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Monthly Archives: November 2013

U.S. Citizens in Canada – Mutual Funds and RRSP v.s. IRA

Mutual Funds – U.S. citizens generally should be cautious when owning mutual funds in a foreign country (like Canada).  They are typically classified as U.S. Passive Foreign Investment Companies (PFIC).  Usually, the onerous reporting and taxation can be excessive.  Fortunately, Dimensional Fund Advisors is one of a handful of fund companies to offer the Annual Information Statement to enable U.S. citizens to own the fund without punitive tax implications.  They can be a core component for a U.S. citizen’s portfolio.

RRSP vs. Traditional IRA – Individuals who have moved from the U.S. to Canada often attempt to “transfer” their Traditional IRAs to an RRSP in Canada.  Before this is done, a cross border accountant should examine the potential transaction.  Additionally, there are important differences between a Canadian RRSP and a Traditional IRA that need to be considered from a financial planning standpoint.

a. RRSPs, at age 71, are required to be converted to a RRIF, which must be withdrawn at a much faster rate than an IRA.  In the first year, 7.5% of the RRIF must be withdrawn.  For an IRA, only 3.6% must be withdrawn.  The RRIF will be depleted much more quickly.

b. A beneficiary who is not a spouse will cause full taxation of an RRSP, whereas an inherited IRA can be withdrawn over the recipient’s lifetime.  As an example, the last surviving parent leaves an RRSP to her son.  It will be fully taxable.  If it were an IRA, the distributions can be spread over the recipient’s lifetime.

To learn more about protecting your wealth when crossing international borders we encourage you to contact CanAm’s Investment Adviser Affiliate, Charles W. Cullen III, CFP® – click this link now – http://dir.rbcinvestments.com/charles.cullen.

Family Physician Job Posting of the Month – Edmonton, Alberta, Canada

 

Clareview Medical Clinic

3504-A 137Ave NW, T5Y 1Y7

Edmonton, Alberta, Canada

EdmontonSkyline2013 

This is your chance to live in a Canadian city ranked among the best places to live in North America. It is a city with education and arts as the center of its cultural life, an outstanding place to raise a family, earn excellent income and enjoy a very comfortable lifestyle.

Edmonton Lifestyle: 

a)      Edmonton is a vibrant, energetic city at once diverse and highly connected by a welcoming sense of community. Northeast Edmonton has the advantage of easy access to shopping, cultural events, youth activities and the downtown, while still providing families with space and autonomy. The public school system second to none featuring a wide variety of programs and extracurricular activities, including sports, the arts, hobbies, and academic pursuits.

b)      Post-secondary education opportunities include the renowned University of Alberta, Grant McEwan College, and Northern Alberta Institute of Technology (NAIT).

c)      Edmonton lives up to its name as the “Festival City” of Canada! Events include the Fringe Festival (showcasing local theatre), Heritage Days (celebrating the city’s multiculturalism), Folk Festival, K-Days, and the Festival of Trees (charitable winter celebration) just to name a few…

d)      Edmonton is a highly diverse city, exemplified by the numerous religious, ethnic and cultural roots of its citizens. The city has hundreds of churches and religious buildings representing a wide variety of religious sects.

e)      With over 460 community parks, 17 recreation centres and dozens of sport fields, arenas, and swimming pools, families always have something to do.  The many indoor facilities ensure that most seasonal sports (cricket, soccer, basketball, lacrosse, etc.) and community activities are available year-round.

f)       Edmonton’s four distinct seasons ensure that youth and adults have boundless and diverse family activities and social pursuits.

EdmontonWestEndMall2013

g)      Professional sport fan?? Do you love the thrill and excitement of cheering on your favourite world class home team? Then plan to buy your season tickets now to cheer on the Edmonton Oilers of the National Hockey League, and/or the Edmonton Eskimos of the Canadian Football League.

h)      Edmonton’s Light-Rail Transit (LRT) system, supported our city-wide public bus transit system provides easy city-wide access. In addition, the Anthony Henday Ring Road highway encircles Edmonton and acts as a quick and easy route to travel from one end of the city to the other. Whether driving or using public transit, the average commute shouldn’t take more than 30-40 minutes.

i)        There is an abundance of quality child care, preschool, and after-school programs options throughout the city.

j)        Depending on size and area, an upscale 3 bedroom, 2500 ft2 home within city limits can range from $600,000 – $1 million.

k)      Edmonton weather changes with each of its 4 distinct seasons – from balmy, hazy summers, to busy harvest autumns, to classic Canadian chilly and snowy winters, finally assuaged by the warming longer days of spring promising a return to the lazy days of summer.

l)        While most outdoor festivals take place in the spring, summer, and autumn – most seasonal sports are also available year-round at numerous, well-appointed indoor venues. However this does not take away from the fact that Canadians still have a love of their outdoor autumn and winter activities, including football, hockey, skating, tobogganing, Nordic skiing, alpine skiing, snowmobiling, to name a few….

