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Category Archives: Political Issues

Discusses Canadian federal and provincial political physician issues.

N.L. ‘on par with Puerto Rico and Venezuela’ financially, health minister says

Dr. John Haggie, Newfoundland and Labrador’s Health Minister discusses the budget deficit his province is facing in this June 29, 2016 article in The Telegram (St. John’s, NL). He called it “unparalleled in Canadian history in any jurisdiction”.

At the July 2016 Primary Healthcare Forum Conference, Dr. Haggie compared the $2.4 billion deficit to the likes of countries such as Venezuela and Puerto Rico. He also stated that Newfoundland and Labrador spend 29% more per capita.

The Newfoundland and Labrador Medical Association has come up with a series of recommendations for the government to consider and has also recommended that their members be a part of the process.

CanAm Physician Recruiting feels the NLMA’s recommendation of including its members in creating solutions is a brilliant idea. Who better than the people who will be trying to balance these new policies and procedures with providing their patients with the highest quality of care?

Please click here to read the full article

Doctors Ratify New Master Agreement:

Doctors NS warn government that this contract doesn’t come close to solving the major problems facing NS health care system. A blick 0.5% raise in physician fees for NS who are already one of, and for many specialties, the lowest paid in Canada. Combined that with the highest tax rates makes us wonder how they plan to attract new physicians? Doctors NS estimate between 50,000 to 100,000 Nova Scotians have no access to a family physician while the liberal government are holding to their guns that Nova Scotians are over doctored!

Time to champion regionalization of Licensure

This April 15, 2016 Medical Post article by Dr. Sarah Giles once again addresses the high cost of credentialing and licensing for physicians seeking to do locum work in neighbouring health boards and provinces. CanAm has been out spoken on this issue. What the general public and government officials don’t realize is that we are talking about thousands for dollars not a few hundred. The redundancy is unreal and in no other profession is it tolerated. Why is it that the only government championing this issue is the smallest province of Canada? Prince Edward Island’s health minister appears to be the only brave government official to champion regionalization of Licensing Colleges.

See full article below:

‘Alphabet soup’ isn’t always easy to swallow

April 15, 2016 by Dr. Sarah Giles

Yet again, I’ve traveled to another province and paid a rather large sum of money to re-certify one of my alphabet courses. The “alphabet courses” is my name for those “mandatory” courses hospital administrators insist locums have up to date but look the other way when none of the physicians in their own ER department have done them in six years. I have quite a collection of these courses: BLS, ACLS, NRP, ALARM, PALS and ATLS, to name the big ones.

I think there is benefit in continuing education, reviewing changes in practice, and going through mock scenarios. I do, however, have some reservations about these courses:

1. Some of the courses are cash cows. They cost a lot of money to attend and for those of us who live outside major urban centres, they are difficult and expensive to get to. I do not believe the vast majority of courses need to be recertified in person or every two years. I think it is likely possible to read the text, write a test, and Skype into a few mock scenarios to prove one’s abilities in a given area.

2. There is an inherent bias in these American-made courses against rural and remote care provision. Basically, in these texts, if you don’t have a CT scanner, thoracic surgeon, interventional radiologist or high-level NICU within your facility, you need to drop everything and call in a plane. Now, that’s often the right thing to do but in rural and remote Canada, there are some opportunities to watch stable patients and to use clinical judgment that these U.S.-based practitioners, who face far more lawsuits than Canadian practitioners, are unwilling to consider.

3. The course faculty are almost exclusively Ivory Tower practitioners because the courses rarely come to the places I work and it’s cheaper to get to a big city than it is to travel to another small town where the courses may have local doctors running them. We need big-city specialists to help our patients but I become enraged when every story coming from the course faculty is about screw-ups in the periphery. I’ve never heard a story about a remarkable save from a resource-limited environment and I think the instructors are often disrespectful of the work remote and rural practitioners do. Of course, I’m not exactly part of the solution but in my defense, becoming a course instructor would require me to spend a lot of time in major urban centres and I would likely have to spend even more time there in order to teach the minimum number of courses needed to stay current.

4. I realize that we need to break the material down somehow, but it seems unrealistic to look at trauma and resuscitation without looking at cardiac rhythms. We need courses that allow us to bring these skills together. Courses such as the Comprehensive Approach to Rural Emergencies (CARE) are dreamy answers to this need but it doesn’t meet those alphabet soup needs, and it requires a hospital administration that is supportive and has money.

