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Monthly Archives: May 2015

PEI Medical College Denying Young Canadian Doctors License to Work on PEI

A Canadian medical student, due to the lack of Canadian medical school seats, chose to obtain her Medical Degree in an English program offered outside of Canada. Due to the medical school’s American affiliation, she was able to complete the final two years of medical school and three-year post-graduate training in Family Medicine in the USA. In addition, she will be eligible for full certification as a Canadian Family Physician, without the need to write any further Canadian exams effective in June 2015.

Why can’t a young anglophone, Canadian-born citizen, who is eligible for full Canadian certification as a Family Physician, be licensed to work on PEI? Because, although approved by the World Health Organization (WHO), the English medical school she attended was not listed on the recent English Proficiency Policy adopted by the Federation of Medical Regulatory Authorities of Canada (FMRAC) and the College of Physicians and Surgeons of PEI.

We fully understand the spirit of the PEI College’s policy is to ensure that physician candidates, whose first language is not English, have a sufficient command of the English language to be able to provide safe, high-quality patient care to Islanders. Unfortunately, not every policy can be written to cover all relevant scenarios. In this case, an anglophone Canadian who chose to obtain her medical education outside of Canada is being unfairly discriminated by a rigid, literal translation of the FMRAC and PEI College policy.

A common sense review of this Canadian’s heritage and stellar academic credentials leaves little doubt regarding her exemplary command of the English language. Every senior administrator knows that policies are guidelines to facilitate decision-making across large organizations. However, when there is an unusual exception to the policy that clearly can be resolved by a common sense review of the circumstances, a common sense executive decision should be all that is required.

Unfortunately, in this case due to treatment she received from the PEI College, the physician withdrew her application to work in Summerside on May 6, and was approved for licensure in another Canadian province 48 hours later.

In summary, it is regrettable that common sense really isn’t that common — and in this case current policy denies qualified young doctors the opportunity to experience the Island’s vibrant lifestyle.

CanAm introduces new summer student, Laura MacLeod

laura-macleod

Armed with a degree in International Development Studies and working towards her Diploma in International Business and Trade, bilingual Laura MacLeod is ready to make an impact as CanAm’s new summer student.

Laura graduated from Saint Mary’s University with a Bachelor of Arts in International Development Studies, which included a double minor in Business and French, and one semester abroad at l’Université Catholique de l’Ouest. She also holds a French Language DELF Certificate Diplome d’Etudes en Langue Française (DELF) from Alliance Française.

Laura is working towards her Advanced Diploma in International Business and Trade from NSCC, where she is excelling in International Market Evaluation, Global Supply Chain Management, International Trade Finance, Exporter Supper & Online Operations, and International Marketing.

She recently joined the CanAm team as our bilingual summer student, and will spend the next several months training with us as a Business Manager. She’ll return to us in January for a four-month internship before her graduation in June.

Physician’s Maximizing Cash Flow and Reducing Debt as an Incorporated Professional

Article by: David Bluteau and Darren Caseley

Do you know the secret to financial success? Maximizing cash flow & reducing your debt as an incorporated professional. Getting there is within your reach if you know the steps to take.

You already know the golden rule of financial success – “spend below your level of income”. Easy enough to understand. The tough part can be putting it into practice as we all live our lives.

The really good news – Incorporated Professionals can get a Turbo Boost in this department, meaning more dollars stay in your pocket. And everyone’s situation is different, so you must first discuss these strategies with your own tax professional or Chartered Accountant to ensure they make sense for you and your family.

Most physicians see a similar path: finish residency, start your practice, incorporate, pay down student debt, pay down the mortgage, start saving – then retire wealthy, healthy and happy. Seems simple enough… so are you ready to do it?

You may know the book The Secret, by Rhonda Byrne. In a nutshell it discusses the process of focusing on the things you want in life to achieve success. The problem is: The Secret only gives you half the picture.

Yes, you have to establish goals and priorities however you also have to DO something to realize those goals: TAKE ACTION. The “doing” part may be unique for everyone, but know this: Inaction will yield few results.

Start with the end in mind. Look at the goals you want to reach. Thirty-something aged physicians often have two immediate goals – paying down debts, and keeping taxes low.

Let’s address these two important challenges:

  1. Goal: keep your taxes low. A good tip – keeping your taxes low is a no-brainer to keeping more cash in your own pocket. Earning income as a “company” rather than as an “individual” can go a long way to making this happen. The bottom line is this – your personal corporation is taxed at lower rates, and then gives you flexibility on how to withdraw your personal income from your company.
  2. Goal: reduce your debts fast. A good tip – there is a right way and a wrong way to eliminate your loans and your mortgage. It’s not always just about a low rate, and pre-payment options. Your advisor can compare all-in-one programs to see how you could benefit, and potentially supercharge your debt-elimination. Many have the potential to save tens of thousands. Only selected banks have true all-in-one programs.

