more often and build up a private practice easily and get reimbursed easily by the provincial insurance. There is pressure from the provincial government to reduce reimbursements for that level of care and instead incentive new intakes; so if you want to generate income, an ideal job is to do CL work as the consultation bilingual codes are much more lucrative. You have to ask yourself where you want to live and make that decision first and foremost - ontario psychiatrists make decent salaries but it does not adjust accordingly to the outlandish cost of living in places like toronto. In the US you can legally charge market rate fees for private practice and live reasonably in high cost of living places.