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Ian Wong

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Ian Wong last won the day on August 24 2017

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About Ian Wong

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    Radiology attending
  1. Hi ralk, Last reply for me too then. It's been good debating with you. I hope that the other readers have a more nuanced perspective of both sides of this discussion. 1. No, I have both a marriage, and a corporation. You have a marriage, and the option to form a corporation. These corporations were fully endorsed and vetted at both the provincial and federal levels. Why do you think the federal government didn't just decide to abolish physician incorporation, instead of adding all these punitive measures while leaving the corporation concept intact? As I've shown you earlier, my corporation is doing everything all other small and large business companies do. It is an important difference that they continue to allow physicians to form new corporations and continue running existing corporations, rather than cancelling them. They've just neutered them to the point of financial non-viability. This begs the question of why? Fairness? I've already given you many other examples of unfair tax behaviour that will never be addressed by the government. Trying to raise money? This $250 million doesn't even scratch the surface of our annual federal deficit. Pandering to voters by continuing to target the 1%? I believe this is the true reason. Attached, is a link to a Dial testing survey conducted by the Liberal government during Bill Morneau's 2017 budget speech. ---- A chunk of the speech talking about tax fairness registered as the best received, with most recipients cranking their dials toward the magic 100. "This was the highest peak of the speech, regardless of gender or location," says Nielsen's report, compiled in the week after the budget. "There was a very positive reaction with the announcement of taxing the richest one per cent more in order to cut taxes for the middle class, cracking down and closing loopholes and paying your fair share of taxes." ---- This was a sample of 54 Canadians, based in either Toronto or Montreal. If you may recall, that budget speech gave a teaser of potential changes for incorporated individuals, but did not announce them, likely because the government was waiting on post-speech surveys such as this one, as well as clarification of potential lowered US corporate tax rates. The middle class remains blissfully unaware that the top 1% already pay 20% of all the taxes, and because it is such a small base of individuals, you could tax them to oblivion and still not significantly lower taxes for the remaining 99% of the population. 2. If we take your tack, as far as holding up to a contractual obligation, then the government should not be able to unilaterally change the corporate rules without either consultation or concessions for those corporations that would be affected. 3. Not at all. As you've alluded to, I would expect all households to be taxed on household income. The taxation would be revenue neutral, so the government continues to take in the same total tax dollars. In this scenario, an 80 hr/0 hr couple is taxed the same as a 40 hr/40 hr couple, assuming same total income. That would be fair. The further a couple deviates from 40 hr/40 hr, the more it is punished by our current taxation regime. Remember that many physicians, and likely most with a heavy inpatient component cannot limit their hours to 40 hr/week. By default, through the vagaries of patient and hospital care, they are going to be putting in 50-60 hr weeks as standard. They are financially punished because they can never approach that 40 hr/40 hr couple. 4. The figures are different because your initial numbers were off. The whole point is that with investing, starting off with a larger principal makes a huge difference when compounded over a long period. The capital gains tax for both the unincorporated physician and the incorporated physician's corporation were the same. That's the concept of integration at work. The unincorporated physician had much less principal to invest, because a large part of it was drained off at the highest personal marginal tax rate (remember, this person made $400,000 in 2016). The incorporated physician had much more principal to invest, because the corp funds were taxed at the small business rate of 13%. If you were incorporated, you would no longer need to take advantage of RRSP contributions; leaving the money in the corporation accomplishes the same thing. The corporate funds also have the flexibility to be used either as a retirement vehicle (a pseudo-RRSP), or for anything else, such as for capital purchases or income-smoothing. 5. You mention the risk component again here, where my risk as a physician is lower than other small businesses, but this does not invalidate the point that I am operating a small business. As mentioned before, radiologists and radiology are in no way a risk-free field. Radiologists are at risk of being supplanted by artificial-intelligence and machine interpretation. We have a constant risk of being outsourced to other readers (our hospitals in BC have been propositioned by non-BC radiologist groups to provide cheaper outside reads). There is a constant risk of physical disability (during internship, one of the radiology attendings suffered a retinal detachment during residency, career over). My private clinic could be out-competed by another clinic or group. Other physicians or non-physician providers could engage in "turf wars" and compete for medical imaging and interventions. As well, Canada has other corporations which face limited risk. Does this somehow invalidate their existence as corporations? How about a corporation which has a sole contract with the government, or a crown corporation? Pretty hard for it to fail. How about a corporation in a monopoly or oligopoly situation? Similarly difficult for it to fail. As Warren Buffet has said, you are looking to build a corporation with an enduring moat to competition. Our moat as physicians is the high level of training and licensure required to practise medicine safely. 