Open Compensation Reports · July 12, 2026

Which medical specialty pays the most in Canada?

Two provinces publish what they pay each physician, and the same specialties top both lists. The common thread is not the scalpel. It is volume.

A BC ophthalmologist billed a median of $1.19 million in 2024. A BC internist, same year, billed less than half that. Both trained for a decade, both are specialists, both are paid by the same public insurer. The gap between them is the single biggest fact in Canadian physician pay, and it barely gets discussed.

Using the payment disclosures from British Columbia and Manitoba, here is the full ranking. Toggle between provinces: the striking thing is how little the order changes.

Median billings by specialty

BC Blue Book (MSP), 2024. Gross billings before overhead.

#	Specialty	Median billings	Physicians
1	Ophthalmology	$1,187,999	193
2	Cardiology	$945,459	163
3	Gastroenterology	$774,242	82
4	Otolaryngology (ENT)	$771,834	64
5	Urology	$759,827	74
6	Family medicine	$704,097	662
7	General practice	$667,142	115
8	Critical care	$642,935	33
9	Anesthesiology	$613,899	106
10	Plastic surgery	$602,498	43
11	Orthopedic surgery	$593,685	124
12	Neurosurgery	$588,226	27
13	Obstetrics & gynecology	$567,094	161
14	Cardiac surgery	$559,313	24
15	Internal medicine	$554,887	402
16	Endocrinology	$539,040	42
17	Dermatology	$535,949	47
18	Physical medicine	$487,132	20

Cell shading scales with the median. Highest and lowest billings, $1188k to $487k.

The pattern: volume pays

The top of both lists shares one trait, and it is not surgery. Ophthalmology (cataracts), cardiology (catheterizations and imaging), gastroenterology (endoscopy), ENT, urology, and diagnostic radiology all bill in high-volume discrete units: a procedure, a scope, an image read, each one a separate charge. The workday is a conveyor belt of billable events.

Radiology is the tell. A radiologist never enters an operating room, yet diagnostic radiology tops Manitoba's list, because reading hundreds of studies a day is the purest form of high-throughput, per-unit billing there is. It is emphatically a thinking specialty, and it pays like a top procedural one, which is the clue that the real driver is not cutting. It is throughput.

The bottom of the list is time. Internal medicine, endocrinology, and clinical immunology are consultation specialties whose core work is a long, complex visit that bills once. An endocrinologist can spend an hour untangling a difficult diabetes case and bill a fraction of what an ophthalmologist bills for an hour of back-to-back cataracts. Fee-for-service rewards the number of billable events, and a careful hour is one event.

Two provinces, one ranking

The clearest evidence that this is structural, not local, is the agreement between provinces. Ophthalmology, cardiology, and gastroenterology sit at or near the top of both BC and Manitoba. Internal medicine sits near the bottom of both. The provinces set their own fee schedules independently, yet the specialty hierarchy is nearly identical, because both reward the same thing: billable volume over billable time. (Diagnostic radiology is classified differently in BC's data, so it is not directly comparable across the two provinces, but where it appears it sits near the top.)

The number is not take-home pay

One honest caveat runs through all of this: these are gross billings, not income. The specialties at the top often carry the highest overhead. An ophthalmologist or radiologist pays for imaging equipment, surgical suites, and technical staff out of that gross number, so the ranking of take-home pay is flatter than the ranking of billings. A family doctor billing $704,000 with low overhead can net closer to a specialist billing more than that suggests. Payments also exclude salaried and alternate-funded physicians, who are common in some hospital-based specialties.

Still, the message to a medical student choosing a residency is blunt and consistent across the country: bill in volume. The specialties that pay most are the ones where a day is many small charges, a scan, a scope, a procedure, rather than a few long, careful visits. Whether a health system should pay a fast hand or a fast eye more than a careful hour is a different question, and a good one.

Explore the data

Method notes

Medians of gross fee-for-service payments per physician, by primary specialty, for specialties with a usable sample (BC n≥20, Manitoba n≥15). BC from the Medical Services Commission Blue Book (2024); Manitoba from Manitoba Health (fiscal 2024-25). Payments are gross, before overhead, and exclude salaried and alternate-funded physicians. Specialty labels follow each province's own classification.