March 2019 Pulse Newsletter: Residency & Financials

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PU SE INSIDE THIS ISSUE

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2019 Resident Awareness Week Recap

RESIDENCY & FINANCIALS march 2019 | issue 39 9-11

Interview with Dr. Geoff Frost

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A Word on Negotiations


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 A Word From Our Board 3 Upcoming Events 4 Plan Your Own Social 5 Resident Awareness Week 7 Resident Spotlight: Dr. Hayden Rubensohn 9 Interview with Dr. Geoff Frost 13 A Word on Negotiations 15 The Value of Saying No 17 Private Company Tax Changes— Income Sprinkling and Passive Income 19 Taxation of Insurance Premiums

21 3 Money Management Habits for Residents 23 Rural Locum Forum 25 Distributed Site: Abbotsford


A WORD FROM OUR BOARD A WORD FROM OUR PRESIDENT

To our members, February has been an exciting month for Resident Doctors of BC. We hosted our annual Resident Awareness Week celebration on February 9, 2019. This year, we partnered with the Canadian Blood Services to highlight the importance of blood donors. I would like to thank all of the residents who joined in our campaign these past few months to donate blood, either for patients or for research, and who encouraged others to become donors as well. The service of donating blood, while seemingly small, can make a life-changing impact for recipients, which we all know well from our first-hand experience. In the spirit of resident awareness, our Communications, Advocacy, and Health & Wellness committees have been working hard in raising the public profile of residents, especially in this important contract negotiations year. Perhaps you have seen our informative ads on Facebook. Check out our newest podcasts, featuring a range of topics from pregnancy during residency to updates on negotiations. Our Humans of Residency initiative continues to provide a window into the amazing group of human beings whom BC should be proud to call its medical residents. We also continue to engage with our elected officials in government and our UBC administration to advocate for you. Residency is a challenging time. Please remember to take care of yourself first and foremost. We have a fantastic team at the Resident Wellness Office dedicated to your mental well being. Make sure to keep an eye out for events organized by RDBC, which occur almost monthly. Favourites from this past year include Fright Night at the PNE, the Christmas Market, and the Parenting Workshop. We have also launched new initiatives to promote wellness at our distributed sites, such as a makeshift pantry in Prince George for long call nights. You can also design your own wellness initiative for your co-residents and apply for funding through RDBC, so think creatively and reach out to us! Lastly, if our work seems interesting and meaningful to you, I encourage you to join a committee and become a resident leader with RDBC. Sincerely,

Dr. James Wang Vice President of Resident Doctors of BC


UPCOMING EVENTS March 20

Vancouver Tax Clinic

March 28

Surrey Tax Clinic

May 1

Board of Directors Meeting

June 26

New Residents Orientation

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RESIDENT AWARENESS WEEK

WHAT HAVE WE BEEN UP TO IN 2019? In December of 2018, members of the Health & Wellness Committee started up the Blood Drive Fundraiser Initative. This was a first for Resident Doctors of BC, and we partnered with the Canadian Blood Services location at Oak Street, Vancouver, as well as the location at UBC to invite residents to donate blood! Residents were able to register their donations under RDBC’s team, allowing for our office to keep track of donations. Thanks to all your help, residents and RDBC raised 21 units of blood throughout the months of December and January! We gave away a total of eight $100 gift cards throughout the campaign to lucky winners chosen through a random draw. On Saturday, February 9, Resident Doctors of BC visited the Canadian Blood Services building on Oak Street in Vancouver, to help spread awareness of residents, as well as to celebrate the success of our first ever Blood Drive. We offered information as well as snacks and warm food to both the residents who stopped by, and members of the public who were in the area to donate blood. Thank you to everyone who stopped by, and especially to those who ended up donating blood as part of our event. RDBC will continue to host a team for residents to donate under throughout the year. We hope to continue to parter with the Canadian Blood Services for more events in the future. If you are interested in donating blood under our team name, be sure to visit our website.

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RESIDENT SPOTLIGHT

FEBRUARY, 2019 Dr. Hayden Rubensohn, PGY-5, Palliative Care *all links within the article are available online IN 2018, YOU GAVE A presentation called “Far Out Therapies: Psychedelics in Palliative Care”, and remain passionate about the potential of psychedelics as a way to manage existential distress at the end of life. Could you tell us a bit about what drew you to this specific topic? Indeed, it was really an honour to be able to give this presentation to the Division of Palliative Care. I was drawn to palliative medicine in my clinical training because of its significant focus on maintaining dignity and humanity in people facing life-limiting conditions. Palliative medicine does a superlative job of providing symptom relief to patients, and I appreciated that relief from suffering could be seen so rapidly. However, I noticed that the psychospiritual aspects of suffering, and the existential challenges that arose didn’t have quite the same treatment offerings. Social work and spiritual care provide incredible supports, and psychiatry can offer useful therapy, but still I found that many patients face psychological distress that can’t easily be dealt with. The more I learned about psychedelic medicines, the more I realized that they might provide the answer. These medicines can engender powerful mystical experiences that result in shifts in how people come to understand and relate to concepts such as life and death. Studies are mounting to demonstrate that through these experiences people are finding peace in the face of life threatening illnesses such as cancer. I strongly feel that these tools are unprecedented in what they can provide, and fill a gap in our currently available therapies.

