1. Information for Canadian Residents - Why do Locums?
The majority of provinces in Canada now offer restricted or defined licensure to senior Canadian residents to allow for moonlighting or short term locums. This is an excellent opportunity for many reasons:
Firstly, this is a fantastic way to transition into independent practice. You have the chance to work independently for a week or two, and without direct supervision you will quickly discover the areas of medicine in which you are not fully comfortable. Then, you can work to improve these areas when you return to your residency program.
Secondly, you have the chance to explore regions and hospitals you may be interested to work in after graduation. By locuming, you have a chance to take the community, the hospital, and the department for a "test drive" to see if they will be a good fit for you.
Thirdly, one typically learns and retains information better by using it. In the future, you may find yourself answering cases asked by RCPSC oral examiners from direct experience.
While not all provinces allow residents to obtain a license, if you are in such a situation there are other provinces that will accept you with open arms.
2. General Overview to Locums/Moonlighting as a Resident
2.1. Are You Ready?
The first question to ask yourself before looking into doing locums as a resident is this: “Are you comfortable with where your skills will be by the time you do the locum?” Are you a RCPSC resident who will be working in your field or will you be doing ER or ICU coverage? Are you a family medicine resident heading out to a rural location where you will be doing everything from delivering babies to administering streptokinase when you are more comfortable with a simple "walk in clinic" style of practice?
You will be the person with primary responsibility. You will have no staff person standing by to help you out if you get into trouble. During daytime hours, you are generally able to easily find backup, but during evenings and weekends your support will be much less accessible. Just because you will likely be at smaller centers for your locum does not mean the situations you will encounter are any less complicated.
That said, Canadian residents are very well trained. By the time a resident is eligible to perform locums, one should have gained the skills and judgment necessary to perform the core aspects of medicine safely and competently. With the exception of certain programs, such as Radiology or Dermatology, one should have the necessary critical care certifications. ACLS is a bare minimum with ATLS an excellent addition to those working in the ER, ICU, or OR. If working at all with children, PALS and NRP would be a good idea as well.
2.2. Timing Your Locums
The only real time constraint to doing a locum is that you should have completed all of your requirements for obtaining your license. For example, to perform anesthesia in Nova Scotia or New Brunswick or Newfoundland, you would need to be at least a 4th year resident and have completed 4 months of pediatric anesthesia and 2 months of obstetrical anesthesia.
2.3. Finding Time for Your Locums
As a resident, you will generally be doing locums during your vacation time. There may be opportunities for overnight coverage or weekend moonlighting positions, but these are often less common.
In general, unless the location where you want to do your locum is desperate, they will generally desire you to work for a minimum of 2 weeks to maximize the value. If doing 2 weeks, you may have to stagger 1 week each over 2 educational periods if doing 1 month rotations, or take the time off a rotation that is longer than 1 month in order to stay under the “no more than 25% off per rotation” that exists at most programs.
It is generally not recommended to pursue weekend locums on a regular basis while on academic rotations. One may be too tired come Monday to fully focus on the academic responsibilities, and weekends during academic rotations are precious for both studying as well as simply resting. Also, by keeping locums to vacation leave, the program director and other department members will be reassured that this will not impact academics. It would be difficult for anyone to criticise how personal time is being used or state that a week performing a locum is more detrimental than a week spent in Cuba.
2.4. Arranging Your Locum
You should usually give yourself at least 3 to 4 months to get everything in place if you don’t already have a license to practice in the province you are interested in. You will have to find a hospital willing to take you, obtain your CMPA insurance, a provincial medical license, a provincial billing number, and hospital privileges. All of this requires a reasonable amount of paperwork, so make sure to give yourself enough time.
2.5. Protecting Yourself
Get all details in writing. Discussing the contract details on the phone and then summarizing the points in a follow-up e-mail is a good idea. An example contract can be found at http://www.medi-mouse.com/business/contract.html.
