The Government of Canada has announced intentions to alter the current tax laws for small businesses. As small business operators, Ontario’s doctors have utilized legitimate tax measures to invest in health care for you. These proposed changes will jeopardize your doctors’ ability to invest in their small businesses and provide quality care for patients like you in their community. You, too, can take action and support your doctors for #TaxFairness.
A petition has been initiated regarding these proposed federal tax changes. We encourage you to support your doctors. Follow the instructions to sign this petition and have your voice heard in the Parliament of Canada.
If implemented, these proposals will make Canada an undesirable place for your doctors to practice medicine. Doctors may retire early, pursue other careers or simply leave the country. Don’t let the government chase our best and brightest doctors away. Voice your concerns in a letter to your local MP.
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Cuts to doctors mean cuts to patient care. The federally proposed changes will affect how doctors have been investing in medical corporations, and could set the stage for a national crisis in primary care. Learn more from Ontario physicians about the potential impacts to your patient care:
Six years ago, Dr. Jenny Clement and her husband, also self-employed, built a small family medical clinic in the west end of Toronto. To meet the growing needs of the community, and specifically seniors in the area, they expanded the office three years later. Today, nine physicians practise out of the clinic, with an approximate patient load of about 9,000 people.
“My husband and I invested hundreds of thousands of dollars in building the clinic, as well as our own time and energy,” Dr. Clement said. “And neither of us has taken a draw from the corporation.”
As incorporated professionals, Dr. Clement says both she and her husband will be hit hard by the recently proposed federal tax changes. “The reason the office exists is to meet the needs of the community around us; it’s one of the reasons I went into family medicine,” she said. “But the tax reforms are going to make it very challenging for us to run the business without it becoming a non-profit organization.”
Despite not having medical benefits, pensions, sick time or paid vacation, Dr. Clement considers herself fortunate and believes she makes a decent living. Running a legitimate corporation has allowed her to plan for her future. “I’m not trying to ask for something that’s not legitimate,” she said. “I take umbrage with the fact that the government is framing this as though there are loopholes that I’m somehow taking advantage of or milking the system.”
Through her corporation, Dr. Clement employs five staff and covers the cost of ancillary services for the clinic such as cleaners, suppliers, and the companies that provide oxygen and liquid nitrogen. Unfortunately, she’s not sure the average person sees the hidden costs of running a medical practice. “They understand that health care comes out of their taxes, but they have no concept that the majority of us are running a business,” she said, “And we have staffing costs and overhead costs that we have to contend with, and no control over what we earn.”
With the proposed tax changes in place, some physicians are making plans to leave the country. “I lived in the United States for a number of years and I had the opportunity to work there,” Dr. Clement said. “But I chose to return to Canada to study and practice medicine specifically because I believe in single-payer medicine.”
But that doesn’t mean others physicians won’t travel south. And when they do, in about five to 10 years is when Dr. Clement says patients will start to understand and feel the impacts of the tax reforms, if passed.
“People care about something when it affects them directly,” she said. “Patients are going to see wait lists get longer, they’re going to see surgical wait times go up again and they’ll see specialists siphon off to the United States.”
Dr. Clement says she’s at a loss of what to do. Attempts to advocate for her rights as an incorporated professional as well as for more family doctors in her community have proved unsuccessful. “These changes are punishing not just docs, but anyone who owns a small corporation. These reforms, if passed, will make it impossible for anyone to start up a small business in Canada.”
“This is me trying to plan around the government that hasn’t planned for me,” she said. “And I don’t want to spend my time talking to my patients about how the health-care system is failing them; I’d rather just practise medicine.”
When Dr. Paul Martin heard about the proposed federal tax changes, his first thought was that they were not well thought-out in terms of long-term impacts to incorporated professionals as well as patients and their families.
Dr. Martin is a urologist in Sarnia, and also an incorporated professional. He owns a solo urology practice, with two full-time employees. He sees about 1,500 new patients each year and averages between 100 and 120 patient visits each week.
While he says the proposed tax changes, if passed, would increase uncertainty in his practise and disincentive further investment in the health-care system—such as buying equipment, hiring additional staff and increasing his clinic size—his main concern is losing some of the country’s top physicians.
“You’re going to see a lot of skilled and hard-working physicians leaving the country,” he said. “We already have trainees writing their American exams to a larger degree than they were before, and are being encouraged by their mentors to do so to keep their options open.”
For those who choose to stay, Dr. Martin expects physicians may opt to work less hard (particularly fee-for-service physicians) who will not have an extra incentive to see more patients.
“If you know that you’re being taxed in not only the highest tax bracket, but beyond that, then what is the additional incentive to see more patients?” he questioned. “With that sort of incentive, wait lists may grow.”
Amid so much uncertainty, Dr. Martin says the proposals make business planning difficult. “We can’t plan or practice in any way with huge uncertainty at both the provincial and federal level,” he said. “We have no idea what our practice is going to look like in the next year. It makes manpower assessments basically impossible.”
“I’m sitting down with my accountant to plan my year in terms of salary, dividends and how I’m going to structure my practice and my life, and effectively I cannot,” he said. “You simply cannot plan.”
Personal plans are also proving difficult for Dr. Martin, his wife and their two children. “We’re not really sure what tax planning and estate planning and education planning for our family is going to look like if these changes go through.”
But ultimately, Dr. Martin’s main focus is the effect on patient care, which he voiced in a letter to the editor that appeared in the Toronto Star.