The overall theme here: Maximizing cash flow comes down to reducing the amount of taxes you must pay. As a professional in Nova Scotia, this is one of the main challenges you face: How do you structure your practice income to minimize taxes?

Your tax accountant and investment advisor should always help guide you, and you should judge the caliber of their advice by how well your income is planned and implemented. All too often, professionals feel like they have been left on their own to manage this very important task.

Here are three effective strategies to move you toward your goals:

  1. The “No RRSP” Option

Consider drawing income from your Medical Company (Medco) only in the form of dividends. Do not take any salary. Dividends receive preferential tax treatment. Your average tax rate will be lower, your estate has the potential to save significant taxes, and both you and your Medco will not be required to pay into the CPP. Without salary income, all retirement savings are retained in your Medco, not RRSPs.

This strategy will not be for everyone: You must be a responsible saver, and your Family Trust must be structured for discretionary distributions. Call us for a cost/benefit analysis to see if this is a fit for you. There are variations on this strategy that could work as well.

  1. Income Splitting

Reduce taxes further with income splitting. Adult family members, such as your spouse or your children, can be made shareholders of your Medco and they can receive discretionary dividends. This could provide additional savings for your family. For example: your spouse or a child in university with little or no other income could receive dividends, and take advantage of a lower tax rate. As well, if a family member does bookkeeping or other work for your practice, then consider paying them a reasonable salary. Discuss what is “reasonable” with your accountant.

  1. Income Planning

As an incorporated professional you have choice in how you draw income: salary, dividends, or even withdrawals from personal investments. Properly structuring your cash flow is the key ingredient to tax efficiency. You should know the best method to take income from your Medco.

No matter what – remember this: Primum non nocere: First, Do No Harm … and do no financial harm to yourself!

A high income does not automatically lead to wealth!

All physicians have their own story of why they became a doctor, and most have the same common theme – a desire to help others or to give back to medicine.

It takes discipline and dedication to become a doctor. At some point you set this as a goal in your mind, and you followed the required steps to achieve that goal. You had a plan.

So, why do so most physicians not have a plan for their financial future?

Author and researcher Thomas J. Stanley in The Millionaire Next Door gives us the following facts about physicians:

  • You dedicate huge amounts of time to serving patients (most work 10 hour days).
  • You are generally unselfish, giving a higher percentage of your income to noble causes than other high-income earners.
  • You do earn higher than average income.
  • However, physicians in general do not tend to be wealth accumulators.

A high income does not automatically lead to wealth. This is a fact!

The problem is: Your focus is on medicine – as it should be. Taxes, wealth goals, investments, cash-flow, CRA, etc.; Delegate these tasks to an advisor you trust, with experience in working with incorporated professionals to assist you.

Take a look at your plan. Do you have a written plan? Do you have clearly established goals? What is your time-line? How are you measuring your financial progress? If your investment returns are poor, have you been shown how this will impact your investment plan and your goals?

If you hesitate in answering these questions, you can call or email to participate in a Private Cash-Flow Strategy Session; a personal session where you will:

  • Uncover obstacles that are limiting cash-flow today.
  • Identify key strategies to maximize cash-flow.
  • Create an action plan to help you reduce your debt costs, minimize taxes, & increase your net-worth.

Maximize your cash flow by using these, and more, benefits of an incorporated practice.

The Bluteau DeVenney Caseley Wealth Management Group of National Bank Financial

is the Family-Office for Incorporated Physicians.

www.BluteauDevenneyCaseley.com

Why a U.S. doctor shut down her practice to move to Canada

More and more U.S. physicians are packing up and moving across the border to Canada. According to the Canadian Institute for Health Information, Canada is gaining more physicians and it’s losing, which is great news.

Dr. Emily S. Queenan decided to close down her practice in Rochester, New York, and move to Canada because she’s tired of battling the private health insurance industry in the U.S.

One out of every 14 claims was paid incorrectly, up to five per cent of the payments were outright denied, and the paperwork alone took up about 16 per cent of her working hour. She said it broke her heart to see her patients struggle to pay their bills, and said “the emotional stress was too great.”