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So it was in this context that I wanted to spread the word and drum up some excitement about this emerging field. The Division of Palliative Care at UBC is DR. MEAGAN MCKEEN staffed by incredible physicians who, like myself, are curious about new therapeutics and opportunities to help people at the end of their lives find peace and meaning. The division has been remarkably supportive of me and my interest in psychedelic medicines and we hope to bring this research to Vancouver in the coming years. You’ve mentioned that you hope to do clinical psychedelic research one day. What would you say has inspired you—and continues to—in remaining passionate in this pursuit? When people hear that I am doing training in palliative medicine the response is almost ubiquitously a comment about how hard it must be, but I don’t see it that way. For me palliative medicine isn’t marred by sadness surrounding the death of many of my patients. Rather, it’s about respecting personhood, about maintaining dignity, about helping people manifest themselves in the time that they have left; and I find that uplifting. Palliative medicine is about people coming into themselves and into union with their loved ones. It’s beautiful to watch people shine as their facades came away, their adherence to imposed social norms fades away, and they get to be their true selves. It is experiences like this, and being a facilitator of such experiences that inspires me. The challenge comes when patients are overcome by depression, fear, worry, concern,


apprehension, and can’t have meaningful death experiences. Being able to sit with patients and create a safe space for them to explore their distress is quite a privilege, especially if it helps them reach the freedom I mentioned before. However, that’s not always the case, and that’s why I think that psychedelic medicines are so important. Right now psychedelics are classified as controlled substances in Canada and can’t be accessed for medical use. Clinical research into the use of psychedelics has increased in volume in the past decade, but all of the work using psychedelics in palliative settings has taken place in the USA and Europe. I think that Canadians should have access to these medicines, and that Canadian researchers should contribute to the data attesting to these medicines’ utility in palliative care. Being involved in that has continued to motivate and inspire me. You have also been involved in research on the use of MDMA-Assisted Psychotherapy for PTSD. Did your interest in this stem from your work in palliative care, or from elsewhere? What has this involvement been like, and how does MDMA compare to the use of psychedelics? When I first found out that research was being done utilizing MDMA, I thought it was a joke. Up to that point I’d only known MDMA to be a recreational drug and something that causes hyponatermia! However, the more I looked into it, the more I realized that the research was legitimate. MDMA is simply a substituted amphetamine, falling into a class of substances called empathogens, which increase interpersonal trust and decrease fear and anxiety. This makes it a potent tool for augmented psychotherapy. Luckily for me, this research was being planned in Vancouver in 2012 when I went through CaRMS. In fact, I chose to rank Vancouver so that I could hopefully be involved in this work. Through a series of events I was offered the chance to work alongside Dr. Ingrid Pacey who is an exceptional trauma therapist in

Vancouver. Together Dr. Pacey and myself treated several participants in a Phase II clinical trial. I was subsequently invited to participate in the Phase III clinical trial that will further explore this interesting new medicine for people with PTSD (https:// maps.org/ ). My involvement in this research has been extraordinarily meaningful and it has been a true honor to be involved in such groundbreaking work. I also feel like my career has been fast-forwarded by about 30 years, as I didn’t think I’d be directly involved in this sort of research until much later in my career. Having kept my ear to the group and met and liaised with the right people has completely changed my early career. MDMA is a serotonin releaser and is not considered a classic psychedelic. MDMA typically creates strong feelings of interpersonal trust, and working with people on MDMA is very relational. On the other hand, psychedelics are serotonin 2A agonists and their power lies in their ability to create transcendent mystical experiences by transiently altering neuroconnectivity. People undergoing psychedelic therapy still require strong support, but often their most powerful experiences take place internally. Suffice it to say, these two classes of medicine are similar but require different approaches and skills.

Hayden Rubensohn with other Canadian MDMA therapists and MDMA therapy specialists Dr. Michael Mithoefer, Annie Mithoefer, and Marcela Ot’alora at a training program in Stony Point, New York.

For the rest of the interview, visit our website, www. residentdoctorsbc.ca.

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FEATURE

INTERVIEW WITH INTERVIEW WITH DIRECTOR OF IMMEDIATE PAST COMMUNICATIONS, DR. PRESIDENT GEOFF FROST DR. GEOFF FROST is current, second term Director of Communications at RDBC and a PGY-3 in Physiatry. For this edition, we chatted with him on spreading resident awareness, and the several campaigns that have been led by him in 2018-2019.

physicians to the public. Can you tell me more about the campaign? Are there already plans to run more social media campaigns in the future, or the desire to?

In the past years, the focus on spreading awareness about Residents was kept primarily to Resident Awareness Week. This year, it has shifted to a lead-up that started in October, with a targeted social media awareness campaign at the centre. What was the thought process behind the shift?

Our social media campaign was about raising awareness. As residents, we provide around the clock care in some of the busiest hospitals in our province. Yet, often, patients do not know who we are. At the same time, we currently have the lowest level of remuneration in the country for the work that we do. We provide value to the province, but we are not compensated appropriately for the value we provide.

