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Showing content with the highest reputation on 08/24/2017 in all areas

  1. 2 points
    Hi ralk, We are good. I respect you, and I believe the feeling is mutual. Healthy discussion or even debate is the whole reason for these forums to exist. I may not convince you of my side, nor vice versa, but finances are a huge blind spot for premeds all the way through to staff physicians. I hope to shed some light from the perspective of someone who is a relatively new attending physician. If nothing else, this discussion will be of significant benefit to the other readers of this thread. Having said that, I disagree with several of your points. 1. This is no minor change to the tax code. This is the confiscation of 1-3 million dollars of your future income. How many extra weekends or call nights are you going to have to take to make up that deficit? How can that not piss you off? 2. Using Sears as an example is in no way the same. The employees of Sears have lost their pensions because Sears was not competitive, is going bankrupt, and doesn't have the money to pay out those pension obligations. Bad luck for those employees, but this is an inevitable part of capitalism. Failing companies are going to fail. No different than Blockbuster, Blackberry, Nokia, Sega, Palm, Radio Shack, or any number of other companies that didn't evolve and adapt to a changing environment. Those Sears employees still had/have access to EI, CPP, and RRSP contribution room, so they had the opportunity to save outside of their pension. Incorporated physicians are losing our main retirement vehicle because the government thinks we unfairly keep too much earned money and they want to take it back. How do you defend against that? Especially when we can't raise fees to compensate. Totally different scenario. 3. If you read all the government preamble, all of these tax hikes are coming because of "fairness". I would be a little happier to see my taxes go up after I see the government close some much larger unfair loopholes like the primary residence capital gains exemption. For example, if a boomer bought a house for $100,000, and now sells it for $3 million, that entire $2.9 million is tax free (totally realistic and common scenario here in Vancouver). No millenial will ever have a chance to take advantage of this tax exemption. A millenial might be able to turn $100,000 into $3 million by buying and selling Amazon shares/bitcoin/marijuana stocks/etc, but they'd pay nearly half of the gain in taxes. Why is it that houses are the only source of capital gains that can be 100% tax free (disproportionately held by boomers, the wealthiest generation of them all), while literally every other type of capital gains that a millennial or Gen-X could use to build wealth will be heavily taxed? How is that "fair?" 4. You had previously written: "I should be paying lower taxes than I otherwise would, but only if I have a spouse and/or adult children who earn much less than I do" isn't exactly an easily-defended position. For clarification, I turned that around, and am telling you that right now, "I am paying higher taxes than I otherwise would, because I have a spouse who earns much less than I do." This is happening because the government doesn't tax me as a household, but rather as an individual. Again, completely unfair. Why should a family with one individual working 80 hrs and another 0 hrs get taxed more than a family where both individuals work 40 hrs? Both families contribute 80 hours of work to our economy, but mine is punished. Dividend sprinkling was a way to even out that discrepancy. My wife has a lot of low tax brackets that she can't use, despite the fact that she is contributing to my household. By getting rid of it, you are discriminating against families like mine and yours. From another perspective, you and I are highly trained physicians. We should be working as much as we can. Canada has invested in our education to serve the public. If I am capable and willing to work 50 or 60 hours a week, and my spouse is willing to shoulder the increase in household work needed to support my medical career, then this is a big win for the Canadian public. It is a much better return on those tax dollars used to train me, than if I worked 40 hours a week, particularly since as an incorporated individual I get no overtime pay. Why not recognize my spouse's work by allowing me to attribute some of my income to her low tax brackets? Either tax me as a household, or give me back my dividend sprinkling. If you are just going to tax the heck out of every additional dollar I make, I should logically cut both my work hours and personal spending. I will disproportionately gain more hours per dollar back in my life. This is not beneficial to the health care system, nor the patients, nor the economy. Remember, this corporation is my retirement fund. It will be used to pay for our household's retirement needs, so that I will not be a future burden to the Canadian tax payer. My income in retirement is likely to be such that I won't qualify for OAS or GIS, even as my taxes pay for OAS and GIS to other Canadians. As an incorporated individual, I pay double the amount into CPP as both an employer and an employee, but I get the same single benefit as if I'd only paid into it once. The government should be incentivizing us to save more now, rather than removing our main retirement vehicle, so that the government doesn't have to subsidize us when we are elderly. 