July 2020 Pulse: Residents in Action

PU SE INSIDE THIS ISSUE

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Icarus - Resident Submission

RESIDENTS IN ACTION july 2020 | issue 42 11-12

An Interview with Dr. Brandon Tang on ICRE2020

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Doctors of BC’s Optional Insurance Update

The purpose of Resident Doctors of BC is to support residents in fulfilling their education to become well-informed, prepared and professional physicians to enhance patient care.

MISSION STATEMENT • • • • •

To To To To To

advocate for contractual matters support members’ education and encourage excellence in the teaching environment promote its members’ professional, personal and financial well-being foster collegiality among its members throughout British Columbia facilitate collaboration with the community and other professional groups

CONTACT US Phone 604-876-7636 | 1-888-877-2722 Email

info@residentdoctorsbc.ca Facebook Resident Doctors of BC Twitter @ResidentDocsBC Instagram @ResidentDocsBC 350 - 1665 West Broadway Vancouver, BC V6J 1X1 CONTENTS 2 3 5 6 7 9 11 13 15

A Word From Our Board Upcoming Events Resident Engagement Dinners Resident Awareness Week 2020 Recap Resident Spotlight: Dr. Tarun Soni “Icarus” - Resident Submission An Interview with Dr. Brandon Tang on ICRE 2020 Keeps Getting Better - Doctors of BC Insurance Income Protect - Doctors of BC Insurance

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“Should I put it in INC?”: Incorporation basics for resident doctors The Dos and Don’ts of Financial Planning for Locums Distributed Site: Tofino

A WORD FROM OUR BOARD A WORD FROM OUR PRESIDENT

Dear colleagues and friends, Thank you for your dedication, advocacy, and leadership each and every day as resident doctors. Over the past few months, COVID-19 has posed one of the greatest public health challenges in recent history and, on behalf of the Resident Doctors of BC (RDBC) Board of Directors, I would like to acknowledge the incredible work of resident physicians during this time.

As an Internal Medicine resident here at UBC, I witness incredible moments of resident engagement on a daily basis. During a global health elective in pre-pandemic times, I recall my co-resident arranging an intercontinental consult with a dermatologist in Vancouver, given the lack of local subspecialists, which led to a critical diagnosis and initiation of therapy. More recently, I was touched by a colleague with a young family who rented a new apartment during the pandemic so he could continue working, while not exposing his wife and newborn baby. These acts of heroism have not gone unnoticed and the public’s renewed appreciation for healthcare workers, on display nightly during the 7 p.m. salute, has been truly humbling.

These examples only capture a fraction of the incredible work I have seen, and they motivate me to be the best physician I can be. But we all know that being a resident doctor is not easy, during COVID or not. In fact, the Canadian Medical Association’s 2018 Physician Health Survey revealed that rates of burnout and depression are actually higher amongst residents compared to other physicians. To me, this underscores the need for our continued efforts to create both systems and cultures of care where residents can thrive, and not just survive. This recognition has fueled my own passion for medical education and my engagement with organizations such as RDBC to promote positive change. Collectively, I am confident that we can improve residency education, one step at a time.

Thank you all for your incredible engagement and please find time to take care of yourselves too. You are all proof that the future of medicine in Canada is bright.

Respectfully, Dr. Brandon Tang Board of Directors, Resident Doctors of BC @DrBrandonTang The COVID-19 pandemic reached Canada during the publication schedule of our March, 2020 issue. As our staff and residents who work on this magazine focused their energy on serving residents, who in turn serve the public, the March issue was delayed until the summer. A decision was made to merge both the March and July issues together, bringing you Issue 42: Residents in Action. We appreciate your patience and understanding.

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UPCOMING EVENTS All upcoming events have been cancelled to take our part in complying with the Provincial Health Officer’s orders. We hope to bring you virtual events during this time, such as our Annual General Meeting on August 26, 2020. Please stay tuned for information on how this will be delivered.

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PLAN YOUR OWN SOCIAL Have a party... on us!

Resident Doctors of BC wants to help you and your residency program plan a social event.

We will sponsor up to $750 (up to $1,700 if two programs collaborate) towards your program social event.

Interested? Visit our website and look under 'Contact'!

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RESIDENT ENGAGEMENT DINNERS WITH THE MINISTRY OF HEALTH As part of an initiative to further engage the residents and the Ministry of Health, we have been working with the Ministry to begin hosting regular dinners that allow residents and ministry officials to meet, and discuss residency.

The first Resident Engagement Dinner with the Ministry of Health occurred on November 20, 2019. It was the first of many engagement dinners, and set a high bar with thoughtful discussions and the dedication residents brought to the table.

Residents once again met with the Ministry for dinner and discussion on February 13, 2020 in Victoria, as part of Resident Awareness Week. We were able to to build on the prior dinner to further establish the importance of residents in British Columbia, and their status as the future physicians of the province. We look forward to future dinners and discussions on medical practice in British Columbia.

