Return of Service Agreements

[Hopeful!]

I'm just wondering how everyone feels about the new Return of Service agreements that International Medical Graduates have to sign to... knowing that I would have to make a commitment to practicing in Sault Ste Marie, Timmins, Thunder Bay or Sudbury if I go to school overseas is going to be a HUGE part of my decision

[futuredoc]

I have never heard of this before. Could you enlighten me as to what it is?

[Hopeful!]

if you go to the CaRMS website

 

http://www.carms.ca/eng/r1_eligibility_prov_e.shtml#ontario

 

you'll see under the Ontario eligibility:

 

Return of Service:

 

All IMGs (International Medical Graduates) will be required to sign a return of service contract with the Ministry of Health and Long Term Care of the Province of Ontario, in the specialty (including Family Medicine) to which they have completed residency training.

Information about the Return of Service requirement can be found in the following document (updated Dec. 18, 2007): Ontario RoS

 

And here is more info:

http://www.carms.ca/pdfs/OntarioROS.pdf

 

This website lists the areas classified as underserviced by specialty:

 

http://www.health.gov.on.ca/english/providers/program/uap/listof_areas/specialist_ladau.pdf

 

and it's a 5 year commitment... according to the Ministry of Health and Long Term Care of Ontario website

[futuredoc]

I think that is unfair. IMGs are given hell just to earn a defined (limited) GP license, let alone a specialty license. After going through all that, they should be able to choose where they want to live. But I guess if it is the only way, then it is the only way.

[clive]

Buffy Pool,

 

Those costs also apply to Canadian graduates. I think that is where futuredoc believes the unfairness lies.

[futuredoc]

The basic logic behind the ROS contract is fairly simple.

 

The federal government has a tacitly understood obligation to fund residency positions for Canadian medical school graduates. It's assumed that if you enter a Canadian medical school that there will be a residency position for you somewhere.

 

It's prohibitively expensive to train a resident. The resident's salary alone over five years comes to at least $300,000; that doesn't include fees, insurance (CMPA & health), interest, and the myriad of other costs that accumulate. From the government's perspective, it's a lot of money to spend. And the provinces themselves end up footing the bill from the cIMGs - they want some assurances that they're going to get their money's worth, and that's where the ROS contracts come in. If New Brunswick pays a million bucks to train two or three residents, they're going to want to guarantee that those residents stay in New Brunswick, at least for a while.

 

When you realize that the country doesn't have any moral obligation to provide post graduate training to IMGs, Canadian or otherwise (that obligation lies with the country that trained the IMG), then the ROS contract seems considerably less unfair.

 

You have to remember though that a lot of that $300000 goes back as taxes and other fees- people in residence are by no means rich. When I see this policy , I see "ok you are not good enough for OUR medical schools, but if you spend thousands upon thousands overseas we will give you an extremely small shot to practice here as your desired specialty (most IMGs become either GPs or internists) BUT you have to work here for some time". As far as I can tell, this system does not exist for Canadian graduates (correct me if I am mistaken). Hopefully I'll never have to go through this myself..........

[shaka84]

This has nothing to do with OUR medical schools are better than YOURS. It has everything to do with, we have a shortage of doctors (especially rural) and since we have been unable to initiate return of service contracts with Canadian medical school graduates we have to put some conditions on the IMGs to try and shore up the void.

 

I believe it is mostly geared toward MDs immigrating to Canada but has also been passed on to Canadian IMGs to minimize the appearance of discrimination.

 

Return to Service contracts are not all bad. They do force people to practice in places they may not choose themselves but in some cases the MDs decide to stay because it turns out to be what they wanted.

 

Those IMGs that are Canadian must be aware of the system before they go and realize what it will take to return to Canada. I have read too many posts on this and other sites that stated that they knew the situation when they left Canada but thought the system would change before they graduated. They now whine about how unfair it is, and maybe it is, but thats the system.

 

If it came down to me choosing a foreign med school or nothing I always thought that I would have choosen the foriegn med school but now, I would be less sure.