5. It is very admirable and altruistic that you aren't angered that the government is taking $1-3 million dollars from you. Yes, you will still live comfortably. Even though you will now work 5-10 more years, or perhaps 500 more call weekends or whatever to make up the money they just took from you. And this is just one tax grab. This will only raise $250 million annually, but our 2017-2018 deficit is $25-30 billion. I'm sure the government will be looking for more tax dollars later, particularly since they haven't done anything to cut spending. And since you are still a 1 percenter, you are still going to be a target. At what point will you conclude: "I'm being over-taxed!" From a Financial Post article. published by William Watson on Nov 23, 2016: In 2014, the 1 percenters in Canada had a median income of $313,200, made 10.3% of all the income, but paid 20.5% of all the federal and provincial taxes. So 1 out of every hundred Canadians is already paying one fifth of all the taxes. Final thought. I am happy to pay taxes as long as they are being spent responsibly and they strengthen my life, my family's lives, and our community. I think a lot of our taxes are being spent frivolously. I would be less unhappy if those taxes were being used appropriately. Take my taxes, and purchase good equipment and infrastructure, so my hospitals can run appropriately. Fund an EMR system that actually works, and make it integrate with both hospitals and outside offices. Pay for enough staff so expensive OR's and MRI scanners aren't sitting idle for many hours each day. Open up more nursing homes now, and invest heavily in home healthcare because there's a huge wave of boomers coming who are otherwise going to overwhelm all our of current resources. The latest agreement on Federal health transfer funding is a substantial cut from where it was previously; fund it back to at least its previous level. Stop giving away money to outside countries and focus on domestic problems, like illicit drugs or mental illness, both of which are a huge chronic drain on our society. Put more money into palliative care and hospice, so we aren't wasting untold millions of dollars on expensive end of life care in ICU and inpatient wards. Invest more in outcomes analysis, so that we find out which hospitals are doing best in different areas, so we can emulate those best-practices across the country. In short, don't take more of my tax dollars until you prove to me that you are using my current tax dollars responsibly. Ian
  2. 2 points
    Couple of points: 1. The system exists as it has, and an entire cohort of physicians has planned for retirement with these mechanisms in place. The government has suddenly moved the goalposts. No different than if you were relying on a govt pension or CPP/OAS for retirement, and it is no longer there. But we are 1 percenters, and therefore a minority of voters, so it's ok? There are lots of other tax guidelines that are equally arguable to be unfair. No tax on capital gains for a primary residence is a massive one. It is a huge tax break for the boomer generation, and confers relatively little to no advantage to your and my generation. 2. To directly address your point, why are we not taxed on a household basis, rather than as individuals? Under current rules, a two family household, with one partner working 80 hrs a week, and the other 0 hrs a week, pays substantially more taxes than if two partners each work 40 hrs a week, earning the same household income. A one physician family is highly likely to be hosed by this. How is this remotely fair? The partner working 0 hrs a week doesn't even gain any RRSP contribution room, gets no access to CPP, gets no employee benefits such as healthcare, dental, sick days, vacation, etc. To flip your last point around, I am paying higher taxes precisely because my wife earns less than I do. Ian
  3. 1 point
    I'm sure there are a slew of "check-off" ECs that don't necessarily help your application if you have them but would hurt your application if you didn't (like volunteering), but I was wondering how it would look to Adcoms if I didn't join a single school club in my undergrad. Don't get me wrong, I love interacting with my peers in the right environment, but for me to truly enjoy doing something I need to know that I'm making a direct impact on something (my research helps sick patients and my volunteering helps them even more directly), and I don't feel like being in a school club (or even an executive position) would interest me very much. What do you guys think? Is this a red flag?
  4. 1 point
    ralk, Great reply, which opens up even more topics for discussion. 1. This income splitting via dividends was designed into the taxation system. As such, it's not a loophole. A loophole is an unintended feature. It was even promoted by various provincial governments as a way to avoid increasing physician fee schedules. Issuing dividends is at the core of business and the stock market, and therefore is a core portion of our economy. If I buy shares of Royal Bank, I receive a fraction of its profits via dividends for as long as I own the shares. Similarly, if my wife purchased shares of my company when I started it, back when it had no income and was carrying outstanding debt related to a radiology buy-in, and the company has now grown to a point where the debts are paid off and there is profit to be shared, I can't issue a dividend? If your parents had gifted you money as an adult, and you bought shares of Royal Bank, you shouldn't be able to receive those dividends? If your parents directly gifted you shares of Royal Bank, you shouldn't receive those dividends? You can't just unwind the issuing of dividends without messing with a much larger taxation framework, that also includes large corporations, dividends, and capital gains. And again, issuing dividends is a feature, not a loophole. 