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Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Old Sep 9th 2017, 9:43 pm
  #646  
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Originally Posted by snoopdawg View Post
Cats/dogs, English /Scottish, United/Liverpool, Corrie/Eastenders, Doctors/Lawyers
Enter the lions den....
I would stay out of a lawyer thread for fear of my life!
I am happy to be in a lion's den and, with the exception of my mini rant about my own doctor's practice, I don't believe that I said anything nasty about doctors.

I do find it very frustrating that I cannot receive my refills via the pharmacy. I attend for blood work every 3 months, and it is my understanding that they allow access to my results to both the dr and the pharmacist. That being the case, I assume that any issues would be dealt with if my bloodwork changed.

I accept that my doctor may spend time reviewing things outside of my presence. It's just that, each time I see her, she simply says, "What medications do you want to be refilled." I answer, she writes and I leave. I have no issue with her getting paid for what she does.

In any event, after JBE's explanation, it would appear that you and I are in agreement so I will leave it at that.
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Old Sep 9th 2017, 9:46 pm
  #647  
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

The income sprinkling won't apply to us anyway, as I will be come November an employee of the Corporation, for three days a week and then there's all the dammed paperwork I do. We haven't earned enough or been stable enough in the last three years to worry about investing either.

I have always assumed that moving country and being this generation that we will end up working way longer than the previous generation. That and having a two year old in our forties
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Old Sep 9th 2017, 10:11 pm
  #648  
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Originally Posted by snoopdawg View Post
...
But again, if we are only deferring tax, not avoiding but it leaves money to create other businesses, why not leave things be? The Government will get its cash eventually...
I am just musing, but one reason might be proportionality. Everyone can participate in tax deferred pension savings. Employees may be in company pension scheme. They may also top up their pension savings in RRSPs. Self-employed people can contribute to RRSPs. These options are also available to owners of CCPCs. However, there are limits to the amount a person can contribute based on earnings and an absolute ceiling of contributions each year so there is an effective limit to the deferral an individual can achieve.

I have clients with a passive investment portfolios of many millions within their operating CCPC. The tax deferral they have achieved is substantial and is in addition to the deferral in their maxed out RRSPs.

Tax issues aside, there is something else to consider. These passive investment portfolios belong to the CCPCs. They are therefore available to creditors in the event of a business failure or a lawsuit. Pension funds and RRSPs are protected from creditors because the assets in them are owned by trustees. There is a lot to be said for separating the risk to your retirement from the risk of your business life.

Last edited by JonboyE; Sep 9th 2017 at 10:14 pm.
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Old Sep 9th 2017, 11:05 pm
  #649  
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Originally Posted by JonboyE View Post
I am just musing, but one reason might be proportionality. Everyone can participate in tax deferred pension savings. Employees may be in company pension scheme. They may also top up their pension savings in RRSPs. Self-employed people can contribute to RRSPs. These options are also available to owners of CCPCs. However, there are limits to the amount a person can contribute based on earnings and an absolute ceiling of contributions each year so there is an effective limit to the deferral an individual can achieve.

I have clients with a passive investment portfolios of many millions within their operating CCPC. The tax deferral they have achieved is substantial and is in addition to the deferral in their maxed out RRSPs.

Tax issues aside, there is something else to consider. These passive investment portfolios belong to the CCPCs. They are therefore available to creditors in the event of a business failure or a lawsuit. Pension funds and RRSPs are protected from creditors because the assets in them are owned by trustees. There is a lot to be said for separating the risk to your retirement from the risk of your business life.
Most of this makes sense too, so maybe passive investment should be taxed but I still think active investment should be allowed- even in a different business if generating employment.
Re risk- that was something we were aware of. We are fortunate to have been able to bring over our NHS pensions- in personal accounts obviously- this is something not available to newbies here.
And as for the rest- we had good advice from our excellent accountant
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Old Sep 10th 2017, 1:04 am
  #650  
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

OK, now to throw the cat back in amongst the pigeons. I have been researching this a bit more this afternoon. Regarding the passive income the government has not issued draft legislation so we have to be guided by thoughts coming out of the finance ministry. In addition to the refundable surtax on income used for investments they have some other ideas and these definitely are bad news.

