Trudeau 'revenue neutral' tax changes - not even close

[hitops]

Right. That's a function of their (a) far higher per capita health spending (the thing that creates a cost problem in our system), and ( b ) their less urbanized country (in terms of large urban cities, not cities of all size).

Well ya that's the whole issue, they can mobilize capital to meet market demand. In my small world, modern techniques of treatment are available in centers in the 30-50,000 size in the US, which are not available anywhere shy of a half million people in Canada.

As far as urbanization, not really the issue. Incidentally I'm not sure exactly what you mean, since a higher % of Americans live in cities vs Canada, just slightly, and about 10x the population density overall.

[ReeferMadness]

Assuming the mean and median would be similar, I would agree. But history categorically demonstrates that the middle in the US has a lower cost of living and higher access to pretty much everything, than here. Comparing both in equivalent USD, the middle income American earns more and each USD equivalent earned goes much further. This has basically always been the case, except for the anomalous period 2-4 years ago when our dollar was puffed by oil.

Can you arrange for history to categorically demonstrate that for the rest of us? If not, could you provide some citations?

[Derek 2.0]

Americans have far, far more centers with a wide array of treatments, in less densely population areas, than we have.

Without a doubt.

The H1-B work visa in the US, is dependent on the state department and a job offer.

There are additional visas you could enter and practice medicine with, including ones afforded through NAFTA. When my wife and I first moved to the States in the 90s, she was only a permanent resident in Canada (with South African citizenship) and was limited to first coming in under my visa at the time and was then able to get a J-1 visa (I'm not sure if they have them anymore) to work/study at a medical collage in our area.

When/if we return, we'll both go under E-2 investor visas, which could be an option for you, if you intend to set-up your own practice.....but then again, you might not want to take that plunge.

Somewhere in the neighborhood of 30% of those who do my job, who graduated in the last few years, went to the US.

If you're serious, talk to a lawyer and look at Texas.......safest place to practice anything in healthcare in the United States with the malpractice laws it has in place.

[Smallc]

As far as urbanization, not really the issue. Incidentally I'm not sure exactly what you mean, since a higher % of Americans live in cities vs Canada, just slightly, and about 10x the population density overall.

Urbanization is defined and experienced differently in each country, which is why I added a caveat to the end. Canadian urbanization is centred around the 20 - 25 largest urban areas, which is why they're growing much faster than their american counterparts. American urbanization is more centred on medium sized cities and small cities spread out throughout the country, with large cities growing by very little overall in comparison.

Edited January 24, 2016 by Smallc

[Smallc]

Have you been to a grocery store lately?

About 50 hours a week - some things are changing, but overall the inflation calculator for Canada pegs it about right.

[hitops]

Citation needed.

http://www.epi.org/blog/2013-acs-shows-depth-native-american-poverty/

I'm hoping you're good on the statscan side, I have to run.

Incidentally I am looking forward to the return of the long-form census. Not because I think it's a good idea overall, but it sure is handy for situations like this. Statscan most recent data remains 2006.

Edited January 24, 2016 by hitops

[hitops]

There are additional visas you could enter and practice medicine with, including ones afforded through NAFTA.

People here have offered this advice before, and I wish it were true. Sadly, entering on a NAFTA limits clinical practice to no more than 10% of your work, for physicians. Basically if you go as a researcher or to do teaching, it will work. If not, nope.

When my wife and I first moved to the States in the 90s, she was only a permanent resident in Canada (with South African citizenship) and was limited to first coming in under my visa at the time and was then able to get a J-1 visa (I'm not sure if they have them anymore) to work/study at a medical collage in our area.

Right, J1's are only for study. Won't work for practice.

When/if we return, we'll both go under E-2 investor visas, which could be an option for you, if you intend to set-up your own practice.....but then again, you might not want to take that plunge.

I haven't looked into this, but I suspect you can invest in a practice, though likely not operate as a worker in it.

If you're serious, talk to a lawyer and look at Texas.......safest place to practice anything in healthcare in the United States with the malpractice laws it has in place.

Thanks for the suggestion. Trust me, I and my contemporaries have talked many, many times about going to the US to practice and how to do it. It is top of mind for Canadian grads, and discussed all the time. Nobody I know has managed to do it without H1-B (requires USMLE exams), being American, or marrying an American.

Edited January 24, 2016 by hitops

[Derek 2.0]

People here have offered this advice before, and I wish it were true. Sadly, entering on a NAFTA limits clinical practice to no more than 10% of your work, for physicians. Basically if you go as a researcher or to do teaching, it will work. If not, nope.

Like I said, talk to a lawyer......I do know my sister in-law, a surgical nurse, could get a NAFTA visa tomorrow and wouldn't be limited to research/teaching. Maybe its different for physicians?

