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Practicing in the US becomes more attractive day by day


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Looks like the NDP wants to increase taxes on people making above $210k. I honestly didn't think taxes could go any higher in this country, but here we are. 

https://www.cbc.ca/news/politics/singh-ndp-commitments-announcement-1.6138156

I just can't believe that the government can't distinguish between the ultra rich and the high income professionals who are making an honest living. Like why is someone making multiple millions each year taxed at the same rate as someone making 250k. The hostile nature in which the government treats physician is sickening. 

If shit really does hit the fan, how easily can Canadian physicians move down south?

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2 hours ago, MasterDoc said:

I just can't believe that the government can't distinguish between the ultra rich and the high income professionals who are making an honest living. Like why is someone making multiple millions each year taxed at the same rate as someone making 250k. The hostile nature in which the government treats physician is sickening. 

They pay the same marginal rate. Someone making 250K and someone making millions will not pay the same overall rate despite having the same marginal rate. Incorporation also allows Canadian physicians to shield a lot of their income from the highest tax brackets during their peak earning years. Also the NDP is not the government. I will eat my stethoscope if this current iteration of the NDP with this current leader were to form a government.

 

2 hours ago, MasterDoc said:

I honestly didn't think taxes could go any higher in this country, but here we are. 

Taxes can go much higher than what they are. Take a look at the top marginal rates in Northern European countries. It's  greater than or equal to 55 in Belgium, Denmark, the Netherlands, and Sweden. Those marginal rates kick in at well under 100K USD. In the 70's and 80's, the top marginal tax rate in Sweden was over 70 percent.

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Let's also not lose sight of the immense work, self-sacrifice, and delayed gratification that forms the foundation for that salary. 

While I agree it is a priveledge to join the medical profession, I grow increasingly weary of the martyrdom complex many of us preach. We do ourselves no service with this self-deprecating attitude and politicians and health administrators are all too happy to chime that gong whenever budgets are being decided and contracts are being negotiated. 

I, like I imagine most of my colleagues, pursued medicine because of a genuine desire to serve others and give back to the community that has given me so much. But at the end of the day it is still a job, and one that carries a heavy financial burden in the form of student loans, compounding interest and opportunity cost. No one questions a prospective law, engineering, business, or trades student pursuing their respective fields to improve their earning prospects, but 'God forbid' a medical student even think of a better life for themselves and their family at then end of 10-15 years of sleepless nights and endless hoop jumping. 

I apologize in advance if I sound snarky or bitter, but I physically gag every time someone in medicine climbs on to the podium to announce that we as a profession are over-payed and over-appreciated. Take a good hard look at ourselves and compare us to the well-oiled machines that are the nurses' unions (and this isn't a knock on nurses, they are advocating hard for a similarly overworked profession and deserve much more...we could borrow a page from their book). 

If anyone disagrees, please feel more than welcome to generously donated 10-15% of your salary to a charity of your choice, but please leave the rest of us out it. /end rant

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This is not even news. The NDP is making this promise in Newfoundland, a bankrupt rock. The NDP is basically at their usual 20% support range so now they can just put on a good show and any extra spectator is a plus. Actually I'd believe him more if he says he'll build a tunnel or bridge to NFLD. 

Also let me tell you, taxes are not as harmful as debt/inflation. Taxes are hard to implement and unpopular. But now a days the government have much more insidious ways of scraping your wealth. You won't even notice their hands in your pocket!

Step 1: borrow lots of money and do targeted hand-out so they get elected, or give insiders contracts so that money can be legally moved away.

Step 2: promote inflation by increasing money supply, so their debt actually pays for themselves (aka if you borrow at 1% for next 25 years and inflation is 5% for the next 25 years you actually come out ahead at the end).

Step 3: tell bank of Canada and statistics Canada to instill in people that inflation is no problem. Hey look CPI is only 2.5%, very manageable! 

Step 4: everyone have job, but everyone feel their wage can buy less and less. Nonetheless, the unemployment numbers look fantastic.