1) Apply the surtax to investment income but stop it being refundable.
2) Only half of capital gains are taxable. Currently, the non-taxable half can be added to the corporations capital dividend account and paid out tax-free to shareholders. The new idea is to keep taxing only half of the gain but not allow the tax-free distribution of the non-taxable half to shareholders.
3) Have different personal dividend tax rates depending on whether the dividend is paid from active or passive income.

3) seems possible but it will involve detailed record keeping. 1) and 2) go against the principal of integration and will significantly increase the tax-cost, not just the deferral, of retaining passive investments in a corporation. If either of these ideas make it to the statute book I will be sharpening my pitchfork and joining you on the march to Ottawa.
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Old Sep 10th 2017, 1:41 am
  #651  
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Indeed, this sounds like bad news.
I assume its all going forward and any current investments are grandfathered.
My accountant meeting just got longer!
Thanks for looking into it!
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Old Sep 17th 2017, 1:55 am
  #652  
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

As a couple looking to emigrate in the next year, we're mainly concerned about how the changes will impact the current workforce. Having just got back after visiting close to 20 clinics, it's apparent that many clinics are run completely by Drs within 5-10 years of retiring. If it aggravates enough Drs to retire earlier or proves financially beneficial to do so before the changes are implemented - it will make an already challenging hiring environment even harder and will detrimentally impact younger Drs that have bought into such practices.

It's definitely making our decision harder. Once you've taken into account the much higher cost of living (at least in B.C) on everything apart from petrol and housing, then any slight financial gain coming from the UK is easily eroded.


We loved our trip: met many wonderful people and explored many amazing places, but the potential fallout from these proposals is rather unnerving for someone about to take the leap.
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Old Sep 17th 2017, 2:31 am
  #653  
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Originally Posted by ecokid View Post
As a couple looking to emigrate in the next year, we're mainly concerned about how the changes will impact the current workforce. Having just got back after visiting close to 20 clinics, it's apparent that many clinics are run completely by Drs within 5-10 years of retiring. If it aggravates enough Drs to retire earlier or proves financially beneficial to do so before the changes are implemented - it will make an already challenging hiring environment even harder and will detrimentally impact younger Drs that have bought into such practices.
I don't follow. If the old guys retire, doesn't that open up more work, and more billing, to the younger ones?
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Old Sep 17th 2017, 7:43 am
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Originally Posted by dbd33 View Post
I don't follow. If the old guys retire, doesn't that open up more work, and more billing, to the younger ones?
I think Ecokid is talking about impact on patients .
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Old Sep 17th 2017, 7:45 am
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Also , working in an extremely underserved area is not always what doctors want .
The clinical risk is higher!
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Old Sep 17th 2017, 2:04 pm
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Originally Posted by Brainwave View Post
I think Ecokid is talking about impact on patients .
Well it will have an impact on everybody - patients and doctors. We stayed mainly in air bnbs during our trip and spoke to many people who have found it impossible to find a doctor. Obviously, if the older doctors retire then more patients will be orphaned and chances are more complicated patients with comorbidities that really require longitudinal care will not be able to find it, which is a travesty. As mentioned already, these patients require more care but the billing system doesn't adequately account for this - whereas patients that visit the doctors infrequently with a variety of different health queries are both easier to manage and prove more financially rewarding by the current billing system.Consequently, this partly explains why in some areas there has been a rapid expansion of walk-in clinics that target such demographics in lieu of the more complicated cases. I can only see this becoming more pronounced if further shortages happen.

In regards to the doctors left in clinics where a large proportion of the older drs retire. Simply put: you don't want to be the last man standing. If you've bought into the practice then presumably your personal overheads will increase with each doctor that retires who isn't replaced. In addition, there will be more work to do with actually running the clinic (these duties are usually distributed among owners of the practice). Even if you don't own a share of the practice and are essentially salaried then there is the chance that the owners of the practice will either eventually pressurize you to buy in or force you to leave if they decide to shut the practice. Moving clinics obviously has its own costs involved (transferring data records can be both expensive and difficult if the clinic you're moving to is on a different system), so there are lots of potential pitfalls if the proposals (from the perspective of a young doctor looking to join a practice) result in earlier retirements.



Building a panel doesn't seem difficult in any of the communities that we were looking at due to the level of unattached patients and so the potential benefit of attaining some of these orphaned patients is negligible.