Right, J1's are only for study. Won't work for practice.

Again they could have changed the rules, but my wife was employed at Baylor UMC Dallas for two years on one.....

I haven't looked into this, but I suspect you can invest in a practice, though likely not operate as a worker in it.

No, obviously you'd require accreditation, but we have family friends that did exactly that and opened a GP practice in OK City.

[Smallc]

http://www.epi.org/blog/2013-acs-shows-depth-native-american-poverty/

I realize that aboriginal people are poorer and that other groups do better. I see no evidence that like for like ethnic groups (leaving aside the fact that they don't exist) are comparably better off in the US, leaving aside blacks (as if they don't count).

[bush_cheney2004]

I realize that aboriginal people are poorer and that other groups do better. I see no evidence that like for like ethnic groups (leaving aside the fact that they don't exist) are comparably better off in the US, leaving aside blacks (as if they don't count).

Seriously ? This tax protest thread has now devolved into disparities between "ethnic groups" in the United States. It's like Godwin's Law #2.

[Smallc]

Seriously ? This tax protest thread has now devolved into disparities between "ethnic groups" in the United States.

Why respond to me, when I'm not the one who made the assertion?

[bush_cheney2004]

Why respond to me, when I'm not the one who made the assertion?

Because you were the last one to extend/expand on the off topic assertion. Moderators must be asleep.

[Charles Anthony]

We interpret the following:

No other reasons help keep me here - proximity to extended family mainly.

to encompass a lot.

[hitops]

Like I said, talk to a lawyer......I do know my sister in-law, a surgical nurse, could get a NAFTA visa tomorrow and wouldn't be limited to research/teaching. Maybe its different for physicians?

Unfortunately it is. Nurses and pretty much every other kind of professional in and outside of medicine are good to go on NAFTA.....just not docs (for clinical practice). Check it out: http://canada.usembassy.gov/visas/doing-business-in-america/professions-covered-by-nafta.html

Again they could have changed the rules, but my wife was employed at Baylor UMC Dallas for two years on one.....

You mentioned work/study in the above post. So ya that's what J1-1's are for, they are basically training/education visas. So for example a medical student or a specialty resident (who technically yes is doing work, and earns in the range of 40-60K) can go on those. However a fully graduated doc with Canadian-only credentials looking to earn full time, cannot. Even Canadian residents who want to do a fellowship in the US (a type of advanced training between residency and full 'staff'), don't like to go on J1 if they want to eventually work full time in the US, because one of the criteria for a J1 is that after your training, you have to return to your home country for at least 2 years.

So if the point of going to the US is for the better wages and better opportunities, J1 is not helpful.

No, obviously you'd require accreditation, but we have family friends that did exactly that and opened a GP practice in OK City.

My guess is that they completed their USMLE exams. But please if you don't mind, I'd love to know if they did not because I have not heard much about this type of entry. Can you ask them? I would really like clarification, because I have been around dozens of highly motivated, highly competent people, for the last 5-7 years, all of whom have a very large direct interest in the going to the US (docs doing residency) and who discuss it often, who have not discovered this.

Edited January 26, 2016 by hitops

[hitops]

I realize that aboriginal people are poorer and that other groups do better. I see no evidence that like for like ethnic groups (leaving aside the fact that they don't exist) are comparably better off in the US, leaving aside blacks (as if they don't count).

I posted that for a reference to the aboriginal people in the US. Those numbers are clearly better than aboriginals in Canada, for which abundant data is available and I'm assuming you don't need me to tell you those numbers. I thought you were wanting references for my claims that comparable groups do better in the US.

Edited January 26, 2016 by hitops

[hitops]

We interpret the following:

to encompass a lot.

Yes a very powerful factor. Grandparents for kids is not something you can buy.

But eventually enough pressure can change decisions. The argument of 'the levy has held so far, so adding more water should be fine', is not logical.

[Smallc]

I posted that for a reference to the aboriginal people in the US. Those numbers are clearly better than aboriginals in Canada, for which abundant data is available and I'm assuming you don't need me to tell you those numbers. I thought you were wanting references for my claims that comparable groups do better in the US.

That's one group. Black Canadians, in reverse, are largely better off.

[Derek 2.0]

Unfortunately it is. Nurses and pretty much every other kind of professional in and outside of medicine are good to go on NAFTA.....just not docs (for clinical practice). Check it out: http://canada.usembassy.gov/visas/doing-business-in-america/professions-covered-by-nafta.html

Fair enough.

You mentioned work/study in the above post. So ya that's what J1-1's are for, they are basically training/education visas. So for example a medical student or a specialty resident (who technically yes is doing work, and earns in the range of 40-60K) can go on those. However a fully graduated doc with Canadian-only credentials looking to earn full time, cannot. Even Canadian residents who want to do a fellowship in the US (a type of advanced training between residency and full 'staff'), don't like to go on J1 if they want to eventually work full time in the US, because one of the criteria for a J1 is that after your training, you have to return to your home country for at least 2 years.

