Tax reform plays politics with doctors’ reputations

Matthew B. Stanbrook

doi:10.1503/cmaj.171132

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Tax changes should be seen as a gateway to a larger discussion on public healthcare reform in Canada
Jillian Ratti

Posted on: 20 October 2017
Doctors Share Responsibility for Damaging Discourse
Kieran Conway

Posted on: 10 October 2017

Posted on: (20 October 2017)
Page navigation anchor for Tax changes should be seen as a gateway to a larger discussion on public healthcare reform in Canada
Tax changes should be seen as a gateway to a larger discussion on public healthcare reform in Canada
Jillian Ratti, Family Physician
Other Contributors:
We read with concern the recent editorial on the government's proposal to eliminate certain tax advantages for incorporated physicians and other small businesses. We appreciate the call for respect and maintaining common ground and agree that a meaningful exchange of ideas, free of bullying, is the best path forward. In this context, it is somewhat ironic that the letter we signed on tax reform was dismissed as "frankly...
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We read with concern the recent editorial on the government's proposal to eliminate certain tax advantages for incorporated physicians and other small businesses. We appreciate the call for respect and maintaining common ground and agree that a meaningful exchange of ideas, free of bullying, is the best path forward. In this context, it is somewhat ironic that the letter we signed on tax reform was dismissed as "frankly naive".
The editorial misses the mark on the content of the letter, which explicitly calls for broader tax system reform while acknowledging that the current proposed changes are a small step toward that goal. We believe the best way to advocate for reform is by supporting the proposed changes that move us in that direction, and then holding the government accountable for further required reforms.
In addition, as physicians with great social privilege, we believe it is our responsibility to consider the larger social context when advocating around tax system reform: we live in a country where the average Canadian makes a fraction of what physicians earn, and where precariousness of work is increasingly common. Our actions and words need to reflect these concerns.
Further dialogue about strategy and the process of reform is welcome and important to ensure accountability. We see this policy moment as an opportunity to move forward on longstanding challenges our profession has faced, and we are asking for parental benefits and access to pensions for physicians (and all Canadians), alongside a dialogue on securing appropriate models of compensation. We call upon our medical associations to focus on a full examination of payment reform, including the option of offering physicians salaried compensation and benefits -- a model which prevails in many of the highest performing health systems internationally.
We are heartened by the recognition of common priorities for advocacy including payment reform, benefit options, and a fair and transparent tax reform process. However, we are concerned that the vehement opposition to the tax reforms adopted by most medical associations may be harmful to our profession's reputation and credibility.
Thus, we reiterate our call to re-focus advocacy onto smart, equitable, and evidence-based policy solutions that address the underlying issues in this debate. Going forward, a more astute, nuanced, and balanced political strategy would help us pursue the common objectives of a tax system that improves the wellbeing of physicians and all people living in Canada, and a health care system that does the same.
Jillian Ratti, MD, CCFP Michaela Beder, MD, FRCPC Vanessa Brcic, MD, CCFP Gary Bloch, MD, CCFP Lesley Barron, MD, FRCPC Monika Dutt, MD, FRCPC, CCFP Samantha Green, MD, CCFP
Conflict of Interest:
We are a group of both incorporated and unincorporated physicians
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Competing Interests: None declared.
Posted on: (10 October 2017)
Page navigation anchor for Doctors Share Responsibility for Damaging Discourse
Doctors Share Responsibility for Damaging Discourse
Kieran Conway, Family physician
Dear Editor (1),
There is little question that the public discourse surrounding proposed tax reforms has been profoundly damaging to the reputation of Canadian physicians. To assign primary blame for this on the federal government is grossly out of touch.
The histrionic and frequently hysterical response of doctors to proposed reforms has been far more damaging to our professional reputation than the a...
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Dear Editor (1),
There is little question that the public discourse surrounding proposed tax reforms has been profoundly damaging to the reputation of Canadian physicians. To assign primary blame for this on the federal government is grossly out of touch.
The histrionic and frequently hysterical response of doctors to proposed reforms has been far more damaging to our professional reputation than the admittedly unhelpful rhetoric from the federal government. These proposals are a first step in reforming a tax system that systematically advantages the wealthiest 5%, which includes doctors, and exacerbates income inequality - a major contributor to poor health outcomes (2). When the public sees us as more concerned with protecting our financial privilege than health outcomes, they have every reason to question our integrity.
According to MD Management's analysis (3), these changes will affect only a minority of physicians, and in only a very small way. Yet physicians have gone so far as to threaten withdrawal of care (4,5), a reckless response that is shamefully reminiscent of the "Doctors' Strike" after the introduction of Medicare.
Dr. Stanbrook's call for unity is an attempt to silence those of us who support, albeit with qualifications, these reforms. No, we are not tax cheats, but we are using a system that needs fixing. Instead of defending it, let's address the legitimate calls among physicians for basic protections including parental and sick leave, retirement planning, and reasonable work hours, which should be the right of all.
Dr. Kieran Conway MD CCFP
References
1. Stanbrook MB. Tax reform plays politics with doctors’ reputations. CMAJ 2017;189:E1249.
2. National Research Council (US) Committee on Future Directions for Behavioral and Social Sciences Research at the National Institutes of Health. Singer BH, Ryff CD, editors. New horizons in health: an integrative approach. Washington: National Academies Press; 2001. Available: www.ncbi.nlm.nih.gov/books/NBK43780/ (accessed 2017 Oct. 2)
3. Maltinsky E. Tax planning using private corporations, what’s next: a summary of finance announcements [blog]. Ottawa: MD Management; 2017. Available: https://mdm.ca/md-blogs/tax-planning-using-private-corporations-what-s-next-a-summary-of-finance-announcements (accessed 2017 Oct. 2)
4. Maritime doctors threaten to leave region over tax changes. CTV News Atlantic 2017 Sept. 30. Available: http://atlantic.ctvnews.ca/maritime-doctors-threaten-to-leave-region-over-tax-changes-1.3613943 (accessed 2017 Oct. 2)
5. Curry B. Morneau defends tax change that has doctors threatening to leave Canada. The Globe and Mail [Toronto] 2016 Dec. 6. Available: https://beta.theglobeandmail.com/news/politics/morneau-defends-tax-change-that-has-doctors-threatening-to-leave-canada/article33225417/?ref=http://www.theglobeandmail.com& (accessed 2017 Oct. 2)
Conflict of Interest:
Dr. Conway is an incorporated physician.
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Competing Interests: None declared.