2018-2019 Guide to Practice - Available positions: pages 33 to 44 - FMRQ
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Volume 41 | Numero 1 | FALL 2018
Guide
to Practice
2018-2019
Available positions: pages 33 to 44
On October 5, 2018,
the FMRQ held its
23
Some 900 medical residents
rd
came to talk with representatives
from 100 or so establishments,
facilities and clinics, and from
the Fédération des médecins
omnipraticiens du Québec (FMOQ),
Fédération des médecins spécia-
listes du Québec (FMSQ), and
Quebec Ministry of Health
Table of contents
Quebec Career Day 2 Practice 19
– Regular Permit 19
President’s Message 4 – Moonlighting 20
– Certification Exams 20
Introduction 5 – Maintenance of Proficiency 21
– Remuneration and Billing 21
Family Medicine 5
– Malpractice Insurance 22
– Obtaining a PREM in FM 6
– Incorporation 22
– Obtaining a PEM in FM in an Establishment 6
– Life, Health and Disability Insurance 23
– Opting to Perform Locums 7
– Automobile and Home Insurance 23
– Fellowships 7
– Financial Services 23
– Financial Incentives on Starting out in Practice 8
– Income Tax 23
In Other Specialties 10 – Post-residency Maternity, Paternity
– Obtaining a PEM in an Establishment 10 and Adoption Leave 23
– Practising Exclusively in a Private Office 12
– Extensions of Training/Fellowships in Quebec 13
Information Sources 24
– Career in Research 14 Canadian Regulatory Authorities
– Fellowships Outside Quebec 15
– Financial Incentives on Entering Practice
Distributing Medical Licences 25
in Non-FM Specialties 17 Resources and Organizations
Related to Medical Practice 27
List of DRMGs 28
List of DSPs 30
BOARD OF DIRECTORS STAFF
Christopher Lemieux, President Johanne Carrier, Director, Communications and Public Affairs
Christian Campagna, Secretary Audrey Laganière, Director, Legal Affairs
Julien Dallaire, Treasurer Sylvain Schetagne, Director, Research and Sociopolitical Action
Marie-Alexandra Campo, Vice-President (AMRM) Jocelyne Carrier, Co-ordinator, Academic Affairs – SP
Daphnée Perron-Couture, Vice-President (ARM) Geneviève Coiteux, Co-ordinator, Academic Affairs – FM
Jean-Philippe Blais, Vice-President (AMReQ) Marie-Anik Laplante, Co-ordinator, Union Affairs
Eric Guimond, Vice-President (AMReS) Carolann Desautels, Assistant
Maxime Cartier, Director, Union Affairs Liliane Francoeur, Assistant
Xavier Tanguay-Rioux, Director, Academic Affairs - SP Louise Francoeur, Assistant
Cassandre Latourelle-Théberge, Director, Academic Affairs – FM Emilie La Boissière, Assistant
Patrice Savignac Dufour, Executive Director Vicki Portelance, Assistant
Edyta Zaniewska, Assistant
Johanne Carrier, Editor
Triade Marketing, Graphic Design
Return undeliverable Canadian addresses to:
FMRQ – 510-630 rue Sherbrooke Ouest, Montreal, QC H3A 1E4
ISBN/ISSN: Canada Post Publication Agreement 1484699
Tel.: 514 282-0256 or 1 800 465-0215
www.fmrq.qc.ca – fmrq@fmrq.qc.ca – Annual subscription: $20
President’s Message
PEMs and PREMs:
always a priority for the FMRQ
Dear Colleagues,
On October 5, 2018, 900 of you took part in the FMRQ’s Quebec Career Day, medical
residents’ yearly gathering that provides opportunities to talk with representatives from
100 or so Quebec healthcare facilities. I trust you found the information and made the
contacts there that you were looking for in relation to your future practice. This year’s was
the 23rd edition of Quebec Career Day, and provided further confirmation of the need
for this annual event. Being able to meet with representatives of establishments from all
“The FMRQ will continue Quebec regions in a single location, on the same day, is a unique opportunity, particularly
in view of the schedules we all have during residency.
ensuring a constant
presence on the different In the wake of this discussion and information forum, we present to you today our Guide
to Practice for 2018-2019. It contains information on all aspects associated with seeking
committees and panels a position or confirming a fellowship, and on the transition to practice, remuneration, and
responsible for physician more besides. As you already know, implementation of the new process proposed by the
FMOQ and FMRQ and accepted last year by the MSSS, centralizing applications for
resource planning and PREMs in FM, has had to be deferred until next year, but the Ministry has informed the
regional directorates of general medicine (DRMGs) that they are not to accept any letters
distribution in Quebec.” of recommendation from clinics within their geographical areas. The FMRQ is monitoring
this issue very closely. Do feel free to get in touch with us if you witness or are a victim of
“questionable” processes or attempts at bargaining to obtain a PREM.