A virtual engagement session took place on May 20 to discuss virtual care with residents.

We look forward to engaging with the Ministry further in the future.

For more photos of the November 2019 event, visit our website, www.residentdoctorsbc.ca.

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RESIDENT AWARENESS WEEK 2020 RECAP Thank you to everyone who participated in this year’s Resident Awareness Week!

Resident Doctors of BC and a group of residents had the opportunity to visit the BC Legislature Building in Victoria for Resident Awareness Week 2020. On February 13, RDBC hosted a breakfast and invited MLAs from various ridings to attend and meet the future physicians of BC. There was a great turnout and residents had the chance to meet and chat with MLAs about the importance of their work, and residency in general.

Following the breakfast, we were invited to the Q&A period.

In the evening, we met for dinner with Ministry of Health officials. This second dinner of a series of Ministry and Resident engagement dinners allowed for follow-up conversation from the previous dinner. The room was full of residents and Ministry enjoying great food, as well as great conversation about the future of health care in BC. The Ministry of Health also hosted a booth in the lobby of their building helping to spread awareness of residents!

Thank you to everyone who came out to Victoria for this busy day, as well as everyone who remained at home and helped us spread awareness in hospitals—whether by chatting with patients, or wearing our “Ask Me, I’m a Resident” buttons—as well as in the online sphere. We look forward to building up the importance of residents in the health care system of BC.

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RESIDENT SPOTLIGHT

NOVEMBER, 2019 Dr. Tarun Soni, PGY-1, Family Medicine TELL US A bit about what inspired you to go into Family Medicine?

Family doctors deal with all specialties: we are the jack of all trades. I get to work on different cases, diversity, age groups, and procedures. It is refreshing and energizing to see a newborn child after a heartfelt conversation with a person going through depression. It is never a dull moment.

When I graduated from high school, I had the opportunity to chase my childhood dream of becoming a doctor. I attended a medical school that my mother had once worked at in India. This is where I got a glimpse of medicine as a child. I had the opportunity to utilize my unique experiences in Canada with my Indian history and use it as a tool to help patients. I had the privilege of going to poverty riddled areas, and with a different outlook on patient care, I learned an approach to helping people that I still use today. I realized that I can make an impact on the lives by counseling patients about a healthy lifestyle and diet, benefits of exercising and a clean environment.

Soon, I realized I was on the right path with most patients appreciating a physician who cared for them more than just their physical complaints.

It was during the toughest times that I realized how much difference a family doctor can make with patients. During the final year of my medical school, I remember getting a phone call from my family, telling me the most terrifying news. My father had passed away with a sudden heart attack, which was a big shock for all of us because he did not have any major cardiac risk factors.

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I felt shocked and confused! I could finally understand what patients feel when they lose loved ones. Now that I understand the impact of grief and loss on families on a more personal level, I’m in a much better DR. MEAGAN MCKEEN position to listen to and comfort my patients.

A few months later when I was in my Family Practice rotation, I saw a young man who was undergoing grief due to his father passing away from cancer. I was able to connect with him on a deeper level, helping him get through a dark period of his life. I realized that sharing my story and building deep relationships helps the patients. No other profession offers that.

What are your plans for the future after your residency?

I see myself becoming a full-time GP in Fraser Valley where my family resides. I want to continue giving back to the community that gave me everything. Currently, I am involved in writing articles for the local newspaper and have a health blog, where I help spread awareness in my community about health literacy, which I will continue to do in the future.

I am also very interested in doing enhanced skills training such as Addiction medicine after my residency as I want to help the youth who are involved in substance use in the future as we are dealing with a huge opioid crisis currently.

Working in India helped me understand the differences between the health services in distinct parts of the world. I witnessed people traveling from faraway places to come see a doctor for many health problems

that we take for granted here in Canada.

I remember managing patients suffering from tuberculosis, mitral heart disease, and even going personally door to door to give polio vaccine to kids for the national polio eradication program. This helped me gain a different perspective of how medicine works in other parts of the world, and I am excited to share the skills that I have gained with the underserved communities here in BC. How do you work on your wellbeing and manage to balance your life around residency?

I believe in a balanced approach to life.

Working hard during the rotations is very important and necessary, but I also believe in de-stressing during my off time. This not only gives me time to work on my hobbies, but also mentally prepares me to work hard for the next day.

During my off time, I enjoy reading non-fiction books, which helps expand my thought process and gain a better understanding of how the world works.

Currently, I am reading Principles, by Ray Dalio.

I also enjoy exercising and strength training. I try to hit the gym at least two times a week.

This allows me to not only work out my physical body but also condition my mind.

Family and friends are a very important support system for me. I am lucky that I have my family in Abbotsford and I try to visit them at least once or twice a month. I get the chance to share my experiences with my family and as a bonus, I also get to enjoy home-cooked meals.