2. You made my point exactly regarding income splitting lower down. If you tax me as a household, I wouldn't have to resort to incorporation to divide income with my wife. There is no reason you couldn't apply the household taxation to all Canadians. It would be more fair. As a single person, you would file as a single person household. Divorced is also a single person household. And one physician family households would be treated just as equitably as all other Canadian families, where our household total income of "X" is taxed the same as any other household making "X", which is currently NOT the case. 3. I would argue that the passive income growing within a corporation can be more powerful than income splitting. That passive income can grow tremendously through compound growth. As noted earlier in my example, $30,000 invested annually over 30 years (total of $900,000 contributed), turns into $4.49 million when compounded at 9%. That is one of the major features of incorporation, to grow your retained earnings, to be issued in the future as needed (whether this be for a capital purchase, for retirement funding, or to pay corporate expenses during a lean period). You can't just arbitrarily take away one of those options without crippling the concept as a whole. 4. You are correct that my views are shared by many physicians. I shared your views when I was a med student. It is my belief as that as we advance in our training and careers, that we become more cynical, but also more realistic. You should not downplay your sacrifices made to become a physician, nor feel guilty that you earn significantly more than the average Canadian. You can and should be a humble 1 percenter. You are making more than the average Canadian because you got better marks, studied harder, put in uncounted 60-80 hour weeks, delayed your earnings by at least a decade, went into massive student debt, and on a daily basis make decisions that require that education and continued commitment to learning, otherwise people get harmed or die. You are also making more than the average Canadian because we share a huge border with the US, and their free market physician salaries directly influence ours. 5. I feel badly for Sears employees. I agree they are getting a raw deal. However, this is still a completely different situation. Getting hosed because your company is going bankrupt due to poor business decisions is completely different from getting hosed because the government thinks you keep too much of your earned money, and will take it away by legal force if necessary. If you think these are equivalent, then we agree to disagree. I hope you agree with me that a failing company needs to be allowed to fail. The alternative is endless government subsidies from tax-payers, and the company losing all motivation to improve or dig itself out of its rut, since it then loses those free subsidies. Bombardier being a perfect example, as mentioned earlier. Those Sears employees will eventually go onto the social safety net provided by the government, paid for by other taxpayers. They will be ok, just like all the employees of those other under-performing companies I mentioned previously. 6. As mentioned earlier, the logical course of action to increased taxes is to decrease hours worked and decrease my spending proportionally. I will get back more free hours per dollar. This is a terrible principle on both an individual and national level, particularly for physicians (due to our long, subsidized training). Taxes should be used to incentivize good behaviour, not punish it. With this, you are incentivizing me to work less hours than I am willing or capable of working. You clearly live well within your means. I do as well; my lifestyle has not changed substantially since fellowship. We are both fiscally responsible households. I'm still going to be unhappy if I am taxed more, just the same as if Shaw decides to increase my cable bill, or someone steals $20 from my wallet. It is true that I am more capable of absorbing a tax increase than the average Canadian, but I'm also already paying far more taxes than the average Canadian. 'We are also not talking about a small sum of money. Whether you think it is true or not, losing $1-3 million dollars will affect your household somehow. A time will arise when someone in your family could use or will need that money, or perhaps you encounter a needy charitable cause to support. 7. You have contradicted yourself. You state that "the public believes we should be paid well for our work, within the top 1% of earners", and then say "where we lose the public is when we fight tooth or nail to maintain or increase our incomes that are already well beyond the 1% threshold..." Here's the problem. Our fee schedules have consistently lagged inflation. We are constantly taking fee cuts. If you are not advocating to stay in the 1%, you won't stay there. You need to be advocating for at least inflation adjusted stasis. Nobody in his or her right mind should be willing to work for less and less money over time, particularly as you are gaining experience and seniority. That shouldn't be happening in any industry or profession. Ian
  5. 1 point
    good plan - plus if you are actually going to use the white coat at all it is going to be in clerkship. we had someone actually try to use the white coat as a lab coat for the cadaver lab because they didn't see the point of it otherwise. The staff did not react well to that
  6. 1 point