Also, physician resource plans (PEMs) in non-FM specialties, which are posted on the
MSSS site, will not be expanded between now and 2020. The table will simply be up-
dated regularly to reflect the allocation of PEMs. Any position added in an establishment
during that period will have to be the subject of a waiver application by the establishment
concerned. Note that we are also continuing our lobbying to ensure that position postings
are altered to reflect the name of the facility (hospital) rather than merely the establishment,
as the current model makes it harder for you to seek a position. Finally, the work to draw
up PEMs for 2021-2025 should be starting during the coming year. In the meantime, the
FMRQ will continue ensuring a constant presence on the different committees and panels
responsible for physician resource planning and distribution in Quebec and lobbying on
an ad-hoc basis in the event of changes or problems associated with this issue.
In the next few months, I encourage you to follow the Federation’s activities with respect
to physician resources: Outside Quebec Career Day, February 28, 2019; Symposium on
PREMs in FM, May 3, 2019; and Presentation Tour for Physician Resources in Specialties
Other Than FM. The FMRQ also offers an information service providing details on how
to find a position. So please feel free to get in touch with us at any time if you would like
further information or assistance in your transition to practice. In closing, I trust you enjoy
this Bulletin, and, above all, I hope you find the position that fulfils your expectations.
Christopher Lemieux, MD, FRCPC
4 | LE BULLETIN
Guide to Practice 2018-2019
Introduction
Here is your Guide to Practice 2018-2019, which presents the latest rules and conditions for the
search for positions or confirmation of fellowships in Quebec. We invite you to read this new edition closely,
to learn about all the steps to be borne in mind in order to make the transition from residency to practice
as smooth as possible.
To make this guide easier to consult, we have grouped together information on family medicine and the
other specialties in separate sections. If you have any questions, we will be pleased to answer them.
To get in touch with us, simply call 514 282-0256 or 1 800 465-0215, or email prem-mf@fmrq.qc.ca
for information on family medicine, or pem-sp@fmrq.qc.ca for further details on the rules to be followed
in other specialties.
Family Medicine
IMPORTANT
At the Symposium on PREMs in Family Medicine in May 2018, the FMRQ had presented, in
conjunction with the Fédération des médecins omnipraticiens du Québec (FMOQ), the rules
which had been agreed upon between the Ministry of Health and Social Services (MSSS)
and the FMOQ concerning the new centralized procedure for receiving and managing PREM
applications in family medicine. Unfortunately, the MSSS recently informed us that this formula
would not be used for the 2019 PREMs, since it had not been possible to make the necessary
changes within the required deadlines for the October-November 2018 application period.
None the less, two new rules apply for the 2019 PREMs.
1) In order to eliminate any inequity and potential conflict of interest in the selection process,
all regional departments of general medicine (DRMGs) will have to ignore any letter
of support from a medical office or an establishment in compiling candidates’ files.
Such letters may not be taken into consideration in the candidate selection process.
2) Also, in the event of a selection process, i.e., when there are more candidates than
positions available in the PREM, (…) the DRMG must base its selection of all applicants
on interviews, whether conducted in person or via other technological means. (Extract from
the letter from the MSSS Assistant Deputy Minister to concerned health system partners).
