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VOL. 43             N O. 1                  FA L L 2 0 2 0

                             AVAILABLE POSITIONS
                                          PAGES 38 TO 55
                                                                                                       THE PRESIDENT’S MESSAGE                                                                            4

OF CONTENTS                                                                                            ---------------------------------------------------------------
                                                                                                       1 . FA M I LY M E D I C I N E                                                                      5
                                                                                                       2 . O T H E R S P E C I A LT I E S                                                                12
                                                                                                       3. PRACTICE                                                                                       19
                                                                                                       4 . C E R T I F I C AT I O N E X A M S                                                            21
                                                                                                       5 . R E M U N E R AT I O N A N D B I L L I N G                                                    23
                                                                                                       6. APPENDICES                                                                                     28
                                                                                                       --------------------------------------------------------------- -

Dr Olivier Fortin, President | Dr Jessica Ruel-Laliberté, Vice-President | Dr Éric Guimond, Secretary-Treasurer | Dr Annick Veilleux-Carpentier, Director from AMRM | Dr Sofia Nene, Director from ARM
Dr Florence Côté, Director from AMReQ | Dr Patricia-Anne Reed, Director from AMReS | Dr Alex Vignola, Director, University Affairs | Dr Raphaëlle Carignan, Director, Academic Affairs – Specialties
Dr Laurence Labine, Director, Academic Affairs – Family Medicine | Me Patrice Savignac Dufour, Executive Director

Johanne Carrier, Editor | Triade Marketing, Graphic Design
ISBN/ISSN: Canada Post Publication Agreement 1484699

STAFF: Me Patrice Savignac Dufour, Executive Director | Johanne Carrier, Director, Communications and Public Affairs | Sylvain Schetagne, Director, Research and Sociopolitical Action
Marie-Ève Breton-Soutière, Manager, IT and Human Resources | Jocelyne Carrier, Co-ordinator, Academic Affairs – Specialties | Stéphanie Chevance, Co-ordinator, University Affairs
Geneviève Coiteux, Co-ordinator, Academic Affairs – Family Medicine | Marie-Anik Laplante, Co-ordinator, Union Affairs | Josée Lévesque, Assistant | Vicki Portelance, Assistant
Edyta Zaniewska, Assistant

Return undeliverable Canadian addresses to:
FMRQ 510-630 Sherbrooke Street West, Montreal, QC H3A 1E4
Tel.: 514-282-0256 or 1-800-465-0215
www.fmrq.qc.ca – info@fmrq.qc.ca

                                                                                                 PA G E 3                                                                      LE BULLETIN

The COVID-19 pandemic continues to have a daily impact on all of us, both           I also invite you to consult this issue of the Bulletin, which stands as a guide
personally and professionally. The certification exam saga, which has been          to the processes involved in obtaining a position and the different physician
going on since last March, is but one example—and you may rest assured that         resource issues. You can also consult FMRQ staff for personalized guidance
we are continuing to lobby for the Collège des médecins du Québec to lift its       on those topics by emailing prem-mf@fmrq.qc.ca for family medicine or
requirement concerning the MCCQE Part II.                                           pem-sp@fmrq.qc.ca for other specialties.

The pandemic has also forced us to postpone several of our yearly activities,       I would like to reiterate that we are doing everything possible to ensure
or to modify how they are run. So this year the FMRQ’s Career Day will be held      optimum work and learning conditions for you, at all times, but especially
virtually, on December 11, 2020, as part of the Federation General Assembly         during this pandemic period. I invite you to tell us about any situation of
meeting on physician resources. We hope this will allow you to attend in            concern to you in your training sites. We are in touch with the government and
larger numbers than ever to talk with representatives of Quebec healthcare          faculty authorities on an ongoing basis, to ensure that the decisions made are
establishments and the other organizations who will be represented there,           not detrimental to your health, or to your academic progression.
among them the MSSS, medical federations, physician associations, and of
course our financial partners. I remind you that you are released to take part in      With the New Year fast approaching, we already know 2021 is sure to bring us
it without loss of pay, and with no penalty with respect to the validity of your       new challenges, which we will certainly be able to meet together. Regardless,
rotation, pursuant to an agreement with the Quebec Conference of Associate             our Federation will be there to promote and defend your rights. In the
Deans for Postgraduate Medical Education.                                              meantime, we hope you will be able to rest a little during the Holiday Season,
                                                                                       taking time for yourselves and your loved ones, while of course following
In family medicine, we had to bring forward part of this event to provide Public Health guidelines.
information for members who had to submit their compliance notice
applications between October 15 and 31, 2020, by holding a webinar on PREMs I very much look forward to seeing you again in person, so we can talk, and
on September 25. Moreover, I am inviting R1s in FM to take part in large numbers exchange ideas, and above all to shaking your (sanitized) hands and saluting
in our December 11 Career Day. In other specialties, we made sure that the you for all you do each day. May that day come soon!
2021-2025 five-year plan would be finalized in time for the Day. That means you
will be able to explore the opportunities available to you for the next five years and
talk with representatives of and partners from the different organizations present.

                                                                                    Olivier Fortin, M.D.

LE BULLETIN                                                                   PA G E 4
This section contains information on the process for granting PREMs in family medicine. It begins with a glossary, to make the rules easier to
understand, and includes full details on the procedure for obtaining a PREM in a university FMG or a PEM in an establishment, the 55%-45% rule,
specific medical activities (AMPs), and locums.

GLOSSARY 101                                                                           services network, or RLS). The frequently used expression “to have a PREM”
Special medical activity (Activité médicale particulière, or AMP)                      actually means holding a notice of compliance with a given region’s PREM.
Medical activities listed in the Act respecting health services and social services
                                                                                       University needs (university physician resource plans, or PEMUs)
as having a priority dimension. These are services delivered in an Emergency
                                                                                       (Besoins universitaires, PEMU)
department; care provided to patients admitted for short-term care; services
                                                                                       Compliance notice reserved for doctors wishing to teach. This involves teaching
involving on-call duty provided in a long-term care centre or rehabilitation
                                                                                       positions set aside to meet priority academic needs.
centre, or in connection with a local community service centre (CLSC) home care
support program; medical services in obstetrics; primary care services provided
to vulnerable patients in their homes, in a private office, or in any other centre          WARNING
operated by an establishment; and, finally, services delivered in the context of
any priority activity determined by a regional department of general medicine               For this type of PREM, it is the director of the family medicine program
(DRMG) and approved by the Minister of Health and Social Services. Conditions               of the faculty concerned who selects the candidate and confirms his
for physicians’ participation in AMPs have been determined through a special                choice with his region’s DRMG and the Ministry of Health and Social
agreement between the Minister and the FMOQ.                                                Services (MSSS) by October 31.