I feel managing to balance your life in residency is very important to prevent burnout in the future, as we all want to keep enjoying our time practicing medicine as long as we can. At the end of the day, life is a marathon, not a sprint. So, I take it one step at a time.

You learned acting from a professional

acting school after finishing medical school.

Tell us a bit more about how that experience helped you as a physician?

As an avid Bollywood fan, I was interested in acting and I dreamt of learning it one day.

After finishing medical school, I took the opportunity where I had some time off to go to the same academy, Barry John’s Acting Studio, which is the same as my favorite actor, Shah Rukh Khan. I wanted to get it out of my system before I worked hard to get into residency. I knew it would make me confident, which would help me later on during my interviews, but after finishing the course I felt it helps me become a better physician as well.

Being an actor and a Family Physician has many similarities, which I found very useful during my clerkship and even now in residency.

I realized that acting teaches you to be more empathetic as a person. When you are acting, feeling the emotions is not enough, you have to express those emotions for the audience to see. Similarly, as a physician caring for the patients is not enough, really expressing, and emoting those emotions is equally important.

Even though you have the lines memorized in a play, things might change as acting is all about “reacting” to the person in front of you. Similarly, in the medical field, you have to always be aware of the non-verbal clues that the patients provide and react to the person sitting in front of you. Sometimes, as the physicians we have our agendas, such as finding the right diagnoses, treating with the right therapy and counseling about the side effects, etc., but understanding the patient’s values and their concerns is very important.

This is where I understood what a patientcentric approach means.

Overall, I feel life can teach us many things, even unexpectedly, as long as we are willing to learn from them.

For more Resident Spotlight features, visit our website.

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RESIDENT SUBMISSIONS

ICARUS PRIMUM EST NON NOCERE Dr. Ashleigh Vallée, PGY-2, Family Medicine I am Icarus: humours devoid of black bile and blood are made airy By groundlessness. My evolving wings split my skin as if torn open by The wisdom of the world. My sternum now a keel, my fingers barbs and shafts: I am flying. But the earth thunders me down. The sky cracked by a rib of light Like the primordial beat of an umbilicus. Electrified man.

A nurse reaches past my curiously blank face to amplify the shocks And the patient’s pupils swell, pitching me through the mind’s eye.

The window into man’s soul is in fact more akin to a rabbit-hole: a dark tunnel Converging in a slimy string of axons that synapse into a cellular stew.

With the instruments of life, I am Frankenstein, creating catastrophe.

I am Ariel: when flying, I am afire, freed from the bureaucracy Of bones and bark. Catching the sharp north wind, I passed easily through the eye of the needle. I do not fear demons, secure in the knowledge that Hell is empty (all the devils being here). Then comes the sun, red and hot in that Copper sky. I can feel my feathers melt, slick arms outstretched, soft as a babe Yet made weighty by Newton’s law, I plunge into a foaming brine below.

“Sterile saline,” corrects the physician, striding past in whites, slamming the door Distractedly on a post-operative patient, who splutters with surprise. His coat billows Behind, moved by a misplaced faith in medical miracles. In the hot air Of his wake, I am the intern and my stethoscope swings like the tail of a bull.

I am the minotaur: keeping the night watch over the slumbering sick.

In the silence of the hospital, I listen for the drag of death’s door.

My heart quickens at the bedside yet remains steady in the certainty That the weariest of worldly lives is still preferable to darkness.

In the shadowy halls, I search for a way through nature to eternity.

As I reach into the night locker for a dose, I pray I will touch pines.

But there’s no wardrobe wonderland waiting, and the joke is in the fact that We are not immune to the decay of age – there is no tincture for time.

The immortal king meets my wavering eye as if to say, despite all, death will have his day: Oh the crunch of capitulating capitalists!

You are my Jahweh: spawning life from the genetics of the universe.

Making me with great gashes, stitching flesh together, like heaven and earth.

From the dead halves of a worm and fish, you fashioned a heart, the valves smacking In an ocean of blood. “Lub, dub, lub, dub” echoes your grotesque instrument.

You pluck my heart strings. Despite the purity of your vision, I sicken: Rotting in a sea of sin, I vomit snakes hatched in my fermented core.

Shaking your head, you turn away, disgusted. The bite of humanity Lingers like spoiled fruit. Unhappily you try to blot me out – damn spot.

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I persist. A hoarse raven, darkening your doorway with my black black wings.

I peck out the whites of your eyes, tasting a vision of the perfect son.

We are the angel-headed hipsters: our minds static with anxiety.

High on Ativan and Adderall we dance beneath those cankerous clouds, The sun stares, steadily, suspiciously even, as we push propofol.

We book for balenotherapy, psychotherapy, halotherapy, Anything to cure the eruption of malignant dissatisfaction.

Our brains metastasize. Glial cells apoptose, absorbed by wavebands And passed wirelessly to strangers, transmitting generational angst.

