Moonlighting as an R2

[bellejolie]

Was wondering now that lmcc 2 is cancelled and new requirements for lmcc are part 1 + 12 months of post graduate training if anyone has started moonlighting in r2? I know Ontario has that restricted registration program but apparently some other provinces are more liberal, just need a letter from your PD? Is this too early in training? Looking for responses from mostly fam med if possible given that our training is only 2 years. 

[CaRMS2021]

1 hour ago, bellejolie said:

Was wondering now that lmcc 2 is cancelled and new requirements for lmcc are part 1 + 12 months of post graduate training if anyone has started moonlighting in r2? I know Ontario has that restricted registration program but apparently some other provinces are more liberal, just need a letter from your PD? Is this too early in training? Looking for responses from mostly fam med if possible given that our training is only 2 years. 

Wondering the applicability of this esp for surgical residents. Where do people usually moonlight? I have heard about it in the ICU overnight as well as FRCPC IM fellows but not really anywhere else

[bearded frog]

Your ability to moonlight will depend on the province, your college licence, and the residency contract. Typically moonlighting only applies to those who have qualified for independent practice (ie. subspeciality fellows who have passed their general IM board exams), although there may be exceptions.

[bellejolie]

3 hours ago, bearded frog said:

Your ability to moonlight will depend on the province, your college licence, and the residency contract. Typically moonlighting only applies to those who have qualified for independent practice (ie. subspeciality fellows who have passed their general IM board exams), although there may be exceptions.

Yes for family medicine residents you just need your LMCC and if in R2 there are diff programs in diff provinces for restricted licensing. You just need the approval of your PD. As a fellow in a +1 you don’t need anything. I’m wondering if in the last months of my R2 I could take on some walk in or locum. 

[blueoval177]

Changes per provincial college. For mine there has been no change, so to qualify you need: CMPA TOW codes for Moonlighting coverage, need PD approval, LMCC (MCC not issuing for current R2 till Jan).  ICU would unlikely take an R2 in FM, usually its for R3+ ER,IM,Surg,Anesthesia, fellows, FM docs (+/- +1), etc. Most moonlighting I see is HMO ICU/Step down work. Perhaps similar type of work at psych hospitals too depending on the province.

To do walk-in or locum work you need your CFPC or provisional accreditation and actual CMPA coverage for practice not r2 resident moonlighting. Policy would vary by province. In FM that means when you are done residency. +1, you are finished FM so do whatever you want. Many programs like EM and FM-A are pretty packed and some don't bother upgrading their CMPA for full practice and just a resident TOW +/- moonlighting privileges. Other programs you may keep your full license and work on the side doing +1.

[bellejolie]

19 hours ago, blueoval177 said:

Changes per provincial college. For mine there has been no change, so to qualify you need: CMPA TOW codes for Moonlighting coverage, need PD approval, LMCC (MCC not issuing for current R2 till Jan).  ICU would unlikely take an R2 in FM, usually its for R3+ ER,IM,Surg,Anesthesia, fellows, FM docs (+/- +1), etc. Most moonlighting I see is HMO ICU/Step down work. Perhaps similar type of work at psych hospitals too depending on the province.

To do walk-in or locum work you need your CFPC or provisional accreditation and actual CMPA coverage for practice not r2 resident moonlighting. Policy would vary by province. In FM that means when you are done residency. +1, you are finished FM so do whatever you want. Many programs like EM and FM-A are pretty packed and some don't bother upgrading their CMPA for full practice and just a resident TOW +/- moonlighting privileges. Other programs you may keep your full license and work on the side doing +1.

it doesn't seem you need the royal college/CFPC licensing tbh! https://cpsns.ns.ca/resource/postgraduate-practising-licence-external-moonlighting/

for nova scotia for instance you just need the LMCC. ontario it's the same thing. perhaps for the various clinics it's a different story though and the job itself requires you to have passed your exam. 

[BCelectrophile]

I’ve looked into this quite a bit as I feel moonlighting in FM makes a lot of sense especially for simple walk-in, urgent care, physician extender for primary care, etc especially due to the massive shortage of these services across Canada. Also aligns with FMs high level of independence attained in a short time. From what I’ve seen Alberta and Ontario both potentially allow moonlighting after 18 months residency + lmcc. Alberta has a pricey cost for the licensing changes ($1000-2000) while I think Ontario is much more reasonable.

I feel that especially in a rural area an fm resident would be able to get their PD and a supervisor(s) on board, allowing for small rural ER/hospital coverage + the aforementioned clinic opportunities. However it seems that both the ON and AB programs are centred more around the academic campuses of their medical schools. 
 

it seems that we are following the American trend of restricting residents moonlighting opportunities while simultaneously allowing midlevel NPs to run wild with a fraction of the training.