You will also need malpractice insurance. This is purchased from The Canadian Medical Protective Association. You will need the "Code 14" category which represents "Trainees WITH moonlighting". The cost for 2010 is between $109-$149.33 per month of coverage. The first time you register you must sign up for 2 months but subsequently you may pay for one month (30 calendar days at a time).
Taking one's professional and academic responsibilities very seriously would include not working on post call days (that is, not finishing academic call and then going to work at another hospital) and not scheduling locums where one has academic responsibilities on a post call day (for example, not locum where one does a night call and then have a full regular academic day the following day). It is important to be in optimal condition both for one's locums and for one's academic responsibilities, and one's academic responsibilities should always come first.
3. Provinces that Allow Residents to Locum
Be aware that the below information is not guaranteed for accuracy and is provided for informational purposes only. Use it as a guideline but do your own research and contact the respective licensing bodies yourself to ensure your eligibility. If you find any information incorrect, please contact us with the corrections. We have spoken with the Ministry of Health and the respective Colleges of Physicians and Surgeons in those provinces that do not allow residents to work (BC, AB, ON, PEI). If you happen to be in one of those provinces and have worked in other provinces, consider contacting your respective college, medical association, resident association, and health minister to notify them of the benefts you found with regards to locuming and encourage them to offer this privilege in their province as well.
BC – Depends
Resident moonlighting options exist for residents in BC programs (ex: ICU, etc. coverage).
If you have a full rotating internship you may be eligible as an R3 for a general practice temporary license. Specialty work is another situation. For example, to perform anesthesia at a general practice anesthetist level you still need a full rotating internship plus 1 year of anesthesia training. (In BC, Anesthesia residents could obtain this by the start of R3.) Requirements for other specialties are unclear. This is very much a case by case basis and is not as well established as in other provinces.
https://www.cpsbc.ca/files/u1/Legislation-MPA.pdf
"Special register
(1) The council must cause the registrar to keep a special register, in which must be entered the name,
address, qualifications and conditions of special registration of each person entitled to be registered
under this section.
(2) A person may be registered in the special register if
(a) the person does not fulfil every requirement for registration in the register, but the executive
committee believes the person is qualified by training and experience to practise in a particular
field of medicine and the executive committee has by resolution directed that the person be
registered in the special register, or
(b) the person fulfils every requirement for registration in the register, but the registrar believes
the person should confine the person's practice to a particular field of medicine because of the
person's training and experience.
(3) It is a condition of registration under this section that the person registered confine the person's
practice of medicine to the particular field of medicine for which the person's registration is granted.
(4) The executive committee may attach further conditions to a registration under this section.
(5) A person registered in the special register must be considered to be registered under the Act as though
the person's name were entered in the register, and is subject to the obligations and entitled to the
rights of a member of the college, subject only to the conditions imposed on the person's registration
under this section.
(6) The registrar must issue to each person whose name is entered in the special register a limited
certificate, which must state the conditions of the person's registration."
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Alberta – No (mostly)
Moonlighting opportunities in the ICU, etc., do exist for Albertan residents but there are no provisions for allowing residents to practice independently (ex: perform GP-anesthesia) or for residents from other provinces to do the same.
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Saskatchewan – Yes
Residents are eligible for locum tenens permits.
http://www.quadrant.net/cpss/pdf/CPSS_Bylaws.pdf
(n) The Council may issue a locum tenens permit to a physician who:
(i) is on the Education Register as a resident or by reason of other postgraduate training being undertaken by the physician; and,
(ii) has filed a practice plan with the Associate Dean of Postgraduate Medical Education and has received the approval of the Program Director in the physician’s program and the Associate Dean of Postgraduate Medical Education for that practice plan; and
(iii) provides proof, to the satisfaction of Council that he/she is the person named in the
documentation and is of good character.
A permit issued under this section may be granted subject to restrictions or limitation.
