indefatigable

No question paying more taxes suck and I agree that paying more in retirement especially sucks. But I think the outrage and hyperbole is a little out of proportion as I explained in my example above - capital gains are still taxed more favorably than income including RRSPs. Even in your hypothetical example of 60 year old family doc with a big corporation (maybe they were working a lucrative practice during the golden days of FM), the current rate is an improvement over the rate they had when they maybe started saving 30 years ago! So if they were planning it all out 30 years ago, they are actually in for a pleasant surprise. Obviously, how much they are actually affected will depend on the extent of their actual realized capital gains - which depends on exactly what assets they own. Sure if they went all in google 20 years ago, they will take a bigger tax hit when they sell those shares e.g. 100 K shares will incur roughly incur 33K of corporate taxes vs 25K! Of course the appreciation of Google share price will mean that their total capital gain more than offsets the relatively small increase in taxes - they would be a decamillionaire had they invested a 100K in shares initially. Of course it's fairly unlikely that someone has only invested in assets that are incurring large appreciations and hence capital gains. I get that there are always more costs, but the sky is not falling and there will not be a stampede to the US. Maybe some cottages will get sold early to avoid paying more income tax. Maybe it will be harder to help with some costs of kids getting settled in or vacations, but it won't mean trips to a foodbank. Of course I find this example a little disingenuous as there was just a recounting of 53-year old FP who was quitting her practice in Mississauga after 20 years who maxed out her take home income at 142 K. However, I doubt any physician at this level of income should be investing in retirement through a corporation - it makes much more sense to max out RRSP and TFSA in which case they would be unaffected. The math for incorporation only (and vulnerability to increase in corporate gains rate) really works best for high earning physicians. https://torontolife.com/city/family-doctor-clinic-closing-burnout-inflation/

The capital gains increase are misunderstood. I don't think it will have a that much of an impact on the average physician including most family physicians. For family physicians, there are much more important considerations with respect to actual income generation during practice. For very high net worth incorporated physicians with substantial holdings in corporation (or personally) who decide to realize significant capital gains in a given year they will pay more tax, but still proportionately much less than a salaried income earner. The biggest tax hits will occur during intergenerational wealth transfe, selling second or third homes under the new rules and during retirement. In capital gains, inclusion rate is a percentage of the realized gain - e.g. suppose stock X doubles in price over 20 years at which point one decides to sell. If one initially purchased 100K of shares then the realized gain is 100K. Now as a personal amount this wouldn't even reach the threshold for a tax increase (which is 250K). For a corporate holding company selling assets the inclusion amount has now increased to 66K from 50K i.e. a difference of 16K which is now taxable (at the combined provincial federal corporate tax rate) so the corporation would probably be looking at tax bill of around 33K vs 25K after selling 200K worth of shares. I get that paying more taxes suck, especially when this would most likely mean less retirement income, but I don't think it's quite the hardship that it's being made out to be. Interestingly, the inclusion tax was changed as high as 75 percent in 1990 and in comparison to personal income tax this is still a big advantage where the personal amount is small fixed amount (15K) rather than a percentage - i.e. it doesn't matter if one earns 50K vs 200K. This is important in comparison to RRSP where withdrawals are taxed at income tax levels. Conversely, an incorporated physician can choose other vehicles for income such as dividends. Ultimately however, incorporation only usually sense when debts are paid and common instruments like TFSA and RRSPs are maxed out. I mostly agree with shikimate's suggestions, but also agree with Bambi's point that children shouldn't generally be delayed as the window really does expire if that is a goal. Moreover, I also think that optimizing career satisfaction may conversely sometimes require further training/fellowship - there's no point in rushing to a job which you may not like much and actually be less productive at. Also, sometimes further training/fellowship can result in disproportionate income gains.. interventional cardiology.. cough.

