Monthly Archives: April 2015

Do U.S. physicians practicing in Canada need to worry about the IRS?

If you’re a U.S. physician living and working here in Canada, you might think Uncle Sam isn’t much of a concern. But what about the IRS? Can they force you to pay taxes to a country where you’re no longer living?

More than one million U.S. citizens living in Canada are facing double tax troubles because of the recent IRS crackdown. Don’t panic, however, because Canadian law has a firewall to help U.S. citizens living in Canada.

If you aren’t up to date on your U.S. taxes and the IRS gets wind of the fact that you sold a home, they may come after you for U.S. taxes as a result of the house sale.

As part of the Canada-U.S. Tax Treaty, the Canada Revenue Agency won’t help the IRS shake you down for the money as long as you were a Canadian citizen at the time the debt came up.

The IRS also can’t seize any of your Canadian assets without first getting permission from a Canadian court — and there’s a precedent that will protect you.

H/T Financial Post via Charles W. Cullen III, CFP®, CIM®

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Doctors trained in LGBT health not always available

Many members of the LGBT community admit they avoid seeking medical attention because of fear of discrimination. But when they do decide to discuss an issue with a doctor, it’s quite possible that the doctor hasn’t been adequately trained to meet their needs.

The results of a study at UCLA show that a “startling low” number of academic medical practices identify “LGBT competent” physicians. This competency means the doctor has received specialized training in how to respectfully interact with an LGBT patient, as well as how to take their medical and sexual history, perform exams, and support with them psychosocial or behavioural issues.

Out of the 138 academic faculty practices involved in the study, 32 per cent of the physicians had LGBT training — and only 9 per cent of the faculties had systems in place to properly care for LGBT patients.

More than 3 per cent of the U.S. population identifies as LGBT, and these individuals have a higher chance of mental disorders — making it critical for them to find timely, supportive medical care.

However, 80 per cent of the physicians responded that they were interested in finding ways to better serve LGBT patients, and study’s senior author is anticipating “a significant increase in procedures and training.”


Virtual healthcare programs growing rapidly

Telehealth services are still relatively new and controversial. There’s no denying the convenience of seeing a doctor virtually — no sitting in a waiting room, or even leaving the house — but there are also questions about the quality of care that can be obtained through a screen.

But these programs are gaining traction throughout the U.S. and Canada as patients and physicians look for new, better ways to connect. In Vancouver, patients can meet with physicians virtually with the help of a medical assistant who collects vital signs, heartbeat, lung sounds, and other data. The appointments can take place in the patient’s home, or in a nearby telemedicine clinic, and the physician speaks with the patient in real-time.

Many believe the Veterans Administration telehealth platform to be “the ideal model for telemedicine.” In 2014, they served more than 690,000 veterans through more than 2,000,000 telehealth visits. More than half of the veterans were living in rural areas with limited healthcare, so it make sense for everyone if they could obtain medical consultation virtually.

The telehealth program has a 94 per cent approval rating from patients, and reduces office visits by 34 per cent. It’s especially helpful in mental health cases, as its patients have demonstrated lower scores on post-traumatic diagnostic scales than they did prior to their telehealth sessions.

Despite the glowing reviews, not everyone is intrigued by the idea of telehealth.

Earlier this month, Arkansas rejected a bill that would have allowed physicians in the state to offer video-based care. Opponents claimed patients deserved “face-to-face” medical care, and there is still a bill under consideration that would allow telemedicine services after an in-person meeting between a doctor and patient.

The American Telemedicine Association is starting the process of establishing accreditation standards to ensure consistent service and a high standard of care. They are also working on establishing a national licensing system so telemedicine can cross state lines.


New project will speed up credential recognition for international medical graduates

Moving to Canada and securing work as a physician can be extremely challenging, according to Canada’s minister of employment and social development, Pierre Poilievre.

Based on a new report by the Panel on Employment Challenges of New Canadians, Poilievre says many new Canadians have trouble getting their qualifications recognized. Other problems include lacking relevant Canadian work experience, or having inadequate pre-arrival information.

The minister recently announced funding for two new projects that will help international medical graduates have their credentials recognized more quickly.

The panel’s report recommended that each occupation develop a single national standard — as well as a point of contact — for skilled immigrants, so it’s easier for them to transition into meaningful employment. It also discussed the importance of producing better, more coordinated labour market information for newcomers. Poilievre has promised to review the panel’s recommendations.


Government regulation forcing family doctors out of Ontario

Michael Verbora has been completing his residency training with a family health team in Toronto for the last two years, but a new government maneuver won’t permit him to work there — or in Windsor, where he grew up.

The provincial government had been trying to move away from the fee-for-service model that rushed patients through the system as quickly — and cheaply — as possible, by building family health teams that include doctors, nurses, social workers, dieticians, and other health professionals.

There are more upfront costs for a family health team, but they save money in the long run because patients receive a high quality of care, and are less likely to develop chronic diseases.

It appears the government has changed its mind, however, as they limit access to family health teams while they review what under-serviced areas needed expanded health teams the most. New doctors have the option to set up a practice under the old fee-for-service model, or take over for a retiring doctor.