Manitoba – Yes
R4’s and R5’s should generally be eligible for conditional registration.
http://www.cpsm.mb.ca/2_1_2_2_conditional.php
“two years of postgraduate clinical training acceptable to the College which meets the requirements as outlined in Appendix A and a postgraduate training program acceptable to the College which would entitle the physician to obtain a licence limited to the specialty training field”
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Ontario – Generally No
No real work permits, but certain schools will let you take on extra calls for extra money. You have to have completed 1 year of residency and only do the call in a rotation you have already completed and the hours you work must NOT contravene the collective agreement. This program is to expire Dec 31, 2010.
http://www.cpso.on.ca/policies/policies/default.aspx?id=1648&terms=residents
“To apply for a restricted certificate of registration to permit him or her to take paid call, the resident must first ensure that the Dean of his or her medical school (or the Dean’s designate) has approved the institution’s participation in the two-year pilot project. Only residents at participating medical schools will be eligible to apply for this opportunity.”
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Quebec - Yes
As of April 2008, R5’s may obtain a restricted license in their specialty. R2’s in Family medicine after 18 months are eligible as well.
http://www.cmq.org/ObtenirPermis/DiplomesQuebec/RestrictifResident.aspx
“Hold a medical degree from a Canadian medical school or university, or obtain recognition of equivalence of their doctor of medicine diploma (M.D.) from the Collège des médecins du Québec (CMQ);
# have completed:
* 18 months of postdoctoral training in family medicine in one of the programs accredited by the CMQ, be registered in a family medicine postdoctoral training program accredited by the CMQ and hold a valid training card, level R2 or more;
or
* 4 years of postdoctoral training in a specialty program accredited by the CMQ, be registered in a postdoctoral training program in one of the specialties listed in section II of Annex I of the Regulation respecting the terms and conditions for the issuance of the permit and specialist’s certificates by the Collège des médecins du Québec and accredited by the CMQ and hold a valid training card, level R5 or more;
or
* a postdoctoral training program in accordance with CMQ regulations in a program accredited by the Board and be registered at the RCPSC exam for the fall session;”
Further information can be found on the FMRQ (residents) website:
http://www.fmrq.qc.ca/formation-medicale/documentsATelecharger_telecharger.cfm?noDocument=228
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New Brunswick - Yes
Eligibility varies depending upon specialties. Some may be eligible as R3’s (ex: Radiology), others are required to be R4’s or R5s.
http://www.cpsnb.org/english/Regulations/regulation-2.html
“Not certified in any of the above manners, but has successfully completed an acceptable internship of not less than two years which, in the opinion of the College, will have adequately prepared the applicant for independent practice in the setting and circumstances intended. This requirement may be abridged at the discretion of the College.”
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Nova Scotia – Yes
R4’s and R5’s in RCPSC programs may obtain licenses in their specialty or if they have a rotating internship may get a Family Practice license as an R3. R2’s in Family Practice may obtain a license. These licenses generally require you to have a supervisor available within 20 minutes anytime you are practicing.
http://www.cpsns.ns.ca/Registration/defined-license-postgrad-trainees.htm
“With the exception of the training requirements in clause 2, applicants must be in the final two years of specialty training in a program accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) or in the final year of a Family Medicine program accredited by the College of Family Physicians of Canada (CFPC).”
“Applicants, in specialty training in a program accredited by the RCPSC, who have completed at least 8 weeks of approved post-graduate training in the United States or Canada in each of surgery, internal medicine, paediatrics, obstetrics and gynaecology, and family medicine or emergency medicine may be eligible for a defined license to provide locum tenens in family practice or hospital emergency departments providing that all other requirements in this policy are met.”
PEI – No
There are no provisions for allowing residents to practice.
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Newfoundland - Yes
If you have a full rotating internship during your RCPSC program, as an R3 you can do locums in general practice and in emergency departments.