Upon obtaining a notice of compliance with the regional physician resource                  (Please note that it is also possible to teach in a university family
plan (PREM), a physician with 15 years of practice or less must choose an AMP               medicine group (UFMG) if a position is available in that UFMG, when
offered by the region to meet local needs. This AMP will be performed in one of             you hold a regular PREM. You then have to go through the process of
the services named, for the equivalent of 12 hours per week.                                applying for a regular compliance notice.)

Compliance notice (Avis de conformité)
                                                                                       Selection criteria (Critères de sélection)
All family physicians practising under the Quebec health insurance plan are
                                                                                       When the number of candidates exceeds the number of positions available
subject to the Special agreement on compliance with regional physician
                                                                                       in the PREM, a selection is made via interview. This selection is made on the
resource plans (PREMs). Under that agreement, the physician has to obtain a
                                                                                       basis not of the physician’s competence, but of his interest in practising in the
notice of compliance with the PREM from the Regional department of general
                                                                                       priority needs identified by the DRMG.
medicine (DRMG) of the practice region in question. Obtaining this compliance
notice implies the physician’s commitment to maintaining the majority of his
practice, i.e., 55% or more of his billing days, in a sub-area of that region (local

                                                                                 PA G E 5                                                         LE BULLETIN

Locum (dépannage)                                                                    Interregional mobility (Mobilité inter-régionale, or MIR)
Part-time locum (Dépannage à temps partiel)                                          Status of a physician who has worked a minimum of 200 days (synonymous
A physician who holds a compliance notice but wants to perform locums part- with “doctor already practising”).
time. Note that this practice is included in the 55%-45% ratio.
                                                                                     Non-compliance with compliance notice conditions
PREM exclusively for locums (PREM dépannage exclusif)                                (Non-respect des conditions de l’avis de conformité)
A doctor wishing to practise exclusively under the locum mechanism can A physician who does not meet his commitment to perform 55% or more of his
obtain a waiver in lieu of a compliance notice if positions are available. He has billing days in the geographical area covered by his PREM compliance notice is
to apply for this on registering for locums with the provincial Centre national subject to a 30% cutback of his total compensation for the year in question,
médecins-Québec. To register for locums, the physician has to hold a permit to i.e., from March 1 to February 28. The physician is notified by the Quebec Health
practise from the Collège des médecins du Québec and malpractice insurance Insurance Board (RAMQ) around September 1 of the following year.
corresponding to the areas of activity covered by his locum practice. A practice
is considered exclusive when it includes 95% or more of the physician’s total He may, however, request an exemption; his file will then be reviewed by
billing days.                                                                        the MSSS-FMOQ Parity Committee responsible for the Special Agreement
                                                                                     concerning compliance with PREMs.
Opting out of a PREM (Désistement à un PREM)
You may opt out of a PREM at any time if you have not started your practice.         New biller (Nouveau facturant)
                                                                                     New billers are physicians who have not yet completed at least 200 days of
Regional department of general medicine
                                                                                     practice under Quebec’s public health insurance plan. During those 200 days
(Département régional de médecine générale, or DRMG)
                                                                                     of practice, the physician must have held a valid notice of compliance with
Each region has a regional department of general medicine (DRMG) consisting
                                                                                     the region’s PREM or a waiver in lieu of a notice of compliance with the PREM.
of all the general practitioners in the region who receive compensation from
the Quebec Health Insurance Board (RAMQ). The DRMG’s responsibilities PEM (Plan d’effectifs médicaux)
are carried out by a Steering Committee consisting of physicians who Physician resource plan of a facility, healthcare establishment
belong to the department. In particular, the DRMG’s mandate is to make In family medicine, the term “PEM” is used to designate positions in hospitals.
recommendations concerning PREMs, general medical services, and AMPs. It You need a PEM to be able to work in a hospital setting.
defines and proposes a regional organization plan for general medical services
and a network of access to general medical care.                                     Initial application period (Période initiale d’application)
                                                                                     The initial application period runs from October 15 to October 31.
Head of DRMG (Chef du DRMG)
Head of Regional department of general medicine                                      Practice without a compliance notice (Pratique sans avis de conformité)
(Chef du département regional de médecine générale)                                  A physician practising under the Quebec Health Insurance Plan (RAMQ) without
The Head of the Regional department of general medicine is in charge of having obtained a notice of compliance with the PREM from the Head of the
authorizing and signing compliance notices.                                          Regional department of general medicine (DRMG) of a region will have his total
                                                                                     compensation cut back by 30%. A five-year waiting period will also be imposed
Healthcare establishment (Établissement de santé)
                                                                                     on him before he can apply for a compliance notice in that region. If, however,
A healthcare establishment is a group of healthcare facilities (hospital, local
                                                                                     the physician obtains a compliance notice from another region and meets his
community services centre [CLSC], long-term care facility [CHSLD], etc.) which cover
services for a given region. Following the adoption of Bill 10 (2015), the Minister commitment there, this period will be only three years.
grouped the 182 existing healthcare establishments into 34 establishments. Regional physician resource plans
Rounding out the network are the university health centres, and institutes.
                                                                                       (Plans régionaux d’effectifs médicaux, or PREMs)
Facility (Installation)                                                                Regional physician resource plans (PREMs) in family medicine authorize, for
A facility is a physical site where healthcare is delivered. Facilities are hospitals, each of Quebec’s administrative regions, a quantitative target for recruitment
CLSCs, residential and long-term care facilities (CHSLDs), rehabilitation of family physicians designed to distribute additional physician resources
centres, etc., which are grouped together under a healthcare establishment equitably. These plans are updated yearly on the basis of the differences
within the meaning of the law.                                                         observed between the resources in place and the needs to be met in each
                                                                                       region. They take into account the mobility of physicians already practising
Billing day (Journée de facturation)                                                   and the expected number of new doctors. Since Quebec’s regions do not all
A billing day is counted only if the compensation (pay) associated with enjoy the same level of access to healthcare services, PREMs aim to provide
that day is equal to or greater than $523. A half day can be counted if the Quebecers with more equitable access to medical services.
compensation associated with that half day is equal to or greater than
$261.50 and less than $523.