In the end, it’s probably best for me to try to recertify these courses at rural conferences, when the room is full of like-minded people. Unfortunately, it turns out that rural doctors who toil away in their small communities really need locums so they can leave to attend the big rural conferences, so I’m usually working during those events. I could try to help create a rural/remote supplement for these courses but I’m not sure I could win a conversation with the ivory tower academics when they often have big studies to back them up and I only have anecdotes.

Dr. Sarah Giles is locum family physician.

“Too many doctors” in Nova Scotia? It sure doesn’t feel that way.

Submitted by

Have you seen this article about how we have “too many doctors” in Nova Scotia?

http://www.cbc.ca/news/canada/nova-scotia/doctors-hiring-rules-halifax-family-doctors-1.3540172

I find this really bizarre, and I’d like to get your thoughts on it.  To me I see a real disconnect between the Liberal government and the Health Authority on this issue.

The Liberal government committed in their election platform in 2013 that every Nova Scotia would have a doctor.

For most people this means a family doctor or another type of primary care provider.

While the Liberals made a few small steps to encourage doctors to stay here, there are still thousands of Nova Scotians without a family doctor or a primary health care provider.

They are forced to emergency rooms, or go begging to doctors in Halifax – sometimes hundreds of kilometres from their home community.

The Health Authority uses the euphemism “unattached patients” or “orphan patients” but let’s be clear: these are people who do not have a family doctor, and have little prospect of getting one in the current environment.

Now these people are being told by the most senior doctor in the Province that we have “too many doctors.”

It sure doesn’t feel that way, especially in rural Nova Scotia.

As stated in the article, there are 20 current vacancies in Metro Halifax (or Central Zone) and – if you look at the Health Authority’s own websitehttp://physicians.novascotia.ca/opportunities.html– there are currently family physician vacancies across the Province.

The vacancies stretch from Sydney to Yarmouth to Amherst.

This list excludes other specialists AND the 20 vacancies in Metro.  I count at least 25 communities here, and I expect some need 2 or more physicians to meet current needs.

So something doesn’t compute here.  We have “too many doctors” but 75 vacancies for family physicians today?

If this is true, what real, tangible steps is the Health Authority taking to move the so called “boutique physicians” out of Halifax?

Do Nova Scotians have to wait an entire generation for doctors to redistribute themselves?  Sounds sort of like a budget balancing itself.

I hope that Liberal MLAs are NOT bringing this message from Halifax home to their constituents,

“You can’t get primary care?  Hey relax, we have too many doctors anyway.”

For your reference, here are the communities that should just relax because we have “too many doctors”:

  • Barrington
  • Bridgewater
  • Chester
  • Digby
  • Kentville
  • Liverpool
  • Mahone Bay
  • Middleton
  • New Germany
  • Shelburne
  • Yarmouth
  • Weymouth
  • Antigonish Town/County
  • Baddeck
  • Glace Bay
  • Guysborough County
  • New Waterford
  • North Sydney
  • Richmond County
  • Sydney
  • Truro
  • New Glasgow
  • Amherst
  • Westville
  • Tatamagouche – CEC

How the 2016 federal budget affects incorporated physicians

Many physicians were nervous about how their professional corporations would fate when the 2016 federal budget was unveiled.

But incorporated doctors were, overall, happy to see that what they most feared — losing a small business tax deduction — didn’t happen. There were also no changes to income splitting with family members — another tax-planning tool that can be helpful to physicians.

However, the government has frozen the small-business tax rate. According to the Medical Post, here’s what that means for physicians:

The tax rate for businesses earning $500,000 or less will be set at 10.5% for the foreseeable future. While this is still lower than the 15% corporate tax rate larger businesses incur, it marks a departure from legislation that was enacted by the Conservative government to eventually lower the rate to 9% over the next three years. Ultimately, this means that doctors with professional corporations earning $500,000 or less will now be paying more taxes in the next few years than they would have if the rate was lowered.

