There isn’t a single best answer to handle the finance implications of dual income households.
CanAm perspective: They say history will repeat itself, and CanAm is predicting another serious “brain drain.” The Canadian dollar dipping below 70 cents U.S., the high Canadian taxes, and the serious threat from the newly-elected Liberal government to eliminate professional corporations is providing the perfect storm for Canadian physicians to move south.
This may be an excellent time for Canada-based physicians to move their career south of the border. The Association of American Medical Colleges reported that the U.S. is expected to face a serious physician shortfall by the year 2025 — lacking between 46,000 and 90,000 physicians.
The situation is going to be especially dire in rural areas where just 10 per cent of physicians live to serve more than 20 per cent of the country’s population. It’s been particularly difficult for these areas to recruit and retain primary care physicians, emergency physicians, oncologists, cardiologists and surgeons.
According to the survey, rural doctors are retiring and new medical school graduates are completing their residencies in cities across the U.S. They’re comfortable with the advantages that come with living in a city, and moving to the country to open up a practice doesn’t seem as desirable.
Since physicians who grew up in small towns are more likely to practice there, medical schools are leveraging that by attempting to recruit students from areas with a physician shortage. Many schools are also introducing preceptorships or rotations in areas in desperate need of more physicians.
CanAm perspective: We find it interesting that the Family Practice model introduced across Canada certainly doesn’t seem to be working. Nova Scotia is seeking to restructure their model and we are not sure where to look or which blended model will work. Perhaps government officials should take the approach of not looking to restrict physicians, and instead look to reward physicians. Otherwise, we predict a significant out-migration of physicians.
According to a recent report on the state of primary care in Ontario, it appears more than half the province’s residents do not have timely access to healthcare.
Survey results from Health Quality Ontario showed that despite 94 per cent of Ontario residents having a primary care provider, just 44 per cent are able to access same- or next-day appointments.
This figures are even lower in rural areas, where only 28 per cent of the population is able to schedule a same-day or next-day appointment with their primary care provider.
According to The Medical Post, Canada’s most populated province ranks “worse than 10 other countries including Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.”
H/T Medical Post
Forbes is reporting another spike in the number of people who renounced their U.S. citizenship or terminated long-term U.S. residency, but what’s the reasoning behind it? Many believe it could be the money.
Tax and litigation contributor Robert. W. Wood says “no group is more severely impacted than U.S. persons living abroad” because they must pay taxes where they live as well as file taxes in the U.S. — and U.S. reporting is based on their worldwide income, despite the fact that they’re already paying taxes where they live.
It’s a capital gain if you sold property when you left, and long-term residents giving up a Green Card may be required to pay the exit tax, too. There are also steep fees for handing in your U.S. passport.
There’s often a bit of confusion over ELP (English Language Proficiency) when it comes to licensure, so CanAm Physician Recruiting has been looking into rumours of recent changes. Here’s what we’ve learned:
The issue of ELP was discussed at a recent meeting of the Federation of Medical Regulatory Authorities of Canada (FMRAC), held in Fredericton.
Every province has a different set of standards. British Columbia and Alberta adhere to the pan-Canadian standard and apply that to even francophone medical schools here in Canada, and Saskatchewan does the same — except they will exempt a Canadian Studying Abroad (CSA) if they have a passing mark in Grade 12 English 1030 or 1040.
Prince Edward Island famously made headlines for denying licensure to a Canadian-born doctor simply because her medical school was not listed on the English Proficiency Policy adopted by the FMRAC and the College of Physicians and Surgeons of PEI.
In Nova Scotia, however, there appears to be room for exemptions. Saba University of Medicine was added as an exempted school/country in 2013, and individual applications are sometimes exempted based on the discretion of the College of Physicians and Surgeons of Nova Scotia.
We are told the CPSNS may look at referring to passing grades in high school English when it comes to licensing a Canadian studying abroad, providing these courses are somewhat standardized across the country. However, in some provinces a recent immigrant is only required to pass “English as a second language” in order to graduate from high school, so it remains to be seen if this solution would work.
The CPSNS’s policy may be changed in the coming months, so stay tuned for more information as it’s available. In the meantime, here is our perspective …
CPSNL conforms with ELP standard set out by FMRAC but ads that if post-graduate training was completed in an English country, it will exempt the physicians. However, if the physician has taken an ELP exam and failed to meet the minimum standard which CPSNL requires, then they will demand the physician to retake the exam.
CanAm became aware of this policy when a Saudi IMG radiologist who had completed seven years of post-graduate training at McGill and passed the FRCPC, MCCEE and MCCQE but had answered “Yes” to the pre-application question “Have you ever taken an English Language test?”
This candidate, whose spoken English is better than most Canadians, has passed the TOEFL-Ibt /IELTS seven times but has failed to obtained the minimum standard set out by CPSNL in the verbal category. Although he has passed the minimum standard in each component of written and verbal English, just not on the same exam.So being 110% truthful on the pre-application has caused great frustration.