LE BULLETIN                                                                   PA G E 6

In family medicine, the term “PREM” is used to designate positions allocated          OBTAINING A PREM IN FAMILY MEDICINE
in one of the 18 administrative regions, with priority hiring in a local services     .    Submitting a compliance notice application
network (RLS). Obtaining a compliance notice implies that the doctor                  .    All compliance notice applications are made by the candidate on the
undertakes to maintain the majority of his practice, i.e., 55% or more of his
                                                                                           electronic form, which he forwards to the MSSS. The form is the sole
billing days, in a sub-area (RLS) of the region where he holds a PREM.
                                                                                           document to be sent in.
PREMs are associated not with a type of practice but with a practice location.        .    The initial period of reception of applications for a PREM compliance notice
                                                                                           runs from October 15 to 31 of the current year, inclusive. All applications
                                                                                           received during that period are deemed to be received on October 31.
Quebec is divided into 18 administrative regions. When you apply for a compliance
notice, you do so to one of these regions:                                            .    Candidates may not submit their compliance notice applications for the
Region 1 – Bas-Saint-Laurent                                                               following year’s PREM to the MSSS before October 15 of the current year.
Region 2 – Saguenay–Lac-St-Jean                                                       .    The MSSS sends each applicant an acknowledgment of receipt.
Region 3 – Quebec City (Capitale-Nationale)
Region 4 – Mauricie–Centre-du-Québec
                                                                                      .    Any response to an applicant from a DRMG following the submission of a
Region 5 – Estrie                                                                          compliance notice application has to be made in writing.
Region 6 – Montreal                                                                   .    Processing of a compliance notice application by the DRMG.
Region 7 – Outaouais
Region 8 – Abitibi-Témiscamingue                                                      Between November 1 and November 11, inclusive, the MSSS forwards the
Region 9 – Côte-Nord                                                                  applications to the DRMGs in the regions stated as candidates’ first choice.
Region 10 – Nord du Québec
                                                                                      Applications received between October 15 and 31 inclusive are processed in
Region 11 – Gaspésie–Iles-de-la-Madeleine
                                                                                      two rounds between November 1 and April 1. Applications submitted after
Region 12 – Chaudières-Appalaches
                                                                                      October 31 are processed at the end of the process, i.e., following the second
Region 13 – Laval
                                                                                      round, as of April 1.
Region 14 – Lanaudière
Region 15 – Laurentides                                                               When the number of positions available in the PREM of a sub-area which
Region 16 – Montérégie                                                                candidates have marked as their first choice is greater than the number of
Region 17 – Nunavik                                                                   applications received for that sub-area, no selection is carried out, and the
Region 18 – James Bay Cree Territory                                                  DRMG has to issue the compliance notice.

Local services network (Réseau local de service, or RLS)                       When the number of applications received for a sub-area exceeds the number
Each region is divided into sub-areas. So you have a notice of compliance with of positions available in that sub-area’s PREM, all applications are evaluated
a region’s PREM, with priority hiring in a sub-area (RLS).                     by the DRMG via interview. This evaluation must comply with the following
                                                                               selection process.
Positions in a PREM have a geographical scope and are not in any way EXAMPLES
associated with a facility, doctor’s office, or specific activity. None the less, the 1. There are fewer applicants than positions – automatic selection – all applicants
DRMG must, within the framework of its mandate, identify its region’s priority           receive their PREM:
needs, both primary and secondary. Identification of needs should guide the                .10 candidates apply with RLS de Verdun as their 1st choice
DRMG in the selection of candidates when there are more applications than
positions in the PREM. Also, the needs identified in a sub-area will guide                 .RLS de Verdun has 12 PREMs available
candidates in their choice of location and activities.                                     .All 10 candidates receive their PREM automatically
EFFECTIVE DATE OF PREMs                                                               2. There are more applicants than positions – selection by interview:
The PREM for a year comes into effect on December 1 of the previous year
and ends on November 30. So, for instance, the 2021 PREM will take effect on
                                                                                           .   15 candidates apply with RLS de Verdun as their 1st choice
December 1, 2020 and terminate on November 30, 2021.                                       .   RLS de Verdun has 9 PREMs available
                                                                                           .   ALL candidates are interviewed

                                                                                PA G E 7                                                          LE BULLETIN

                                                                                                                              You accept it                          Completed
                                                                       First choice                                            You refuse it                         Next round

                                                                            NO,                                               You accept it                          Completed
                                                                  but offers 2nd RLS
                                                                            NO,                                                You refuse it                         Next round
                                                                     but other RLS

                                                                             NO                                                                                      Next round

Selection process                                                                                          Candidates who did not identify any regions for the second round on their compliance notice
First round                                                                                                application forms cannot be granted compliance notices by the DRMGs until the application
.  From November 1 to January 20, only applicants’ first choice as entered
                                                                                                           process is complete, as of April 1.