The 2018-2019 academic year saw a shift in our priorities as a union. This year was all about one thing: negotiations. We are in the process of renegotiating our Collective Agreement with the government of British Columbia. Negotiations began in earnest in January. By moving forward the start date of Resident Awareness week to October of 2018, we created an opportunity to start a conversation around who residents are and how we are compensated. The earlier we start the conversation, the greater the chance that our cause would be understood as a high priority by the government. And of course, the greater the visibility we have with the government, the greater the chance of a favourable outcome in the negotiations process. The social media campaign consisted of a targeted ad leading to the RDBC website, centered around the three largest teaching hospitals, with the aim of introducing the difference between Residents and staff

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The goal of our engagement campaign was to introduce the idea of a resident to the general public. We hope that this will help generate awareness of the important role that residents play in the healthcare system. We hope to leverage this increased awareness when renegotiating our Collective Agreement with the government. In short, if the public supports us, we have the ability to credibly ask for fair pay for the work we do. We do not have any plans for a future campaign at present, but I do hope that we continue this kind of outreach. We need to build up our name recognition in the eyes of the public, and the political decision makers that control our employment destiny. My term as Director of Communications is coming to an end in the near future, so whomever decides to take up the torch will be left with an important decision: whether to continue public engagement campaigns, and if they do decide


to continue engaging the public, how to go about engaging the public. The lead up awareness campaign for Resident Awareness Week also made its way to print media, featuring several weeks of advertisements in The Metro. In our social media and digitally saturated world, what encouraged the expansion into print media? While social media excels at reaching certain demographics, it misses others. Print media provided us with an avenue into a demographic we felt was essential if we want to achieve long term recognition of the work that we do. I’m happy with our decision to pursue multiple advertising platforms. As a group, residents have extremely low visibility in the eyes of the public. There was only upside to engaging with the public, no matter how we did it. You worked together with the Advocacy Committee to develop the “Ask Me, I’m a Resident” buttons and five quick tips negotiations pamphlet. Would you say the invitation for patients to inquire about residency was a success? What would you do differently, or the same, for future campaigns that rely on person-to-person interaction, as opposed to digital or print media? I have had a few patients ask me about the buttons and those opportunities have been invaluable for introducing the concept of what a resident is. I like to hope those were helpful conversations. I think the buttons have been even more successful at generating a sense of cohesion as we enter negotiations amongst ourselves as residents. I have found these conversations to be incredibly high yield. It was enlightening to hear one of my staff comment that she heard residents in BC were the best paid in the country! If I were to change the button campaign, I would better publicize and organize the launch. As a word of mouth campaign, we launched via a small group of motivated residents. Motivation is essential to success. I would also aim for a larger, more visible launch, to

similar campaigns in the future. My aim would be to reach more people, more quickly, than we did this time around. One of the most difficult aspects of communications is engaging your audience, particularly so when the audience for Resident Awareness Week is the whole general public. What are some specific challenges you’ve faced and have managed to overcome? How are you working to overcome other barriers? Apathy is the bane of my existence at RDBC. Apathy comes in many forms, and is found wherever you care to look for it. When engaging with the general public, with the government, with hospital administrators, and lamentably sometimes with other residents. It’s a busy world, there are many different needs pulling each and every one of us in different directions at all times. I see the cause of residents as an important one, and specifically the conditions under which we work in British Columbia as a critical issue worth addressing. Often, I’m one of the few people in the room interested in the issue. I am forever encountering and combatting apathy.

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I cannot honestly say I’ve figured out how to reliably overcome apathy. That is not to say that we haven’t tried. We have enhanced the suite of communication tools we use to contact the membership. In the last year we added podcasts and videos to our communications arsenal. This is one small step, and we have yet to see if there are long term benefits to these new communication tools. To be honest, I suspect apathy is a forever problem that I and whomever comes after me will be continually addressing. Lastly: you have stayed on as the Communications Director for a second year in a row. What drives you to this role? What are your hopes and plans for communications in the future, both for RDBC, and for yourself? I fell into the role of Communications Director by accident. I was asked to take on the role after no other board directors showed interest last year. After taking on the role, I wanted to work hard at improving awareness of the work that the Resident Doctors of BC does on behalf of its membership. To that end, we added the Pulse Podcast to the suite of communication tools we use to contact the membership. I’m really happy with that decision, it motivated me to stay informed about resident issues, and pushed me to seek solutions to hot button topics. For example, in the spring of 2018 the federal government released new rules surrounding the taxation of personal corporations. This would by design affect many physicians. The podcast team spent about a month and a half understanding the changes and how they would impact residents, and then put out a podcast summarizing all the important information. It was a fun exercise in journalism, and taught me something completely new – the taxation side of running a medical corporation. While the audio from that episode is cringe worthy – for some reason we thought we should script the dialogue, and none of us are particularly gifted voice actors – I stand behind the content. What I am trying to say is, I have been motivated to tell the interesting side stories of medicine while in my role as

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the Director of Communications. Of course, there are more stories to tell than there is time to tell them. I have a list of about 10 podcast topics I wish I could touch upon that I will probably never get to. But just doing the 15 or so episodes we’ve done in the last year have been a blast. From the basic research and journalism, to recording, to editing. It’s been fun. The podcast really has motivated me to stay engaged. And by staying engaged, that’s bled into other aspects of life as a resident. For instance, just this year I became deeply involved in the Negotiations process. It seemed like a natural extension of all the rooting around and investigating I had been doing for the podcast. From one story to the next! After working on multiple resident related issues over the past two years, I’ve been struck by one thing: As residents, we need to do a much better job of advocating for ourselves to both the public and institutional power sources like UBC and the provincial government. We need to be heard. I hope that moving forward, the Communications team at RDBC makes a serious effort at engaging those two key pillars. If we want to change how we are treated by the government during Negotiations, we must first be noticed by the government. Engagement with political parties, citizens, and other stakeholders moving forward is essential. For myself I’m not sure where my communications journey ends. In the next two years, I’ll be hunkering down in a library somewhere in Vancouver as I prepare to write my Royal College exam. Who knows, maybe when I bubble up from the stacks in two years I’ll keep podcasting and telling interesting stories about medicine!


