LE BULLETIN - GUIDE TO PRACTICE 2020-2021 AVAILABLE POSITIONS - FMRQ
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LE BULLETIN VOL. 43 N O. 1 FA L L 2 0 2 0 GUIDE TO PRACTICE 2020-2021 AVAILABLE POSITIONS PAGES 38 TO 55
TABLE --------------------------------------------------------- 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 --------------------------------------------------------------- - BOARD OF DIRECTORS 2020-2021: 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
PRESIDENT’S MESSAGE FINDING A POSITION IN QUEBEC IN 2020: COMPLICATED, BUT POSSIBLE! 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. President LE BULLETIN PA G E 4
FAMILY 1. MEDICINE 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
FAMILY MEDICINE 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
FAMILY MEDICINE 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 Region 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. SCOPE OF A PREM COMPLIANCE NOTICE 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
FAMILY MEDICINE You accept it Completed YES! First choice You refuse it Next round NO, You accept it Completed but offers 2nd RLS INTERVIEWS 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
FAMILY MEDICINE . 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
FAMILY MEDICINE 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. LE BULLETIN PA G E 1 0
FAMILY MEDICINE 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: IF YOU PRACTISE WITHOUT A PREM 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: h38.pub.msss.rtss.qc.ca/Fichiers/H38_Depannage_20181011132054.pdf . 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: h38.pub.msss.rtss.qc.ca/Fichiers/H38_Depannage_20190830142914.pdf 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. PA G E 1 1 LE BULLETIN
OTHER 2. SPECIALTIES 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; https://www.msss.gouv.qc.ca/professionnels/medecine-au-quebec/plans- d-effectifs-medicaux-pem-en-specialite/ . 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. LE BULLETIN PA G E 1 2
OTHER SPECIALTIES 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. LOCUMS 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 PA G E 1 3 LE BULLETIN
OTHER SPECIALTIES 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. LE BULLETIN PA G E 1 4
OTHER SPECIALTIES 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 www.fmrq.qc.ca 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 https://medpostdoc.umontreal.ca/etudiants/reglement-et-politiques/ than 12 months’ duration. They must be supported by a medical faculty, and poursuites-de-formation-et-demandes-de-formation-complementaires/ 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 jean-francois.duval@usherbrooke.ca PA G E 1 5 LE BULLETIN
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