   on the compliance notice application is forwarded by the MSSS to the                               .     No later than February 2, the MSSS forwards applicants’ information to the
   respective DRMGs.                                                                                        DRMGs in the regions concerned. Also, the MSSS will inform applicants of
.    No later than November 11, the compliance notice applications in question are
                                                                                                            the positions available in the regions they identified in the second round
                                                                                                            section of their compliance notice applications.
     forwarded by the MSSS to the DRMGs.
.    No later than December 20, interviews are conducted by the DRMG, and
                                                                                                      .     No later than February 19, interviews are conducted by the DRMG, and the
                                                                                                            candidates to whom the DRMG will be offering PREM compliance notices
     the candidates to whom the DRMG will be offering PREM compliance
                                                                                                            are identified.
     notices are identified.
.    Between December 20 and January 10, the DRMG responds to the applicant by
                                                                                                      .     No later than March 5, the DRMG notifies the applicant and the MSSS by
                                                                                                            email, confirming the geographical area or specifying that the candidate’s
     email (with c.c. to the MSSS), confirming the area corresponding to his first
                                                                                                            application has been denied.
     choice, offering another sub-area that has remained vacant, or informing him
     that his application has been denied.                                                            .     No later than March 15, an applicant who has been offered a position responds
.    WARNING: The applicant has 10 days to respond to the DRMG in writing.
                                                                                                            to the DRMG, stating whether or not he accepts. Should the applicant fail to
                                                                                                            respond within 10 working days, the compliance notice is withdrawn.
     Should the applicant fail to respond within 10 days, the compliance notice
     is withdrawn.                                                                                    .     As early as possible, but no later than March 17, the DRMG forwards to
.    As early as possible, but no later than January 28, the DRMG forwards to the
                                                                                                            the MSSS and RAMQ the names of candidates who have accepted their
                                                                                                            compliance notices, and the names of candidates not selected or who have
     MSSS and RAMQ the names of candidates who have accepted their compliance
                                                                                                            refused their compliance notices.
     notices, and the names of candidates not selected or who have refused their
     compliance notices.                                                                              .     On March 24, the MSSS forwards the compliance notices to the DRMGs concerned.
Second round                                                                                          .     No later than March 31, the MSSS receives the compliance notices signed
From January 21 to March 31, the contact information of candidates not selected                             by both parties.
in the first round will be forwarded to the DRMGs identified by the applicants in Following the two rounds
the second round section of their compliance notice application forms.                                   When positions are available in the PREM, the first come, first served
* If all the positions in the PREM are filled in the regions identified by the candidate for this second principle is applied.
    round, the MSSS notifies the candidate not selected that the processing of his application has
    been terminated. The MSSS informs the candidate that he may contact the DRMGs of regions for      Nevertheless, if the number of applications received on the same date exceeds
    which positions are available. Nevertheless, if the candidate wishes to be granted a compliance   the number of positions available in the PREM, the DRMG has to conduct
    notice in a region that was not identified in his application, he will have to forward another    candidate selection, in line with the following principles:
    compliance notice application form to the MSSS. This application will be processed in line with
    the first come, first served principle, once the second round is completed.
                                                                                                      .     A selection committee must be formed;
                                                                                                      .     The selection criteria have to be limited to matters within the DRMG’s jurisdiction;

LE BULLETIN                                                                                     PA G E 8

.   All candidates are interviewed;                                        OBTAINING A PREM IN A UNIVERSITY FAMILY MEDICINE GROUP
.   No letter of recommendation from a medical clinic may be considered in (PREM UFMG)
    determining the choice of candidate.                                            First, the DRMG has to set aside positions in the PREM to allow for the
                                                                                    recruitment of physicians in the university family medicine groups (GMF-U, or
Interview and selection criteria
                                                                                    UFMGs) to which the MSSS gives priority.
All candidates are interviewed. These interviews are conducted in person, but could
in exceptional cases be carried out remotely by means of a medium permitting As soon as a candidate is identified to fill one of these positions, but no
visual contact (e.g., Skype), if the candidate is unable to attend in person.        later than October 31, the director of the family medicine department of the
                                                                                     medical faculty concerned must confirm his choice to the MSSS and the DRMG
The objectives of the interview are the following:
                                                                                     responsible for issuing the selected candidate’s compliance notice.
.   Evaluate the level of knowledge of special regional features, approach
    carried out, reason for this choice;                                             If, as of October 31, no UFMG applicant is recommended for the priorities
                                                                                     identified, the sub-area PREM compliance notice is then released and returns
.   Evaluate experience acquired, career path, achievements, challenges, and goals;
                                                                                     to the regional pool. The position in the PREM is then no longer set aside for a
.   Find out intentions in terms of professional interests and activities envisaged; UFMG position, and can be attributed to another candidate, who will meet other
.   Evaluate the level of knowledge of the healthcare system;                        available priorities.
.   Evaluate personality, capabilities and behaviour through scenarios whereby When an academic applicant comes forward during the year to meet a UFMG
    the candidate can show his qualities;                                      priority recruitment recognized by the MSSS, recruitment will be possible
.   Provide relevant information on the region;                                provided the candidate is selected by the director of the family medicine
                                                                               department of the medical faculty concerned and a position in the sub-area’s
.   Answer the candidate’s questions;                                          PREM is available. If no sub-area target is available, but positions remain vacant
.   Interviews must be conducted in keeping with the hiring conditions in the regional pool, the DRMG will have to use positions from the regional pool
    established by the provincial human rights and youth rights commission.    to meet this need.

                                                                                    When a recruitment is used to meet priority academic needs, the DRMG may,
     WARNING                                                                        on certain conditions and subject to approval from the Physician Resource
                                                                                    Management Committee – General Practice (COGEM), grant a compliance
     Questions should be asked about your interest in patient
                                                                                    notice over and above its regional target for authorized recruitment. The
     management, and not about your interest in a specific clinic.
                                                                                    physician contemplated by the recruitment must:
     The choice of clinic where you perform your patient management                 .    Qualify with respect to inter-regional mobility and have accumulated three
     will be left up to you.                                                             years’ active practice within the meaning of the agreements (i.e., 600
                                                                                         billing days at $518 per day);
Acceptance and withdrawal                                                           .    Have obtained the recommendation of the director of the university family
A candidate who accepts the compliance notice offered by the DRMG is                     medicine department of the medical faculty concerned;
removed from the process.                                                           .    Have the expected practice profile in line with the guidelines recognized
A candidate who refuses the compliance notice offered by the DRMG                        by COGEM;
continues the process.                                                              .    Carry out all his patient registrations within the UFMG concerned.

A candidate who does not respond within 10 days is deemed to have BURSARY RECIPIENTS
refused, and so continues the process.                                     In late May, the MSSS forwards to the eligible DRMGs a list of bursary recipients
                                                                           to be designated for the upcoming year, along with the form to be completed
A candidate who first accepted and then withdrew from his compliance to show their interest in obtaining bursary recipients for their regions.
notice will have to submit a new application if he wants to receive a PREM
compliance notice again. This new application will be processed in the In late June, the DRMGs have to inform the MSSS, by means of the duly
order in which applications are received at the Ministry after October 31, completed form, of the number of bursary recipients being requested, the
once the second round has been completed.                                  areas targeted for them to set up in practice, and the applications identified.