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FEATURE

A WORD ON NEGOTIATIONS Dr. Geoff Frost Fellow Residents, As you may know, earlier this year we entered into negotiations with the Health Employers Association of British Columbia (HEABC) to renew the Collective Agreement. The Collective Agreement is the contract that governs your work. It sets the rules of being a resident in BC: from things as mundane as how often you do call, to monetary matters like how much you get paid. It’s all in there. The Collective Agreement is a big document. It takes a long time to get two parties with different needs to agree on what it will say. As your union, we know the Collective Agreement and its wording is the most important deliverable we accomplish on your behalf. We have been working intensely on these Negotiations for the better part of a year and a half. Our preparation shows, since Negotiations have started we have tabled asks at the table trying to improve every aspect of the Collective Agreement. But how did we get here? How did we prioritize our asks? PASSING ON A HUGE OPPORTUNITY Negotiations preparations started in earnest during the fall of 2017. At that time, we collected the mountains of feedback and phone calls we had received with regards to the Collective Agreement and used that to inform a membership-wide survey. That survey asked residents to consider the Collective Agreement, where there were holes in the Agreement, and what residents would change if they were able to wave a magic wand and fix its flaws. The results

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were overwhelming. Many of you participated in the surveys, and most of you focused on the same core issues. Our salary, the costs of being a residents, the structure of call, and getting paid for the work we do consistently came up as hot button issues amongst the entire group. There were of course other asks, focused around more discreet issues like mandatory rotations away from our home hospital and maternity leave. We gobbled this up. At the end of the day, our goal at the union is to best represent the views of the membership. CREATING A SOLUTION Once we understood what you as a membership wanted addressed, the next question became how. In the late summer of 2018, the board of directors at the union – a group of 10 residents you elected to represent your interests – put out a call for applications to join the Negotiations Committee. Residents interested in participating had their applications reviewed by the board. It was a competitive process that aimed to pick residents best equipped to negotiate on your behalf. The board selected Drs. Patrick MacDonald (Psych R3), Grace Qiao (Ophtho R3), David McVea (Public Health R4), and Geoff Frost (PM&R R3) to participate in Negotiations. The team was rounded out by RDBC’s Executive Director - Harry Gray, RDBC staffers Michelle Seymour and Brandi MacLean, and Tony Glavin. Tony is a labour


lawyer and partner at Glavin and Koskie. Harry Gray has worked at HEABC and in the private sector, he has been involved in negotiating employment contracts for the better part of his working career. Tony has represented multiple labour unions in negotiations with the government, and is one of Canada’s most respected labour lawyers. With our team set, Harry led the process of turning the survey results into concrete asks at the Negotiations table. This grueling process involved countless meetings, many late into the evening. The team looked at what was contained in the survey, looked at the existed Collective Agreement, and tried to square the circle. Harry’s wealth of experience in negotiating contracts of this scale was essential to moving this part of the process forward. Many meetings and sheets of paper later, the team had our ask package together. This 102 page tome represented many months of work from many different people. But most importantly, it was our best attempt at most faithfully representing what you as a resident in British Columbia have asked us to address at the bargaining table. NEGOTIATING So that leaves us with where we are today. Negotiating. We are still in the middle of the process. We have had many difficult discussions with HEABC already, and there are plenty more on the horizon. We expect to complete the majority of Negotiations by the end of March, at which point the Board of Directors of the Union, and then you yourself

as a resident, will get to vote on whether or not you agree with the new contract. This is, to put it bluntly, a big deal. This contract will govern the reality of your residency for the next three years. I encourage you to take the time to consider the contract, and vote in your best interests when the time comes to have your say. PARTING THOUGHTS If negotiations and the process around it interest you, I encourage you to check out the Pulse Podcast, the Podcast we produce at the Resident Doctors of BC. We have recorded three episodes that deal exclusively with negotiations. In the podcast, we cover the preparations in more depth, in addition to discussing what the government’s approach to Negotiations has been. For me personally, becoming involved in the negotiations process has been one of the most rewarding activities I have been involved in as a resident. I look forward to continuing to push the process forward in hopes of addressing our needs as a group. On behalf of the whole Negotiations Team, thank you for putting your trust in us. We will do our utmost to secure you the best possible Collective Agreement.