6. I haven't seen those surveys, but I can tell you from the inpatient side, there's no way that inpatient-based physicians at any of the sites where I've worked or trained are working less hours than previously. Perhaps those surveys are skewed by the substantially increased numbers of female physicians over the last 20 years, and these physicians disproportionately work less hours than male physicians, and self-select into more lifestyle-friendly specialities like FM, peds, psych, etc. If so, this is even more worrisome from a workforce perspective, because the current generation of male-dominated doctors in their 50's and 60's who are willing to work those 60 hours weeks are soon to retire. These tax changes will only accelerate that retirement. Ian
  2. Hi ralk, Still have to disagree with you. 1. My wife did purchase shares in my corporation. Of course, this was early on when the corporation had little value. Subsequently, through my work, the corporation generated profits, and as a shareholder, my wife should be able to share in those profits. When Jeff Bezos started Amazon, or Mark Zuckerberg started Facebook, those initial privately held shares were worth very little. Now those shares are worth a substantial amount of money. This is the goal of a corporation, to grow, create value, and generate profits for their shareholders. My wife did take a risk along the way, namely by supporting me along the way. In turn, I allowed her to buy into my practice at an early stage, no different than an initial venture capitalist providing seed money and getting early shares of Amazon. There was always a potential risk that my corporation could fail (whether due to infirmity of its creator), or could have lost money by being me getting fired or losing licensure to practice after the corporation had taken on the debt for a practice buy-in. I acknowledge that I am significantly less likely to fail as a subspecialist radiologist as compared to a new Mom and Pop store, but I am certainly not fail-proof. My corporation acts similarly to other corps. It pays for the building leases for our private clinics. Inside those private clinics is corp-purchased diagnostic imaging equipment and servers, with annual service contracts, and a rapid rate of depreciation. We hire technologists, medical assistants, transcriptionists, and admin and clerical staff. We purchase internet, water, electricity, parking, security, laundry, and all manner of other services from other corporations. We compete directly with other private clinics. The corporation generates revenue, out of which is paid a significant amount of overhead and tax. Whatever is left from year to year can either be paid out to its shareholders, or retained in the corp. This is no different than any other corporation, so why again should it not be allowed to act as one, and issue dividends? 2. The federal government was fully aware that physician incorporation and subsequent income splitting/dividend sprinkling was going on from inception. You really think the federal government was oblivious to provincial government negotiations with physicians? Now, after allowing their provincial governments to cap or minimize fee schedule increases by offering incorporation, they take away that incorporation. That is a bait and switch, and an unfair tactic. This is completely different than a Sears pensioner, because it is being done by the government. 3. My whole point about household income is that if the household earns "X", it should be taxed the same as any other household earning "X", irrespective of how its constituents earned it. That is fair. Equal taxes for equal income. Right now, if I earn $150,000 working 80 hrs, and my wife earns $0 working 0 hrs, my household pays substantially more tax than your household where you and your wife both earn $75,000, both working 40 hrs. Even though both households make $150,000 total, and both contribute 80 hrs of work to the economy, my household is discriminated against. You are arguing that basing taxes on household income would disadvantage your household, because your taxes would rise to my level. Well, doesn't that mean that your household is currently unfairly being under-taxed and subsidized relative to mine? Why does my household have to pay more tax so yours can pay less? Dividend sprinkling allows me to even that up by paying dividends to my wife so that her low tax brackets aren't wasted. If you take away my dividend sprinkling in the name of fairness, I would expect household taxation to come in as a replacement, in the name of fairness (which it won't). 