The cost of ELP is $300 U.S. so this physician who has interviewed and obtained an job offer to work in one of Canada’s most rural regions where the local dialect is so thick you would think they speak a foreign language. To make matters worse, he is a radiologist who would have very little to no interactions with patients — not to mention, living in a rural location where it would be doubtful that anyone would pass the ELP test.
CanAm would like to see a registrar from each College across Canada take the TOEFL-ibt or IELTS exam and publish the results. We are betting 50% would not meet the minimum standard set out by FMRAC. CanAm has witnessed numerous physicians taking the ELPs exams multiple times. Does it make sense that a physician can pass the MCC and even Royal College exams but not have a basic grasp of the English language? I guess common sense is not that common. What happen to picking up the phone and interviewing the candidate?
Demand for psychiatrists in the United States is at an all-time high, according to an annual report tracking physician recruiting trends.
Prepared by Merritt Hawkins, the leading physician search firm in the U.S., the 2015 Review of Physician and Advanced Practitioner Recruiting Incentives tracks the 3,120 physician and advanced practitioner recruiting assignments the firm conducted from April 1, 2014 to March 31, 2015. Now in its 22nd year, the report indicates that Merritt Hawkins was retained to conduct more searches for psychiatrists in the prior 12 months than in any other similar period in its 27-year history. Psychiatrists trailed only primary care doctors on the list of the firm’s 20 most in-demand medical specialties.
“Psychiatrists are aging out of practice at a time when demand for their services is spiking,” said Travis Singleton, senior vice president of Merritt Hawkins. “Finding a psychiatrist willing to practice in an inpatient setting is like looking for a needle in a haystack.”
A job in a new licensing board is within your grasp, and the only thing standing in your way is a few pieces of paper.
Trish Dehmel, Director of CSI Inc. in Halifax, says her job is to help physicians cut through the red tape — allowing them to obtain those documents quickly and easily.
“It can be hard for individuals to contact the right people in some countries — or even to know who to contact — and how to get them to take you seriously,” says Dehmel. “Providing criminal checks is not a priority in some foreign countries, and so they may not attach as much importance to providing the results as we do in North America.”
In some instances, records are centralized to the region in which they lived, searches cannot be conducted nationally, and data may only be obtainable for the past seven years.
A former federal police office, Dehmel knows the industry inside out and has been helping healthcare professionals navigate the system for the last decade.
CSI employees work with healthcare professionals, hospitals, private clinics, and licensing colleges in order to simplify the process of obtaining police clearance checks and certificates of conduct.
The requirements are different for each licensing board. In Nova Scotia, for example, a new physician needs a criminal records search to satisfy the requirements of the College of Physicians and surgeons. If they plan on working for Capital Health or the IWK Health Centre, they will also need a search of the pardoned sex offender database, which requires a set of fingerprints and takes about two weeks.
But it’s not always as easy as it sounds.
“We often work with physicians who are in Canada and apply for a job within a new board, and the board says ‘Well, you worked in Saudi Arabia, so you need to provide a criminal record check from Saudi Arabia,’ or ‘You worked in four different U.S. states. We need checks from all of them,’” explains Dehmel. “That’s where we can help.”
In many cases, a criminal record search can be ordered on CSI’s website using a system called e-Consent. You’ll be asked five “out of wallet” questions about things that only you would know, and answering correctly allows the system to verify your identity without a passport or fingerprints.
While many people still refer to the “vulnerable sector check” that was in place prior to 2009, Dehmel says it’s now a search of the pardoned sex offender database. It involves using fingerprints to ensure a person is not listed in the sexual assault database under any name, in any province. CSI has a portal service with the College of Physicians and Surgeons so the results are reported directly to them.
Dehmel says healthcare professionals are welcome to call CSI with questions about the process, and they have resources and contacts in most countries around the world.
“We provide fast, efficient service, and make the process easier for professionals who need these documents,” says Dehmel. “We’re here to help.”
Physician recruitment specialist John Philpott understands the frustration of foreign doctors who move to Canada in search of better lives, but end up having to take other jobs because they can’t find residency seats.
“This is a national problem that we’ve been dealing with for 20 years,” says Philpott, chief executive officer of Halifax-based CanAm Physician Recruiting.
“Shame on the government of Canada for granting landed immigrant status to doctors without providing them with a pathway for licensing.”
Read Mark Cardwell’s full story in The Medical Post by visiting CanadianHealthcareNetwork.ca.
Only two nations in the world tax their citizens who live abroad. One of them is a small and vicious African dictatorship. The other is the world’s most powerful democracy.
Does the U.S. really want to share this distinction with Eritrea?
It’s true that most expatriate Americans end up with no U.S. taxes to pay on their worldwide income, because they can exclude some income and offset host country taxes against what remains. Yet all must file and many do pay, because anomalies are rife. Apart from this, the principle is simply wrong.
Read the full article on BloombergView.com.
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