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FEATURE

THE VALUE OF SAYING NO WHAT A CAREER-GOAL OPPORTUNITY TAUGHT ME ABOUT PRIORITIZING MY ROLES

Dr. Tatiana Jevremovic THREE MONTHS AFTER I had my first daughter, the role of Chief Medical Advisor (CMA) for Skate Canada opened up. For me, this was a career-goal opportunity. I’d been working with Skate Canada for seven years, and had travelled to a number of international events with the national junior and senior teams. The idea of taking the lead role thrilled me. But as I began to read the job description, my heart sank: the first bullet stated that I would have to travel to several international events every year. As a new mom, that was something I was no longer prepared to do. The idea of saying no – of turning down an amazing opportunity – was foreign to me. As a medical student and resident, I was always determined to put my best foot forward, and to prove to my staff that I was a valuable member of the team. Whatever task was asked of me – staying on during post-call days to help with consult volumes, preparing last minute round presentations, taking on extra call – I did. I had the time, the energy, and I was having fun. As a young staff member, I continued with the same tempo. I had the drive, the energy, and most importantly the free time. I took on project after project, and I delivered on each and every one. I set high expectations on how much I could handle, and people responded with more and more opportunities. But when I started my family, my life priorities shifted, and I found myself in uncharted

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Tatiana is third from the left. territories. I no longer had the free time, and I wondered how I was going to handle it all. PASSING ON A HUGE OPPORTUNITY Before I knew it, the Skate Canada posting came up, and I was forced to face my new reality… I was upset and scared. My heart and brain were at war with one another. The professional in me did not want to throw away everything that I had worked so hard to accomplish, but the mother in me was firmly saying no. I explored every possible scenario to try and make it work, but deep down I knew I would be forcing things. It just wasn’t the right fit for me. I shared my struggles with the outgoing Chief Medical Advisor of Skate Canada, and she encouraged me to still interview for the position. At the very beginning of the interview, I heavy-heartedly informed them that I was not able to fulfill the very first requirement in their job description. “I am a new mother”, I told them. “My first priority is my daughter.” They were kind enough to continue the interview. But it was over. I knew it. This career-goal opportunity had passed me by. What happened next taught me a lesson that I hope to pass on.


Tatiana at work. SHOWING MY TRUE VALUE A few weeks later, Skate Canada came back to me with an offer. They had decided to split the role. They wanted me to become their Domestic Chief Medical Advisor. My role would be to oversee the medical coverage of skating events, both national and international, taking place on Canadian soil. It was a job I could do from home with no travel commitments. It was perfect.

Dr. Tatiana Jevremovic is a primary care sport and exercise medicine physician in London, Ontario and an Associate Professor with the Department of Family Medicine at the Schulich School of Medicine and Dentistry. She has covered sporting events of all calibers, sat on a number of medical committees and board of directors, and has just completed her President term with the Canadian Academy of Sport and Exercise Medicine (CASEM). If you ask her though, she will tell you that her greatest joy by far are her 2 girls, and raising them to be confident, intelligent, happy and not afraid to reach for the stars will be her greatest accomplishment.

I realized that by being honest with myself – and others – about what I was able to commit to, I had done exactly what I thought I was doing by committing to everything: I had shown my true value to the team. There is no benefit to taking on more than you can handle. Your work, your reputation – and, worst of all, your happiness – will suffer. Take the time to prioritize the different roles in your life, and the time-commitments they each require. Things may not always work out at first, but as long as you work hard and deliver quality work, there will always be new opportunities on the horizon. So where am I now? Well…. Skate Canada eventually removed the travel requirementsfrom their original Chief Medical Advisor role description, and offered me the job.

This article was originally published in onboardMD. Republished with permission. onboardMD’s mission is simple: to help Canada’s next generation of doctors navigate the beginning of their medical careers. Check out onboardMD’s suite of tools and resources, including articles that bring you tips, tricks and life hacks along with real-life stories from students, residents and doctors.

This time, I did not say no.

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FINANCES

PRIVATE COMPANY INTERVIEW WITH TAX CHANGES— IMMEDIATE PAST INCOME PRESIDENTSPRINKLING AND PASSIVE INCOME IN THE PAST YEAR, the federal government has rolled out significant changes regarding the taxation of private companies. Since many residents intend to incorporate their practices at some point, this is of particular relevance to them. INTRODUCTION TO INCORPORATION Incorporation, the creation of a separate legal entity, is done by many physicians mostly for the tax benefits: • Tax Deferral: Effective January 1, 2019 in BC, income in a corporation is taxed at the small business low rate which is 11% on the first $500,000 of business or professional income. This contrasts with personal tax rates which are much higher, topping out at 49.8% on income above $205,843 in 2018. The low corporate tax rate leaves more funds for a corporation to invest which is financially beneficial. While corporate tax rates are lower, additional taxes apply to funds withdrawn from corporation so this is a tax deferral as opposed to a tax savings strategy. • Income Sprinkling: A corporation enables a high income earner to sprinkle income to family members at lower tax brackets which realizes tax savings. This can be done through salaries and dividends; aside from a few exceptions, these now need to be “reasonable” meaning that it must be similar to the amount paid to an unrelated individual for the same work. CHANGES TO INCOME SPRINKLING Prior to 2018, dividends could be paid to related shareholders without regard for reasonability. This resulted in significant tax savings when

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paid to family members at lower tax brackets (e.g. children aged 18 or over). This benefit was removed on January 1, 2018 since dividends paid to family members must now be reasonable on the basis of labour and capital contribution as well as risk assumption. Dividends in excess of this amount are now subjected to an additional tax on split income (TOSI). There are certain circumstances that exempt family members from the reasonability test, such as the spouse of an owner who is aged 65 or over, and family members aged 18 or over who work at least 20 hours a week in the year or a total of five years in prior years. Although not eligible for professional corporations or companies who earn more than 90% of their income from services, family members aged 25 or over who own at least 10% (by vote and value) of such a business are also exempt. CHANGES TO THE TAXATION OF PASSIVE INCOME EARNED IN A CORPORATION Passive income includes investment income, rental income, and capital gains (although for this purpose capital gains from the sale of active business assets are not included). For tax years beginning after 2018, if total investment income in the prior year exceeds $50,000 (assuming a 5% return it would require investments of $1 million) the $500,000 limit of active business income eligible for the low tax rate would be reduced such that it would be nil once investment income reaches $150,000. In other words, for every $1 that the $50,000 passive income threshold is exceeded the small business deduction limit is reduced bt $5.