Drunk on dopamine, from each click and swipe, we float across the atmosphere, Searching for the hole: the snag in the fabric of fate. Those witches couldn’t Recall the formula for ozone and chose instead to make radicals.

Who is this poet? A hollow man howling into apocryphal winds.

An incoherent torrent of tomorrows whipped by furies of future.

“Code red. God is dead,” announces the overhead, in a monotone voice.

Who knew that we would slope sadly towards mediocrity, aged and paunched?

That, facing the fire, ablaze with our rage, we would forsake the promised rains.

That the Bible was filed with Bebel and Bernstein and accidently burned.

That every woman loves a boot in the face: America loves a fascist.

“Reduce, renew, and rejuvenate” we chant, mid-millennial crisis, But the answer is always “tomorrow and tomorrow and tomorrow.”

Now it’s too late to build the boat. Pine a’rot with beetle. We’re animals.

In the dark of the last night, a winged figure launches from the hospital.

My coat like a sail, a smile across the moon, I escape into ether.

Perhaps I was lifted by a dream, held by narcotics and tobacco In a state of suspended animation and disbelief in a kingdom Of in vitro fertilization, incubated in the womb of father God mother Earth and goddess. C-sectioned into being By a scalpel of photons. The echo of a maternal cry forgotten, Or perhaps never even heard by the headless, heartless angels of fate.

Those murdering ministers. I skim the milky pearls of a starry way, Pushed by an afterglow of microwaves in the moonless night of eternity.

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FEATURE

AN INTERVIEW WITH DR. BRANDON TANG DR. BRANDON TANG is a PGY-2 in Internal Medicine and sits on the Resident Doctors of BC Board of Directors. He is one of four Chief Residents at the 2020 International Conference on Residency Education, which is being hosted in Vancouver.

For those who may be unfamiliar with ICRE (International Conference on Residency Education) or have not attended in the past, can you tell us a bit about the conference?

ICRE is the world’s largest conference focused on residency education. It is a truly international gathering, with a number of international attendees annually, although it takes place in Canada as it is hosted by the Royal College.

Having attended a variety of academic conferences before, it was immediately clear to me that ICRE has a distinct energy. In the past, it has featured lively debates, live patient encounter simulations, and high-quality plenary sessions that feel like they could be broadcasted on TV. The attendees are so passionate about medical education, and it is inspiring to see these like-minded individuals come together.

This year, I have been involved in the planning of ICRE 2020 as one of four Chief Residents and have been amazed at our planning committee’s dedication to crafting an amazing conference experience. We are always looking for ways to make the conference bigger and better, building upon the success of previous years.

This year, due to COVID-19, ICRE 2020 is one of the events that has transitioned to a virtual stage. How are you expecting this to play out?

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I am so excited about the first ever virtual ICRE, starting with the kickoff event on September 25, 2020! The entire world has had to adapt to the pandemic, and the embrace of virtual technology for trainee education and patient care is a prime example. As we started to envision how a virtual ICRE would play out, we saw many opportunities to innovate with the online platform. We are still finalizing the program, but the kickoff event in September will likely begin with a live plenary presentation followed by a panel discussion. Afterwards, there will be parallel sessions where you have the opportunity to move between breakout rooms to watch different presentations.

Following the kickoff, we will release regular serialized content such as workshops or live presentations that will lead us into ICRE 2021, which is a unique approach that would not be possible with a face-to-face conference.

Overall, hosting a virtual ICRE is an opportunity for us to continue innovating in residency education. In many ways, the virtual medium has incredible upside, such as ease of access and the ability to record content for future viewing. We are ecstatic about the potential of ICRE 2020 and believe it’s going to be a real game changer for residency education.

This year, you are one of the Chief Residents for ICRE. What are the roles of the ICRE Chief Residents? What is the application process like to become a Chief Resident?

Every year there are four ICRE Chief

Residents selected from around the world, and I am honoured and excited to be working with this amazing team. Prior to the conference, we participate in monthly planning committee meetings and offer resident input on proposed ideas. We’re constantly trying to think of new ways to keep the conference fresh and engaging.

During the conference, we will facilitate social media engagement, host a resident networking session, and chair many of the sessions themselves. Overall, we’re dedicated to creating an amazing conference experience for everyone who attends!

In terms of the application process, the majority of pieces required are fairly standard, such as a CV, a personal statement, and a letter of reference. However, one unique new requirement was the creation of a short video explaining our motivation for being Chief Resident. For me, this involved learning an entirely new skillset – the technical skills of video and sound editing – but it was a valuable learning experience in the end. I would encourage anyone interested to apply for the role. It’s been an amazing experience thus far and I really value being a part of this incredible medical education community. If you have any questions, please don’t hesitate to reach out!

What are you looking forward to most about a) being one of the Chief Residents

and b) at ICRE 2020 in general?

In terms of being Chief Resident, I’m most looking forward to all of the new ideas we have planned for ICRE 2020! I am really grateful to be part of the planning committee, and am learning so much from our dynamic team.

