Proposed tax changes - what will that mean for us

[NutritionRunner]

4 minutes ago, JohnGrisham said:

True, but also likely an attending far into their career. Or not.  But honestly having a luxury car is not a terrible thing. Who are we to judge what someone does to save their money? I have a colleague with a luxury car, but they live at home, never eat out, and are very frugal otherwise - they just happen to like cars.

Also, I think there are many in their 20s and 30s who you likely(at least I do) see all the time eating out, having boutique coffees, desserts, craft beers, etc etc. Again those are all luxuries - it just so happens that some people choose to spend their extra money in different ways. 

But in all likelihood yes, that doctor with the luxury car - probably isn't the case of my colleague who is otherwise very frugal. But what they choose to spend with their income is really none of my business.  Especially given I have no understanding of their financial wellness or situation even remotely. Maybe they are otherwise independently wealthy already from family money(many in my medical school class), or had very good investments?Or chose not to have kids(Very expensive endeavour) Speaking of averages, its probably just that they have a decent salary and spent their money on something they wanted.  

Also, the salaries at many health centres are well in line with FFS, in many cases the work load to pay ratio is actually better than FFS. So maybe its just correlation and not causation there.  This was the reason i was led to believe that some of the health team models for FP were limited, because it was costing the govt too much money.

Well, I don't know all the details of compensation, but I do know that Community Health Centres (where I work) are different from Family Health Teams.  Family Health Teams don't ever seem to have problems attracting new family physicians.  Community Health Centres do.  That's party because of the client type (i.e. Community Health Centres deal with a lot more complex clients, lots of mental health issues, lots of poverty, lots of opioid addiction, lots of homelessness, lots of formerly incarcerated, lots of disabled, lots of people who have been "fired" from their previous family doctors, etc.) but partly due to income.  See:  http://www.healthforceontario.ca/UserFiles/file/PracticeOntario/FM Compensation Practice Models EN.pdf (All income from Salary from CHC physicians)

[JohnGrisham]

16 minutes ago, NutritionRunner said:

Well, I don't know all the details of compensation, but I do know that Community Health Centres (where I work) are different from Family Health Teams.  Family Health Teams don't ever seem to have problems attracting new family physicians.  Community Health Centres do.  That's party because of the client type (i.e. Community Health Centres deal with a lot more complex clients, lots of mental health issues, lots of poverty, lots of opioid addiction, lots of homelessness, lots of formerly incarcerated, lots of disabled, lots of people who have been "fired" from their previous family doctors, etc.) but partly due to income.  See:  http://www.healthforceontario.ca/UserFiles/file/PracticeOntario/FM Compensation Practice Models EN.pdf (All income from Salary from CHC physicians)

https://www.aohc.org/job-posting/family-physician

This is one posting i found, a few years old, and may not be a similiar centre as yours. But that pay looks pretty damn good and well within range, and definitely higher than the average FM doc. Especially considering the hours, the fact that you have RN and other allied health staff support... and wow look at those BENEFITSSS. Safe assumption of no overhead?

Seriously, if that is representative of CHC physicians, sign me the heck up, because that blows away most FM docs if you take the hours into account and all the benefits(monetary and non-monetary considering the non-MD staff on deck, and no overhead).

EDIT: For a second I thought it was probably in the middle of nowhere, but its in Kitchener and only an hour out from Toronto. Amazing. 

[JohnGrisham]

Another one : https://www.google.ca/url?sa=t&source=web&rct=j&url=https://www.brockchc.ca/wp-content/uploads/2013/08/familyphys.pdf&ved=0ahUKEwiOu5TQ_MjVAhUHHGMKHdw6AIY4ChAWCCowAw&usg=AFQjCNGK92xB9_EFfG3O4JIIidHp5FAHVw

 

Again unsure how reliable these numbers are

[NLengr]

Just to make things clear for people who aren't familiar with incorporation: Those family health team jobs are salaried positions (aka you are an employee of the health authority). They do not allow those physicians to incorporate. FFS physicians do not receive things like fixed salary, pension, health/dental, vacation etc.

 

As for the changes to jobs, eliminating the main vehicle for FFS physician retirement planning is gonna mess up a lot of retirement plans. I'd expect a ton of people won't be retiring as planned if the changes go through. The job prospects for new grads could look even bleaker if the changes happen. 