FALL 2018 | 5
Guide to Practice 2018-2019
Obtaining a PREM in FM Obtaining a PEM in FM
To practise in family medicine in Quebec, two procedures have to be in an establishment
followed, carried out concurrently:
OBTAINING A PEM IN FM
• Obtain a compliance notice in one of the 18 regions of Quebec,
with an undertaking to perform the main practice in a subarea (RLS); Vis-à-vis the establishment
To seek a notice of appointment in an establishment, you must:
• If you wish to work in an establishment, obtain the support of an
establishment. • Send your appointment application form to the director
of professional services of the establishment;
• If you wish to work in an office, in a clinic, identify a team you would
like to work with. • You will receive a letter from the DSP confirming the status
of the establishment’s PEM;
Position applications must be made to the regional department(s) • Your application will be reviewed by the Executive Committee
of general medicine (DRMG(s)) which you have identified for your of the CPDP;
practice, between October 15 and November 15 of each year. Your
• The Credentials Review Committee will study your file and report
approach to obtain a position in an establishment may be carried out
to the Executive Committee;
ahead of time, so you can demonstrate your interest to the DRMG.
• The Executive Committee will make a positive or negative
Note that you will be given your PREM compliance notice, within an RLS, recommendation to the establishment’s Board of Directors
by the Head of the DRMG. You will have to choose one or more of the concerning your application;
special medical activities (activités médicales particulières, or AMPs) • The Board of Directors will accept (or deny) your application,
available within the network covered by the DRMG. Currently, subject to approval from the DRMG;
the following AMPs are offered: • The DSP/DRMG will submit a waiver application to the Management
1. Emergency committee for physician resources (COGEM) in general practice,
2. Patient management which will review whether or not the need is real;
3. Residential and long-term care facility (CHSLD) • The COGEM will then make a recommendation to the Minister
4. Walk-in consultations, in line with the priority needs of Health and Social Services, who will ratify, or refuse to ratify,
of the region and RLS the recommendation;
• The DRMG will send you its response directly.
Note that you have three months from your first
What the DRMGs Want to Know
day of practice to sign on to this agreement. • Your professional interests
• Where you intend to set up practice in future (establishment/subarea)
See elsewhere in the Bulletin for further details on this subject. Also, the • The clinical/professional activities you prefer to perform in your practice
application for a PEM in an establishment will have to be made to the • The status of your approach to an establishment and/or private
parity committee made up of the Fédération des médecins omnipraticiens office (involved here is not demonstrating your interest for one
du Québec (FMOQ) and the Quebec Ministry of Health and Social clinic specifically, but rather demonstrating your interest for patient
Services (MSSS). management through the steps you take to visit clinics)
In view of the limited number of positions in certain regions, we suggest If You Practise Without a PREM
that you apply for compliance notices to more than one region or RLS. A list (in the public system, and not in private practice)
of DRMGs and their representatives is provided at the end of this Bulletin.
• Your overall pay will be cut by 30% for any medical act performed
in your practice;
• You will have to wait five years before being allowed to apply
for a compliance notice in that region;
• Also, if you obtain a compliance notice in another region and work
there for three years, you will be able to ask subsequently for a
position in the region where you have practised without a PREM.
6 | LE BULLETIN
Guide to Practice 2018-2019
Opting to Perform Locums Medical residents wishing to practise on locums
(PREM Exclusively on Locums and Part-time Locum) during residency
Medical residents holding a permit to practise from the Collège des
Physicians wishing to perform locums exclusively
médecins du Québec may be authorized to perform moonlighting without
Physicians wishing to practise exclusively under the locum mechanism can holding a compliance notice from a region or a waiver in lieu of a com-
obtain a waiver in lieu of a compliance notice if places are available. They must pliance notice. They then have to apply for this when they register with
apply for it when they register for locums. The number of doctors exclusively on the CNMQ. Such an authorization is valid for as long as the physician
locums is limited each quarter. To register for locums, physicians must hold a is registered in a postgraduate medical education program. During that
permit to practise from the Collège des médecins du Québec and have proof of time, however, the physician does not accumulate practice days. At the
malpractice insurance corresponding to the sectors of activity covered by their end of that period, he has to obtain a PREM compliance notice as a
locum practice. A practice is deemed exclusive when it includes 95% or more “new biller” and sign on to the Special agreement concerning specific
of the physicians’ total billing days. medical activities (Entente particulière relative aux activités médicales
Registration period particulières).
