The Real Cost of Chasing the Highest Percentage

A Guide for GPs Relocating to Canada

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Every week, we speak to GPs comparing clinic offers across Canada, and the conversation nearly always starts the same way: “What’s the split?”

It’s an understandable question. A UK GP coming from a salaried NHS role, or even a partnership, often has no real reference point for associate overhead arrangements. So the split becomes the headline number, and headline numbers get compared like price tags. 80/20 looks better than 70/30. 75/25 looks better than 70/30. The lower the overhead, the better the deal, surely.

Except it isn’t that simple, and getting this wrong can cost a GP a great deal more than a few percentage points.

Relocating to Canada? The percentage tells you almost nothing on its own

An overhead split is really shorthand for everything a clinic provides in exchange for that cut. From the reception and administrative staff, billing support, equipment, technology to the EMR systems, premises, management and a buffer for when something breaks or goes wrong. Squashing all of that into a single percentage makes it easy to compare on paper and very easy to compare badly, because two clinics offering the same split are rarely offering the same thing.

We’ve seen this play out directly. One of our GPs in Ontario took an 80/20 split over a 70/30 offer, on the logic that keeping 80% of billings was obviously the better financial outcome. In practice, the clinic offering 70/30 had a stronger support team, better technology and a fuller patient panel from day one. Over the year, our GP on the 70/30 split ended up earning somewhere in the region of $100,000 more than they would have done on the 80/20 arrangement, purely because the higher overhead bought a practice that let them see more patients, more efficiently, with far less admin sitting on their own desk.

The lesson isn’t that higher overhead is always better. It’s that the percentage is meaningless without knowing what it’s attached to. 20% of a poorly supported practice can easily be worth less than 30% of a well-run one.

What a 70 to 75% split is usually paying for

Across the clinics we work with from Ontario to British Columbia, the pattern tends to hold. The most supportive practices, the ones with genuinely good technology, experienced MOAs, proper billing support and enough staff that a GP isn’t fielding their own referral chasing, tend to sit around a 70 to 75% physician split rather than the more aggressively marketed 80/20 or better offers. That extra overhead isn’t disappearing. It’s funding the infrastructure that lets a GP actually be a GP, rather than an unpaid office manager on the side.

It’s also worth saying plainly, our most successful GPs, the ones with the fullest panels, the best patient outcomes and the longest tenures, are consistently the ones working within these more moderate splits. That’s not a coincidence.

Why the lowest offers cluster around new and struggling clinics

There’s a reason the most eye-catching splits tend to come from brand new clinics or ones actively trying to fill empty rooms. A newly built practice with unfilled capacity has every incentive to recruit cheaply, because an empty exam room earns nothing at all. A clinic that’s just lost a GP has every incentive to offer the next one a discount to stop the bleeding. Neither of those situations tells you what it actually costs to run a well-supported, comprehensive family practice over the long term. It tells you what that particular clinic is willing to accept today to fill a gap.

GPs relocating from the UK are especially exposed to this, because they’re seeing the job market rather than the settled market. Advertised vacancies disproportionately come from clinics that need someone urgently. A GP comparing three or four job ads has no easy way of knowing whether they’re looking at the sustainable going rate or a short-term recruitment incentive that may not hold once the panel fills up or a promised onboarding period ends.

The questions worth asking instead before Relocating to Canada

Rather than starting with “what’s the overhead,” it’s worth asking what that overhead is actually buying. How many support staff per physician, and how experienced are they? Is billing support included, and who chases rejected claims? Is the EMR and its ongoing licensing covered? What happens to panel payments, are they included in the split or on top? Who covers the clinic when staff are off sick, and who’s actually the medical director? And, perhaps most usefully, how long do the GPs who work there tend to stay?

None of this means a GP should assume expensive is automatically better. Some clinics genuinely are inefficient, and a lean, well-run practice on a lower split can be an excellent choice. But the percentage on its own tells you the recruiting price, not the value on offer, and conflating the two is how GPs end up disappointed, under-supported or, in the case above, quietly leaving hundreds of thousands of dollars on the table over the life of a contract.

Our role in this

Part of what we try to do at Menlo Park is help GPs look past the headline number before they sign anything, because the split that reads best on a job advert isn’t always the one that serves a career, a patient panel or a bank balance best over the following five or ten years.