[NutritionRunner]

Exactly.  The physicians at the Community Health Centre where I work are on salary.  Those salaries are before taxes, so much less of that is take-home.  Plus, they are not allowed to incorporate (because they are salaried), so they pay tax on the full amount of the salary (no tax "loopholes" to pay a lower level of tax).  Also, they cannot bill OHIP or patients for anything.  So those forms that the "typical" family doctor charges the client $50 for, our physicians can't charge for - they do it on their salaried time.  Same with form completion that would normally be reimbursed (i.e. Special Diet Allowance forms) - the physicians and allied health can't bill for those either - they are completed on our salaried time. 

On the plus side, our physicians do receive benefits (medical/dental), pension (HOOPP), and vacation time.

Community Health Centres are very different beasts than Family Health Teams or regular family physician practices (in Ontario at least).  We've even had residents through our program who had no idea what a Community Health Centre was - they either thought we were a Family Health Team (similar, but very different funding models and very different patient population), or part of the Public Health Unit (nope).

[GrouchoMarx]

15 minutes ago, NutritionRunner said:

Exactly.  The physicians at the Community Health Centre where I work are on salary.  Those salaries are before taxes, so much less of that is take-home.  Plus, they are not allowed to incorporate (because they are salaried), so they pay tax on the full amount of the salary (no tax "loopholes" to pay a lower level of tax).  Also, they cannot bill OHIP or patients for anything.  So those forms that the "typical" family doctor charges the client $50 for, our physicians can't charge for - they do it on their salaried time.  Same with form completion that would normally be reimbursed (i.e. Special Diet Allowance forms) - the physicians and allied health can't bill for those either - they are completed on our salaried time. 

On the plus side, our physicians do receive benefits (medical/dental), pension (HOOPP), and vacation time.

Community Health Centres are very different beasts than Family Health Teams or regular family physician practices (in Ontario at least).  We've even had residents through our program who had no idea what a Community Health Centre was - they either thought we were a Family Health Team (similar, but very different funding models and very different patient population), or part of the Public Health Unit (nope).

 

Being salaried by the government is allowing them to have direct influence over your practice. I think this is a very bad thing.

[JohnGrisham]

47 minutes ago, NutritionRunner said:

Exactly.  The physicians at the Community Health Centre where I work are on salary.  Those salaries are before taxes, so much less of that is take-home.  Plus, they are not allowed to incorporate (because they are salaried), so they pay tax on the full amount of the salary (no tax "loopholes" to pay a lower level of tax).  Also, they cannot bill OHIP or patients for anything.  So those forms that the "typical" family doctor charges the client $50 for, our physicians can't charge for - they do it on their salaried time.  Same with form completion that would normally be reimbursed (i.e. Special Diet Allowance forms) - the physicians and allied health can't bill for those either - they are completed on our salaried time. 

On the plus side, our physicians do receive benefits (medical/dental), pension (HOOPP), and vacation time.

Community Health Centres are very different beasts than Family Health Teams or regular family physician practices (in Ontario at least).  We've even had residents through our program who had no idea what a Community Health Centre was - they either thought we were a Family Health Team (similar, but very different funding models and very different patient population), or part of the Public Health Unit (nope).

As for tax loopholes, again, even if you are incorporated  you PAY TAXES, and you pay personal income taxes on any money you take OUT of the corporation. Yes, you can keep money in the incorporation etc but that may soon lose its benefits anyways. So while being salaried you lose on some of those benefits, the fact that you're salaried for a 35hr week makes it a wash. As for not being able to charge for extra forms etc, sure thats fine - i'll gladly spend an hour on forms knowing i'm being fairly reimbursed on gov't time (i.e. salaried).  If a FFS doctor didn't charge for those forms, they would be working for free. The salaried doctor is actually using paid time to do so, so it makes sense they cannot double charge the patient. 

I'll stand by the statement that those salaries at CHC of N= 2 are very comparable and actually probably better than the average FM doc who is busting their bottom in the FFS system. The Pros of CHC > cons, and the benefits(the HOOPP pension is very good), no overhead, and you have allied staff on hand to refer too is great.   We have CHCs out west too, yes they are different, but not necessarily in a bad way. 

BUT I do agree that working in a salaried manner opens you up to not being necessarily able to practice as you want, and with govt oversight even more so, can lead to potential for overshadowing of administrators dictating the practice of medicine. 

[NLengr]

Salaried docs also pay no overhead (office rent, equipment and expenses, secretary etc). That can be quite expensive when you are FFS and have to pay for it all yourself. 

