Doctor Relocating to the US - MCA Cross Border Advisors Inc. (2024)

Canadians looking to permanently move to the US should be aware of the following investment planning and portfolio management issues.

Passive Foreign Investment Companies
Within a taxable or non-registered account, Canadian mutual funds, exchange-traded funds (“ETFs”), and real estate investment trusts (“REITs”) are classified as passive foreign investment companies (“PFICs”) by the IRS, with extremely punitive tax treatment. Any taxable or non-registered accounts holding these securities should be “cleansed” or “purified” prior to becoming classified as a US person for IRS purposes.

Within tax-deferred or registered accounts (such as “RSPs” and “RIFs”), Canadian mutual funds, ETFs, and REIT holdings are not subject to the PFIC classification.

We can help build, maintain, and oversee a holistic and optimized cross-border investment portfolio that remains aligned with your strategic investment objectives, risk tolerance, and time horizon, and complements other aspects of your cross-border financial plan while remaining compliant with Canadian and US tax authorities.

Regulatory Compliance
For investment professionals, the relevant regulatory bodies in Canada are the Investment Industry Regulatory Organization of Canada (“IIROC”) and the provincial securities commissions. The relevant regulatory body in the US is the Securities and Exchange Commission (“SEC”).

While there are recognition and reciprocity of investment credentials on both sides of the border, investment professionals who are licensed only in one country need to formally apply for registration with the relevant regulatory entity in the other country so that their education, training, and work experience is recognized.

Owing to the additional legal complexity, heightened business risk, and regulatory reporting workload associated with operating in another country, most firms are unwilling to embark on the registration process because of their focus on domestic or regional clients.
Once you officially exit Canada and become a tax resident of the US, it is very likely that your current investment professionals will no longer be able to continue to work with you due to regulatory and compliance restrictions.

In such cases, we can help build, transition, and oversee an optimized and compliant cross-border investment portfolio that remains aligned with your strategic investment objectives, risk tolerance, and time horizon, and complements other aspects of your cross-border financial plan. We work with each client to independently determine the most suitable investment portfolio for your particular situation.

Foreign Source Income (“FSI”)
As a US resident, you will receive Foreign Tax Credits (“FTCs”) for any tax paid to Canada. However, you will only be able to use these credits on your US tax return to offset other foreign passive income. Where it makes investment sense, it can be beneficial to re-structure your portfolio and investments to take advantage of these FTCs by ensuring that your investments generate an adequate percentage of FSI, thereby potentially reducing your US federal tax liability.

The most effective source of FSI is generated from foreign (outside of US) bonds and other interest-bearing securities. Investment in such vehicles should be considered to the extent that the fixed income allocation remains consistent with your overall investment objectives, risk tolerance, and time horizon.

Manager Selection and Oversight
Portfolio management is a daunting process for many individuals in general and is compounded by the additional complexities within a cross-border context. Your advisory team should be knowledgeable about investing on both sides of the border; ideally, they will have a comprehensive understanding of the cross-border tax, financial planning, and regulatory issues that can arise.

Having an investment manager who understands your situation and needs and who works seamlessly with tax experts, lawyers, and financial planners is crucial to your financial well-being.

We favour a multi-manager approach to portfolio management – identifying and selecting top-tier managers for a particular asset class or investment mandate. Our independent oversight helps you determine which managers fit best with your investment objectives and risk tolerance. Moreover, we will coordinate total portfolio reporting, manager monitoring, optimized tax management, and comprehensive cross-border advice to help you avoid tax traps, penalties, and other issues. Where possible, we negotiate preferential pricing on investment management fees for our clients.

As an independent firm and investment fiduciaries, we can help build, transition, and oversee an optimized and compliant cross-border investment portfolio that remains aligned with your strategic investment objectives, risk tolerance, and time horizon, and complements other aspects of your cross-border financial plan.

Canada taxes only its residents on worldwide income. As such, after exiting Canada, Canadian citizens no longer pay taxes to the CRA on worldwide income.

Instead, as US tax residents, they must file US income tax returns, reporting their worldwide income to the IRS. However, such clients may still need to file Canadian income tax returns for Canadian-source income that they receive, paying any tax owing on that income to the CRA.

US residents will typically receive foreign tax credits for tax paid to Canada that can be used to offset tax owing to the US. If planned accordingly, foreign tax credits present exciting cross-border financial planning opportunities for our clients – opportunities that are ongoing and can be capitalized upon each year after implementing a cross-border financial plan.

Needing to file income tax returns in two countries necessitates organization and careful planning. Since US tax residents must report foreign bank accounts and financial assets that they retain offshore to the IRS, US tax filings can become complex, with several moving pieces.

Canadians who move south of the border and retain bank accounts and financial assets in Canada may have to meet FATCA filing requirements. Reportable financial assets under FATCA range from bank accounts to Canadian partnership interests and stocks and securities issued by non-US corporations. US residents with Canadian assets may also have to file FinCEN 114, the Report of Foreign Bank and Financial Accounts, commonly known as the FBAR.

US income tax filers must not only manage many moving pieces, but there are also different methods of filing in the US than there are in Canada. In Canada, all taxpayers file individually. In the US, taxpayers can choose whether they would like to file as individuals, as married filing jointly, as married filing separately, or as the head of their household.