As for ICRE 2020, I feel like we have a huge opportunity to pave the way for virtual education. This is a unique opportunity to be innovative and demonstrate leadership in residency education, and I am so excited for what we’ve put together for the international medical education community.

Dr. Brandon Tang currently sits on the Resident Doctors of BC Board of Directors.

He is a second year Internal Medicine resident, who has previously served as an Official Observer, and been a member of the Joint Task Force and the Communications Committee. He co-chaired the Resident Doctors of Canada Practice Committee, advocating for National Physician Licensure as well as resident wellness through the Resident Anthology. He is passionate about improving the resident educational experience and hopes to continue advocating for these issues as a Director.

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INSURANCE

KEEPS GETTING BETTER - DOCTORS OF BC INSURANCE AFTER A COMPREHENSIVE review, Doctors of BC insurance plans transitioned to new carrier to provide enhanced programs at the same or lower costs to residents and practicing physicians.

of underwriting to determine the eligible monthly benefit you qualify for. There will be no additional income testing or reduction of benefits at time of claim for Total Disability.

LIFE COVERAGE

New Worldwide Portability. Your coverage as a practicing physician continues protecting you in practice anywhere in the world.

NEW Lower Rates. On May 1, 2020, members and their spouses will receive a 10% reduction to their life insurance premiums. These reduced rates are in addition to the partial refund of premium that is given to members if the life plan accumulates surpluses.

IncomeProtect DISBABILITY INCOME INSURANCE Same Low Rates. The Doctors of BC DII rates is maintained.

New Increased Monthly Benefit.

IncomeProtect for Practicing Physicians now offer benefit amounts up to $25,000 per month. This will be in addition to the PDI monthly benefit of up to $6,100 per month for a new combined benefit of $31,100 per month.

New Increases to No Proof of Income Limits.

When you finish residency or fellowship, you can switch your IncomeProtect for Resident to the Practicing Physician plan and apply as a family physician for up to $7,500 per month, and as a specialist up to $11,000 per month, without proof of health.

New Enhanced Total Disability Benefits.

A financial assessment will take place at time

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New Increased Retirement Protection Rider. You can apply for up to $1,500 per month under this Rider to provide continuing contributions into a Registered Retirement Savings Plan if you were to be Disabled.

PHYSICIANS’ DISABILITY INSURANCE Same great benefits. If you have at least $2,000 of the Doctors of BC IncomeProtect Disability for Residents at least 12 months prior to practice, you will be eligible for the provincial governmentpaid disability plan. This coverage is at no cost to you, but you must enroll when you complete residency.

PROFESSIONAL EXPENSE INSURANCE Same Low Rates. If there’s a possibility of you joining a practice with shared expenses or opening your own practice, PEI will help cover office and professional costs if you’re unable to work due to accident, illness, or maternity leave.

New Higher Maximum Monthly Benefit Amount. The PEI Insurance will be enhanced to offer benefit amounts up to $30,000 per month.

CRITICAL ILLNESS INSURANCE COVERAGE NEW Higher Benefits Levels. The Critical Illness plan maximum has been increased to $500,000 to provide higher financial security in the event of a life threatening illness.

NEW Lower Rates. On May 1, 2020, the Critical Illness rates will decrease by 12%.

ACCIDENTAL DEATH AND DISMEMBERMENT NEW Lower Rates. Current rates will be reduced by 35% effective May 1, 2020.

New Increased Maximum Benefit Amount. The AD&D maximum benefit amount will be increased to $2,000,000.

To learn about how you can benefit from these changes, please email insurance@doctorsofbc.ca or call 604638-2904.

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INSURANCE

INCOME PROTECT - DOCTORS OF BC INSURANCE DOCTORS OF BC congratulates and welcomes all new residents to the province.

Doctors of BC is a voluntary association of 14,000 physicians, residents and medical students. You can enroll in membership for $4.33/month, which will get you connected to physician resources and provide you access to discounted no-medical insurance, mobile plans, and other discounts.

IMPORTANT NOTICE: 90 Day Deadline for IncomeProtect™ Disability Insurance Enrollment!

Residents New to BC - You are not enrolled in the voluntary Doctors of BC IncomeProtect™ for Residents disability plan. You have until September 28, 2020 (90 days from starting residency in BC) to enroll without medical questions.* While residents in BC have access to a mandatory employer disability plan, Doctors of BC encourage you to supplement your employer disability with a personally paid plan because: 1. BC is an expensive province to live in, especially if you’re disabled. IncomeProtect™ will pay you up to $3,000 additional disability payments so that with your employer plan, you have $6,000 of monthly income if you’re unable to work due to a disability.

2. Your employer disability will reduce benefit payments if you have coverage through another association plan. As a private plan, Doctors of BC IncomeProtect™ is not reduced.

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3. Your employer disability plan provides limited coverage after 2 years of being on claim. While the employer plan would continue to cover serious disabilities, some claims may no longer qualify.