If if the government made all physicians salaried, the wait time to see a doctor would go through the roof. Why would I see 3 new consults per hour in clinic and bust my ass when I could see 1-2 new consults per hour, get paid the same and have a way less stressful life? 

[coolboi99]

4 hours ago, NutritionRunner said:

Plus, they are not allowed to incorporate (because they are salaried), so they pay tax on the full amount of the salary (no tax "loopholes" to pay a lower level of tax).

Are you sure? Salaried physicians in rural NS are able to incorporate.

[coolboi99]

I think the current system is fine. If the government does not like the way the current system works then they should come up with salary + variable compensation, full time position = 40 hours/week and everyone should get a pension after 65. 

If the current bill goes through then financially speaking becoming a doctor is not worth it. You'd be better off becoming a nurse, RT anesthesia assistant, physiotherapist or any other HCP which really only requires 4-6 years of schooling rather than 10-16+ years. Very little stress, less lifetime commitment to education.  

I personally know someone who recently graduated as a RT and is an anesthesia assistant and makes 110K in Halifax. I don't know how medicine would be financially rewarding after all that school when someone who's 24 with only 4 years of education can make 100+K, gets a pension plus other benefits. 

Even going into the RCMP you'd make more. 

[coolboi99]

On 8/5/2017 at 8:17 PM, Clapton said:

It would be interesting to see how much the average physician makes in Europe. If I remember correctly, it's not rare to see surgeons making less than 180k in Germany... And I'm pretty sure that the average GP in France is somewhere around 90-100k.

Yeah this is true. BUT guess what.... They have a socialistic system. They have high quality education for free, better healthcare, better pension plans, social security, paid vacations etc. Here doctors are capitalistic, but the healthcare system isn't. 

[indefatigable]

On August 8, 2017 at 8:27 PM, qnzjlo said:

Hey everyone, 

I am a tax lawyer with some background on this. Our law firm in conjunction with an accounting firm are issuing a joint submission to Morneau regarding his proposed changes. Just to give you guys some perspective from a tax side. The perceived "tax loophole" is hard to close simply because it is hard to achieve perfect integration (i.e., earning income through a corporation or earning it as an employee - people should theoretically be indifferent). The feds do not recognize that doctors and many professional corporations do not enjoy some of the benefits that salaried employees do. Sick days, RRSP group matching, vacation days, etc. these all come "out of pocket" if you may for professional corporations. But the perceived unfairness stems from the fact that tax deferral opportunities compounds over time in a corporation - this would not have happened had an individual invested this himself or herself through, let's say a broker. 

This is interesting.  But wouldn't these be deductible expenses - otherwise how else would corporations afford it?  And if so, would it still be advantageous from a tax point of view to incorporate and then pay a physician mostly as an employee with benefits instead of shareholder with dividends?  Or would be disadvantageous - i.e. double taxation?  

41 minutes ago, NLengr said:

Salaried docs also pay no overhead (office rent, equipment and expenses, secretary etc). That can be quite expensive when you are FFS and have to pay for it all yourself. 

If if the government made all physicians salaried, the wait time to see a doctor would go through the roof. Why would I see 3 new consults per hour in clinic and bust my ass when I could see 1-2 new consults per hour, get paid the same and have a way less stressful life? 

There'd have to be more managerial oversight -i .e. performance reviews, etc - otherwise the government would be essentially handing out cheques.  But I would suppose this would be expensive and not very practical and defeat the point of a more efficient system.  The individual bottleneck often seems to include billing and paperwork, but it seems as if EMRs aren't that much of a timesaver, so not sure what really could be done.  

 

[distressedpremed]

12 minutes ago, coolboi99 said:

I think the current system is fine. If the government does not like the way the current system works then they should come up with salary + variable compensation, full time position = 40 hours/week and everyone should get a pension after 65. 

If the current bill goes through then financially speaking becoming a doctor is not worth it. You'd be better off becoming a nurse, RT anesthesia assistant, physiotherapist or any other HCP which really only requires 4-6 years of schooling rather than 10-16+ years.  I personally know someone who recently graduated as a RT and is an anesthesia assistant and makes 110K in Halifax. I don't know how medicine would be financially rewarding after all that school when someone who's 24 with only 4 years of education can make 100+K, gets a pension plus other benefits. 

Even going into the RCMP you'd make more. 

Agree fully. Financially this doesn't make sense anymore. 