                                                                                    Bursary recipients are notified of the regions’ lists and the geographical
                                                                                    areas accessible to them. They then have until September 30 to express their
                                                                                    preferences as to the designated area.

                                                                              PA G E 9                                                         LE BULLETIN

In early October, the MSSS-FMOQ Advisory Committee will analyse the To seek a compliance notice in an establishment:
applications and make its recommendations to the Minister for the designation       .
                                                                              You must send your appointment application form to the executive director
of bursary recipients.                                                        of the establishment;
No later than October 15 of the current year, the DRMG is informed of the list of   .      You will receive a letter from the executive director confirming the status
bursary recipients whose designation is officially recommended for its region              of the establishment’s PEM;
and for whom a position will have to be set aside in the PREM.                      .      Your application will be reviewed by the Executive Committee of the Council
No later than October 15, bursary recipients are informed of the                           of Physicians, Dentists and Pharmacists (CPDP);
recommendation with respect to their designated region and their obligation         .      The Credentials Review Committee will study your file and report to the
to submit an application for a notice of compliance with the PREM for that                 Executive Committee;
region between October 15 and 31 of the current year. After October 31, a           .      The Executive Committee will make a positive (or negative) recommendation
bursary recipient who has not submitted his compliance notice application for              concerning your application to the establishment’s Board of Directors;
the recommended region is deemed to have withdrawn from his commitment
as a bursary recipient.
                                                                                    .      The Board of Directors will accept (or deny) your application, subject to
                                                                                           approval from the DRMG.
The DRMG is required to grant a PREM compliance notice to each of the bursary
recipients recommended for its region who has submitted his compliance YOUR OBLIGATIONS
notice within the prescribed deadline. The DRMG then informs the MSSS of Deadline for setting up in practice
the location where it will be deploying the services of the bursary recipients To be eligible for obtaining a notice of compliance with a region’s PREM, a
recommended for its region, to ratify the designation officially.              candidate has to undertake to start his practice in that region within 12 months
                                                                               following the receipt of his compliance notice application by the MSSS.
Failing an adverse decision from the MSSS, the applicant’s designation as a
bursary recipient remains valid, even in the event that the start of practice The physician may, however, ask for his start of practice to be deferred for
is deferred. In such a situation, and in order to comply with the requirement a maximum of six additional months. It is up to the DRMG whether or not it
provided for in the Special Agreement to set up in practice within 12 months, agrees to the deferral request for reasons it deems fair and equitable.
the candidate is required to submit an application for a notice of compliance
                                                                               55% - 45% rule
with the following year’s PREM, thus freeing up a position for a non-bursary
                                                                               The doctor must devote at least 55% of his annual billing days to the region
recipient applicant who would set up in practice in the meantime.
                                                                               or area where he holds his PREM compliance notice.
OBTAINING A PEM IN AN ESTABLISHMENT (for family physicians)                         A day is considered as soon as the physician has billed at least $523 in the
Identification of sectors of activity authorized to recruit and priority needs
                                                                                    geographical area. A half day is considered as soon as the physician has
The DRMG, in conjunction with the directors of professional services (DPSs)
                                                                                    billed at least $261.50, but less than $523.
of its region and its area partners, draws up a list, by sub-area, of the sectors
of activity with recruitment needs in its region. This list is analysed by the      The distribution of the doctor’s practice is evaluated on an annual basis with
Physician Resource Management Committee – General Practice (COGEM) so it            regard to days worked, from March 1 to February 28-29 of the following year,
can make its recommendation.                                                        from the date of issue of the PREM compliance notice.

From August 1 onward, the DRMG releases, in particular through the MSSS If the physician begins during the year, the calculation is prorated, from the
website, the list of needs for recruitment in establishments. Added to this list date of issue of the compliance notice.
will be, no later than October, the list of priority needs for delivering front-line
care to patients in doctors’ offices.                                                A doctor may therefore devote up to 45% of his billing days to practising
                                                                                     outside the area where he holds his compliance notice, either in another
These lists must be released before the initial application period, and may be RLS in the same region, in one of Quebec’s 17 other regions, or on part-
updated during the year. A list of all medical clinics in the region should be time locums. WARNING: Currently, only the Quebec City (Capitale-Nationale)
drawn up, highlighting clinics that have shown they are actively recruiting region (except for the Portneuf and Charlevoix sub-areas) is subject to the
family physicians.                                                                   following rule: a doctor who has no compliance notice from that region may
                                                                                     not perform more than 5% of his billing days there.
As the situation evolves, new needs can be submitted to COGEM during the
year for approval.