Continue reading in the Medical Post to see which other changes may affect physicians with professional corporations … 

Opposition howls for repeal of doctors’ incorporation rights in Quebec

The decade-old right of Quebec doctors to incorporate is being called into question by opposition politicians. And the issue is being raised on the eve of next week’s federal budget, in which the Liberals may introduce changes to the tax benefits of professional corporations across Canada.

Last week, all three opposition parties in Quebec called for a public debate over the impact that the incorporation of doctors and dentists was having on the public purse. According to these parties, the income tax savings generated by the estimated 10,000 Quebec physicians (roughly half of all doctors in the province) who have become incorporated since 2001 deprives the state of $150 million a year.

In his Medical Post piece, Mark Cardwell describes this as “mean-spirited politics” and “sectarianism,” adding that it’s “a disgrace to propose it.”

Continue reading in The Medical Post …  

What can physicians expect from the 2016 federal budget?

The 2016 federal budget will be tabled in less than a month and everyone’s wondering what tax measures can be expected.

Since the Liberal party’s win in October, the government has implemented many of the tax measures that were included in their election platform, as well as some new measures such as …

  • a 4% increase in the top federal rate of tax (from 29% to 33%) for taxable income over $200,000;
  • a reduction in the second federal tax bracket rate from 22% to 20.5%;
  • a reduction in the annual Tax-Free Savings Account (TFSA) contribution limit from $10,000 to $5,500; and
  • some unexpected changes to several tax measures affecting Canadian-controlled private corporations (CCPCs) and other private corporations.

Since proposed measures often take effect on budget day, Grant Thornton advises the best course of action is to “address all tax-sensitive transactions before that day.”

So what’s in store for active versus passive incomes, employers and EI premiums? View a full chart summarizing possible tax measures you can expect.

H/T Grant Thornton

Manitoba oncologist wants Canada to lead cannabis crusade

An oncologist and palliative care consultant with CancerCare Manitoba and the University of Manitoba says he would like to see Canada become a world leader in the use of medical marijuana for pain relief.

The Medical Post reported that Dr. Paul Daeninck told CTV News many patients “know more than the doctors” about medical cannabis and that physicians “get their backs up” when a patient comes in making a specific treatment demand.

Daeninck says there needs to be more studies outlining how medical cannabis can be used, including daily allotments and the benefits patients can experience. He is personally involved in updating the curriculum at the University of Manitoba’s medical school to include information on medical cannabis.

H/T Medical Post

An open letter to Scott Brison

Joint Response by:

John Philpott B. Eng., CMC
CanAm Physician Recruiting Inc.

John A. Flaim, CPA, CA, CFP
Flaim Wolsey Hall, Chartered Accountants

***

Dear Honourable Member,

We would like to thank you for your time on January 12th and for the valuable exchange of information. The purpose of this letter is to outline the main points of our discussion with respect to the taxation of professional corporations and more importantly the potential repercussions to the social fabric of our communities with the Government possibly entertaining changes to how doctors are taxed within a corporation.

Background

During the election campaign, the Federal Liberal party gave indication that it would be looking at the tax system with consideration given to tightening rules around professional corporations (PCs). There is a belief that PCs take advantage of the income tax rules.

The following are the main areas where PCs could enjoy favorable income tax treatment:

  • The ability to claim the lifetime capital gains exemption on the sale of the shares of the company operating the practice
  • Low corporate tax rates which may result in income tax deferral opportunities
  • The opportunity to income split with family members

These advantages that may be perceived as substantial benefits that are not available to every citizen in Canada.

Issue

Changing the taxation rules for PCs, specifically for doctors, will have immediate impact on the social fabric of our communities and will result in unintended ramifications with long lasting effect.

The ramifications of such changes are outlined below using the impact in Nova Scotia to provide example where applicable.

Lifetime Capital Gains Exemption

With respect to doctors who have a PC, the lifetime capital gains exemption is not applicable. Doctors are not normally in a position to sell their practice as it has no or very limited value.

Low Corporate Tax Rates and Income Tax Deferral Opportunities

PCs provide the opportunity for low corporate income tax rates assuming that the gross income derived from the medical practice exceeds practice-related expenses.  

In Nova Scotia for 2015 the combined corporate income tax rate is 14% composed of 11% Federal tax and 3% provincial tax. This tax rate is applicable for taxable income within the corporation up to a maximum of $350,000.