Last edited by Verdant; Sep 17th 2017 at 2:31 pm.
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Old Sep 17th 2017, 5:18 pm
  #657  
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Originally Posted by ecokid View Post
Obviously, if the older doctors retire then more patients will be orphaned and chances are more complicated patients with comorbidities that really require longitudinal care will not be able to find it, which is a travesty. As mentioned already, these patients require more care but the billing system doesn't adequately account for this - whereas patients that visit the doctors infrequently with a variety of different health queries are both easier to manage and prove more financially rewarding by the current billing system
I think some of what you say is true but not the above. The "well, infrequent attenders" do not pay well, it is the complex elderly who pay the bills. In fact the more conditions, the more "valuable". Its quite horrible talking about human beings like that but that's the system.
At present in our town, very few complex elderly patients have no GP ( something like only 3-5%), its the younger patients who are orphaned.
As you have no obligation to take on new patients ( unlike the UK) , as others GPs leave, you personally would not feel pressure other than being asked 5-6 times a day to take on friends, relatives. I get that everyday, I swear it adds an hour on!
The issue of being last man standing with an office, staff, equipment is another matter, and you sum that up well.
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Old Sep 17th 2017, 6:16 pm
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Originally Posted by snoopdawg View Post
I think some of what you say is true but not the above. The "well, infrequent attenders" do not pay well, it is the complex elderly who pay the bills. In fact the more conditions, the more "valuable". Its quite horrible talking about human beings like that but that's the system.
At present in our town, very few complex elderly patients have no GP ( something like only 3-5%), its the younger patients who are orphaned.
As you have no obligation to take on new patients ( unlike the UK) , as others GPs leave, you personally would not feel pressure other than being asked 5-6 times a day to take on friends, relatives. I get that everyday, I swear it adds an hour on!
The issue of being last man standing with an office, staff, equipment is another matter, and you sum that up well.
I appreciate the correction - I guess it might vary depending on area and obviously everyone has their own bias which influences them. We were told that the additional billing associated with these patients was restricted to an annual payment, which didnt accurately reflect the work, time or associated risk/stress with looking after these patients and were told that you didn't want just these patients to look after. It's awful that patients are objectified in such terms, but sadly the Canadian system of billing does seem to depersonalise through an obsessive but practical need to quantify everything.

Last edited by Verdant; Sep 17th 2017 at 6:21 pm.
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Old Sep 17th 2017, 7:16 pm
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Originally Posted by ecokid View Post
I appreciate the correction - I guess it might vary depending on area and obviously everyone has their own bias which influences them. We were told that the additional billing associated with these patients was restricted to an annual payment, which didnt accurately reflect the work, time or associated risk/stress with looking after these patients and were told that you didn't want just these patients to look after. It's awful that patients are objectified in such terms, but sadly the Canadian system of billing does seem to depersonalise through an obsessive but practical need to quantify everything.
TBH- and I'm talking BC here- whoever sold that to you was either not great at billing or was ( cynical me!!) trying to fleece you! "I'll take that difficult 80 year old with CCF, COPD, DM and you can have this nice 18 year old who might want the pill yearly."
I personally think we are reasonably compensated for complex patients- as do all the other GPs in town given the lack of these patients! Remember each visit is also billed and above 50 years old the amount goes up per decade.
They are removing the incentive to take complex patients on which I think is short sighted. I think its because there aren't that many "complex" patients orphaned BUT we were also able to bill it for new mums/babies, people with cancer, mental health needs and the disabled who will now fall through the cracks .
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Old Sep 24th 2017, 9:29 pm
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Hello all

I have been following this thread for some time and have have gained a huge amount of information with regards to relocating to Canada. I wanted to thank everyone for their input -everything on here is gold and has made the process thus far much easier.

My wife and I are both GP’s in the UK and have decided that we want to make the move over to Toronto. We have had all our documents source verified, are members of the CFPC and are now at the point where we need to start looking into jobs and supervisors (a bit daunting!).



We both are planning to visit Toronto in early November and were wondering if anyone here would be happy to have a quick drink one evening to get some insight into practices and jobs??

I have messaged many practices from Health Force Ontario and are waiting on some responses. I was wondering if anyone else has any information or methods of finding practices other than the HFO website?

We would both be grateful for any help - it would be much appreciated. Looking through the posts I can see that a few have had very bad experiences with signing up to practices and would hope to escape this misfortune.

It would also be nice to have a little community in Canada to meet up with when we are missing M+S and the local chippy.

With everything thats going on in the UK now with GP we have both agreed that maybe the grass is greener on the other side!



Thanks
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