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SPECIFIC MEDICAL ACTIVITIES (AMPs)                                              3. When all positions in a region’s PREM are filled, the DRMG submits to
Specific medical activities (AMPs) stem from the Act respecting health             physicians eligible for this rule a list comprising at least three sub-areas
services and social services, and physicians with 15 years’ service or less are    among which they can choose to obtain a compliance notice.
required to sign on to them.                                                    As long as the region’s PREM is not full, a doctor returning from a remote region
                                                                                cannot be counted as being surplus to the PREM.
It is the DRMG that manages the AMPs of doctors in its region. It assigns them
according to an established order and in line with its region’s priority needs. OPTING FOR LOCUMS
If several AMPs are available, an agreement may be reached with the DRMG.       The locum mechanism enables a doctor to come to the assistance of sites
                                                                                    designated by the MSSS-FMOQ Parity Committee in four sectors of activity:
                                                                                    Emergency, short-term, Anesthesiology, and Obstetrics.
(in the public system, and not in private practice)
.   Your compensation will be cut back by 30%;                                   There are two situations where a doctor may practise under the locum mechanism:
.  You will have to wait five years before you can apply for a compliance notice I. PREMs EXCLUSIVELY FOR LOCUMS (PREM DÉPANNAGE EXCLUSIF)
   in that region;
                                                                                     He holds a waiver in lieu of a compliance notice for practising exclusively on
.  You will retain new biller status;                                                locums. He then undertakes to practise for at least 95% of his annual billing
.  But, if you obtain a compliance notice in another region and work there           days on locums.
   for three years, you will subsequently be able to apply for a position in the II. PART-TIME LOCUM (DÉPANNAGE À TEMPS PARTIEL)
   region where you practised without a PREM.
                                                                                     He holds a compliance notice from a region and registers as a locum
PHYSICIANS RETURNING FROM REMOTE REGIONS AFTER THREE                                 (médecin dépanneur). In this scenario, the doctor has to maintain his
YEARS’ CONTINUOUS PRACTICE                                                           commitment for the majority of his practice (55% of his billing days) to be
A PREM compliance notice cannot be denied to a doctor who has practised              carried out in the area where he holds his PREM compliance notice.
continuously for at least three years in one of the areas listed in Appendix XII
                                                                                 Information handbook for general practitioners performing locums:
of the FMOQ-MSSS Agreement, even if the PREM is full:
.  The doctor must undertake to practise principally in a sub-area;
.  Practice carried out under the locum mechanism is not considered in the
                                                                                 Locum mechanism registration form:
   calculation of principal practice in a remote region;
.   Principal practice is deemed to be continuous if it is carried out without      FINANCIAL INCENTIVES ON ENTERING PRACTICE/
    interruption of more than 24 months in one or more regions contemplated in      ESTABLISHMENT AND MAINTENANCE (RETENTION)
    Appendix XII of the Agreement..                                                 BONUSES AND PREMIUMS IN FAMILY MEDICINE
                                                                                   In remote or designated regions
The granting of compliance notices to physicians returning from remote Family physicians setting up in practice in remote or designated regions have
regions evolves in line with the implementation period and whether the PREM their pay increased. They receive availability and professional development
is full or not.                                                                    premiums. In remote regions, allowances are provided for remote area bonuses,
1. A doctor returning from a remote region after three years’ continuous home leave expenses (with or without dependants), and food transportation
    practice who applies during the initial application period will be given expenses. Establishment and maintenance premiums are also awarded by the
    priority by the DRMG for obtaining a position in the sub-area of his choice in region. Premiums vary depending on the remote sector in question.
    which inter-regional mobility positions (places MIR) are posted.
                                                                                   For more information, contact the Regional department of general medicine of
    If the number of doctors returning from a remote region exceeds the the region concerned.
    number of positions available in a given sub-area, the DRMG will have to
    make a selection. Unselected physicians returning from a region will be
    offered a sub-area in which positions are available, on a priority basis.
2. Following the initial application period, and as long as a region’s PREM is
   not full, a physician returning from a remote region must obtain a notice of
   compliance with the PREM of a sub-area not filled via inter-regional mobility.

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OBTAINING A PEM IN AN ESTABLISHMENT                                                     THE PROCESS
Holding a position in an establishment’s physician resource plan (PEM) is a             .      First, make yourself known in the establishment where you are seeking
prerequisite for delivering care there, in all medical, surgical, and laboratory               a position. If you have the opportunity ahead of time, include a rotation
specialties. A doctor may obtain privileges in more than one establishment, but                in the facility.
will be counted only in the PEM of the establishment where he performs most             .      Get in touch with the head of department and the deputy director or
(75%) of his practice. So it is possible to obtain associate member privileges in              director of professional services (DPS);
another establishment’s PEM for a maximum of 25% of his practice, with the
agreement of the directors of professional services of both establishments.
                                                                                        .      When you have made your choice, send the appointment notice
                                                                                               application form to the Director of Professional Services of the
This year, the Ministry has a five-year plan that will cover 2021 to 2025, inclusive.          establishment concerned (this form is available from the DPS’s office);
Owing to the pandemic, PEM positions will be announced on December 1, 2020,             .      The application will then be evaluated by the Credentials Review
in time for the FMRQ’s virtual Career Day. PEMs are posted according to the                    Committee, which makes a positive or negative recommendation
year in which they come into effect, by specialty and establishment. They are                  concerning your application to the Council of Physicians, Dentists and
uploaded to the Ministry website and updated monthly, under Plans régionaux                    Pharmacists (CPDP), which follows the same procedure with respect to
d’effectifs médicaux/pour la médecine spécialisée/postes disponibles, at:                      the establishment’s Board of Directors;
                                                                                        .      If your application is accepted, the establishment’s Board of Directors
                                                                                               submits an application for this position to the Ministry of Health and
Positions will still be posted by establishment in the MSSS table this year, rather            Social Services to obtain confirmation that this appointment is in
than by facility (hospital), as the FMRQ and FMSQ had requested, because of                    compliance with the establishment’s PEM;
delays caused by the pandemic. Posting by facility (hospital) should eventually         .      If the MSSS agrees, it issues a notice of compliance with the
be re-established. Also, note that it is possible for the establishment granting               establishment’s physician resource plan (PEM) and forwards it to the
you a position to impose on you the obligation of practising in two of its                     establishment;
facilities in the same PEM, on the basis of needs identified in the different
geographical areas covered by the establishment. If an establishment
                                                                                        .      The establishment (CISSS, CIUSSS, Institute, etc.) must, as early
considers that it has needs exceeding the number of positions allocated to                     as possible or within no more than 90 days following receipt of an
it in the plan, it is the establishment, that will be able to apply for a waiver to            appointment notice application, send the applicant a written decision
add a position to its PEM once the five-year plan has been tabled. The rules                   setting out his privileges;
concerning waiver applications are available on the FMRQ site, in the Specialty         .      The grounds for any refusal must also be given in writing;
Physician Resource Handbook.                                                            .      The physician must confirm his decision and acceptance of his
                                                                                               conditions of appointment in writing within 60 days following the
                                                                                               notification date in order for his privileges to be validated.