For example, if a doctor were to earn $350,000 after expenses in the company the corporate taxes would amount to $49,000 ($350,000 *14%). This leaves $301,000 in the company before the doctor takes a dividend from the company to fund personal expenditures.

The income tax deferral is only available if the doctor leaves funds in the company. Once funds are taken out of the company one is then taxed personally, just like any other taxpayer. The benefit is the PC provides the doctor with the opportunity to keep the funds in the company for the purpose of funding their retirement similar to a RRSP or pension.  Doctors are self-employed and are not employees of the province so they do not have access to a pension plan from the provincial government.

In addition, doctors attend university for minimum 10 – 12 years to obtain their training and non-subspecialized certification. Subspecialized specialist spend 14 to 16 yrs in training. These time lines assume students get into medical school first time applying after their undergraduate degree, which rarely happens.

This generally results in doctors starting their working career much later in life (mid 30s) and to have significantly higher student loans than most Canadians who attend university to study a different trade or profession. Combine this with the actual cost to be a licensed physician, which includes thousands of dollars in fees for provincial licence, provincial associate fees, CMPA, compulsory CME (Continuing Medical Education) and basic life and Disability insurance, there is very little money left in PCs.

As a result, the doctor has a reduced number of working years to retirement, no access to provincial government pensions, and significant financial commitments like student loans. So the doctors tend to use their PC as their retirement vehicle.  To the extent the doctor saves money for his retirement in a PC, this is a tax deferral and not a permanent tax savings. Income taxes will be paid by the doctor when the money is withdrawn as a dividend during retirement much like it is for RRSPs and registered pensions.

Opportunity to Income Split with Family Members

Unlike an individual taxpayer who receives a salary and cannot income split with family members, PCs provide an income splitting opportunity assuming the family members are over the age of 17. This is where a PC could take advantage of the income tax laws. The age limit of 18 was introduced in the late 1990s as part of the Kiddie Tax Rules. Prior to that time, one could income split with a minor at any age.

The Kiddie Tax was designed to keep parents from splitting investment income or dividends from the PC to their children to take advantage of the child’s lower tax bracket. Without the Kiddie Tax, this resulted in lower taxes being paid by the family as a group since the children usually were in a lower tax bracket than the parents.

Family Trust and spousal income splitting has been a significant attraction for recruiting new doctors to Canada. But it has also provided the ability to draw returning Canadian Doctors who departed Canada during the “Brain Drain” in the ’80s and ’90s. They see the ability to pay for the children’s university education through family trust and provide a spousal income to create a spousal RRSP.

Potential Impact

If the government were to change the rules around PCs, they can propose changes at the small business rate level or at the income splitting level.  

The Province of Quebec has decided to deal with the perceived abuse by allowing the low corporate tax rate only for those companies that have three or more full time employees or if they are operating in the primary or manufacturing sectors.  In our view this is the wrong approach as very few businesses start off with having more than three full-time employees. Small businesses need time to grow and they need time to hire fellow Canadians and to reinvest in their companies to continue the path of growth.

Implementing such a policy at the Federal level could significantly stunt Entrepreneur and small business growth in a time where the country needs as much assistance in this area as possible. The Federal Liberal government has committed to create jobs and additional economic activity through making significant investment in Canada’s infrastructure.  We believe that implementing a tax measure similar to the one proposed in Quebec would significantly undermine your efforts to build a stronger Canada and a strong middle class.

As an alternative to imposing federally the tax measures similar to the ones proposed in Quebec, a better alternative would be to the low corporate tax rate applicable to small businesses to generate more jobs and investment in the economy. As an example the government could increase the age on the Kiddie Tax from over 17 to 25 and over. Such an income tax measure would not target any one group in society as it would apply to all small businesses in Canada and not just those owned by doctors.  

The low Canadian dollar vs. US dollar, similar to the ’80s and ’90s makes migration to United States very attractive. If you consider the high cost of living in Canada vs United States, GST vs. no US federal sales tax, continuous climbing province tax rates, and now you limited the benefits of PCs such as Incoming splitting, family trust, and deferred personal taxes. Canada will 100% guarantee see a new “Brain Drain” into the U.S. for all physician specialities.