Work-life:

1)      Physician income is Fee-For-Service, with average annual income of $325,000+.

2)      Revenue is split 70% /30%, physician/clinic to cover capital costs and operating expenses.

3)      Average patient intake per hour ranges from 6-10 depending on individual physician work style and patient acuity.

4)      The on-call is shared by the physicians, and is not onerous.

5)      Patient records are electronic.

6)      The patient mix is currently 60% appointment and 40% walk-in patients.

7)      The patient population is a cross-section ranging from middle class to low income families, living in detached homes, apartments, and condominiums in the local area. The Clareview clinic is located in the densely populated Clareview community, on a major thoroughfare serviced by several transit bus routes.

8)      The clinic currently accommodates various medical students as part of their curriculum.

Incentives include:

– Practice setup assistance, and advertising.

– Immigration assistance and/or referrals for you and your family, if required.

– Medical licensing and credentialing assistance.

– Housing and travel assistance.

– Pre-approved Banking services.

Contact:

Phil Jost, HSM,MBA

VP Operations & Regional Manager

CanAm    Physician Recruiting Inc.

Office: 902-439-3400

Toll Free – Canada/USA: 866-446-4447

Email: phil@canamrecruiting.ca

www.canamrecruiting.com

UK NHS managers pump a further £150m more into emergency services this winter

It seems that Canada isn’t alone in its efforts to calm the Emergency Department ‘beast’, as the UK too must implement extra-ordinary measures to cope with public demand for EM services…

the UK’s CCGs will receive an extra £150m from NHS England to help hospitals cope with winter pressures in A&E departments.

The money will be in addition to the £500m the Government committed to ‘at-risk’ A&Es in August, which will cover this winter and the following year. It will be up to individual CCGs will decide on how to spend their allocations after consultations within urgent care working groups, the partnerships between hospitals, community and primary care clinicians, an NHS England statement said.

Some CCGs are likely to spend the money on A&E departments themselves, while others could introduce ideas for cutting the numbers of unnecessary visits to A&E, the statement added.

It suggested that some regions could appoint specialists with responsibilities for minimising unnecessary admissions of older people living in care homes, while walk-in centres and pharmacists could extend their opening hours, it said.

NHS England deputy chief executive Dame Barbara Hakin said: ‘This year we started preparing for winter earlier and we are monitoring the situation with great care to see what more might need to be done.’

Pulse, November 27, 2013 edition

ER wait times and caregiver support in Newfoundland and Labrador

In the Newfoundland and Labrador legislature Tuesday, NDP Leader Lorraine Michael asked about ER overcrowding at the Health Sciences Centre in St. John’s, and she said the problem has persisted despite an ER Wait Times Strategy launched last year. Health and Community Services Minister Susan Sullivan said “incredible progress” has been made, “but it does take time.” She also referenced the deployment of rapid response teams in the strategy to deal with the needs of seniors in the community instead of them being forced to turn up at the ER. Ms. Sullivan said four such teams, double the number originally envisioned, will be in place “very early in the New Year.”

This Wednesday, Progressive Conservative MLA Kevin Parsons reminded the minister she had told the House in June 2012 that the government was very close to finalizing a paid family caregiver program, and that it would be announced very soon. “That was seventeen months ago,” he said, asking the minister if she will announce details of the paid family caregiver pilot project by this Christmas. “I will,” Ms. Sullivan promised.

Patient off-loading ER waits in Manitoba

In the Manitoba legislature on Monday, Progressive Conservative Health Critic Cameron Friesen said the problem of lengthy patient off-load wait times at Winnipeg hospitals is getting steadily worse. The city, which runs the ambulance service, is fining the health region for waits of over an hour to offload patients because of hold-ups in the ER. He said that in the first eight months of this year the fines have totalled $1 million.

Health Minister Erin Selby pointed out that most patients are dealt with promptly, and she alluded to the role nurse practitioners play in seeing patients in other care settings. Manitoba celebrated its first Nurse Practitioners’ Day Monday, and Ms. Selby said NPs at the province’s four QuickCare clinics have seen 50,000 patients to date. “Nurse practitioners are a very important part of what we’re doing when it comes to emergency rooms and making sure that people are getting the care they need when they need it, the right care at the right time.”

ER overcrowding in Saskatchewan

In the Saskatchewan legislature the government has been questioned about the emergency department overcrowding situation in Regina. ER physician staffing levels at the two city hospitals are about a third lower than they should be, and the Regina Qu’Appelle health region is considering the necessity of reducing the number of hours at one of them in order to cope.

On Monday, Premier Brad Wall acknowledged that there are 26 funded positions for resuscitation-capable physicians but only 20 practicing. He said “there is a shortage of ER docs right across North America,” and said the government is aggressively recruiting doctors to deal with the issue. He pointed to the government’s record since taking office in doubling the number of residency positions and training seats, and expanding the number of countries from which foreign-trained doctors are accepted.

