Thanks Doc!

Most of the time, I can get as many hours of sleep as I want. I generally sleep about 6 hours a night, but it could easily be 8 or 9 if I so desired. When on call, this can obviously vary dramatically, but I do not need to be up in the middle of the night all that often. The number of patients who need surgery emergently in the middle of the night are relatively few, and much of the preliminary nighttime patient evaluation is done by residents and fellows.

The reality is that my 2 year-old daughter has a far more deleterious effect on my my sleep habits than my job does.

I guess this is a complicated question, but in reality, I did not make a decision to specifically seek employment in the US instead of Canada.

When I was finishing my training, I looked into the available opportunities without restricting myself to either side of the border, and found a good match at the University of Washington/Harborview Medical Center in Seattle. At the time, they were looking for a surgeon who had an interest in spine and extremity trauma, and I had just finished one-year post-residency fellowships in each of these specialties. My girlfriend at the time (a Canadian from Ottawa who is now my wife) happened to be living in Seattle. As an added bonus, Harborview was reputed to be one of the best orthopaedic trauma centers in the world. Given all these factors, taking the job was an easy decision.

I think there are advantages and disadvantages to practicing in either the American or Canadian systems. In Canada, I believe the primary challenges are posed by government regulation/bureaucracy and resource allocation. In the US, the bigger issues from a practice standpoint are the insurance bureaucracy and medicolegal circus. Overall, salaries are said to be higher in the US, but I think that may be somewhat overstated and depends on many factors, since many variables impact salary in both countries, such as location of practice, private vs academic practice, clinical volume, patient demographics, etc.

In academics I’m not sure that this generalization holds true. I know several Canadian colleagues who get paid more than the average US orthopaedic surgeon, so salary is not really much of a consideration in my decision to practice in the US. My Canadian and American colleagues also seem to be similar from the standpoint of job satisfaction. As a natural consequence of the above, if I were to change jobs in the future, I would not restrict myself to either country, and would investigate opportunities throughout North America.