Sometimes it's really frustrating to be in a field where you're just labelled as greedy, to be stuck with high debt and limited ways out of it, have people consistently misunderstand gross and net income, and then work hard for less money than your predecessors made because people feel that as taxpayers, they're entitled to control any number they don't agree with. 

 

[la marzocco]

36 minutes ago, calcan said:

This is interesting.  But wouldn't these be deductible expenses - otherwise how else would corporations afford it?  And if so, would it still be advantageous from a tax point of view to incorporate and then pay a physician mostly as an employee with benefits instead of shareholder with dividends?  Or would be disadvantageous - i.e. double taxation?  

There'd have to be more managerial oversight -i .e. performance reviews, etc - otherwise the government would be essentially handing out cheques.  But I would suppose this would be expensive and not very practical and defeat the point of a more efficient system.  The individual bottleneck often seems to include billing and paperwork, but it seems as if EMRs aren't that much of a timesaver, so not sure what really could be done.  

 

Under the current system, those benefits are considered deductible expenses. What you described is a classic tax problem: salary v. dividends question. Since the tax system in Canada is not fully integrated, one can solve the optimal tax plan by looking at the jurisdictional tax rates and income brackets. Since this differs province by province, the indifference point between salary v. dividends would also change. Under the current system, double taxation is limited by the refundable dividend tax on hand (RDTOH) system. 

Let me describe - it's worth understanding. 

When your professional corporation earns a taxable income of $100,000, this is taxed at the Canadian-controlled private corporation rate, which is about 15% (11% federal + 4% provincial [assumed]). However, since the whole point of incorporating is to tax advantage of these low tax rates, physician would be inclined to keep after-tax earnings without the corporation and invest it in marketable securities, etc. These earnings are considered passive earnings. Passive earnings are what Morneau is gunning after. These passive earnings, in the past, are subject to refundable Part IV tax, which was about 33%. Refundable in a sense that the corporation pays it at 33%, but this flows into a RDTOH pool. The pool gets released as you pay dividends back to yourself - at which point this is a taxable dividend, and the corporation gets a "refund." So double taxation is very limited. 

This was the perceived benefit is that the company can enjoy tax deferral until the physician decides to release funds to himself. And precisely, why Morneau thinks it's "unfair." Normal Canadians would not have access to this as they cannot let their investments "brew" passively and have the discretion on WHEN to release the funds. Laymen can only have a few tax-effective tools at their disposal and are disadvantaged because they cannot choose when to release funds - partially they can by deciding when to sell, but if the stock pays dividends, they absorb the dividends as income in the same year. Unlike a professional corporation, where that dividends from stocks can be considered passive income and have that tax deferral opportunity. 

[NLengr]

1 hour ago, calcan said:

There'd have to be more managerial oversight -i .e. performance reviews, etc - otherwise the government would be essentially handing out cheques.  But I would suppose this would be expensive and not very practical and defeat the point of a more efficient system.  The individual bottleneck often seems to include billing and paperwork, but it seems as if EMRs aren't that much of a timesaver, so not sure what really could be done.  

 

The government has never been really good at making sure any of it's employees work at a reasonable speed. I can't imagine they are all of a sudden going to turn around and fix the problem is the salary all physicians. 

[indefatigable]

22 minutes ago, qnzjlo said:

Under the current system, those benefits are considered deductible expenses. What you described is a classic tax problem: salary v. dividends question. Since the tax system in Canada is not fully integrated, one can solve the optimal tax plan by looking at the jurisdictional tax rates and income brackets. Since this differs province by province, the indifference point between salary v. dividends would also change. Under the current system, double taxation is limited by the refundable dividend tax on hand (RDTOH) system. 

 

Yeah thanks - I have read the gist before of the refundable tax credits.  I guess my question is quite simple but maybe not clear- does incorporation provide any other advantage at all from a tax point of view for benefits? As you mentioned, the feds don't seem to recognize that a salaried employee gets pension contributions and other benefits from a company separate from pay - is there any  mechanism to do this via incorporation favourably? vs just standard RRSP contributions etc of a non-incorporated physician?  

It kind of seems as the feds are glad if physicians continue to operate on the small business model (i.e. hire staff, buy equipment), but receive essentially no outward benefit for that extra service and work.  