Each type of filing status has advantages and disadvantages that affect our clients in unique ways, depending on the timing of their exit from Canada. We therefore assist our clients with selecting a US taxpayer filing status, as well as with organizing their filing obligations and planning for maximal foreign tax credit use.

Doctor Relocating to the US - MCA Cross Border Advisors Inc. (2024)

FAQs

Can a foreign medical doctor work in the US? ›

Nearly one-fourth of the active U.S. physician workforce are foreign graduates and international medical graduates (IMG). Nonimmigrant or immigrant visas are needed for IMG physicians to legally practice in the U.S. when they are not U.S. citizens.

Can Canadian doctors work in USA without Usmle? ›

Any foreign doctor who wants to practice medicine in the United States must first: Pass the US Medical Licensing Exam (USMLE) Obtain ECFMG certification. Enter a fellowship or residency program approved by the Accreditation Council for Graduate Medical Education (ACGME)

Can Canadian trained physicians practice in the US? ›

Permanent Residency and Visas

The H-1B is a temporary employment visa that Canadian doctors can obtain to work, teach, or research in the US, or to participate in a training program like residency. The visa is initially issued for three years and can be extended for up to six years.

Is it better to be a doctor in the US or Canada? ›

The U.S. generally offers lower taxes and higher average salaries across medical specialties. Canadian doctors have lower education, insurance and operational costs. Lastly, remember that compensation is not the only factor to consider.

Can you work in the U.S. as a doctor without residency? ›

Yes. Residency is not mandatory, it is a specialty training program that you can choose to enter after completing your MD. However, residency is a mandatory step to achieving medical licensure in the US, which will allow you to practice medicine as an independent physician.

Can foreign doctors work in USA without residency? ›

No. International Medical Graduates (IMGs) must complete a US medical residency to be eligible for an employment visa, and a job in the US. it is true that the state in which you are doing your residency may issue you an unrestricted license when you have completed the licensure requirements.

Is it possible to work as a doctor in USA without USMLE? ›

What is the USMLE? You are required to pass parts 1 and 2 of the United States Medical Licensing Examination (USMLE) in order to get your MD degree from a US medical school. Most DOs trained in the United States also take it. And you cannot receive a medical license without passing parts 1, 2 and 3 of the USMLE.

Does US accept Canadian medical residency? ›

If you are a Canadian citizen, Canadian permanent resident, or international student, you will require a visa to carry out residency training in the US.

How does a foreign doctor get licensed in the US? ›

Pathway to Licensure

International Medical Graduates (IMG) must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). To become certified by ECFMG, an IMG must pass USMLE Step 1, Step 2 CK and Step 2 CS. Doctors can take these exams in any order, but we strongly recommend the order listed.

Are doctors paid more in the US or Canada? ›

While the USA generally offers higher average salaries across various medical specialties, Canadian doctors experience a more balanced salary-to-debt ratio due to lower education costs.

What do Canadian doctors need to practice in US? ›

Generally, a graduate of a foreign medical school must complete an Accreditation Council for Graduate Medical Education (ACGME) accredited graduate medical residency program, and successfully complete the U.S. Medical Licensing Exam (USMLE), before applying for and being issued a state license to practice medicine.

Which two Canadian provinces lift licensing barriers for US doctors? ›

Two Canadian provinces, Nova Scotia and Ontario, have lifted board certification requirements for physicians licensed to practice in the U.S. in anticipation of a 44,000 physician shortage, according to a May 1 report from Medscape.

What is the hardest medical school to get into? ›

The hardest medical program to get into is Stanford Medical School. Only 1.4% of students who apply to Stanford are accepted.

Is Canada med school harder than US? ›

Canadian medical schools are among the hardest medical schools to get into in North America, and medical school acceptance rates in Canada are actually lower on average than US schools.

What is the easiest medical school to get into? ›

The easiest medical schools to get into (by percentage of applicants enrolled)
  • University of Kansas School of Medicine – 6.6% ...
  • University of Nebraska Medical Center College of Medicine – 6.4% ...
  • University of South Dakota Sanford School of Medicine – 6.4%

How can a foreign doctor get a job in USA? ›

Foreign physicians wishing to practice medicine must also:
  • Prepare to pass the US Medical Licensing Exams (USMLEs)
  • Get certified by the Educational Commission for Foreign-Trained Medical Graduates.
  • Enroll in and apply to and complete residency programs for foreign medical graduates.

Is a foreign degree accepted by U.S. medical schools? ›

Completing USA accredited coursework

An additional step for international medical school hopefuls is completing coursework at a U.S. institution. The majority of U.S. medical schools will not accept an undergraduate degree from another country as equivalent to a U.S. degree because the curriculums are different.

Can a foreign medical doctor work as a nurse in USA? ›

They would need to apply to an accredited nursing program, complete the 2–4 year program, take and pass the NCLEX exam, and apply for licensure in their state of choice. That's assuming they meet all the requirements to become a permanent resident.

Can you practice medicine in USA without USMLE? ›

The USMLE is a pre-requisite for international graduates to acquire a license to practice in the USA and to participate in specialty exams that grant you Board certification to establish expertise in a specific specialty.

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