So if the point of going to the US is for the better wages and better opportunities, J1 is not helpful.

Again, I wonder if things have been changed, as my wife was a fully accredited dentist (in South Africa) and was able to work as a hygienist in the center's dental clinic (which is a part of Texas A&M's dental collage) until she took/passed the State licensing board test.....maybe it's different rules again for physicians?

My guess is that they completed their USMLE exams. But please if you don't mind, I'd love to know if they did not because I have not heard much about this type of entry. Can you ask them? I would really like clarification, because I have been around dozens of highly motivated, highly competent people, for the last 5-7 years, all of whom have a very large direct interest in the going to the US (docs doing residency) and who discuss it often, who have not discovered this.

I know they did have to pass State exams for sure. They bought an entire practice off a retiring physician (and expanded it into a small clinic), that stayed on through the transition. Under the investor entry program there is a benchmark for funds to be invested, I know they would have put in well over 100k.

As I said though, your best bet is to talk to a lawyer.....the United States, like most countries, will/is facing a massive shortage of all healthcare practitioners.

[Smallc]

I'm sure there is a give and take, Canada's "better social programs" would be offset by a lower cost of living........do you pay $8 for a cauliflower?

As I stated, this was do to problems mostly unrelated to currency. Cauliflower is now less than $2 a head.

[hitops]

That's one group. Black Canadians, in reverse, are largely better off.

False comparison. Black Canadians are almost entirely first or second generation African immigrants. The comparable group in the US would be, unsurprisingly, first or second generation African immigrants. And yes, they do better.

Incidentally, African immigrants in the US far outperform African Americans, on average (one exception being Somalians). For example, the rates of graduation for Nigerian immigrants vs African Americans is the same......except that number is for university degrees for the Nigerians, and high school for the AA's. Nigerian immigrants outperform the average, and outperform whites.

And all those racist white cops? Apparently they don't bother African immigrants. It's not at all that your behavior and choices determine whether you interact with law enforcement. No.....their racism is so advanced....they can detect and harass African Americans more often than whites based on 'color', but not african immigrants. Quite the trick eh?

Edited January 28, 2016 by hitops

[hitops]

Again, I wonder if things have been changed, as my wife was a fully accredited dentist (in South Africa) and was able to work as a hygienist in the center's dental clinic (which is a part of Texas A&M's dental collage) until she took/passed the State licensing board test.....maybe it's different rules again for physicians?

And then what about after she passed? Here's what the state department says about those on J-1:

You may not arrive more than 30 days before the program start date shown on your DS-2019. Upon completion of your exchange program, you have a grace period of 30 days to depart the United States.

Did your wife stay in a non-training, non-educational, working capacity on a J-1?

I know they did have to pass State exams for sure. They bought an entire practice off a retiring physician (and expanded it into a small clinic), that stayed on through the transition. Under the investor entry program there is a benchmark for funds to be invested, I know they would have put in well over 100k.

There are no 'state exams' for medical specialties or GP's in the US, to my knowledge. There are national ones. Most likely what they mean is that whichever state they were going to, required that they pass the USMLE's (which are national). Some states require this, some don't. Are you still in contact with them?

As I said though, your best bet is to talk to a lawyer.....the United States, like most countries, will/is facing a massive shortage of all healthcare practitioners.

Actually I did speak with a lawyer a few years back, but maybe not the right one.

[Derek 2.0]

Did your wife stay in a non-training, non-educational, working capacity on a J-1?

Yes and no, she was admitted as a resident into their pediatric dentistry program, so yes was fully employed, receiving a salary etc, no in that she was in a program that applied to her completing 2/3rds of her Orthodontics certificate and her Masters degree (Oral biology).......which she completed several years later after our second child.

There are no 'state exams' for medical specialties or GP's in the US, to my knowledge. There are national ones. Most likely what they mean is that whichever state they were going to, required that they pass the USMLE's (which are national). Some states require this, some don't. Are you still in contact with them?

Ahhh there is if you want to practice medicine and not end up a resident in prison......each State will have different rules and reciprocity agreements (for exams, credentials etc).....dependent on which State, some will very much so treat your Canadian credentials as their own.........as I said, your best bet is to first short list a handful of States you would be interested in going to, contact their Boards and talk to a lawyer.

Actually I did speak with a lawyer a few years back, but maybe not the right one.

A lawyer in the United States?

