FM practice in Quebec vs Ontario

[MD_scientist]

Hello folks,

I am starting my residency in FM in July in Québec. I am interested in having a diverse practice varying between outpatient clinics, hospital medicine, ER shifts ...etc. (I heard even that some family physicians practicing in rural Quebec are doing sub-specialization in oncology, OB-GYN, drug dependance ...etc which will be interesting for me too)

I have a couple of questions regarding the flexibility of FM practice in Quebec vs in Ontario :

1- Which province give family doctors more flexibility in their practice regardless of the remuneration and the geographic location ( rural Quebec vs rural Ontario / urbain Quebec vs urban Ontario ) ?

2- If both provinces are similar in terms of flexibility of practice, which province is better in terms of remuneration for family doctors ? 

Some facts:

- I have family and friends in both provinces, so no absolute ties in any of the two.

- I care more about having a diverse practice more than living in urban vs rural location

- I am able to practice in both English and French

- Trying to avoid doing an R3 but will be willing to do it if necessary

 

Looking forward to hearing from you. Feel free to ask for more details if it will help you better answer my questions

Thanks,
 

[destiny deoxys]

It’s probably very similar in terms of salary and workload tbh, especially if you compare to others specialities, also curious to know

[MD_scientist]

Anyone ?

I am hearing a lot of negative things about the "PREM" and "AMP" system in Quebec. I would like to know if other provinces (particularly Ontario) has a similar system ?

 

 

[Ms_Sunshine]

My impression (I work in Ontario), is that Ontario is significantly more flexible. If you are looking to do rural, there are lots of opportunities, and there is flexibility to do extra things (i.e. ER, hospitalist, surgical assist, Ob, etc). These additional things are also completely optional. I have several friends from Quebec that work in Ontario because they find the system better. I don't know how the pay compares though. 

[MD_scientist]

Interesting! thank you for your reply.

I would assume that the pay is better in Ontario than in Quebec as well (I might be wrong), although the cost of living might be higher.

I am starting to worry about the situation in Québec after hearing negative reports from junior family doctors here regarding the regulations imposed by the government.

 

 

[F508]

If you're aiming to work rural, PREM is not as difficult vs getting one in the city. I've heard FM pays better in Quebec than in Ontario (at least in first years of practice, there are incentives to get you to enroll more patients), but I think there is really too much variance to make a sweeping generalization (depends on payment model and how rural you want to go). Anywhere rural will pay better. In Quebec, rural areas will be paid anywhere from 105-140% base rates. Even in the city, FM doctors can work in obs and hospitalization. However, getting PREM and hospital privileges (PEM) will be more complicated in Quebec than in rest of Canada

[MD_scientist]

Thank you for your reply, that was very helpful.

2 hours ago, F508 said:

However, getting PREM and hospital privileges (PEM) will be more complicated in Quebec than in rest of Canada

Could you expand on this ? I kinda have an idea on how PREMs work in Québec, but I have no idea how does the system work for freshly graduating FM residents in Ontario let's say for someone who wants to build a practice in a rural area where he/she does office, hospitalization ± ER shifts or OBS 

[MDinCanada]

following

[F508]

I do not speak from personal experience, but people who work outside of Quebec say that work is very easy to come by.. you can arrange things a few weeks in advance. Anywhere that's looking for a MD will be able to give you the position. The reason it's complicated in Quebec is because it's government regulated. PREM allocates a certain amount of spots for new graduates to work in different geographical areas. PEM = hospital privileges (hospitalization, ER, obs). Even if certain hospitals in Quebec need doctors, if the hospital wasn't allocated a PEM or if you don't have a PREM, you can't work there.

[MDinCanada]

1 hour ago, F508 said:

I do not speak from personal experience, but people who work outside of Quebec say that work is very easy to come by.. you can arrange things a few weeks in advance. Anywhere that's looking for a MD will be able to give you the position. The reason it's complicated in Quebec is because it's government regulated. PREM allocates a certain amount of spots for new graduates to work in different geographical areas. PEM = hospital privileges (hospitalization, ER, obs). Even if certain hospitals in Quebec need doctors, if the hospital wasn't allocated a PEM or if you don't have a PREM, you can't work there.

If you work private (non-RAMQ remunerated), can you work wherever you want in Quebec?

[MD_scientist]

1 hour ago, MDinCanada said:

If you work private (non-RAMQ remunerated), can you work wherever you want in Quebec?

I think you can, but I also believe the downside to that is the fact that the government will cut out 30% of your total billings 

[F508]

If you work private, you can work wherever you want. However, there is the ethical/moral consideration and higher overhead usually. No cut from government billings.. you can't participate in the RAMQ public system and be in private system at same time

[MD_scientist]

1 hour ago, F508 said:

No cut from government billings

I must have been confused working without RAMQ remuneration and working under RAMQ but without a PREM then 

[F508]

Yes exactly. If you work in an area without PREM, you will be cut 30% billings and you will not be allowed to apply to that area for 5 years.

[MDinCanada]

On 8/11/2020 at 3:07 PM, F508 said:

you can't participate in the RAMQ public system and be in private system at same time

I've heard about this but I don't understand how they know that you're working in 2 places and why this rule is in place.

Why can't you, for example, work 4 days at the ER/walk-in clinic and then work 3 days in private (telemedicine, cosmetics, etc.)?

 

[F508]

I think cosmetics is different, because it's not covered by RAMQ (so you can do both at the same time). Not sure how it works for telemedicine.. I think you can do telemedicine through the public system and that's ok (during the pandemic anyways). 

You just can't have a private practice (offering services covered by RAMQ) and work in the public system as well.

[Snowmen]

You can't offer private medicine for services that are covered by the RAMQ unless you withdraw for the RAMQ. This is to make sure physicians don't have separate RAMQ and private billing waitlists for the same service since it would be easy to prioritize the private billing waitlist as it brings in more money.

If you are still affiliated with the RAMQ, you can privately offer services that aren't covered.