While active income within the small business limit is taxed at 11%, such income above the limit would be taxed at 27% which in essence is an additional tax on investment income. However, it is important to note that this higher tax enables the payment of eligible dividends to shareholders which result in a lower personal tax so that the overall tax (combined corporate & personal) is only marginally higher. The additional tax on passive income essentially decreases the benefits of tax deferral by reducing the differential between corporate and personal tax rates. Various strategies can be employed to minimize the impact of the additional tax including: • Withdrawing more funds from the corporation and investing in RRSPs. • Employing permanent life insurance (whole or universal life) products since those earnings are not included in the passive income calculation. These also enable wealth transfer to future generations through payouts as tax-free capital dividends to beneficiaries. • Selling investments and realizing capital gains over several years to stay under $50,000 per year. • Ensure that passive income is minimized through deducting related expenses such as interest on loans used in investments and investment management fees.

BC PROVINCE EMPLOYER HEALTH TAX (EHT) In conjunction with the end of MSP premiums beginning on Jan 1, 2020, the BC government introduced a new Employer Health Tax (EHT) which came into effect on January 1, 2019. This tax applies to employers whose BC remuneration exceeds $500,000 in a calendar year. The EHT is taxed at 2.925% of BC remuneration between $500,000 and $1.5 million with amounts above this taxed at 1.95%. Note that this only applies to salary paid out (including to shareholders) but does not include dividends or gross revenues. As such, most physicians will be below the $500,000 threshold but this could affect larger clinics whose payroll exceeds $500,000. CONCLUSION As a result of these new changes, residents contemplating incorporation in the future are encouraged to consult their accountants to ensure that they are in compliance and in the best position to optimize their tax situation. Nonetheless, there are still significant tax benefits to be potentially realized through professional corporations.

TAX CHANGES REGARDING UNBILLED WORK OR WORK-IN-PROGRESS (WIP) For tax years starting after March 21, 2017, professionals with rendered but not billed services or WIP will need to include in revenue these amounts (at the lower of underlying costs and expected revenue at the hourly rate). In the past, only amounts that were billed by year-end needed to be included in revenue. Fortunately, this is usually not applicable to most physicians since most services are billed when rendered. An example of when this would be applicable is when a patient comes for a multi-visit treatment but is only billed at the end and the year-end falls before that; this unbilled work would now need to be included in revenue at year-end.

This article is courtesy of Richard Wong, CPA, CA of Baker Tilly WM LLP (formerly Wolrige Mahon LLP). Richard has extensive experience in providing accounting and tax services to physicians and other health professionals. For more information, Richard can be reached at rwong@bakertilly.ca or at 604-691-6886.

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FINANCES

TAXATION OF INTERVIEW WITHPREMIUMS INSURANCE IMMEDIATE PAST

Julie Kwan, CFP, CLU, GBA PRESIDENT

Business Development Manager, Insurance, Doctors of BC

TAXATION IS QUITE simple when you’re a resident. Resident Doctors of BC deducts your personally paid portion of health, dental and life insurance directly from your paycheque. Other taxable benefits you receive will be noted on a year-end T4A which you report on your tax-return. Your CMPA dues, being an expense required to do business, is tax-deductible. Most personal insurance premiums that typically arise during residency, such as those for your longterm disability plan, are paid personally and are not tax-deductible. When you start practice, taxation can become more complicated. Once physicians start incorporating, it’s appealing to tax-deduct as many expenses as possible. When it comes to insurance during practice, there are some general do’s and don’ts that this article will outline.

corporation (perhaps it’s your spouse or child), you should pay premiums personally or the corporation should issue a taxable benefit to you personally for the premium to ensure the death benefit remains non-taxable. Although the premiums can be paid by your corporation, the premiums are usually not a tax-deductible expense; premiums are added back to the net income of the company. A portion of corporate-paid life premiums is tax deductible only if the insurance is assigned to a loan at the request of the lender. DISABILITY INSURANCE

Always receive qualified advice from a certified accountant regarding how to properly arrange your insurance premium payments for your unique situation.

Ideally, you would pay disability premiums with personal after-tax dollars so that any benefits received are non-taxable. Your corporation can pay for disability insurance premiums and deduct them as an expense, but the benefit you receive would then be taxable. Since disability payments over a career can be millions of dollars, it’s best to avoid taxes at claim time.