    3.6+ GPA after wGPA

    I believe if you qualify for wGPA they do that calculation first and then apply the cutoff. As far as I know, 3.6 wGPA is the cutoff, not cGPA.
  7. 1 point

    OMSAS ABS inquiry

    This always seems to be a tricky determination! If you were paid to do the research, I believe what's most common is to put it under employment. If you weren't paid, it can go under volunteering. What you produce from your research can go under the research section - publications, posters, conference presentations, etc. That said, I've also heard of people listing the actual research assistant position under research, especially if working towards a publication. It's a bit of a grey area, so I don't think they'd penalize you for putting it in under the wrong category. Good luck!
  8. 1 point
    The biggest sticking point for the proposals related to passive income and the ability to keep money inside the corporation. Lots of people have mentioned the retirement planning aspects of this feature of incorporation so I won't rehash that. However, from a small business point of view, this has another massive downside that the government hasn't really considered/has ignored. It's not so much applicable to doctors, but is a huge issue for people who operate in the free market (plumbers, accountants, contractors, fisherman etc.). Right now, you can keep money inside the corporation and build up some savings (the same as the retirement savings scenario). However, many small businesses use this money as a float to help keep them in business during bad economic periods. For example, lets say you are a contractor who installs hot tubs (a luxury item per say). You employ 6 people who you spent time and money on training them to be very good at what they do. It would be somewhat hard to replace them. During the good economic times, you are installing lots of hot tubs and saving some of the profits inside the corporation as investments. Soon, there is an economic bad period for some reason. You have less demand for hot tubs but you think it'll probably be fairly short term. Therefore, you decide to take some of your money saved inside the corporation and use it to pay for expenses and employee salary until the economy picks up again (you don't want to lose your highly skilled employees unless absolutely necessary). With the proposed changes, keeping a float for the bad times becomes much harder to do. Small businesses will see themselves either cutting spending or laying off employees much sooner than desired during bad economic times. And of course, laying people off and reduced spending by businesses will further depress the economy.
  9. 1 point
    So after reading UBC admissions post, they said if necessary, use a sparingly placed symbol. In all of my entries, i replaced and with "&". Did any of you who received interviews also do that?
  10. 1 point