Quarter 01 (March, April, May): from February 22 Physicians can register with the locum mechanism
Quarter 02 (June, July, August): from May 25 through the CNMQ. For further information,
Quarter 03 (September, October, November): from August 25 consult the following (French only) sites:
Quarter 04 (December, January, February): from November 24
Site: http://www.msss.gouv.qc.ca/professionnels/medecine-au-quebec/
depannage-ou-remplacement/
*** CAUTION *** Registration form: https://h38.pub.msss.rtss.qc.ca/public/
H38InscriptionMedecin.asp?m=Ins&s=Med
In April 2018, the MSSS lifted the quarterly registration
quotas for physicians conducting locums exclusively,
and this measure was still in effect at press time. If Fellowships
you would like to obtain a PREM to perform locums
Emergency Medicine (3rd year)
exclusively in order to have a practice comprising 95%
(via CaRMS)
locums, all you have to do, for the moment, is complete
the registration form on the provincial Centre national To obtain a residency position (R3 in family medicine) in Quebec with
Médecins-Québec (CNMQ) site. To do so, you must a view to performing further training in Emergency Medicine following
have your permit to practise number and appropriate certification in Family Medicine, you must apply using a special form
malpractice insurance coverage. available on the medical faculty sites. You must also submit an applica-
tion on the Canadian Resident Matching Service (CaRMS) platform. In
For the links, see the end of this section. view of the fact that CaRMS responses are not sent to terminating
residents until late December—after the PREM application period
If performing locums interest you, you may contact us (October 15 – November 15)—we encourage you to make a PREM
at the FMRQ. application anyway, in case you do not obtain your position. Should
you receive two favourable responses, you will be able to withdraw
Doctors wishing to practise part-time on locums from your PREM.
Doctors wishing to practise part-time under the locum mechanism may
register via the provincial Centre national Médecins-Québec (CNMQ).
There is no limit on the number of doctors on part-time locums. But
physicians must ensure that they hold a PREM in a region where they
will be carrying out at least 55% of their practice in terms of billing
days. Locums must therefore not exceed 45% of their practice. Note that
any practice carried out in another local services network (RLS) than
where the physicians hold their PREMs or in another region will also be
calculated within this 45%.
FALL 2018 | 7
Guide to Practice 2018-2019
Clinical Scholar Program Financial Incentives on Starting
(via Faculty) Out in Practice/Establishment and
In order to apply for a clinical scholar position, you must complete the Maintenance (Retention) Bonuses
extension of training application form available from your faculty, sign
it, and obtain the signature of the program director concerned. Your
and Premiums in Family Medicine
document must be emailed to the faculty. An original must also be In isolated or designated regions
forwarded to the Office of your Associate Dean, so it can be submitted Family physicians setting up in one of the isolated or designated regions
to the Conference of Associate Deans (CVDFM) for analysis and decision. receive higher pay, as well as premiums for call duty at home and
The candidate and the program director are notified by email once the professional development. In isolated regions, remote area bonuses,
application is approved by the CVDFM. The program prepares future home leave bonuses (with or without dependants), and food and
family physicians for a university career and to take on a leadership role transportation bonuses are allocated. Establishment and maintenance
in developing the discipline of family medicine through their scholarship premiums are also given by the region. Premiums vary depending on the
and research activities. Requirements may vary slightly from one faculty isolated sector in question. A table illustrating pay in an establishment
to another. Only medical residents having completed their residency in and in an office is presented below.
a program accredited by the College of Family Physicians of Canada are
eligible for this program. For further information, consult the site of each HIGHER PAY FOR GENERAL PRACTITIONERS
medical school that offers the program. BY PRACTICE AREA
Training offered by the faculties includes the following : 1st year 4th year 7th year 20th year
• Clinical Scholar % % % %
• Emergency Medicine Group Establishment 130 135 135 140
• Mother/Child Care 1 Office 120 125 125 125
• Drug Addiction Group Establishment 135 140 140 140
• Palliative Care 2 Office 120 125 125 125
• Care of the Elderly Group Establishment 130 130 130 130
3 Office 120 120 120 120
Application deadline: February 1, 2019
Group Establishment 120 120 120 125
Extensions of training 4 Office 115 115 115 115
Some 30 positions are available for extensions of training for six months
Group Establishment 120 125 130 130
or less in the following specialties: Mother/Child Care, Perinatal Care,
5 Office 105 105 105 105
Maternity Care, and Women’s Health (advanced competency
or extension of training). Group Establishment 115 115 115 115
6 Office 105 105 105 105
For more information, conduct a Web search of “Carte de la rému-
nération différente des omnipraticiens” (map of differential pay for
general practitioners). You can also consult the Ministry of Health and
Social Services site at www.msss.gouv.qc.ca/statistiques/atlas/docs/
consom/CarteOmnipraticiens.pdf, or get in touch with the Ministry’s
Physician resource branch (Direction de la main-d’œuvre médicale)
at 418 266-8868 or 1 888 708-0393.