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For positions in university settings, candidates must perform a fellowship of           acronym, PRF, for poste réseau facultatif), provided a service agreement has
3 to 12 months’ duration. A second year is possible, but requires justification from    been reached between two establishments. Some establishments have a
the establishment to the Ministry. Note that the medical faculties with which           mandatory network position PEM (PRO, for poste réseau obligatoire). These
the establishments are linked often require at least a 1-year fellowship to award       positions are generated when a service corridor is created permanently between
those positions, owing to the teaching responsibility associated with them. Some        two establishments (e.g., MUHC and Nunavik).
non-university establishments may also require a fellowship in order to cater to
a specific need that will meet the requirements of the population in their territory.
Training of 6 months or less does not require MSSS approval, and is negotiated with            IMPORTANT
the department concerned and the Office of the faculty Associate Dean. For further
                                                                                               These positions cannot be based on a single individual, and have
information on fellowships, consult the section on that topic.
                                                                                               to demonstrate a commitment from the establishments’ entire
                                                                                               medical team and their administrations to fulfil the associated
    TO START YOUR PRACTICE, YOU MUST AT LEAST:                                                 undertakings (service corridors).
    .   Have your specialist certification
    .   Have confirmation of your participation in an ALDO-Quebec                       RESEARCH SCIENTIST POSITIONS
        information session                                                             There are certain situations where a doctor can be hired outside the PREM. It is,
    .   Have your permit to practise                                                    however, necessary for the candidate to obtain a PEM from the establishment
                                                                                        where he wishes to practise and conduct his research. When the person
    .   Have your proof of malpractice insurance coverage                               concerned has obtained research grants, his position can be recognized by
    .   Be registered on the membership roll of the Collège des médecins                the Ministry as outside the PEM, for the purpose of hiring other candidates in
        du Québec, and have paid your annual membership fee                             the department. Research scientists must sign on to the Memorandum of
    .   Registration with the Quebec Health Insurance Board (RAMQ) for
                                                                                        understanding concerning the establishment of special pay terms and conditions
                                                                                        for research scientists (Protocole d’accord concernant la mise en place de
        billing purposes may then be carried out online
                                                                                        modalités de rémunération particulière pour les chercheurs-boursiers).

RECRUITMENT IN ANTICIPATION OF A DEPARTURE DURING THE YEAR                              A research scientist who changes careers may remain within his facility even
(retirement or other)                                                                   if he withdraws from the above Memorandum of Understanding, and will then
Even when an establishment’s PEM is full, a compliance notice may be issued for         be deemed to be surplus to the PEM. This status will be corrected upon the
a recruitment in anticipation of the departure of a physician who has provided          departure of a colleague in that specialty. The same rule applies to those with
written notice of his intention to cease practising in the establishment and            an exclusive practice in palliative care and intra-operative assistance. For
whose resignation will take effect within 1 year. The recruited physician may           further details, please consult the management rules for physician resource
not, however, take up his duties until six months prior to the departure date of        plans in specialties (Règles de gestion des plans d’effectifs médicaux en
the incumbent doctor.                                                                   spécialité) on the Ministry site, which you can access by doing a web search
                                                                                        for PREM en spécialité.
The purpose of a locum (temporary replacement) is to enable a doctor to take            RETURNING FROM THE REGIONS (three-year rule)
on the clinical and administrative duties of another physician who holds a PEM,    After three years’ continuous practice in a remote or isolated region, a
who has to take time away from his or her position (illness, sabbatical leave,     physician cannot be refused entry to another region on the grounds that
maternity, etc.). This position does not constitute a permanent position for       the region’s PREM or establishments’ PEM are full. Nevertheless, to obtain
the replacing doctor, who loses his privileges once the locum is over, and the     a position in a university hospital, he will have to meet the fellowship
physician concerned has to find himself another position. It is also possible in   requirements and receive the agreement of the region’s medical faculty. A
an emergency to obtain authorization to practise in an establishment without       physician taking advantage of this rule will be able to do so once only, within
a position in the PEM. But this measure is valid for no more than three months,    no more than 12 months from the date on which he left the establishment in
and cannot be renewed, barring exceptional circumstances determined by the         the regions. To obtain a position in a new region, he will first have to fill the
establishment and accepted by the MSSS.                                            positions available in the PEMs of the new region where he will be setting up
                                                                                   in practice. If all the PEMs in his discipline are full, he will be sent a list of
NETWORK POSITIONS (PROs/PRFs)                                                      five establishments determined according to Ministry priorities, from among
Some agreements allowing for the addition of positions are associated with a which he may choose. In such cases, the MSSS may authorize the PEM of the
network position. These positions may be used to recruit a specialist physician establishment concerned to be temporarily exceeded. To consult the list of
in the establishment holding the position, or to recruit a specialist physician in remote or designated regions, please contact the FMRQ.
another establishment, i.e., an optional network position (known by its French

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RECRUITMENT VIA WAIVER                                                                 PRACTICE EXCLUSIVELY IN AN OFFICE
When an establishment’s needs warrant, the Director of Professional                    Practice in an office in specialties other than family medicine is not governed
Services (DPS) may apply for its physician resource plan (PEM) to be                   by physician resource plans (PEMs). Doctors wishing to practise exclusively in
exceeded temporarily via waiver. A PEM waiver is an exceptional measure,               an office have no steps to take to obtain a PEM, but in such cases they will be
and requests to that effect have to meet strict criteria: candidate’s                  unable to obtain hospital privileges, however limited. This does not prevent
specific expertise; volume of activity; waiting lists; development (addition           them, though, from billing the Quebec Health Insurance Board (RAMQ). We are
of equipment); stabilization of teams (age of practising physicians);                  referring here to working in a private office, not to withdrawing from RAMQ.
establishment of a service agreement; and, in very rare cases,                         But this option applies to a limited number of specialties, such as dermatology,
humanitarian grounds. The waiver confers a permanent position on the                   psychiatry, and rheumatology, for instance.
candidate. The PEM will then have been exceeded, and the next departure
in the specialty concerned will not be replaced. Waiver applications                   FURTHER TRAINING/FELLOWSHIPS IN QUEBEC
are reviewed by the members of the Physician resource management
committee for specialties (COGEMS), which includes the Fédération des                         NEW
médecins spécialistes du Québec (FMSQ) and the Ministry of Health and                         Obligation to practise for three years on your PEM
Social Services (MSSS). The Fédération des médecins résidents du Québec
(FMRQ) also sits on the COGEMS as an observer.                                                From July 1, 2021, performing a fellowship in Quebec will carry with
                                                                                              it a rule whereby the candidate will have to practise for three years
                                                                                              in the setting that granted him a position (PEM). Indeed, a clause to
    WATCH OUT FOR VIRTUAL PREMs                                                               that effect in the fellowship application form (p. 3) must be signed
                                                                                              by the applicant.
    If you see virtual positions, i.e., positions available in the physician
    resource plan on the Ministry site but that the establishment tells you
    have already been filled or that it has no intention of filling, we advise         To obtain a position in a university setting
    you to take the following steps:                                                   To obtain a position in a university setting, 3 to 12 months’ further training/
                                                                                       fellowship is required. The duration of this training is usually 1 year, depending on
    1) Send in a formal appointment application anyway;
                                                                                       the requirements of the faculty concerned. The purpose of fellowships is to acquire
    2) Wait for the establishment’s response;                                          ultraspecialized clinical expertise surpassing the usual requirements of training
    3) If the establishment does not intend to recruit for the position                in the specialty or subspecialty, along with the development of competencies in
       allocated by the MSSS, get in touch with the FMRQ so we can                     teaching, research, and evaluation of technology and intervention methods. Any
       investigate the situation and lobby the Ministry to have the                    proposed fellowship to be carried out in Quebec required for a position in a university
       position moved elsewhere.                                                       setting must be supported by the recruiting establishment (Director of Professional
                                                                                       Services [DPS]) and the medical faculty concerned.