    Health Issues and the MCAT

    First of all, sorry to hear that you've been dealing with this; studying for the MCAT is bad enough by itself, let alone with a health issue thrown into the mix. If my understanding is correct, unfortunately, the MCAT cutoffs are strict, no exceptions. From what I've been told, the academic explanations essay is used for only GPA, as that cutoff is flexible and changes year to year. Email/call the admissions office to be sure, because you certainly have a compelling case. And who knows- maybe your MCAT score will be pleasantly suprising.
  11. 1 point
    I don't necessarily think it's a red flag, as long as you can demonstrate that you have had experiences in leadership, working with others, etc. like you would in a school club. Joining clubs is just one very common way that you can gain those experiences and build those skills, but it's not the only way. I think that as long as you can show how whatever you did helped you develop certain skills/strengths, that is what counts more than the nature of the experiences themselves.
  12. 1 point
    Just to add some hard numbers. It would be very easy for all these new taxation changes to cost a new physician an extra $20,000-$30,000 per year. If you invested that $20,000 annually, for 30 years, here's how much it would be worth: 5% annual return: $1.42 million. 7% annual return: $2.04 million. 9% annual return: $2.99 million. Here's what $30,000, invested annually for 30 years, would be worth: 5% annual return: $2.12 million. 7% annual return: $3.06 million. 9% annual return: $4.49 million. It gets even crazier if those taxes hit you for an additional $40,000 or $50,000 annually... This is a massive amount of money which is about to be taxed away from incorporated physicians, as well as other small business owners, particularly those who can't raise their fees to compensate. How many extra years are you willing to work to make up this sort of downfall? Would a government worker be willing to accept an immediate 50% paycut in his or her defined benefit pension plan? Would a baby boomer be willing to have his or her OAS or CPP rolled back 50%? If you are a physician who has been planning finances based on the current regime, this will be a disastrous setback, at the same level as the above. Ian
  13. 1 point
    I'm unhappy with the proposed changes, as I expect the majority of incorporated small business owners to be as well. These changes will cause small business owners to pay more tax. Whether this is "fair" or not, depends on whether you are paying more as a result. It is unfair to myself and other incorporated physicians, as we are simply working within the rules of the tax system, and this government has abruptly changed the rules. If your corporation is your retirement fund, as it is for most incorporated physicians, you will be working more years/hours before you can retire. To the general public, doctors are 1 percenters, and therefore taxing doctors more is a popular tactic. This is unlikely to ever change. The general public does not see nor care how many hours you have worked on call, how much stress you endure, nor how much education you've undertaken. On a federal level, physicians have been hit with several taxes by the Trudeau government. In my particular demographic cohort, this is particularly bad (young physician less than 10 years in practice, with small children, and spouse with reduced hours or stay at home.) 1) Increase in top income tax bracket. 2) Roll-back of TFSA contribution from $10,000 to $5500. 3) Loss of income splitting to a lower earning spouse. 4) Loss of child benefits. 5) Multiplication of small business deduction. This does not affect all physicians, but does affect many physicians operating in groups, including radiologists. 6) Dividend sprinkling (proposed) 7) Increased taxes on "passive income" retained in a corporation (proposed). This is tens of thousands of dollars of increased taxes, annually, abruptly coming in the last 2 years. These last incorporation changes are supposed to help save $250 million, a pittance compared to our $30 billion federal deficit. Ian
  14. 1 point
    I thought the questions are not too bad, but typing your answers made Casper a beast! This is my first time writing it and I thought it was fun doing it, but I'm definitely not sure about my performance I'm more terrified of my mcat score . Nevertheless, All the best to everyone applying this year
  15. 1 point

    Dr. Pa?