In the last 10 years, federal governments have forced spending cuts in health to the point where subspecialist physician graduating in Canada cannot find permanent full-time work resulting in unacceptable wait times which is very evident in high tax provinces such as Nova Scotia. It is increasingly difficult for Canadian Physicians in general to find employment in areas suitable for spousal employment and the desirable family lifestyle.

Right now without making changes to taxation of PCs, Canada cannot compete with the U.S. for physician employment options and take-home pay for retirement investments. Sixty per cent of physicians in Canada are over the age of 40 and 40% are over the age of 60 (CIHI). They are looking at the number of years they must continue to practice in order to retire.

It would be a serious mistake in physician Recruitment and Retention for the Federal government to change any aspect of tax benefits of PCs.

Other points to note:

  1. Middle Eastern countries such as Saudi, UAE, Kuwait, and Qatar are already taking some of Canada’s most value experience physicians. They are offer tax free status, zero cost of living, full array of benefits, higher competitive salaries, access to top quality services which produces an easier practice environment.
  2. Attracting International Physician to Canada to address the future “Brain Drain” is a much more difficult than three years ago;
    1. License for International physicians (IMGs) is much more restrictive and demanding. FMRAC (Federal of Medical Regulatory Authorities of Canada www.fmrac.ca ) have and are implementing serious changes which will deter Doctors from considering Canada.
    2. CanAm is projecting the cost for International doctors to consider Canada to be at $10,000 before they are able to apply for a licence to practice.
    3. Immigration changes have significantly slowed recruitment. The processing time to obtain a work permit for a physician is gone from a few weeks to 6 to 9 months. Canada will see depart closures because we can no longer consider International physician to fill urgently need shift in such critical places as OR and ER. Even physicians who are on a work permit for a hospital cannot put up extra shifts in another location.
  3. Canadian Physician Associations will have a huge bargaining chip to increase salaries and benefits because of the inability to recruit international physicians in a timely manner. Simply stated without the benefits of PCs, doctors will go back to the institutions, ask to be hired as employees, ask for pension and benefits — and the entire provincial health system collapses because of the added cost of hiring health professionals as employees with benefits. Doctor’s work less — as they are on salary — they take longer vacations, and the system backs up — and the availability of health care becomes even more scarce.

    Ultimately, these extra costs will have to be funded by either the Federal Government in transfer payments — or by higher provincial taxes — or cuts elsewhere in the system. Just look into the top heavy civil servants of Nova Scotia government where 58% of budget goes into paying civil servants salaries. They are imploding on pension plans alone therefore we can’t imagine adding high paying physician salaries.

Why Doctors Should Receive Special Status within the PC Structure

Unlike accountants, lawyers, and other professionals, our experience causes us to believe doctors are in a unique situation. For most businesses, even if there are corporate or personal income tax changes, they will stay in the province where they have built their clientele. Doctors are substantially more mobile and their services are always in high demand.

A doctor could easily mitigate higher federal income taxes (either corporate or personal) by moving to a province that has lower personal or corporate income taxes.  We have seen firsthand the masse exodus of doctors from Nova Scotia to other provinces due to income tax changes that have already occurred provincially such as the reduction of the small business limit in Nova Scotia to $350,000 (from $500,000) and of Nova Scotia having one of the highest personal income tax rates in the country.

This allows provinces that can afford these services to entice doctors to move from a higher provincial tax jurisdiction to mitigate what would be a federal income tax change. The richer and more affluent provinces are also at risk as their doctors may choose to move to another country such as the United States where taxes are significantly lower. In a nutshell, this impacts the social fabric of our communities and the country as a whole.

Please also be aware that when doctors were able to incorporate in the 1990s, the provincial government of the day promoted these same tax advantages of income splitting and deferring opportunities to act as a compromise in dealing with the slower fee growth from the provinces for the services provided by doctors.

Thank you for taking the time to listen to our concerns. Please contact us with any questions or areas of clarification.

Yours very truly,

John A. Flaim, CPA, CA, CFP

Flaim Wolsey Hall, Chartered Accountants
3058 Oxford Street, Halifax, NS B3L 2W7
T: 902-431-7613   F: 902-431-2385


John Philpott B. Eng., CMC

CEO,  CanAm Physician Recruiting Inc.
CanAm Health Management Consulting
T: 902-883-7426   F: 902-482-3434
www.canamrecruiting.com
www.canamconsulting.ca