TAXATION OF BENEFITS

CRITICAL ILLNESS

Negotiated benefit payments (CME, CMPA, CPRSP, PLP and REAP) are considered taxable benefits and as such a T4A is issued for any amounts paid in the calendar year. Note that you are able to deduct the corresponding costs as an expense on your income tax return. LIFE INSURANCE You can pay life premiums through the corporation if the beneficiary is the same corporation. If your beneficiary is not your

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Similar to disability insurance, premiums must be personally paid to ensure benefits received are non-taxable. There are some strategies where you can have split ownership or have corporately paid coverage, but you should speak with qualified advisors before entering such arrangements. Since a critical illness benefit is paid as a lump sum, you definitely want to avoid giving almost half your benefit away to CRA.


PROFESSIONAL OFFICE OVERHEAD INSURANCE

HEALTH AND DENTAL INSURANCE Premiums for health and dental plan premiums are generally considered tax-deductible expenses.

This type of insurance reimburses eligible office expenses like rent, employee salaries, and equipment leases. The premiums are paid by the corporation and are a tax-deductible expense. Although the benefits received are considered taxable income, the office expenses that the benefits reimburse would be deductible, placing you in a neutral tax position.

Speak to your Insurance Advisor and accountant to implement optimal bookkeeping procedures for your insurance premiums, especially when you begin practice.

HAVE YOU HAD YOUR INSURANCE CHECKUP? Doctors of BC provides member Residents across Canada with complimentary noncommissioned, licensed insurance advice. We are the only insurance planning team working exclusively with physicians and their families, making us industry experts. Unlike advisors who earn commissions from each product they sell, Doctors of BC advisors are salaried employees who provide service-oriented advice. From full reviews to second opinions - what you’ll always get from us is non-pushy, real advice. Whether you’re starting residency or transitioning to practice, we welcome you to book a complimentary insurance check-up. We offer daytime and evening in-person, phone and Skype appointments. Contact us today at insurance@doctorsofbc.ca or 1-800-665-2262 ext. 2807 to get financial peace of mind.

YOUR RESIDENT INSURANCE TEAM insurance@doctorsofbc.ca

Channelle Erin Sawyer Connors

Hali Stus

Jeffrey Gopal

Julie Kwan

Paula Rooney

Renee Brickner

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FINANCES

3 MONEY MANAGEMENT HABITS FOR RESIDENTS Bobby Ning, CFP

Managing Director of Financial Literacy Counsel

BEING A FINANCIAL Planner to Residents for over 15 years has taught me one important thing - Residents dedicate a lot of time to develop the habits necessary to deliver the best patient care outcomes. However, the same cannot be said about how their personal finances are managed. The following three money management habits will help you thrive financially, not only in residency but also, in practice. HABIT #1: BUILD YOUR MULTI-DISCIPLINARY FINANCIAL ADVISORY TEAM AND MEET WITH THEM YEARLY. I like to share to residents that “you need to think like a doctor and act like a business owner”. This will require developing the habit of working with a team of financial professionals to help you navigate the financial journey associated with your medical career. As you approach the completion of your residency training, you will need to transition from being an employee, to being selfemployed. This transition will require a team of multi-disciplinary subject matter specialists, in the areas of banking, finance, accounting and law. During your time as a resident, I encourage you to attend the yearly financial coaching sessions available to you through your VCH Employee Wellness Program. These sessions can connect you with specialists who understand your journey as a resident and are able to help you put together the team you will need to thrive financially, in residency and beyond.

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HABIT #2: TAKE CARE OF YOUR MOST IMPORTANT FINANCIAL ASSET: YOU. Sickness, illness or a disability will delay the use of all the clinical training you have acquired over the years. Unfortunately, no one is immune from life threatening illnesses or unexpected accidents; as a result, it is beneficial to regularly review your insurance coverages. Whether it is extended health insurance, life, disability or critical illness insurance through your association or private plan, make it a regular part of your yearly financial review with your financial advisory team. HABIT #3: PRACTICE EVIDENCE-BASED INVESTING. One of my favorite quotes in investing is, “Fear is loud. Evidence is quiet. Listen to the evidence.” There is a lot of noise out there these days when it comes to fear in the stock market. However, evidence shows that you are better off financially, if you start the habit of investing early and doing it on a regular basis. Albert Einstein has been quoted “the eighth wonder of the world is compound interest” which means start early and invest regularly. For example, suppose you have a goal of having $500,000 for retirement. Assuming an annual rate of return of six per cent, if you start at the age of 25, you will only need to save about $3,231 a year to reach that target. If you say to yourself, I will start when I’m in practice at the age of 35, you will need to save $6,324 annually. My hope is that you take the three money management habits that I’ve shared in this article to heart and that it will help you establish the habits necessary to thrive financially, not only in residency but also, in practice. If you need help to get started on these habits, my team is ready to meet with you. Simply reach out by contacting your VCH Employee Wellness Program at 604.872.4929 or 1-800505.4929 to be connected with my team or email me directly at bobby.ning@flci.ca.


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Join rural physicians and allied healthcare professionals from across BC for relevant, accredited CME/CPD. We offer:

Join us Friday morning before the RHC!

Rural Locum Forum | May 24

● Interactive group sessions ● Hands-on workshops ● Add-on courses and events: Rural Patient Transport, HOUSE, The CARE Course, CASTED, the Rural Locum Forum, and more ● Complimentary childcare available during conference hours ● Provider wellness opportunities, including complimentary onsite yoga and stretching sessions, running groups, massage chair services, minimeditation sessions, and more ● Opportunities to socialize & network with colleagues from across the province and beyond Bring your entire family and bike, hike, paddle or explore beautiful and historic Hub City of Nanaimo.