4. Your example about passive income in a corp being relatively minor isn't correct. I'll show you why passive investing in a corp is so powerful, because the initial amount the corp can invest is much higher. This has a massive effect when compounded over time. If you live in BC, and made $400,000 in 2016 as an unincorporated physician, you would pay $161,161 in provincial and federal taxes, and keep $238,839 in after-tax income. If you spend $70,000 of that this year for living expenses, that leaves you $168,839 to invest. Compound that out for 30 years at 9% gives you $2.24 million. If you sold all of that at once, that's a capital gain of $2.07 million. Half of that is tax free ($1.04 million), and you'd pay taxes on the other half, $1.04 million, at your individual tax rate. Assuming you had no other income in BC that year, you'd pay $466,441 in taxes, and keep $573,559. In total, you'd keep $1.04 million + $573,559, for a total of $1.61 million. Let's see how an incorporated physician does. The physician knows he/she needs $70,000 in living expenses, so for 2016 the corporation will pay a salary of $90,00 to the physician. On that $90,000 salary, a physician in BC will pay $19,920 in provincial and federal taxes, and keeps $70,080 after tax, for that year's living expenses. The corporation made $400,000 in 2016, and had a salary expense of $90,000, so it declares total taxable income of $310,000. The small business tax rate in BC for 2016 was 13%, so the corp pays 13% taxes on the $310,000, which is $40,300. This leaves the corp $267,000 in retained earnings. If the corp invested $267,000 for 30 years at 9% percent, it gives $3.54 million. If the corp sold all of that at once, it's a capital gain of $3.27 million to the corp. Half of that is tax free, and can be issued to the physician shareholder as a capital dividend, which is tax free to the shareholder. The shareholder gets $1.64 million in personal money, tax free. The other half, $1.64 million, is taxed in the corp at interest income levels (47%), and what is left remains in the corp. So, the other $1.64 million is taxed at 47%, which is $770,800 in corp taxes, and $869,200 remains in the corp, and can again be used for investment. So, unincorporated physician gets $1.61 million in after tax, personal dollars to spend. Incorporated physician gets $1.64 million in after tax, personal dollars to spend, AND the corp still has another $869,200 in after tax corp dollars, which could be reinvested or paid out at any time. The incorporated physician is much farther ahead because the corp had much more principal to invest passively. Remember, this is not a loophole, even though there is a substantial difference in outcomes. This is an intentionally designed feature of incorporation, which was set up to reward small business owners. A small business owner takes risks well beyond an employee, and there needs to be an incentive for these individuals to create and grow a small business. The small business owner gets no sick leave, benefits, pension, vacation, nor any guarantee of financial success, compared with an employee. 5. Physicians are working longer hours where I'm at, and patients are older and sicker. We keep people alive far longer than ever before, and the expectations and demands only increase. I don't know where you are at, but all physicians where I'm at are working longer hours, or at a higher intensity. Inpatient care has certainly ramped up. Surgeries that used to require multi-day stays are now done as outpatient or overnight cases. ICU patients are now managed in "step-down" or "high acuity" units. The hospitals are so overloaded with patients that it is now a common instance that a patient could be admitted through the ED, treated as an inpatient, and discharged home without ever getting a ward bed. A chest CT for PE 20 years ago came on film and with 60 images, and now has 700 images including all three imaging planes, MIP images, and bone and soft tissue algorithms, and the report better come out within an hour or two or the reading room phone starts ringing. 6. At a loss of $70,000 per year, let's again do the math for $70,000, invested annually, for 30 years. 5% return: $5.06 million 7% return: $7.46 million 9% return: $11.3 million That income cut is somewhere between $5-11 million! If losing $11 million doesn't anger you at some level, it should. It is highly likely that you wouldn't be able to spend all that money even if you tried, which means that it is an endowment for future generations, either within that physician's family, or likely a worthy charity. That is money which could be used to help all sorts of individuals, perhaps fund an educational scholarship which would live on in perpetuity, or any number of other wonderful things, except you never had a chance, because the government decided it could use the money more effectively than you (which it almost never does). As I said earlier, the key to this is being a humble 1 percenter. Sorry that you have seen physicians complaining about fee cuts to anyone other than other physicians. It's no more appropriate than a movie star complaining to the general public about being underpaid despite earning millions. Remember that if you see a physician driving a flashy car or living in a nice house, there is a decent chance the car is leased or the house has a big mortgage, so it is just the appearance of wealth, no different than anyone else who can borrow money. Humble people with real earned wealth tend not to show it off. 7. Finally, remember that these tax changes affect all small business owners. I confined my discussion to physicians, because that's what I am. However, small business is the main driver of the economy, and a source of employment for 70% of private sector employment. This is as unfair to those other small business owners as it is to us physicians. Ian
  3. 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
  4. 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
  5. 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
  6. Don't have time for a full analysis right now. Here's the Govt of Canada's example, for dividend sprinkling, with annual tax savings of $35,000 (my point #6). https://www.fin.gc.ca/n17/data/tppc-pfsp-eng.pdf (page 10) Now, this relies on having 3 adult family members to income split (unlikely for a new physician), but you can get a significant way there just with a non-working spouse (very common for a new physician with young children). Ian
  7. Ian Wong