Step 3: your money from salary is slowly garnered "invisibly" to pay for government debt. Same thing with your house. It's worth more and more, but then you can't really sell it because the asset prices are increasing at the same pace too. Property tax will increase as your house value increase, so you are richer and richer on paper but cashflow is poorer and poorer.

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The government has a spending problem. Sooner or later they're going to run out of places and people to tax. If the marginal rate goes too high, people are goign to start questioning themselves whether or not its worth it to work after billing 210k or try even harder to find some loophole to avoid paying more income tax. 

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Moving to the US? I don't think so. Gun violence and violent deaths, no place to bring up children in a safe and sane society if given a choice such as Canada! And to practice where malpractice suits are a sport and physicians practicing defensive medicine where their first priority is to cover themselves from potential future malpractice cases is not for me. Practicing medicine in Canada is just fine for me.

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10 hours ago, Bambi said:

Moving to the US? I don't think so. Gun violence and violent deaths, no place to bring up children in a safe and sane society if given a choice such as Canada!

I have lived in the US and had a gun pointed towards me once.  I also grew up near major US crime cities like Detroit and would hear daily of violent crime.  

I agree overall that Canada is much safer.  But, the US is too big/diverse to effectively generalize - even more so than in Canada. 

Just like in any major Canadian city where you have exercise more caution in some areas/times, in the US this is even more extreme.  There are some cities in the US like Baltimore and Detroit where the homicide rate is so off the charts that it's not comparable to Canada.  And one of the most prestigious US med schools, Johns Hopkins is actually in one of the worst crime areas in the entire country - this kind of incongruence doesn't happen in Canada.

But, digging into the stats shows that cities like Winnipeg and Thunder Bay have a very similar homicide rate to Los Angeles.  This is despite the fact that LA has well-known high-crime regions like South Central and Compton which are considered to be "gang land".

Even though Harlem is notorious for being one of the worst crime districts in the US, TO actually has a very comparable crime rate to NYC (in 2018 TO had a higher homicide rate than NYC).  Likewise, Irvine CA - heart of "Orange County" has a smaller homicide rate than Québec city.

tl;dr US, even more than Canada is marked by strong regionalism, with extreme differences in wealth and also crime/homicide.  This applies at the macro/city level (e.g. Baltimore or Washington, DC), but also within the biggest cities like LA or NYC (Upper West Side is not too far from Harlem).  While overall Canadian cities are much safer, there's much more overlap than first appears, when excluding the most extreme US cities.  In many places in the US, higher wealth individuals can often effectively insulate themselves from crime/poverty - there is often much more division by skin color than in Canada.

 

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10 hours ago, Bambi said:

And to practice where malpractice suits are a sport and physicians practicing defensive medicine where their first priority is to cover themselves from potential future malpractice cases is not for me. Practicing medicine in Canada is just fine for me.

I agree this is much more of an issue in the US.  But, I do believe that this exists in Canada to varying degrees.  I find there is much more legal-medical concern in ON vs QC for instance.  I was surprised to learn things that weren't considered to be an issue in QC is much more controlled in ON.  The distinctive approaches to litigation can be seen in car insurance which is much less expensive in QC than ON due to difference in government regulation of lawsuite.  

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On 8/13/2021 at 12:25 AM, zoxy said:

Taxes can go much higher than what they are. Take a look at the top marginal rates in Northern European countries. It's  greater than or equal to 55 in Belgium, Denmark, the Netherlands, and Sweden. Those marginal rates kick in at well under 100K USD. In the 70's and 80's, the top marginal tax rate in Sweden was over 70 percent.

Yea but I don't really want Canada to turn into Europe. If I wanted to pay high taxes, I would go live in Sweden. I believe in personal responsibility and don't need the government to look after me. 

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I think moving south to the US can be heavily dependent on your specialty area. I think some fields are difficult because our training isn't transferable (e.g., neurosurgery last I heard), some fields have worse job markets (e.g. ER market just collapsed when I caught up with a US friend 2 weeks ago), and some fields just pay less than Canada (e.g., FM based off that same friend).