    WATCH OUT FOR PROFESSIONAL SUICIDE PREMs                                                  IMPORTANT
    Some positions are located in regions where practice in a given                           .   Your fellowship must be carried out in a facility of a university
    specialty is limited, owing to the very low quantity and limited                              network other than the network where you performed your
    diversity of cases, or because the doctor will be practising on his                           residency.
    own. These positions are seen as professional suicide, because they                       .   In the case of a fellowship for recruitment in an establishment with
    could mean the physician is unable to return to practise in another
                                                                                                  university designation, the faculty submitting your application is the
    setting owing to loss of expertise, which is known to occur rather
                                                                                                  one where you will be recruited once the fellowship is completed.
    quickly in medicine, depending on the conditions. In such cases,
    the FMRQ recommends that service corridors (network positions)
                                                                                              .   You may also perform a fellowship in the university network that
    be established instead, to enable candidates for these positions                              offered you a position, although usually the practice sites want you
    to maintain their knowledge and technical skills, by sharing                                  to bring different expertise to meet the needs in the team
    responsibility for delivering care with the other doctors in the partner
    hospital department.

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    Fellowships in specialties paid by RAMQ . . . in brief                                 Time frame for applications for fellowship positions
                                                                                           for July 2021 (2021-2022)
    .   Complete the fellowship application form;
    .   Before having it signed, email it to the Office of the Associate
                                                                                           .   Deadline for submitting applications to faculties
        Dean for Postgraduate Medical Education of the faculty concerned                       November 30, 2020 (12 noon)
        for validation and confirmation that everything is complete and                    .   Review of all applications by associate deans for postgraduate
        in order;                                                                              education and transmittal to MSSS
    .   Once it is validated, print out the form and obtain the                                December 31, 2020
        necessary signatures;                                                              .   Review of files by MSSS and emailing of results to candidates
    .   In the case of an application for university or non-university                         by the Ministry
        recruitment, the MSSS requires that your PEM be confirmed,                             no later than March 1, 2021
        and that your application be accompanied by the letter of
        confirmation from the DPS for your recruitment and from the                 EXTENSIONS OF TRAINING
        Board of Directors of the establishment recruiting you. Failing             Any application for an extension of training other than a fellowship must be
        this, your application could be denied. This year, however, the             sent to the Office of the Associate Dean for Postgraduate Medical Education
        MSSS has assured us that it will be more flexible in that regard,           of the medical faculty where you intend to perform your extension of training
        since the 2021-2025 five-year plan will be released only after the          and, as applicable, the home medical faculty of the hospital establishment
        fellowship application deadline;                                            that will be recruiting you when you have completed that extended training.
    .   In the case of a PEM linked to the retirement of a physician,               It is not necessary to hold a PEM to be authorized to perform this training,
        a letter from that doctor confirming the effective date of his              but a position must be available for you in line with the quotas imposed by
        retirement is required;                                                     the MSSS, without exceeding the maximum number of positions authorized in
                                                                                    each program, category and subcategory, as determined by the government
    .   When you have all the signatures, email the form, in a single PDF,          decree to that effect.
        with the letter and other required documents;
    .   Incomplete applications will not be considered;                             Exceptions
                                                                                    Extensions of training targeting advanced competency in Emergency Medicine and
    .   Confirmation of your fellowship will be emailed to you by the MSSS;         Adult Critical Care Medicine, and specialized training in Pediatrics whose matching
    .   Upon receipt of this positive response, you will be invited by the          is handled by CaRMS are not subject to this procedure.
        Office of the Associate Dean for Postgraduate Medical Education to
                                                                                    To access the instructions and application form for fellowships and extension
        complete your application for admission online and, as applicable,
                                                                                    of training, you may consult the following sites:
        to forward the documents required for your admission file.
                                                                                    Fédération des médecins résidents du Québec
To obtain a position in a non-university setting
                                                                                    University of Montreal
Fellowships for obtaining a position in a non-university setting may be of less
than 12 months’ duration. They must be supported by a medical faculty, and
the candidate must hold a position in a PEM to be able to perform such training
in Quebec. In the case of a fellowship for recruitment in a non-university          McGill University
setting, the faculty submitting the application is the one where the candidate      https://www.mcgill.ca/pgme/admissions/formation-complementaire
will be performing his training.                                              Université Laval
                                                                              Email the Adviser, Postgraduate Medical Education at
N.B. Training of less than six months’ duration does not require confirmation gestionempd@fmed.ulaval.ca
of a PEM, and is negotiated directly with the faculty authorities (program
directors, associate deans).                                                  University of Sherbrooke
                                                                              Email Jean-François Duval, in the Office of the Secretary of the Associate
                                                                              Dean for Postgraduate Medical Education, at

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