On Tuesday Health Minister Dustin Duncan said the government is pursuing a number of innovative strategies to deal with the issue including targeting the needs of frequent ED users to reduce traffic. The government has set a bold target of reducing all ED waits by 2017, and Mr. Duncan said a two-day meeting with emergency physicians took place last week on how the government is going to deliver on this promise.

Health Edition, November 21, 2013

Canadian Emergency physicians call for action

The Canadian Association of Emergency Physicians (CAEP) has released a position paper listing recommended national wait-time benchmarks for various stages of an emergency department visit. It also says hospital wait times for these benchmarks should be reported on a national basis, and performance linked to incentives and infrastructure investment.

The CAEP says the problem of ED overcrowding is getting worse despite efforts to deal with the situation and calls the situation a “public health crisis.” The position paper cites a number of international studies which indicate that patients run an increased risk of dying if they turn up at ED when it cannot cope with the traffic.

The CAEP wants 90 per cent of ED patients to have an initial physician assessment within three hours (median of one hour) and 90 per cent of admitted ED patients to be transferred to a hospital bed within eight hours (median of two hours).

The position paper also specifies ED lengths of stay for different levels of urgency.

The paper calls for a coordinated approach to dealing with the issue, saying overcrowded EDs lead to “access block” in the hospital with admitted patients not able to get a bed. The problem is exacerbated by elderly inpatients, ready for discharge, who are unnecessarily taking up a bed while waiting for a continuing care placement. This problem continues to increase every year, the CAEP says, and will get worse with an aging population and lengthening life expectancy.

The position paper is at http://caep.ca/sites/default/files/caep/PositionStatments/edoc_document_final_eng.pdf. Health Edition, Nov. 21, 1973

Canadian Study finds for-profit seniors’ care deficient.

Study finds for-profit seniors’ care deficient

 

Serious concerns about the state of elder care in Alberta have been raised in a report from the Parkland Institute in Edmonton. It found a significant gap in staffing levels between facilities, a situation that is “far more dire in for-profit facilities.” The report said that based on available evidence both within and outside the province, “for-profit elder care is inferior to care provided publicly or by a not-for-profit agency.” It said for-profit long-term care facilities, especially private assisted-living homes, are earning a high rate of return on their investments, and it urged the government to not only suspend subsidies and programs that benefit the for-profit sector, but phase out for-profit elder care altogether. The report, From Bad to Worse: Residential Elder Care in Alberta, can be found at http://s3-us-west-2.amazonaws.com/parkland-research-pdfs/ELDER_CARE_NOV_5_web.pdf.

It is now a Race Against the Clock to meet needs of aging population: CMA

Preparing for an aging population is a race against the clock, the Canadian Medical Association said in a pre-budget submission to the Commons Finance Committee Wednesday. The CMA wants Ottawa to invest in a pan-Canadian continuing care strategy focused on seniors. (Submission at www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Submissions/2013/Pre-Budget-Submission-2013-2014_en.pdf)

Family doctors grade Ottawa’s health-care performance

Family doctors grade Ottawa’s health-care performance

The College of Family Physicians of Canada has given the federal government poor grades for its involvement in health care.

In a report card released Wednesday, the College gave colour-coded scores for five areas “where the federal government has a role in making or keeping our health care system the very best possible to serve the needs of Canadians through all stages of life.”

These areas are: putting care front and centre; caring for the most vulnerable; having enough health care providers; establishing the vision for health care and measuring performance; and; supporting health care research.

Ottawa received just one top grade (green) denoting “strong leadership”. This is in establishing a National Homelessness Plan in 1999 and providing funds for a “housing first” approach in the last budget.

In all, there are 23 aspects of health-care involvement under the five headings, and aside from the one green grade, it received 14 yellows and eight reds. A yellow signifies that the government “is somewhat involved but could do more” and red means the government “has shown no involvement” and this requires immediate attention.

The eight reds are for:

• Lack of federal funding or guidance in supporting the Patient’s Medical Home model of team-based care
• No current National Immunization Strategy
(“Report card” from page 1)
• Lack of a National Home Care Program
• No National Poverty Plan
• Absence of a federal strategy on child and youth health issues such as mental health and obesity
• Failure to evolve national health goals created by federal-provincial-territorial health ministers in 2005 into a national strategy and measurable actions
• No federal funding for primary care

College President Dr. Marie-Dominique Beaulieu says the purpose of the score card is not to “scold” the federal government. Instead, it is to “highlight the specific areas in which the federal government should, in our opinion, assume a larger leadership role.”

The report card can be found at www.cfpc.ca/uploadedFiles/Health_Policy/_PDFs/CFPC_FederalReportCard2013_EN.pdf. Health Edition, November, 8, 2013.