Dr. Queenan investigated Canada’s healthcare system and liked that she didn’t have to sacrifice her family medicine career because of the “dysfunctional system” on her side of the border. She and her family are moving to Penetanguishene, Ontario (on the tip of Georgian Bay), where she will start and grow her own practice again.

H/T Toronto Star

JOB POSTING: Family Medicine / GP

Family Medicine / GP
Family Physician $300K+/Year

Job ID: 941

LOCATION ON, Canada PLACEMENT Permanent
START DATE 2015/05/04

Located two and a half hours north of Toronto in the heart of cottage country, this small community has much to offer an incoming physician. Great income potential with living expenses much lower than large city prices.

Practice Overview

  • One of two existing Family Physicians leaving August 1st for family reasons and the incumbent physician can inherit 1,500 – 2,000 patients
  • Patients are mostly elderly and there is potential to take on more patients if wanted
  • Rent, hydro and other overhead expenses are covered by the municipality
  • Clinic has EMR
  • The only expense to the physician is to assume the cost of a dedicated receptionist who is already working there and familiar with the set-up

Remuneration

  • This is a fee-for-service opportunity where you keep 100% of your billings
  • Location qualifies for Underserviced Area Grant by MOH of $80K payable over 4 years
  • Incumbent can make $300K+ working a moderate schedule

Learn more: https://www.canamrecruiting.com/ViewJob.php?JobID=941

Guiding a doctor’s professional identity to prevent burnout

The medical community is suddenly interested in the concept that perhaps the way a person decides to go into medicine indicates their likelihood of “burnout, cynicism, and ethical decay.”

In a special june issue of Academic Medicine, there were 23 pages dedicated to the subject. Those who lacked “a deep personal clarify and commitment of purpose” are said to be more susceptible to the stresses of physician life.

The trouble is that a medical school education can weaken an aspiring doctor’s connection between what they’re doing and their original motivation to care for patients.

“[As a doctor you are] trying to remain your authentic self, that beautiful self that chose this amazing career, this profession that has a calling to help the sick—what a privilege—and to hold onto the humanized person that you are so you don’t become dehumanized and then dehumanize the patient,” said medical educator and clinical psychologist Hedy Wald, who guest-edited the special issue.

Read more: http://medicalxpress.com/news/2015-04-medical-professional-identity-burnout.html

H/T Medical XPress

What is the future of family medicine in Canada?

Family medicine is changing quickly across Canada, as nurses discharge patients from hospitals, emergency attendants are replacing doctors in community emergency centres, and pharmacists take care of vaccinations and prescription refills.

While it may sound like those changes are freeing up a family doctor from “trivial” appointments, they’re actually making their job harder – and cutting into their income.

A family practitioner and ER physician in Nova Scotia, who wishes to remain anonymous, says many of his colleagues are complaining of burnout because they’re lacking the reprieve that comes with the “easy” appointments.

“We’re left with only the more complex cases, which makes for a fuller, more intense schedule – more than anything we’ve seen in the history of family medicine,” says the physician. “People like a balanced workday, no matter what you do. If every patient you see is a complex case, the burnout will hit you more quickly.”

“It’s like doing the heaviest of labour all day long, and never getting to pick up anything light. That’s how family doctors are feeling.”

When the changes came down the pike originally, the physician remembers thinking “We’re going to lose our quarterback here.”

“It feels like the family doctor could have less responsibility, and be shouting order to a team of people from the sidelines,” he says.

Dr. Francine Lemire, Executive Director and CEO, College of Family Physicians of Canada, supports this move towards team-based care, describing it as “a welcome addition.”

“We feel that given the increasingly complexities that many of our patients present with, and patients living longer with core morbidities and several coexisting medical problems, the family physician is often no longer able to do it all by himself or herself,” says Dr. Lemire.

She says avoiding isolation is key, and that incorporating other healthcare providers into a practice prevents a family doctor from “feeling alone in providing what is quite complex care.”

“A practice made up of family physicians working with other providers — that really is the ideal model,” says Dr. Lemire.

The College of Family Physicians of Canada is promoting The Patient’s Medical Home – a family practice is transformed into a patient-centred space where patients feel most comfortable discussing personal and family health concerns.

The 10 goals are providing patient-centred care, having the family doctor as the most responsible care provider, giving patients access to a broad scope of services carried out by teams of providers, timely access to appointments and services, comprehensive care, continuity of care, electronic medical records, access to research, regular evaluations and quality improvement, and internal and external support.

While The Patient’s Medical Home is a team-based environment, Dr. Lemire says it’s important for family practice teams to have a family doctor as “the most responsible provider.”