Additionally, the visa situation complicates things unless you're a dual citizen or permanent resident. I suspect the only institutions willing to sponsor your visa are larger centers where the pay is less compared to their community counterparts.

This is all based on conversations with my friends who live in the US. Feel free to correct any of the above but I don't think the solution for everyone is to move to the US. I'm not sure we will have a similar brain drain to the last one based on the hurdles above. I know for myself it would be difficult for me to transplant myself and my family to the US while I'm mid career and I am willing to bet many other mid career physicians are probably going to stay and grumble in Canada rather than start a new life in some random US city.

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On 8/16/2021 at 7:03 PM, Snowmen said:

I guess it does lead to some great exposure...

It certainly does. The birthplace for shock and trauma surgery is the R. Adams Cowley Shock Trauma Center in Baltimore. It's a free standing trauma hopsital associated with the University of Maryland rather than Hopkins. Memorial Hermann in Houston and the new trauma centre at the University of Chicago are probably very busy with shootings as well.

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1 hour ago, zoxy said:

It certainly does. The birthplace for shock and trauma surgery is the R. Adams Cowley Shock Trauma Center in Baltimore. It's a free standing trauma hopsital associated with the University of Maryland rather than Hopkins. Memorial Hermann in Houston and the new trauma centre at the University of Chicago are probably very busy with shootings.

All the best trauma surgeons in Canada train in the US for some time IMO. Only way to get that exposure, sadly. I could never live in the US though. 

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On 8/12/2021 at 10:53 PM, unarmed walrus said:

I think we, having the positions we have, lose sight of what an immense privilege it is to make such a salary. I for one am happy to pay more in taxes so that those less privileged can live better.

lol gimme a break dude. Those idealist beliefs self destruct medicine from within. Apparently sacrificing over a decade of your life to society isn't enough. Your compensation must also be given away (to the government). 

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1 hour ago, medigeek said:

lol gimme a break dude. Those idealist beliefs self destruct medicine from within. Apparently sacrificing over a decade of your life to society isn't enough. Your compensation must also be given away (to the government). 

Just my opinion and my values, friend. You're allowed to disagree with me.

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1 hour ago, unarmed walrus said:

Just my opinion and my values, friend. You're allowed to disagree with me.

Sure. I just don't understand why every profession advocates for much muchh higher pay but doctors (who usually have done 10x the work) advocate for less pay. It's such a unique weird scenario. 

Teachers can make just about 100k working 45 hour weeks and go on strike for more pay (despite having 4 + 1 years of school). Doctors train for 13-15 years and advocate for less pay. Thankfully you're in the minority. 

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4 hours ago, medigeek said:

Sure. I just don't understand why every profession advocates for much muchh higher pay but doctors (who usually have done 10x the work) advocate for less pay. It's such a unique weird scenario. 

Teachers can make just about 100k working 45 hour weeks and go on strike for more pay (despite having 4 + 1 years of school). Doctors train for 13-15 years and advocate for less pay. Thankfully you're in the minority. 

I think most actual doctors and residents advocate for more pay for the ever increasing work load and complexity of medical problems that they are ultimately responsible for. Difference is the idealistic people here are usually medical students, pre-medical students, or naive young people that really have no real life experience. Sure this might be judgemental on my part, but it's generally true.

Once you are past the bullshit MMI stuff to get into medical school and go through clinical medicine, things and views change.

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On 8/13/2021 at 1:25 AM, zoxy said:

They pay the same marginal rate. Someone making 250K and someone making millions will not pay the same overall rate despite having the same marginal rate. Incorporation also allows Canadian physicians to shield a lot of their income from the highest tax brackets during their peak earning years. Also the NDP is not the government. I will eat my stethoscope if this current iteration of the NDP with this current leader were to form a government.