    New Site Layout

    Yeah, rmorelan is a saint. Ian
  8. 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
  9. 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
  10. I'm now an attending out 5 years since fellowship. It's tough not to have your cynical moments in medicine. I think there's a major shift in cynicism throughout medical school. I think there's a big one between med school orientation (when everyone and everything is immensely positive, and the world couldn't be better), and the end of preclerkship (where you are getting tired of hitting books and memorizing). Then, there's an even bigger increase in cynicism as you go through clerkship. Hours are long, call is frequent, and you are always the low-person on the totem pole rotating into an unfamiliar specialty/ward. You also start to really experience the widespread dysfunction in medicine, and finally get lots of 1 on 1 time with bitter interns/residents/staff. You will probably get treated like crap by a higher-up at least once, if not frequently. Unlike when you were premed, and you could brush off a cynical physician as "just being jaded, and I'm not going to be like that", you start to discover that there are lots of reasons to be unhappy. Additionally, if your personal life wasn't super resilient prior to clerkship, the added stress of clerkship often spills into your personal life, and can affect your relationships with friends and family. Internship/residency/fellowship is additional climbing along the staircase of cynicism. You are directly responsible for the care of most patients in the hospital, often work the longest hours, and are paid a fraction of what you'd be paid if doing that work as a staff physician. Along with all the call and weekend work, you are expected to pump out research and prepare for board exams. Given your stage of life, you may also be balancing raising young children at this point. Between the 60-80 hours/week of clinical work, and all those additional duties, there's not a lot of personal time left. You are also likely in 6-figure debt at this point. Then there's attending-hood. I'm really happy with work and life in general here. Still have a few cynical moments here and there, but nothing like during training. In my specialty, the hours are much better as an attending, and work-life balance is easily achievable for most. I realise there are many specialties where this may not be possible, as a young attending who is trying to build out a practice. I think a lot of the happy physicians out there are ones who have managed to control their work-life balance. If I were advising a young medical student, I would say that choosing a specialty where you can control your lifestyle is likely to make you happier on a day to day basis. I'm also very fortunate to work in hospitals where we have good relationships with the other physicians, and this makes the work-day infinitely more fun. Inter-specialty squabbling and fighting is draining and exhausting for all. I haven't worked at that many sites, but my overall impression is that staff at community hospitals tend to be more friendly, compared to most academic places. Smaller sites tend to have less politics. I think a lot of people who end up working in a smaller community site go in with the goal of having a drama-free day, and the focus is on getting in, getting the work done, and getting back home. As well, you are likely to know all the other physicians personally within a short amount of time, and it's a lot harder to tell someone off if you see them on a daily basis. Although it's impossible to generalize, I think it's fair to say that many trainees may have limited exposure to community work in medical school and residency. Just don't forget that it is out there, and many/most physicians will end up working in a community setting after training. Ian
  11. If you did your residency in the US, as long as you met the Royal College requirements (they list the minimum number of months required in each radiology subspecialty), you should still be allowed to take the Royal College exams at the end of your PGY-5 year. The new negative for you is that your US program likely isn't going to devote as much time into boards preparation, and may not permit any study time allowances in the second half of your PGY-5 year. It is incredibly helpful to get board review lectures and hot seat conferences while you are studying for boards. Hearing other co-residents take cases is almost as valuable as taking the cases yourself. One of the rumoured/controversial reasons that the ABR switched away from having boards at the end of the PGY-5 year was that the PGY-5's needed so much boards prep and time off studying; you are losing the services of your most capable and productive residents. Ian
  12. I don't think there should be any significant effect for Canadian radiologist residents. The Canadian Royal College exams will continue on. Canadian residents devote the bulk of their study time towards these exams, and the US exam is almost an after-thought. The Canadian exams are generally felt to be harder than the US exams. Where it may come into play is that in the past, you would take both sets of exams concurrently, so studying for the Canadian exam in your PGY-5 year also simultaneously prepared you for the US exam. Now that the final US exam has been delayed out beyond residency, I wonder if we will see many Canadian graduates simply decide not to bother taking the US exam (particularly if you are planning on doing your fellowship and final staff job in Canada). Ian
  13. I'm going to lock this thread, as I don't think it would be productive to allow it to continue further.
  14. Online presence plays no positive role in getting you into a residency. I suppose it could be a potential negative if the residency program were to search you online and you had compromising or inappropriate content on your profile, but I would think most programs would not have the time nor inclination to do that. Getting into a particular residency is much more about making sure that you have the appropriate level of qualifications for it, and that you have strong letter of reference and hopefully some people in the program or closely connected to the program who will vouch for you. If there was one factor overall in getting accepted into a residency, it would be having influential people in that program who like you and want to work with you. Ian
  15. Ian Wong

    Knee pain and instability

    Hi all, This radiologic sign is known as the "Double PCL sign." This is diagnostic of a bucket-handle tear of a meniscus, usually the medial meniscus, which is flipped into a position where it lies anterior to the PCL, and mimicks the appearance of a second PCL. In the above image, there is a curvilinear black structure originating from the distal femur, and then extending posteriorly and inferiorly to insert on the posterior aspect of the proximal tibia. This structure is the PCL. Just anterior to the PCL is a second, flatter, curvilinear structure interposed between the distal femur and proximal tibia. This is the torn meniscus. On this single image, it is impossible to tell which meniscus it is, but usually it is the medial meniscus, and it would be evident when you are shown the remaining MRI images. Here's the Radiopedia article for the "Double PCL sign." http://radiopaedia.org/articles/double-pcl-sign frozenarbitor and TheFancyPanda, The ACL is only seen on a few slices in the sagittal plane, and I haven't shown you any of those images. So unfortunately, on the single image provided, no comment can be made on the ACL. Similarly, the LCL complex is not included in the above image, and also therefore is of unknown status.
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