It's a surprise to see cardiac surgery have two unfilled spots after the second round. I'm not sure if there are more issues within the discipline - e.g. turf vs cardiology or whether it was just a very poorly planned CaRMS selection process. I don't think the CFPC is practical enough to think about negotiating power - in any case, the true power resides in provincial governments which keep increasing the number of FM residency positions despite lagging demand from CMGs. In response, FM programs are basically backfilling their positions with more and more IMGs - "But when second-round results were released on Thursday, all but two spots reserved for military doctors were filled in Ontario, the majority of them with graduates of international medical schools. Many of those students are Canadians returning home after completing a medical degree abroad, Dr. Green said. CaRMS matched more international graduates to residency spaces this year than ever before: 671, up from 555 last year and 439 in 2022." It's also true that the trends will likely continue unless more provinces decide to prioritize FM. Instead, as mentioned by shikimate, it looks like AB decided to give NPs what looks like to be a better contract than most FPs nationwide. In other words, FM is really no longer becoming a value proposition. https://www.theglobeandmail.com/canada/article-family-medicine-resident-graduates/ https://open.alberta.ca/dataset/00a02c21-141b-46be-af2c-528ef6ee29a6/resource/1fc45515-397e-4984-9b23-5f1ca6c76754/download/hlth-nurse-practitioner-primary-care-program-guide-2024-04.pdf

I can't think of any other profession where experienced practitioners are quitting and the solution is somehow to try to coax more graduates into comprehensive FM in part by building more med schools. Yet another "I am quitting FM in Ontario" article.. in this case a 20 year seasoned primary care practitioner. https://torontolife.com/city/family-doctor-clinic-closing-burnout-inflation/ Granted she was working in a HCOL location (Mississauga), although it's close to where these new med schools are being built, but some of the highlights are "When I was first building my practice, I made about $90,000 per year, after all our office expenses were accounted for. In 2022, that figure was about $142,000". When the average medical student debt is somewhere around 150-200K, Ontario FM in HCOL locations is becoming unsustainable. Like MedicineLCS noted, this is all about show and not about substance - it sounds good for other universities to have med schools but does almost nothing to fix the underlying issues. What's the point in building more med schools if you're facing accelerating losses? Any rational strategy would involved both retention as well as recruitment. This makes me think of health care in Ontario .

At the moment, the most important thing is to focus on the road ahead of you - especially the soos. Your thoughts and worries won't change your results on the samps but further practice and studying may help with the soos. It may help your anxiety to acknowledge the uncertainty and also spend a little time thinking of the rudiments of a contingency plan. If it's helpful, even graduates who were unsuccessful on any part of the exam were able to find work settings and successfully retake any part of the CFPC exam whether it be the soo or samp. The CFPC exams are run twice a year so any setback should only be temporary. The CFPC also provides detailed feedback in the case of an unsuccessful attempt. However, I wouldn't spend too much time worrying or planning for the worse as the results are uncertain and you still have important soos in front of you.

I don't think there's any absolutes. Extra training should on average help improve areas like clinical knowledge, critical care skills and managing patient flow, but training centres may only partially reflect real-life work settings which often have fewer resources (especially consultants and diagnostics). Also patient population and standards of care may not accurately reflect community practice which may overlap more with primary care as mentioned above. While simulation exposure helps to manage HALOs (high acuity low occurence) situations, it isn't a substitute for direct experience. As such, a CCFP who may have worked in lower resource settings, and been fastidious about developing their clinical acumen, may be more comfortable with certain areas of clinical practice which aren't seen in larger academic centers by FRCPs. Of course this more the exception than the rule. Still, a CCFP who has put in the time to learn the intricacies of nuanced clinical management may in fact 5 or 10 years into practice may be a stronger clinician, especially in a community setting, than a certified ED physician who has put less time into CME and development after their residency. Nonetheless, all things being equal, FRCP is a higher standard of training than the CCFP certifications and should on average be able to better perform the job, at least initially, in most cases especially in a larger academic centre.

It looks like they use the "Medical School Application Fee Waiver Program". It's based on three components: applicant's pre-tax income (also +/- parents & partner income) annual deficit (i.e. how much going into debt each year - highest level is 18K+) personal statement It's explained in detail on page 4-5 of the following link https://www.afmc.ca/wp-content/uploads/2023/05/2023_Application_Fee_Waiver_Program_Guide.pdf