Are you interested in becoming a rural locum in British Columbia? Join rural residents and rural practice locum physicians for a half day of exploration and networking! ●

explore rural locuming in BC

learn about available locum supports

network with BC rural locums

Registration opens in February! For more information, email conference@rccbc.ca

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rccbc.ca/conferences


Available on Podbean & iTunes

PULSE PODCAST Residency • Finances • Parenting 24


DISTRIBUTED SITE: ABBOTSFORD

Abbotsford www.tourismabbotsford.ca

ABBOTSFORD IS a city located in the heart of the Fraser Valley, neighboring the US border, the Fraser River and Greater Vancouver. Abbotsford is the largest municipality in BC outside of Metro Vancouver with a population of just over 141,000. Abbotsford is a hive of activity with many things to see and do in and around the city, from sky dives to wine tours. THINGS TO DO Outdoor Adventures Abbotsford has been described as a ‘city in the country’ as it has access to both rural settings and modern amenities. Abbotsford has over 2,584 acres of parklands, 98kms of trails and 154 parks. Some of the most popular outdoor activities in the area include: • Abbotsford Discovery Trail - a 10km paved corridor trail connecting East Abbotsford to West. Perfect for all types of activities including walking, running, rollerblading and cycling. • Matsqui Trail Regional Park - this trail stretches along the Fraser River and under the Abbotsford-Mission Bridge. Along the trail are great views of the local farms, mountains, the river as well as looking over the river to Mission. • Skydive Vancouver - situated in Abbotsford the skydive drop zone has panoramic views to Vancouver, Mount Baker and Vancouver Island from jump altitude. Even more outdoor adventures can be found in the areas outside and surrounding Abbotsford.

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These include: • Hicks Lake- an hour from Abbotsford is this beautiful mountain lake with numerous coves and islands to explore. Paddleboard rental is available at the lake’s boat launch. There is also a provincial campground by the lake should you want to extend your stay more than just an afternoon. • Harrison Hot Springs- 45mins drive from Abbotsford is the beautiful town of Harrison Hot Springs with watersports, boat tours, wildlife viewing, hiking, golfing, spas, and BC’s world-famous hot springs there are endless possibilities for an adventure-packed day out! • Rock climbing- there are lots of great crags to explore for those who love to rock climb. A 25min drive from Abbotsford is Hatzic Prairie with seven different climbing routes. Harrison Bluffs is slightly further out (45mins from Abbotsford) but is more popular with 36 different routes to test out. Food and Drinks In the last year local business owners in Abbotsford launched the Valley Food + Farm Collective, with an aim to “use food to transform the local community and to position the Valley as a global food destination.” • The Rail District Community Market- launched as part of the Valley Food + Farm Collective, this weekly farmer’s market features an array of vendors from across the Fraser Valley with fresh local produce, food trucks and Summer months


Tulip Festival www.abbotsfordtulipfestival.

live music. The market only runs through the Summer months and is expected to run again through Summer 2019. • Field House Brewing- Craft brewery in downtown Abbotsford serving creative brews (such as a Pinot Noir Brut IPA and a Flat White Oatmeal Stout) and tasty food TuesdaySunday. • Bow & Stern- If you’re looking for seafood in Abbotsford, Bow & Stern is the place to go. A family owned restaurant serving food & drink 7 days a week. • Boardwalk Café- Boardwalk Café offers a unique experience, this café has over 250 board games in house. For just $5 you can sit and play for as long as you desire! They serve snacks, main courses and a range of wine & beer. • Restaurant 62- Fraser Valley’s no.1 farm to table restaurant These are just a few of the popular spots in Abbotsford to eat & drink, with many others also coming highly recommended. Abbotsford also hosts a cluster of wineries, all of which would make for the perfect day trip. • Campbell’s Gold Honey Farm & Meadery • Maan Farms Country Experience & Estate Winery • Mt. Lehman Winery • Ripples Winery & Woodbridge Ponds • Seaside Pearl Farmgate Winery • Singletree Winery

Events • Abbotsford Annual Agrifair (Aug 2-4, 2019): The fair will be the 108 years running this August. This 3-day fair runs from 10am-11pm and aims to promote and educate on the importance of Agriculture. It is a community event not to be missed with a wide range of entertainment for all ages including food trucks, mini golf, magicians, bands, motor cross shows, to name but a few. • Abbotsford Centre: This multi-purpose arena seats 7,000 people and is located just off the Trans-Canada Highway. It plays host to a number of concerts, sporting events and shows throughout the year. Abbotsford International Airshow (Aug 8-11, 2019): Canada’s largest annual airshow, with Bob Freeman, a 3-time member of the US Aerobatic Team just one of many performers announced for this year’s show. • Bloom, Abbotsford Tulip Festival (April/ May 2019): The Bloom festival opens when the tulips begin to bloom for summer. It features over 2.5million colorful tulips all in one field. With stunning photo opportunities, it is an event that is definitely worth stopping by.

Check out the Abbotsford Tourism website at http://www.tourismabbotsford.ca/Calendar for an up to date calendar of events happening around the city.

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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: pulse@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