IncomeProtect™ uses True Own Occupation definition of disability to maximize claims payouts. The plan also has a Top-Up Feature that provides up to $2,000/month of additional benefit on top of your base coverage if the employer disability stops paying after 2 years.

4. Your employer disability plan terminates upon graduation. Doctors of BC IncomeProtect™ continues coverage in practice, worldwide.

5. If you begin practice in BC, you will be eligible to enroll in the BC governmentpaid Physicians’ Disability Insurance (PDI) without proof of health if you have at least $2,000 of IncomeProtect™ throughout residency/fellowship.

Doctors of BC also offers residents $100,000 life insurance without medical questions. You have $50,000 life coverage through your employer benefits.

Monthly rates for Doctors of BC IncomeProtect™ for Residents $3,000/ month tax-free coverage: (See next page)

AGE

MALE NON SMOKER

FEMALE NON SMOKER

< 34

$15

$31

35-39

$22

$44

40-44

$36

$62

45-49

$43

$69

50-54

$57

$94

Monthly rates for Doctors of BC Life Insurance $100,000: AGE

MALE NON SMOKER

FEMALE NON SMOKER

< 34

$3

$2 - $3

35-39

$4

$3

40-44

$6

$4

45-49

$8

$5

50-54

$11

$9

2. Complete Life Insurance Application 3. Complete Membership form ($4.33/ month) – required for insurance enrollment 4. Read More: a. IncomeProtect information b. Life insurance information 5. Book an appointment with Lisa Fincaryk, Resident Insurance Advisor, to discuss your situation or call 604638-2904 to learn more. *This offer is only available to residents new to BC. If you were a UBC student with IncomeProtect™ for Students, your plan will switch to the Resident plan automatically.

The voluntary insurance is offered by Doctors of BC, a physician association that is separate from Resident Doctors of BC. Doctors of BC membership fee of $4.33/month is required for this insurance coverage.

Next Steps 1. Complete IncomeProtect™ for Residents Application

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FINANCES

“SHOULD I PUT IT IN INC?”: INTERVIEW WITH IMMEDIATE PAST INCORPORATION PRESIDENT BASICS FOR RESIDENT DOCTORS Alphil Guilaran, Executive Director, The Financial Literacy Counsel ONE OF THE most common questions resident doctors have as they complete residency training is, “Should I incorporate my medical practice?”

Although there is no cookie cutter answer, there are basic questions that you need to answer for yourself before proceeding with incorporating your medical practice after residency.

In this article, we will explore when incorporation is right for you.

1. What is incorporation?

Incorporation for doctors is the creation of a new legal entity that becomes the owner of your medical practice. As a result, you will own shares of the corporation and the money you earn for your work is paid into your corporation first, rather than directly to you.

To access money to pay for your personal household expenses, you will need to choose how much income you will take out from your corporation in the form of a salary, a bonus and/or dividend. A qualified accountant who specializes in working with incorporated medical professionals will be able to advise on the best mix to choose.

2. What are the benefits of incorporating for Physicians?

There are 2 key benefits when incorporating:

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•

•

•

The money you leave inside your corporation after taking out what you need to cover your personal household expenses is taxed at a lower rate.

For 2020 the combined federal and BC small business tax rate is 11% on profits under $500,000 compared to 53.5% if you are self-employed and not incorporated.

More money to save and invest for the future.

As a result of paying only a 11% tax rate on money left inside your corporation every year, that leaves you with 89 cents to invest when compared to having only about 50 cents to invest after paying taxes at selfemployed/ personal non-incorporated tax rates. The tax saving helps you save and invest more effectively over your years in practice. However, you also need to consider how to take the money out in the future for personal spending purposes such as buying a home or in retirement. Plan ahead, seek out tax and investment advice before you begin investing through your medical corporation to avoid unintended consequences in the future.

3. How much do you need to live on and how much can you save inside your corporation?

If you are trying to decide when is the best time to incorporate your practice, you have to start with having realistic expectations of how

much your personal household expenses will cost when you transition into practice from residency.

Paying the accounting and legal fees for incorporation makes little sense if you need to pull out most of the money inside the corporation to pay for your personal and household expenses.

Ask yourself the following questions: • •

•

Do I have outstanding balances on my student loans and line of credit that I want to pay off as soon as possible?

Do I have a significant expense coming up such as a down payment on a home, paying for a wedding or an expensive vacation when COVID19 restrictions are lifted?

Will my household expenses increase when I am in practice making it difficult for me to save any money?

One litmus test to consider before incorporating is the $40,000 Rule. It is worth exploring incorporation if you can save at least $40,000 or more per year inside the corporation after paying for all your business related, personal and household expenses.

4. How much does it cost to get incorporated?

are hiring are experts at incorporating medical practices.

It’s also important to remember that in addition to the initial set up cost you also have to budget the ongoing yearly accounting and legal fees to file your taxes and make sure your corporation is in good standing with regulators.