As an R4 (even without a rotating internship) you may be able to obtain a provisional license to practice your specialty. The ability to work as an R4 varies by specialty (ex: easy for Radiology, Dermatology, harder/impossible for surgical specialties, and not available to others such as Neurosurgery). Most R5’s may obtain a “Provisional License for Locum Specialty Practice”.
http://www.cpsnl.ca/default.asp?com=Policies&m=340&y=&id=36
"Categories of Licensure:
Full License - Residents who have successfully met the College of Physicians and Surgeons of Newfoundland & Labrador’s (the “College”) postgraduate training requirements and who have passed Part I and Part II of the Medical Council of Canada Qualifying Examination may be eligible for full licensure. This category of licensure allows a resident to enter general practice and requires a minimum of 150 hours of general practice per year for annual renewal.
Provisional License - Residents who have within the preceeding two years completed a PGY 1 program in a CACMS/LCME accredited program which includes an eight week rotation in each of medicine and surgery, and an eight week rotation in any two of pediatrics, psychiatry and obstetrics/gynecology may be eligible for a provisional license. The surgical rotation must include 4 weeks in General Surgery. The remaining four weeks must also be in a hospital based service – e.g. urology, neurosurgery, orthopaedic surgery or cardiovascular surgery. This category of licensure allows a resident to perform locums in general practice and in emergency departments at the request of a sponsor and requires a minimum of 150 hours of general practice per year for annual renewal. Granting of a license is contingent upon a letter from the program director agreeing to the resident performing locum practice.
Residents who have completed at least two years of postgraduate training in a specialty training program may be eligible for a provisional license to enter a restricted practice, within the scope of the specialty postgraduate training, at the request of their program director and provided the letter of request states that the resident has the knowledge, skills, judgement and attitudes to independently perform the restricted practice and in the opinion of the College, the resident’s postgraduate training and recent experience would qualify the resident for entry to the restricted practice.
Note: Residents in family medicine during their second year of family medicine training are granted a modified provisional license which enables them to write prescriptions and to practice within the family medicine program. This modified provisional license does not permit second year family medicine residents to perform locums.
Provisional License for Locum Specialty Practice - Residents who are in the final year of a specialty training program may be eligible to provide specialty locum services in the specialty at the request of a sponsor. Granting of a provisional license is contingent upon a letter of approval from the resident’s program director which states the resident has the knowledge, skills, judgement and attitudes to independently practice the specialty on a locum basis.
Full license for Locum Specialty Practice – Residents who hold a full license who are in the final year of a specialty program may be eligible to provide specialty locum services in the specialty. The Board requires a letter of approval from the resident’s program director which states the resident has the knowledge, skills, judgement and attitudes to independently practice the specialty on a locum basis.
The College requires verification of appropriate CMPA moonlighting coverage before approving all of the above licenses for residents to enter locum practice."
Yukon – Qualified Yes
There is no formal process for licensing residents. It is possible to do a “back door” approach via the “special licensing” program. This is mostly an IMG program and requires a statement of defined need and an offer of employment. In general, there are no openings for specialists. However, if you are able to find a specialist who needs locum relief and the medical council determines that your training would be sufficient, you may be able to do this.
http://www.yukonmedicalcouncil.ca/special_licensing.html
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Northwest Territories – Qualified Yes
From speaking with the responsible individuals in the NWT, if you already have a resident defined or restricted license in another province that allows you independent practice (ie. NOT Nova Scotia, which requires a supervisor), they will give you a license. If you do not have a license in another province you can not get one in the NWT.
“Specialists must provide proof of being licensed or eligible to be licensed in their specialty in a province.”
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Nunavut Physician Services - Potential
There is a possibility of residents obtaining restricted permits if you have one in another jurisdiction (similar to NWT), but we have not yet received confirmation on this.
http://www.nunavut-physicians.gov.nu.ca/lrequirements.shtml
“A general practitioner must provide proof of successful completion of one year of a rotation internship or its equivalent consisting of training in medicine, surgery, pediatrics, obstetrics and gynecology.”
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4. Guides to Successful Transition to Practice
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5. Search for Canadian Vacancies
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