From https://www.theglobeandmail.com/canada/article-queens-university-medical-school-lottery/ (also https://healthsci.queensu.ca/stories/news-announcements/new-admissions-process-improves-equitable-access-queens-md-program) A wacky social experiment or an improvement on current system? Besides formalizing the idea of luck, ultimately it seems as if the final selection criteria are more or less the same (except for the low income pool) although the candidates that are being considered are based on the lottery (if meeting GPA/MCAT/Casper cutoffs ). Not sure how it compares to the McMaster lottery year .. FYI - It appears to the lottery will narrow the field from around 3 000 (making cut-offs) to 650-750 - i.e. roughly 1/4 will make it to MMI. https://www.cbc.ca/listen/live-radio/1-92-all-in-a-day Queen’s University plans to introduce a lottery to its medical student selection process in the hope it will make admissions more open to candidates from diverse and low-income backgrounds. The university in Kingston said the lottery component, set to be announced Tuesday, is unique among Canadian medical schools and will be in place starting this fall. The lottery will occur early in the application process, not for the final selection. To reach the lottery stage, students must first exceed threshold cutoffs for grade point average, scores on the Medical College Admissions Test and the Casper test of ethical judgment. A random lottery selection will winnow the pool of qualified applicants that exceed the cutoff scores to approximately 600 to 750 students. They will proceed to a series of online mini-interviews known as the MMI. From there, the top candidates are invited to an in-person panel interview, typically granted to about 300 to 400 students a year. Queen’s School of Medicine admits only about 115 candidates every year from roughly 5,000 applications, so the process is highly competitive. Health sciences dean Jane Philpott said the admissions process has historically put up barriers to students who, for various reasons including socio-economic disadvantage, haven’t been able to develop a portfolio of accomplishments that gets them to the interview stage. “This actually levels the playing field,” Dr. Philpott said of the lottery. “You still have to be exceedingly intelligent and be able to do well at school. But amongst those who can meet that bar, you have an equal chance of being offered an interview.” Peggy DeJong, Queen’s assistant dean responsible for admissions to the MD program, said the school is trying to make data-driven and equitable decisions. Under the new system, roughly 8 per cent of spaces at the MMI stage will be reserved for students of lower socio-economic status, although the number could fluctuate from year to year. Students who qualify would be entered into the first lottery to reach the MMI stage. If they aren’t successful, they would be entered into a second, smaller lottery with students who fit certain socio-economic background criteria. The criteria were devised independently for a fee-waiver program used in the Ontario medical school admission system. They include student income, parental income, spousal income if applicable, student debt and a personal statement. A 2020 study of Canadian medical student demographics, conducted through an online survey, found they had parents with significantly higher levels of education and who were more likely to be professionals or high-level managers compared with the Canadian population. They were more than twice as likely as the general population to have a family income greater than $100,000 a year. Dr. DeJong said she was impressed by a lottery model that was used in medical school selection in the Netherlands. In that case, however, the lottery was used for final admission decisions, whereas in this case it’s only to get to an interview stage. McMaster University used a lottery system in part of its med school admission process during the pandemic in 2020. “We did not want to move to a lottery to admission, because I think that would be quite distressing and it would really reduce autonomy over the process to get into medical school,” Dr. DeJong said. “We do know that when we look at the diversity of our class and looking at the data points, we’re often losing people in the admissions pathway and screening people at that initial step between application and file review.”qq

I think the pretext for both medical schools in TO is the primary care shortage, but more medical schools will not address the root causes of the shortage. In fact, there are actually more FM doctors than ever - but they're not doing comprehensive primary care. TMU is adding residency spots in excess of UGME spots, however I agree that the same matching trends will likely continue in terms of specialty preference (>)> FM. The Ontario Government announced on March 15, 2022 that TMU will receive the following ministry-funded spaces as of 2025: 94 Undergraduate Medical Education (UGME) seats for medical students 105 Postgraduate Medical Education (PGME) seats for residents If York builds a medical school like Queen's FM stream, at best it will create more FM docs, not necessarily comprehensive physicians for which there are many articles highlighting a poor practice environment: https://www.ctvnews.ca/canada/sinking-ship-doctors-say-unfair-salaries-driving-them-away-from-family-medicine-in-canada-1.6821795 https://www.thestar.com/opinion/contributors/as-family-doctors-our-prescription-for-residents-is-to-not-set-up-a-practice-in/article_92430004-d015-11ee-9408-d711cf0d1b55.html