[hitops]

Yes and no, she was admitted as a resident into their pediatric dentistry program, so yes was fully employed, receiving a salary etc, no in that she was in a program that applied to her completing 2/3rds of her Orthodontics certificate and her Masters degree (Oral biology).......which she completed several years later after our second child.[/size]

Ok we're splitting hairs here. You wife was on J-1 because she was in training. Docs in residency or fellowship are also 'fully employed', and earning a salary, but they are training. J-1 is all good when you training. But you don't make the real doc income in training. If you want to do that, you have to finish training, get licensed independently, and start a practice (not training or getting education or working under anybody or doing research or anything similar etc etc), and that is when you need an H1-B, as a doc.

Ahhh there is if you want to practice medicine and not end up a resident in prison......each State will have different rules and reciprocity agreements (for exams, credentials etc).....dependent on which State, some will very much so treat your Canadian credentials as their own.........as I said, your best bet is to first short list a handful of States you would be interested in going to, contact their Boards and talk to a lawyer.

No that is not about 'state exams', there is no such thing as state medical exams. That link is for the state licensing body. They all accept the national ones. It says right there in the first paragraph In general, applicants must graduate from appropriate educational institutions, pass national exams, pass the appropriate Texas Jurisprudence exam, and possess good professional character.

The national exams are the USMLE's. The jurisprudence exam has nothing to with clinical medicine or medical knowledge, it is about making sure the doc knows the legal side of practicing in Texas. It is a sleeper, like when professionals have to take 'ethnics exams' for a provincial body.

Not every state requires the USMLE's or US board exams. But they are require a legitimate work visa. The only work visa a Canadian (who is not dual, and not married to an American) doc can get to practice independently in the US and earn real, full-practice income (not training, etc), is the H1-B. To get this exam, the state department (federal government dept run by Hilary) requires passing the USMLE's.

A lawyer in the United States?

Yep. Here's a rundown of the situation:

http://medicalemployers.com/us-immigration-for-canadian-physicians/

Edited January 28, 2016 by hitops

[Derek 2.0]

Ok we're splitting hairs here. You wife was on J-1 because she was in training. Docs in residency or fellowship are also 'fully employed', and earning a salary, but they are training. J-1 is all good when you training. But you don't make the real doc income in training. If you want to do that, you have to finish training, get licensed independently, and start a practice (not training or getting education or working under anybody or doing research or anything similar etc etc), and that is when you need an H1-B, as a doc.

How are we splitting hairs? As I said, my wife practiced her profession, well receiving additional training, under a J-1 visa. If those circumstances aren't applicable to you, as said, talk to a lawyer.

No that is not about 'state exams', there is no such thing as state medical exams. That link is for the state licensing body. They all accept the national ones. It says right there in the first paragraph In general, applicants must graduate from appropriate educational institutions, pass national exams, pass the appropriate Texas Jurisprudence exam, and possess good professional character.

The national exams are the USMLE's. The jurisprudence exam has nothing to with clinical medicine or medical knowledge, it is about making sure the doc knows the legal side of practicing in Texas. It is a sleeper, like when professionals have to take 'ethnics exams' for a provincial body.

The issue is what? I relayed our friends (and my wife's) experience, which very much so included (as cited) the writing of exams in the State one wishes to practice in, which is a legal requirement. I didn't speak to their content or their difficulty, as I am not in the healthcare profession.

Not every state requires the USMLE's or US board exams. But they are require a legitimate work visa. The only work visa a Canadian (who is not dual, and not married to an American) doc can get to practice independently in the US and earn real, full-practice income (not training, etc), is the H1-B. To get this exam, the state department (federal government dept run by Hilary) requires passing the USMLE's.

From your link:

Interestingly, although Canadian physicians are required to pass the USMLE (or the FLEX or the NBME, neither of which is offered anymore) before they may practice medicine in the U.S. in temporary H-1B status, there is no such requirement for a Canadian physician who applies for permanent residence in the U.S.

To become a permanent resident of the U.S. through employment (as opposed to being sponsored by a relative or through an investment), a Canadian physician has two primary options: (1) PERM and (2) National Interest Waiver.......

As I said, talk to an American immigration lawyer......as one, I'm not an immigration lawyer, and two, my wife's (or friends experiences) might differ, as they were over a decade ago (two now for my wife) and laws, regulations and rules do change.......what is clear (and highlighted in your above link), there are several other alternative, and legal, methods to make the switch.

[bush_cheney2004]

....The issue is what? I relayed our friends (and my wife's) experience, which very much so included (as cited) the writing of exams in the State one wishes to practice in, which is a legal requirement. I didn't speak to their content or their difficulty, as I am not in the healthcare profession.

Right....my last employer registered, delivered, and reported candidate results for many of the credentialing exams for U.S. national organizations / boards (doctors, nurses, pharmacists, EMTs, etc.) States ultimately certify and license these folks who "write for the exam", along with several over hoops to jump through.