 

Taxes can go much higher than what they are. Take a look at the top marginal rates in Northern European countries. It's  greater than or equal to 55 in Belgium, Denmark, the Netherlands, and Sweden. Those marginal rates kick in at well under 100K USD. In the 70's and 80's, the top marginal tax rate in Sweden was over 70 percent.

the doctors there also earn a lot less as well. The overall effect is that doctors would earn a lot less but have the usual increased benefit package such societies offer 

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10 hours ago, MasterDoc said:

Please get back to us when you are an attending.

Ok well....I am attending. I don't mind paying the tax rate we pay at all. Between the high rate of pay, the tax shielding of the incorporation, the stability of the income, and the comparison income other fields make I don't think we are that bad off at all. Doesn't mean I deal with a huge tax increase but there has to be some balance after all in things. Of course I structure things to minimize expenses and taxes, and train myself in and apply proper personal finance techniques....so things work out just fine. 

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On 8/20/2021 at 8:00 AM, rmorelan said:

Ok well....I am attending. I don't mind paying the tax rate we pay at all. Between the high rate of pay, the tax shielding of the incorporation, the stability of the income, and the comparison income other fields make I don't think we are that bad off at all. Doesn't mean I deal with a huge tax increase but there has to be some balance after all in things. Of course I structure things to minimize expenses and taxes, and train myself in and apply proper personal finance techniques....so things work out just fine. 

I think we all have different view points. I believe in personal responsibility and don't need the government to look after me. And I don't believe in putting a higher tax burden on the rich just because they are well off. 

Also, when I see politicians talking about raising the taxes it doesn't sit well with me because I damn well know that it won't matter because the government will still continue to spend money like it grows on trees. I have worked for a federal government agency before and saw first hand how irresponsibly the government spends taxpayer's money. I saw how completely useless most of the government agencies are along with the entitled federal employees who don't get anything done because they know they won't ever be fired. 

I don't mean to sound like a tin-foiled hat conspiracy theorist but from my experience as a previous federal employee I will say that the government isn't always acting on public's best interest. They often have their own agenda which they value more over the public's wellbeing. Trudeau calling the snap election in September is an example of this. 

Our problems are not going to be fixed by taxing the rich more, but rather we need to put pressure on the government to start spending our tax money more responsibly.

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On 8/21/2021 at 5:01 PM, MasterDoc said:

I believe in personal responsibility

The older you get the more you realize how a lot of life is based on luck. Ergo, there is a need to re-distribute the luckily obtained income/capital. To give a medical school example, if my GPA were 0.15 percent lower, I wouldn't have made the OOP cutoff for the school that I eventually got into. That's the difference between getting an A- instead of an A in the 47 classes I took in four years of undergrad. I could very easily have not gotten into medical school changing the outcome of my life and most probably my place in the income ladder.

Anyway, I think John Rawls A Theory of Justice and explains how redistribution is necessary if we have a "veil of ignorance" about our lives. In other words, if you have no idea what race, gender, creed, economics status, intelligence, etc you will be born into, you'd want to be born in a country with a robust welfare state. The Stanford Encyclopedia of Philosophy does a decent summary of it.

Having said that, I agree that the federal government is bloated and a lot of the money is wasted, but to say "I believe in personal responsibility" and that graduated taxation shouldn't exist is naive in the context of life being so dependent on luck and circumstance.  Additionally, The goal of the Federal government, like any large organization, is self perpetuation and not the public's best interest. The sooner you understand this general concept and apply it to life, the more society as a whole and the actions of the Federal government will make sense. Don't expect the government and its workers to act in people's interest, but expect it to act in its own interest. Then its actions become entirely logical and predictable and explains the bloat and inefficiency.

 I still don't see a better form of society than a capitalist system with strong anti-trust regulation and a robust welfare state redistributing a portion of the spoils of capitalism. But I feel that outside the US, we have one of the worst implementations of such a system in the western world, especially if you're unfortunate enough to live in the GVR or the GTA and not own property.

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