Everyone processes grief differently - some people like to talk about loss and others prefer to do anything but talk about the issue itself. Most people appreciate support though through presence and listening. Refocusing attention to non-medical aspects of life can help people get over their loss as mentioned above. Like everything, time has a habit of numbing one to the emotions associated with loss and eventually memories became more and more faded until disappointment is just part of the past. However, your friend is also making a value judgement on their own self worth based on a process over which they have very limited control. At the same time as encouraging acceptance and getting over their grief, I would also encourage your friend to perform strongly in PGY 1 to help position themselves for a possible transfer. If they are still really passionate about their first choice in IM, then I think FM to IM is probably the most common FM to RC switch and there seem to be open positions if your friend is willing to potentially learn in a less desirable location. But, I also agree that medicine normalizes sacrifices of all other aspects of life including living away from family and friends with no acknowledgement that work should only be one part of life and that living wherever can lead to dissatisfaction in other areas of life. Of course the flip side is that some people do get both their number one choice and end up living where they want to live. So experiences can obviously greatly differ. There was a recent business article in the G&M suggesting that luck plays the biggest role in financial success versus merit or talent. This included noting that the most talented individuals do not necessarily experience the most financial success. Extrapolating to medicine suggests that probably luck probably plays a greater role in CaRMS than is commonly acknowledged (and that would include the luck of having parents in the business, etc..). Like in life, CaRMS winners may disproportionately reap rewards. https://www.theglobeandmail.com/business/commentary/article-rich-and-successful-its-likely-youre-just-lucky/?utm_source=dlvr.it&utm_medium=twitter

Agree. Cardiac is a very small specialty. I've also never seen unfilled RC EM spots before. Still holding my breath for a full ROAD + Plastics in round two. Geographic distribution is mostly as expected although Western seems to have an unusual number of competitive positions left over. Possible transfers? UofT filled up except for an open neurology spot.

This is no longer an issue in Ontario where US Certified physicians no longer have to satisfy RC requirements - i.e. US completion and certification is sufficient. https://www.cpso.on.ca/en/Physicians/Registration/Registration-Policies/Alternative-Pathways-to-Registration (Pathway A) https://www.cpso.on.ca/News/News-Articles/CPSO-Removes-Barriers-for-Internationally-Educated

Basically the slides are comparing how well matching vs non-matching applicants do going through the CaRMS process - in uncompetitive (supply>demand) & competitive (demand>supply) disciplines. Applicants who that end up being unmatched have less chances of getting interviewed or of being mutually ranked and ultimately matching. In other words, being unmatched doesn't happen in isolation - it's the end point of a series of steps where such applicants are on average less successful than their matched colleagues. The matched percentage being higher in competitive disciplines may be a reflection of the fact that competitive disciplines (demand>supply) may be more selective with interviews, but also likely will be higher on an applicant's rank list and so an interview may be more likely to end up in a match. This could be part of the reason. However, I think it's simply a reflection of the fact that CMGs as a whole are moving away from FM (both in terms of matching & ranking) including CMGs that are unmatched.

it was definitely intentional - on a systems level, I suppose it doesn't matter too much. The raw data needed to make those comparisons will be released later in the month, but means that someone will have to process that.

The CaRMS forum was published today, but didn't include most competitive programs,.. as it usually does My takeaways: The overall CMG quota is the best it's been in 10 years at 1.08 positions to applicants (Slide 10). Increases in specialty positions are proportionally greater than increases in FM (Slide 11). Languages differences aren't accounted for however. FM is filling a record number of positions (Slide 36), but with a decreasing number of CMGs (Slide 40) & fewer matched CMGs rank FM (Slide 39) IMGs are doing better and better in CaRMS with current year grads having an 80% match rate (Slides 25 and 26) and have had a slight increase in quota (Slide 9) Unmatched CMGs as a whole are less competitive in both uncompetitive and competitive disciplines (Slides 48 and 51) - but have increasingly less interest in uncompetitive disciplines and increasingly more interest in competitive disciplines while programs are slightly trending in the opposite direction (Slides 49-50 & 52-53). Unmatched CMGs that skip the second iteration (presumably have stronger applications) have about 40-45% chance of matching to their original first choice discipline the next year (Slide 61). Unmatched CMGs unmatched in the second iteration struggle to get ranked at all or highly by programs (Slide 55) -i.e. are not close to matching. https://www.carms.ca/pdfs/carms-forum-2023.pdf