“If you want to affect change, you must focus on the people who are making the decisions, and on the patients and on the voters,” he said. “The important thing is to focus on the patient impacts: growing wait lists, increasing wait times, decreased health-care infrastructure and decreased quality of care.”
When Dr. Rohit Kumar first heard news of the federally proposed tax changes, he felt another level of government was negatively hitting doctors. Dr. Kumar, an anesthesiologist who practises at Trillium Health Partners in Mississauga, didn’t realize how negative the proposed changes were at first.
But, after learning more about it, he truly began to realize the impact. He even wrote an open letter to all Canadian politicians addressing some of his concerns.
“At a very basic level, it’s just one more added stress in our environment, especially in Ontario,” he said. “Physicians are already feeling burnt out, and it negatively adds to their overall morale, which will no doubt impact patient care.”
For some practising physicians who have to pay for office space, support staff and equipment costs, Dr. Kumar says the proposals may impact their decision to hire more employees or keep their equipment and skills up to date. “These are little things that will add up to how patients will be indirectly impacted.”
Specifically in a hospital setting, the impact for physicians like Dr. Kumar is the added stress of knowing that he and his colleagues are worried about saving for their futures. Doctors do not have pensions and must save for their own retirement, sick days, vacation time, maternity or any other type of extended leave. “Everyone else working around me is having the same type of thoughts,” he said. “It’s an added frustration to think about, which distracts us from providing patient care or focusing completely on patients.”
The topic of leaving Canada to practise elsewhere is something that Dr. Kumar says is definitely coming up in conversation. But, now 10 years into practise, he says it’s not an option for him. But is still worrisome.
“I certainly think that people who are graduating and have a grasp of the implications of what’s coming down the road, may consider it,” he said. “When I was thinking of going to medical school, I was talking to physicians and they were saying ‘don’t do it, go into another field, times are tough, it’s not worth it.’”
Dr. Kumar thinks we’ve circled back to the same stage.
“Some graduating doctors will put weight on that when practicing doctors are saying the same thing to new grads. They may say they’re going to explore the United States,” he said. “When I was a medical student, there was a great majority of our class doing American exams at the same time, and I think that trend may come back.”
Albeit difficult during times of uncertainty, patient will remain his top priority. “Physicians go to work every day with one intent, and that is to make patients feel better,” Dr. Kumar said. “Remuneration is nothing when a sick patient is in front of you. We don’t think, ‘Am I going to get paid for this or not?’ That doesn’t determine whether we’re going to provide care or not. We provide care first. That is our job as physicians; it’s what we do and we take it seriously.”
As the only full-time adult clinical metabolic geneticist in Toronto, Dr. Chantal Morel follows more than 1,000 patients in the city who have rare genetic metabolic conditions, and provides ongoing consultations for various genetic conditions. While she predominantly practises out of University Health Network (UHN) and Mount Sinai Hospital (MSH) in downtown Toronto, Dr. Morel is also the Genetics Advisor for the North Bay Parry Sound District Health Unit, covering a population of 142,000 individuals.
She’s also an incorporated professional. As a sole-income earner supporting four individuals, her corporation has allowed her to save for retirement and fund four months of maternity leave per child. But upon hearing the news of proposed federal tax changes for incorporated professionals, including physicians, Dr. Morel is being forced to consider other career options, which will leave more than 143,000 patients in limbo.
“If these proposals go through, it will no longer make sense to maintain my corporation, nor am I going to continue to practise and see the amount of patients I’m seeing,” she said. “If I’m going to be taxed at a higher rate, what’s the incentive for me to do two jobs?”
To start, Dr. Morel would consider cutting down two jobs to one, beginning with her North Bay clinic. “If I’m essentially going to be giving all that over to taxes, then I don’t see the point of continuing that job,” she said. “But it’s going to leave the northern region underserviced when it comes to genetics.”
Her second decision would be to cut back on her hours at UHN, or leave clinical medicine altogether, to pursue a position in pharmaceuticals that would provide her with health benefits and a pension. But this means giving up what she loves doing, after 16 years of training and $150,000 in student debt.
“This is a vocation for me, it’s not a job. This is something that I’ve devoted by life towards, and I really enjoy what I do,” she said. “But I have to think about my future; if I can’t incorporate to save for my retirement and fund my children’s post-secondary education, I cannot continue no matter how much I love my job.”
But Dr. Morel worries about the patient impact that her vacancy would leave, combined with a second vacancy at the UNH and MSH clinics for a fellow geneticist who is currently on maternity leave. “The impact on adults with metabolic conditions is going to be pretty significant,” she said. “These are patients who can decompensate and die when they’re not well.”
“I’m extremely worried about the consequences of me having to scale back. I’m a super specialized physician, and if I do cut back on my hours, the impact is going to be huge, especially for the northern community.”
Her passion for her career has been what’s kept her going, despite feeling like she’s being spread too thin. “I’m working hard, but the fact that I love my job, I love my patients and that I want to do what’s best for my patients has kept me going,” Dr. Morel said. “But with the proposed tax changes, I really have to reconsider my priorities.”
Dr. Morel reinforced that she cares significantly for her patients and the population that she follows, but ultimately now has to think about herself, which she’s finding difficult. “I have this altruistic view where I think about others first. And now these proposed tax changes are going to prompt me to consider what’s best for me, instead of what’s best for my patients,” she said. “And it breaks my heart that I have to make that decision.”