“There is data emerging that shows the importance of attachment for better care, and better outcomes for chronic conditions,” says Dr. Lemire. “Balance is important in terms of looking at a physician’s work day, but it’s also enabling them to get a better understanding of their situation, understanding the context of life for those patients, and getting to know their family.”

Dr. Lemire practiced in Newfoundland for nearly 25 years, and says she still runs into former patients when she goes home for visits.

“I’ll see them at the supermarket or at the ski hill, and I know that when we see each other, we have the same kind of flashing back in our minds,” says Dr. Lemire. “I think about key moments in their life that I had the privilege to be a part of, like delivering their babies.”

Many family doctors enter the field because they desire to build a connection with their patients, and the new changes will require them to share that responsibility with colleagues. Some doctors believe these changes will prompt fewer students to go into family medicine, but Dr. Lemire says 38 percent of medical students are currently choosing that path – which remains about the same as last year.

“I think they recognize that it remains an attractive career, with many opportunities for employment and doing good work,” says Dr. Lemire. “Very few professions enjoy the level of support which the public gives family physicians. Patients who have a family doctor they can access will report greater satisfaction with their care, and will have an easier time navigating the healthcare system.”

“Family medicine remains one of the most nimble medical professions, and we want to preserve that flexibility while recognizing that we need to be team players.”

According to the Canadian Medical Association, there are more than 40,000 family practitioners in Canada. As for whether they will ever be replaced with nurses, nurse practitioners, and pharmacists, Dr. Lemire says “there’s enough work for everybody.”

 

“We do believe the best care comes when teams of providers can capitalize on the unique expertise that each provider brings to the table, and they work together for the best care of the patient,” says Dr. Lemire. “Yes, there is some overlap, in the scope of practice – but in my experience, the best way of dealing with that is within the individual practice.”

“You look at the team you have and the region you’re practicing in, and you negotiate how to address those overlaps.”

In many cases, these “overlaps” can mean nurses and physician assistants taking over the duties, since they are far less expensive than a physician – saving the government significantly in healthcare costs.

In Ontario, a physician assistant is qualified to handle upwards of 60 percent of ER cases – sometimes as many as 80 percent of cases. In more complex cases, they may begin the process with a patient before turning it over to a physician or specialist.

The frustrated Nova Scotia family practitioner and ER physician acknowledges that the move towards team-based healthcare will “save the system a fortune,” because doctors bill more than nurses. But he says the fee structure needs to evolve, too – recognizing the level of acuity for each case.

He says students going into family medicine need to be trained to expect this new model – what a family doctor does now, compared to what they did then. He also says there’s a very real chance that the job will continue to change drastically.

“I can foresee the possibility of a day when the description of a typical family doctor is going to be different — with more training, and each having their own area of expertise, so they have the level of a specialist,” the physician says.

“Hold onto the concept of family medicine, and practice it the way it was meant to be practiced,” he adds. “Resist the idea of other people doing primary care for your patient. Continue to advocate to be their only primary care provider.”

Canadians ‘playing the waiting game’ for healthcare

If your family doctor decides you should have a colonoscopy for cancer screening, you may feel anxious thinking about the potential health issue. You may also worry about the procedure itself, and if you’ll feel much discomfort.

But for one Nova Scotia patient, that’s nothing compared to the frustration he felt when the referral letter arrived in his mailbox, within the week, announcing that he was looking at a wait time of 12 months.

Canadians are famous for ignoring an issue until it strikes a chord with us, personally. Wait times for diagnostic services are getting longer and longer, and we know they remain significantly higher than in most leading industrialized countries.

So how long are you expected to wait for a service? It seems to depend on where you live.

The Canadian Medical Association (CMA) works with other national medication organizations to lobby for implementation of wait-time commitments. They co-founded the Wait Time Alliance, and run annual Taming of the Queue conferences.

According to the Wait Time Alliance, 90% of patients in Newfoundland and Labrador received their hip replacement within six months compared to only 37% of patients in Nova Scotia.

In 2004, the Canadian government committed $5.5 billion to a 10-year plan to reduce wait times in five key areas: cardiac care, cancer care, diagnostic imaging, joint replacement, and sight restoration. However, 11 years later, we haven’t seen much progress in shortening these wait times.