 

I may have been a little harsh.

 

shaka84

[Cobey]

Hey guys,

I feel kinda dumb right now because I don't know anything about the return of service agreement. I find it strange that I went through the whole atlantic bridge admissions process and nobody informed me about this. Maybe I missed something (but I read all of the information their provided), or maybe they didn't provide any info about it. Is this already being implemented? Because I know somebody who just graduated from a school in Ireland, and got a Canadian residency position and didn't say anything about honouring this agreement.

[Cobey]

Ahhh I'm kinda confused right now. I just read through the Ontario ROS document, and I still don't understand everything. It does not specify how long you have to spend in the underserviced communities.

 

My father (a physician in Toronto) hires international medical graduates and immigrant doctors all of the time to join his team. All of them immediately start working in Toronto after immigrating, and I have never heard of any of them having to work in an underserviced community. Am I missing something?

[futuredoc]

This has nothing to do with OUR medical schools are better than YOURS. It has everything to do with, we have a shortage of doctors (especially rural) and since we have been unable to initiate return of service contracts with Canadian medical school graduates we have to put some conditions on the IMGs to try and shore up the void. shaka84

 

That is actually a very good point that I didn't think of. Thanks for pointing it out.

[Cobey]

Thank you Buffy Pool, that was helpful.

 

So if you do med school overseas, then do a residency in the US, you can get a job in Canada afterwards?

 

Note: I am totally not opposed to working in an underserviced region, I just want to be informed about all of the rules/regulations before going to med school overseas. I think the whole ROS thing is a great idea.

[Guest copacetic]

Medical graduates in Ontario generally go through two stages of registration to practise medicine in Ontario .

 

1. First, they obtain a certificate of registration authorizing Postgraduate Education.

2. Second, once they complete the required postgraduate training and Canadian examinations, they obtain a certificate of registration authorizing Independent Practice .

 

The qualifications and requirements for certification with the College are outlined in the registration regulation of the Regulated Health Professions Act.

_______________________________________________________________

CERTIFICATE OF REGISTRATION AUTHORIZING POSTGRADUATE EDUCATION

 

A Postgraduate Education certificate, which is renewed annually and held during postgraduate medical training at an Ontario medical school, is obtained after graduation with a medical degree from an accredited medical school in North America or an acceptable medical school outside of North America. There are terms, conditions and limitations to the certificate. The holder may practise medicine only as required by the postgraduate program and only in clinical teaching units or settings affiliated with a postgraduate program, and may not charge fees for services.

_______________________________________________________________

CERTIFICATE OF REGISTRATION AUTHORIZING INDEPENDENT PRACTICE

 

A certificate of registration for Independent Practice authorizes the holder to engage in independent, unsupervised medical practice, subject to the term, condition and limitation that the holder of the certificate only practise in the areas in which he or she is educated and experienced.

 

The requirements for an Independent Practice certificate are:

 

1. A medical degree from an accredited Canadian or U.S. medical school or from an acceptable medical school listed in the World Directory of Medical Schools.

2. Parts 1 and 2 of the Medical Council of Canada Qualifying Examination.

3. Certification by examination by either the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC).

4. Completion in Canada of one year of postgraduate training or active medical practice, or completion of a full clinical clerkship at an accredited Canadian medical school.

5. Canadian Citizenship or permanent resident status.

 

The holder of the Independent Practice certificate is entitled to all the rights and responsibilities of a physician in Ontario and must pay the annual membership fee to maintain the Independent Practice certificate.

 

Students considering taking postgraduate training outside Canada , and who wish to return and obtain an Ontario certificate of registration are cautioned to seek confirmation from either the RCPSC or the CFPC that such training will allow them to be eligible for the certification exams of either of those bodies. Certification by the RCPSC or CFPC is one of the fundamental requirements for registration in Ontario for independent practice.

 

________________________________________________________________

it seems to me than an american img could finish their residency, then do a felowship in canada, and that would count towards their one year of experience. then all they have to do is apply for their certificate of independent practice.

________________________________________________________________