More than 500 new family doctors will finish their residency training in June, and many are expected to leave for other provinces — or even the U.S.

Verbora describes the move as “frustrating” and says he’s “overwhelmed.” He is now considering a move to B.C. or Alberta, rather than stay in Ontario to perform fee-for-service medicine.

According to the Windsor Star, approximately 900,000 Ontario residents don’t have a family doctor.

Many physicians in Ontario — such as Dr. Jen Bondy, who works at a family health team — are concerned that the government is “stepping backwards, as opposed to moving ahead.”

H/T The Windsor Star

Tough for small communities to attract, retain physicians

Many rural areas find it difficult to attract doctors, but it can be even harder to keep them.

The city of Powell River, B.C. has introduced a program called “A GP for Me,” which aims to help interested patients have access to a family doctor.

There are close to 5,000 people in Powell River who do have a family doctor — out of the population of 16,000.

Dr. Bruce Hobson, chair of the Powell River Division of Family Practice, says they had been successful in bringing family doctors to the area but they haven’t been as lucky about retaining them.

He says many of the doctors who have come to Powell River have been international medical graduates who didn’t have much of a choice, and didn’t want to stay in a rural community for long.

Other family doctors have left because their spouses couldn’t find employment in Powell River.

Hobson says the community needs to figure out how to make doctors and their families feel welcome in the area.

Another option is having patients meet with a nurse practitioner who would straighten out their medical history and records, order tests, and “package” them so they are more appealing for a busy family physician to take on.

H/T PeakOnline

B.C. facing major family doctor shortage

Back in 2010, Health Minister Kevin Falcon announced that every British Columbia resident would have a family doctor by the year 2015. Yet today, more than 220,000 residents in B.C. still don’t have a family doctor.

They rely on walk-in clinics for treatment, which means they face long line-ups and lack the continuity of care that comes from having a family doctor. It’s especially hard on elderly patients, or people with chronic conditions, who are more likely to slide into illness.

The University of British Columbia increased their graduating class of medical students to 288, but experts say the province needs to be about 450 new physicians annually to meet the demands.

In an editorial in Tri-Cities Now, family doctors are described as “the backbone of the medical system,” though they often lack the praise rained down on surgeons who save lives on a daily basis.

H/T Tri-Cities Now

A pharmacist responds to the notion of “playing doctor”

In pharmacist Andrew Schonbe’s response to a recent op-ed from Dr. Edwin Kruys, 5 little-known reasons why pharmacists should not be playing doctor, he fought back against Krys for “challenging progress and advancement in the expanded scope of pharmacy practice.”

Schonbe described the piece as “alarming, albeit not surprising,” as well as “insulting” and “self-righteous,” and proceeded to go through Krys’ claims one at a time.

Kruys wrote that pharmacists “want to be doctors” or “want to be paid for what they think are the easy parts of the doctor’s job,” but Schonbe responded that that isn’t the case. He says it’s a matter of identifying any potential overlap in skills and training, and expanding a pharmacist’s scope accordingly.

When a patient comes to their doctor to have a prescription refilled, he said he believes that’s “a valuable opportunity for a family doctor to screen for, and treat health issues before they escalate.” Schonbe agrees that patients see their doctor for quality medical care — “not just a slip of paper” — and suggests implementing a system where a prescription could indicate if a patient should get all new scripts from their doctor directly, or if a pharmacist is authorized to issue a refill.

Kruys’ op-ed compared pharmacists having a larger role in medicine to someone buying a book on law and representing themselves in court. Schonbe described this view as “misguided,” and suggested it originated more from “a feeling of personal superiority than logic and reason.”

Kruys’ conclusion was that pharmacists “playing doctor” would hinder general practitioners in the delivery of care, and eventually increase costs. Schonbe agreed that there were concerns and limitations to expanding the scope of pharmacists, but said there needs to be “an open and respectful conversation” without insults or negativity to an entire profession.

H/T Medical Post

New doctors choosing part-time practices in southern Ontario

A quickly-growing region of southern Ontario is taking action to attract new family physicians.

Ontario’s Halton Region — which includes the City of Burlington, and the towns of Halton Hills, Milton, and Oakville — has new hospitals opening, and officials say it’s a place both new and established physicians want to “put down roots.”

Halton began a physician recruitment and marketing program in 2003, which has led to 219 family physicians establishing practices in the area so far — 85 in Burlington, 65 in Oakville, 40 in Milton, and 29 in Halton Hills.

Halton officials have identified a trend in physicians choosing to set up part-time family practices — which allows them time to also work in hospitals, long-term care facilities, and smaller clinics specializing in sexual health, sports medicine, or psychotherapy.

Out of the 11 family medicine residents who graduated from the McMaster Halton Family Health Centre, five of them have stayed in Halton to open practices.

Halton is also proving itself to be a popular spot for international medical graduates. Half of the area’s family physicians that have been recruited since 2011 went to medical school outside of Canada.

The area’s need for new physicians is expected to grow over the next two years, as the population booms and existing doctors retire or reduce their hours.