[la marzocco]

Just now, calcan said:

Yeah thanks - I have read the gist before of the refundable tax credits.  I guess my question is quite simple but maybe not clear- does incorporation provide any other advantage at all from a tax point of view for benefits? As you mentioned, the feds don't seem to recognize that a salaried employee gets pension contributions and other benefits from a company separate from pay - is there any  mechanism to do this via incorporation favourably? vs just standard RRSP contributions etc of a non-incorporated physician?  

It kind of seems as the feds are glad if physicians continue to operate on the small business model (i.e. hire staff, buy equipment), but receive essentially no outward benefit for that extra service and work.  

Aside from tax deferral opportunities there aren't any additional advantages from a tax perspective. There are some expenses that would only be deductible in a corporation, but not deductible if the physician acted as a sole proprietor - but those are minor. 

Ya - honestly Morneau's proposal is just a backstop for passive investments that are held in professional corporations. I honestly don't think it is an issue because end of the day, you will get taxed on it, merely just timing. 

 

[Coronaxtra]

Only if Canada allowed the "US style S-Corporations" to run medical/dental practices. I feel like down south, being a small business owner is much better with the tax reduction for wealthy individuals. 

[JohnGrisham]

1 hour ago, NLengr said:

The government has never been really good at making sure any of it's employees work at a reasonable speed. I can't imagine they are all of a sudden going to turn around and fix the problem is the salary all physicians. 

I know literally dozens who work in the public service in government jobs, and enjoy amazing benefits and pension plans - the efficiencies are superbly lackluster. Case in point: My best friend is a BSc grad, ambitious guy, and has worked his way up from zero skills post-grad with an unrelated BSc, through many positions in gov't and civil service. He's done at least half a dozen govt jobs and has interviewed and been offered a dozen others(but turned them down, as merely just going through the process as practice and keeping options open). He continually talks about how inefficient his colleagues are. His metrics are constantly >100% without breaking a sweat, and he has to slow down to not make others look bad. The average age of his workplaces hover between 45 and 55 mind you, and he's a late 20s guy, with a "i'll take all the extra overtime and bank that $$$" kind of attitude. A guy with a simple unrelated science education, but smart nonetheless. The common sentiment is that once out of probation, the majority of salaried government admin type workers know they just need to coast until retirement and are set - so they keep their metrics in the 50% range, and not raise any flags etc.  

If those workers worked half as hard as physicians or any healthcare staff for that matter do, their numbers would be 200% efficiencies. 

Yet people continually dump on physicians, when people without very much education at all are pulling easily close to 6 figures a year when factoring in benefits and retirement..without breaking a sweat, doing good work at a snails pace.  It is infuriating. 

[5th time the charm]

On 2017-08-09 at 8:40 AM, NLengr said:

Just to make things clear for people who aren't familiar with incorporation: Those family health team jobs are salaried positions (aka you are an employee of the health authority). They do not allow those physicians to incorporate. FFS physicians do not receive things like fixed salary, pension, health/dental, vacation etc.

 

As for the changes to jobs, eliminating the main vehicle for FFS physician retirement planning is gonna mess up a lot of retirement plans. I'd expect a ton of people won't be retiring as planned if the changes go through. The job prospects for new grads could look even bleaker if the changes happen. 

physicians in a family health team do not have salaries. They are in capitation models (such as a family health organization -FHO) and most are incorporated- they are independent contractors and also are considered under FFS because they can bill for health care procedures outside their basket and work in other FFS venues like surgical assist, ER, nursing home.  It is the allied health staff of a FHT (social workers, dietician, diabetic educators etc) who are salaried. 

[NLengr]

12 hours ago, 5th time the charm said:

physicians in a family health team do not have salaries. They are in capitation models (such as a family health organization -FHO) and most are incorporated- they are independent contractors and also are considered under FFS because they can bill for health care procedures outside their basket and work in other FFS venues like surgical assist, ER, nursing home.  It is the allied health staff of a FHT (social workers, dietician, diabetic educators etc) who are salaried. 

My mistake then. My province doesn't have FHO's.

[Ian Wong]

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

[Ian Wong]

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

[ralk]

5 hours ago, Ian Wong said:

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

If we're talking hard numbers, could I ask where those initial figures come from? I've run the numbers for my likely future income and don't get an impact anywhere near $20,000 per year from these changes, let alone $30-50k annually. Yes, the total loss from potential investment works out if there's an annual loss of that size, but if a physician is looking at tax losses of $50k per year from these changes, they're either earning an absolute ton of money (not just 1%'er income, but closer to 0.1%'er income) or paying a shockingly low tax rate for their earnings.

[Ian Wong]

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