Our pediatrician was being recruited by the Children's Hospital in Boston. He was being offered twice as much as OHIP paid him, but after he considered the cost of operating his office, cash flow issues due to unpaid bills, (5X the billing and collections staff), the liability insurance and incremental tax brackets (plus the cost of college for his kids) he figured he'd maybe net 5k more a year. With the risk of malpractice high in his field (as it is in most other fields in the US) he decided the whole thing was a waste of time. Canadian doctors have essentially no cash flow and minimal malpractice issues. The fact that they can no longer pay for their kids college out of their earnings at a low tax rate, or pay stay at home spouses for the privilege will not offset those items.