    "Hi, my name is Anne and I'm a Physician Assistant working with __." [shakes hand] Start with patient encounter. Our practice has been using PAs for the past 7 years so our patients are used to PAs. I elaborate a little bit more about how patients react to being seen by a PA below. Patient: "Are you a doctor? My response:" No I'm a Physician Assistant." [insert elevator pitch about PA education and practice, 4-5 sentences I use frequently with patients, pre-PA students and other allied health] Patient: "Are you training to become a doctor? When are you done?" I still get this question a lot, and understandably some patients didn't hear me the first time when I introduced myself as a PA. My response: "I actually finished school for Physician Assistant studies, and I've been practicing with Dr. X for the past 6 years. [insert elevator pitch about PA education and practice] Depending on the practice, the patient may see: The PA only The PA first, then the physician (in the same patient encounter) The medical learner (i.e. medical student, PA student, resident, or fellow) first, then the physician (in the same patient encounter. The physician only Note #2 and #3 are essentially the same --> In Ontario, many PAs practice in a setting where the patient sees the "PA only": A PA colleague of mine who works in family medicine has her own list of patients for the day. She is very experienced and consults the physician perhaps a few times a month for very complex, atypical or unusual cases. A new grad would likely review each case (as part of training, mentoring and orienting the PA to a new practice) to begin with but as they gain more experience they will likely transition to indirect supervision where PA sees patients autonomouly. My PA colleague is usually more on time than the family physician (she doesn't like to keep her patients waiting, and is very thorough, yet efficient, good bedside manner helps too!), and there are some patients that would prefer to see the PA rather than the physician because of the rapport the PA has built with that patient over time. At the end of the day, the PA is doing the same clinical duties as the physician (e.g. well baby exams, PAP smears, skin biopsies, vaccinations, sore throat assessments, follow-ups, new consults, etc.), but you have two clinicians seeing patients simultaneously. She also prescribes medications under medical directives, but does not do narcotics - those patients who require prescription of opioids and other controlled substances see the physician. If the patient is adamant on seeing the physician only (this very rarely happens), then it doesn't take a lot of time to quickly grab the MD. One strategy you can use as a PA is to inform the patient that they are more than welcome to see the physician, but while they're waiting you can get started on the history and physical, which will be case reviewed with the physician. The PA proceeds to do the entire encounter history to physical, review investigations, formulate diagnosis and treatment plan. We do patient education around treatment modalities & preventative health, and take time answer all of their questions - they usually are impressed at the time, attentiveness and how thorough the PA is during the encounter. By the end of the encounter the patient is happy, they get to see the MD (if at this point they still want to at this point, and are happy to see the PA again. If patient is resistant (I haven't seen this happen in 6 years in practice, but it is still a possibility), then just inform the patient the physician may see them but they may have to wait longer, which most patients are not happy to do anyway. The "PA first, then physician after" is very similar to how physicians work with 3rd and 4th year medical students (clinical clerks)/residents/and medical fellow model, where there is more direct supervision as the physician does participate in the patient encounter. This model is much more common in the beginning of a PA's experience with work (as I mentioned above, to orient, mentor and train a PA to a new practice). Some physicians prefer this way (i.e. see every patient) because of personal preference rather than actual need as the PA is usually capable to see simple, routine conditions and with more experience handle more complex conditions autonomously with physician collaboration (e.g. established medical directives, review cases/chart after each patient without seeing the patient or at end of the day, tec.). You still have two clinicians seeing patients simultaneously - while the physician goes to finish off the PA encounter, the PA can now start on the next patient. In cases where the PA starts, and physician finishes, the interaction usually goes like this: "Hi I'm Anne, I'm a PA that works with Dr. X__. I'll be getting us started today, and Dr. X will be joining us after." [PA proceeds to do entire encounter, communicate diagnosis (depending on case), review imaging, explains treatment modalities before the MD comes in] PA exits room --> Case reviewed with physician ( either by 1 - PA case presents to MD,or 2- physician will read the PA's clinical note in the EMR) --> Physician enters room while PA starts on next case Physician: "Hi I'm Dr. X_, Orthopaedic Surgeon, I had a chat with Ms. Dang, our PA and she's told me a lot about you. [Quickly verify a few pertinent facts, 1-2 exam findings, review imaging, confirm/discuss treatment options] The amount of time the physician has spent with the patient is significantly decreased as the PA has done 90% of the work. With years of practice my clinical reasoning and familiarity with treatment protocols in this practice. As a result of this model, although the MD is going in to "verify" what the PA found, we have been able to decrease wait times to be seen by a specialist, reduce physician workload and decrease time spent seeing patients in clinic (shorter clinic hours) while simultaneously increasing the volume of patients the physician can see without burning out. We don't wear white coats, because my physician does not wear a white coat in clinic. Business casual for us in clinic. PAs in hospitals wear scrubs, some wear the PA white coat, but note it is a different length than the physician white coats. More common for "PA Hospitalists" as the white coats provide handy pockets to put pocketbooks, pens, etc. Hope that provides some clarity! Anne Blog: http://www.canadianpa.ca Twitter: http://twitter.com/AnneCCPA Linkedin: https://www.linkedin.com/in/annedang/ Canadian Pre-PA Student Network: https://www.facebook.com/groups/canadaprepa/
  16. 1 point
    Yeah my first day of clerkship my resident left me at the nursing station, told me he would come back for me, and never did. I went home and cried.
  17. 1 point


  18. 1 point

    How much sleep do you get?

    Sleep is for wimps and dermatologists.