It is particularly important to count the costs of being incorporated, so please make sure the benefits of being incorporated outweigh both the setup costs and the ongoing costs.

In closing, incorporating your medical practice after residency is a big decision and needs to be aligned with an integrated financial plan that considers your overall personal and financial goals.

I encourage you to invest the time to learn and to get expert advice from financial planners and accountants who understand your medical career journey to determine if and when incorporation is right for you.

As a Physician, you will need the services of both an accountant and a business lawyer who will work together to incorporate your medical practice.

The accountant’s job is to design the structure of your corporation ensuring it can grow with your practice from an accounting and tax planning perspective. Once the structure is agreed upon, the lawyer will ensure that your corporation meets the requirements set forth by regulatory bodies including the province of BC and your respective college of medicine.

Although accounting and legal professionals set their own fees, it is a good idea to budget between $2,500-$6,000 to go through the incorporation process. Please do your due diligence and make sure the professionals you

This article is submitted courtesy of Alphil Guilaran who is the Executive Director of the Financial Literacy Counsel (FLC). FLC is contracted by Vancouver Coastal Health Employee Wellness to provide financial education and two financial planning coaching sessions per year to all resident doctors in BC. To book your confidential coaching session, contact Employee Wellness at 604.872.4929 or 1.800.505.4929 or contact@flci.ca

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TRANSITION TO PRACTICE

THE DOS AND DON’TS OF FINANCIAL PLANNING FOR LOCUMS MD Financial Management

DO keep track of work-related expenses

Whatever your motivation, here are some tips to help you avoid common financial pitfalls while starting out with locum work:

Document your work-related spending so that you can claim the tax deductions, including moving expenses, home/office expenses, costs related to a vehicle that is used for work, professional dues and memberships, and insurance premiums.

Keep receipts as proof — either paper copies or digital images are acceptable, and mobile apps make it easy to keep track, on the go.

DO be clear about how and when you’ll be paid

DON’T get hit with unexpected tax penalties

Locum agreements vary widely, depending on the location of the locum, type of practice and specialty. A contract should clearly state responsibilities and detail payment terms. These may range from fee-for-service billings to daily or negotiated rates, as well as potential income from uninsured services, oncall hours or other work.

Your first cheque earned as a selfemployed physician may feel substantial.

But don’t forget that you’ll likely need to pay income tax directly to the CRA in your next income tax filing, and in quarterly instalments after that. Be sure to set money aside so you can pay the taxes owed, by the deadline, to avoid having to pay interest and penalties on the outstanding amount. You may already know that most insured health and medical services that physicians provide are exempt from GST/ HST, but the exemption may also apply to other services you perform — it’s best to check with your accountant.

TAKING ON TEMPORARY work as a locum tenens is a common early career choice for physicians. It can provide a way for physicians to get experience, contribute to a community, balance work with family, and/or earn some money while seeking a full-time dream job.

DON’T look like an employee If you plan to claim income tax deductions as a locum, it’s important to stay on the right side of the Canada Revenue Agency (CRA) and establish your status as a self-employed professional. For instance, to be recognized as an independent contractor, you must submit regular invoices to your employer, carry your own professional liability/malpractice insurance, and not be included in a practice’s benefits plan or receive holiday pay.

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DO consider incorporation As you start earning more, there may be advantages to incorporating your medical practice. This establishes your business

as a separate legal entity. One benefit is that small business tax rates are much lower than personal tax rates. And any business earnings you don’t draw as income can be left to accumulate and grow tax effectively in a separate, corporate account. Whether incorporation is right for you depends on a variety of factors. An MD Advisor* can help you decide what’s best.

DON’T rush into your own practice The business of medicine is evolving, and working as a locum may give you firsthand experience with different business models. You may see many different ways to administer and to manage billings, payments, staff and office expenses. Who knows, you might even find a great mentor or role model in a host physician!

DO verify your medical liability insurance coverage In addition to your permit to practise in British Columbia, ensure you have the required practice-related insurance or Canadian Medical Protective Association coverage for procedures you may be expected to perform, such as assisting in surgeries or providing hospital emergency department coverage.

DON’T neglect your own security net As a physician, your ability to earn future income is one of your most valuable longterm assets. You don’t get sick leave as a self-employed physician, so it’s a good idea to reinforce your financial security net.

Disability insurance income can replace part of your earnings, if an illness or accident prevents you from working. Life insurance, which protects your dependants, is also important to consider. And the earlier you begin your insurance coverage, the lower the premium rate. It’s worth talking to a specialist about why you need life and disability insurance.

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TRANSITION TO PRACTICE DO chip away at those debts Even with variable income, you can work at reducing any lingering student debt. In fact, a locum placement might provide an opportunity for you to erase student debt through the Canada Student Loan forgiveness or British Columbia’s Return of Service program.