The Wait Time Alliance designed benchmarks for these five key areas:

  • Cardiac care: An acceptable wait time ranges from within 24 hours (for consultation in most emergency situations) to within three months (catheter ablation).
  • Cancer care: An acceptable wait time ranges from within 24 hours (for emergency radiation therapy) to within 10 days for scheduled consultants and treatments).
  • Diagnostic imaging: An acceptable wait time ranges from within 24 hours (for Priority 1 MRIs and CT scans) to 60 days (for Priority 4 cases).
  • Joint replacement: An acceptable wait time ranges from within 24 hours for emergency cases, within 30 days for urgent cases, and scheduled treatment should be done within six months of consultation.
  • Sight restoration: An acceptable wait time for a scheduled case is within 16 weeks.

Then the Wait Time Alliance went a step further – rather, seven steps further – and devised wait-time benchmarks in 12 other areas of care:

  • Arthritis care: An acceptable wait time ranges from 7 days (for a patient with Systemic Onset Juvenile Idiopathic Arthritis) to three months (for a patient with potential inflammatory back pain).
  • Chronic pain: An acceptable wait time ranges from 14 days (for cancer patients who do not have access to palliative services) to six months (for types of chronic pain that do not include nerve damage, disc problems, cancer pain, or exacerbations/flare-ups).
  • Digestive health: An acceptable wait time ranges from within 24 hours (for urgent cases of gastrointestinal bleeding, esophageal food bolus, ascending cholangitis, severe acute pancreatitis, severe decompensated liver disease, and acute severe hepatitis) to six months (for Chronic gastroesophageal reflux disease for screening endoscopy, screening colonoscopy, or persistent unexpected abnormal liver enzyme tests).
  • Emergency rooms: An acceptable wait time for an initial assessment by a physician is one hour, and an acceptable length of stay ranges from two to eight hours.
  • Family doctors: The majority of appointment slots are open for patients who call that day for routine, urgent, or preventive visits.
  • General surgery: An acceptable wait time for urgent cases is two weeks (six weeks for semi-urgent cases, and 16 weeks for scheduled cases).
  • Nuclear medicine: An acceptable wait time for all emergency cases is immediately or within 24 hours. An acceptable wait time for an urgent bone scan or fluorodeoxyglucose positron emission tomography (FDG-PET) is within seven days (within 30 days for schedule cases), and an acceptable wait time for urgent cardiac nuclear imaging is within three days (within 14 days for scheduled cases).
  • Obstetrics and gynaecology: Acceptable wait times range from one week (for a consultant with a pregnant woman who risk factors for adverse perinatal outcomes) to 12-24 weeks (for uterine prolapse surgery).
  • Pediatric surgery: Acceptable wait times range from 24 hours (for Priority I cases) to within 12 months (for Priority VI cases).
  • Plastic surgery: Acceptable wait times range from less than three hours (Necrotizing fasciitis, ahdn replanations) to 12 months (cleft palate).
  • Psychiatric care: Acceptable wait times for access to a psychiatrist range from within 24 hours (emergency cases of first episode psychosis, mania, postpartum severe mood disorder or psychosis, and major depression) to within four weeks (scheduled cases).

Take Nova Scotia, for example. The current wait time for a hip replacement ranges from an average of 119 days (four months) in Sydney (at the Cape Breton Regional Hospital) to 366 days (just over a year) in Dartmouth (at the Dartmouth General Hospital).

The Wait Time Alliance says an acceptable benchmark for a hip replacement is within 24 hours for emergency cases, within 30 days for urgent cases, and scheduled treatment should be done within six months of consultation. Patients waiting for a hip replacement at the Dartmouth General may wait double the acceptable wait time — or even longer.

Nova Scotia’s current wait time for a knee replacement ranges from an average of 172 days (almost six months) in New Glasgow (at the Aberdeen Hospital) to 516 days (one year and four months) in Dartmouth (at the Dartmouth General Hospital).

The Wait Time Alliance says an acceptable benchmark for a knee replacement is within 24 hours for emergency cases, within 30 days for urgent cases, and scheduled treatment should be done within six months of consultation. This means that only a single hospital in Nova Scotian has an average knee replacement wait time that squeaks in within the recommended benchmark.

According to a study on the cost of wait times in Canada, there’s a high cost to our excessive waits for medical care. Long wait times for just four procedures (joint replacement surgery, sight restoration, coronary artery bypass graft surgery, and MRI scans) cost the Canadian economy an estimated $14.8 billion in 2007.

Cost aside, wait times also take an emotional, physical, and financial toll on patients and their families.

When a patient has to wait for a procedure, their condition may worsen — putting the patient at risk for complications, and possibly needing a more invasive treatment.

Long wait times do not automatically go hand-in-hand with having a universal health care system. Canadians are suffering from excess wait times, and something needs to be done.

For more information on wait times in Canada, please visit http://www.waittimealliance.ca/for-professionals.