If you’ve had a line of credit since you were in full-time studies, review how its terms and conditions may change as you transition into practice. Plan to steadily repay loans when you can — and ease back in leaner months — to shrink any balance owing.

An MD Advisor can help you with all your financial planning needs as a locum and full-time physician. Financial planning is an ongoing process of setting priorities at each stage of your life and career, in line with your goals, your obligations, and what’s next. * MD Advisor refers to an MD Management Limited Financial Consultant or Investment Advisor (in Quebec), or an MD Private Investment Counsel Portfolio Manager.

DON’T be afraid to use your line of credit Cash flow may be unsteady as you ride out downtime between locums or wait to be paid.

A line of credit can bridge the gap until your income steadies, and it provides a financial cushion in case of emergencies. It also provides a much less expensive way to borrow than using credit cards, which have higher interest rates.

DO establish good financial habits The financial planning considerations of working as a locum will serve you well in the transition to your own practice. Selfemployment will likely provide an incentive for you to take control of your finances and to budget day-to-day, while establishing shortand long-term goals for your life and your practice.

DON’T feel like you have to do it all at once At this stage of your career, you may well be managing work expenses, repaying debt and coping with erratic income: you may feel that it’s a stretch to contribute much to a savings account or retirement savings plan right now — and that’s okay.

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The information contained in this document is not intended to offer foreign or domestic taxation, legal, accounting or similar professional advice, nor is it intended to replace the advice of independent tax, accounting or legal professionals. Incorporation guidance is limited to asset allocation and integrating corporate entities into financial plans and wealth strategies. Any tax-related information is applicable to Canadian residents only and is in accordance with current Canadian tax law including judicial and administrative interpretation. The information and strategies presented here may not be suitable for U.S. persons (citizens, residents or green card holders) or non-residents of Canada, or for situations involving such individuals. Employees of the MD Group of Companies are not authorized to make any determination of a client’s U.S. status or tax filing obligations, whether foreign or domestic.

The MD ExO® service provides financial products and guidance to clients, delivered through the MD Group of Companies (MD Financial Management Inc., MD Management Limited, MD Private Trust Company, MD Life Insurance Company and MD Insurance Agency Limited). For a detailed list of these companies, visit md.ca. MD Financial Management provides financial products and services, the MD Family of Funds and investment counselling services through the MD Group of Companies.

COMING SOON:

Financial basics for residents, by residents. Bridge the gap between being a student and an employee.

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DISTRIBUTED SITE: TOFINO

Tofino TRIPADVISOR

TOFINO IS A beautiful city on Tla-o-qui-aht First Nation land, enjoying inlets, old growth rainforests, and the ocean.

With a population of approximately 2,000 people. it is a quiet yet popular destination for both tourists and settling down.

THINGS TO DO Fun Escapes Tofino is an amazing place to enjoy typical and not-so-typical BC activities. From beaches to scenic flights to ziplining, Tofino has enough to keep you busy and active in your downtime.

• Are you eager to spend time at the beach?

Tofino is famous for its Chesterman Beach, Cox Bay Beach, MacKenzie Beach, Long Beach, and Wickaninnish Beach. All of these offer stunning views and long walks!

• Are you dreaming of being out on the open water, casting a line? Tofino offers plenty of fishing services, both for fishing in Clayoquot Sound and Saltwater Fishing.

• If you want a new perspective on beautiful BC, Tofino has seaplanes to offer flights to bring you on new adventures. Grab a camera and book a sunrise or sunset flight to catch those scenic views.

• Want to zip line? Check out Ha’uukmin Tribal Park!

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Events • Monday Night Movies - every Monday there is a new movie playing, with award-winning films from around the world.

• Festivals - Every month there is something new happening, from garden shows to chowder chow down to a celebration of lights in the winter.

• Tofino Market - Running weekly from May Long Weekend to Thanksgiving, this market offers hand-crafted wares to the public.

• Sports - Is surfing your thing? Tofino offers surfing competitions in the spring, and even a fishing derby in the summer.

Food and Drink • Despite its small size, Tofino offers a wide variety of cuisines. Bars, sushi spots, coffee houses, bakeries, and of course, plenty of fishbased opportunities await you.

• Looking to go outside the regular coffee shops? Tofino has you covered! Offering a distillery, a kombucha stop, a brewing company and a coffee company, these places are just steps away.

• Grocery shopping has never been easier.

Several grocery stores are available to pick from, alongside a co-op food store and a liquor store offering up options.

Available on Podbean & Apple Podcasts

PULSE PODCAST Residency • Finances • Parenting 24

PU SE The Pulse newsletter is always looking for submissions from residents like you!

If you have article ideas, announcements, or other interesting insights about life as a resident doctor, please contact us at: info@residentdoctorsbc.ca

IMPORTANT PHONE NUMBERS

HSSBC Benefits & Payroll 1-866-875-5306

Physician Health Program 1-800-663-6729

Employee Wellness 1-800-505-4929