8 | LE BULLETIN
Guide to Practice 2018-2019
Rémunération différente des médecins omnipraticiens
No Région
1re année 4e année 7e année 20e année
• Ivujivik ✈ 01 Bas-Saint-Laurent
• Salluit ✈ Groupe 1 Établissement 130 135 135 140
• Umiujaq
02 Saguenay–Lac-Saint-Jean Cabinet 120 125 125 125
• Kangiqsujuaq ✈
03 Québec Groupe 2 Établissement 135 140 140 140
• Akulivik ✈ Cabinet 120 125 125 125
• Quaqtaq ✈ 04 Mauricie–Centre-du-Québec
• Puvirnituq ✈ BAIE D'UNGAVA 05 Estrie Groupe 3 Établissement
Cabinet
130
120
130
120
130
120
130
120
Carte de la rémunération différente
des médecins omnipraticiens
• Kangirsuk ✈
06 Montréal-Centre
Groupe 4 Établissement 120 120 120 125
07 Outaouais Cabinet 115 115 115 115
Région éloignée ou isolée
• Aupaluk ✈
• Inukjuak ✈ • Tasiujaq ✈ 08 Abitibi-Témiscamingue Groupe 5 Établissement 120 125 130 130
• Kangiqsualujjuaq ✈
09 Côte-Nord Cabinet 105 105 105 105
• Kuujjuaq ✈
Groupe 6 Établissement 115 115 115 115
17 10 Nord-du-Québec
Cabinet 105 105 105 105
BAIE D'HUDSON • Umiujaq
11 Gaspésie–Îles-de-la-Madeleine
Note : Les majorations en « établissement » s’appliquent pour les services dispensés dans un centre hospitalier,
12 Chaudière-Appalaches dans un centre de réadaptation, dans un centre d’hébergement et de soins de longue durée ou dans un CLSC
du réseau de garde intégré lorsque le médecin participe à la garde.
• Kuujjuarapik ✈ 13 Laval Les majorations en « cabinet » s’appliquent pour les services dispensés en cabinet, à domicile ou dans un
• Whapmagoostui ✈ CLSC hors du réseau de garde intégré lorsque le médecin ne participe pas à la garde.
• Poste-de-la-Baleine ✈ 14 Lanaudière
La rémunération de base est de 100 % (zone beige sur la carte).
15 Laurentides Quelques établissements ont cependant une rémunération majorée à 105 % ou 115 % dans d’autres régions du Québec :
• Schefferville ✈ Québec, Mauricie et Centre-du-Québec, Estrie, Chaudière-Appalaches, Saguenay-Lac-Saint-Jean, Montérégie.
• Baie-James ✈
16 Montérégie Le médecin omnipraticien reçoit 105 % pour les services dispensés à l’urgence de certains CLSC du réseau de garde
• Chisasibi ✈
BAIE-JAMES intégré des régions de la Mauricie et du Centre-du-Québec, de l’Outaouais, de Chaudière-Appalaches et de Lanaudière.
17 Nunavik
• Wemindji ✈ 10 Cette carte de rémunération est présentée à titre illustratif seulement. Il faut se référer à l’annexe 19
09 18 Terres-cries-de-la-Baie-James de l’Accord-cadre pour les données officielles.
• Fermont ✈
• Eastmain ✈
• Waskaganish ✈
• Waskaganish ✈
• Rivi • Blanc
• Vieu
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• Waswanipi • Chapais • Port-Cartier ur
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• Port-Menier ✈
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• Lebel-sur-Quévillon Groupes de rémunération
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ÎLE D'ANTICOSTI
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• La Sarre
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Le médecin omnipraticien reçoit une rémunération majorée selon le taux applicable
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• Macamic • Baie-Comeau ✈
•
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• Mont-Louis au groupe auquel appartient la région.
Do
• Amos • Betsiamites • Grande-Vallée
•
• Sainte-Anne-des-Monts Ces territoires sont désignés aux fins de rémunération de la façon suivante :
an
• Rivière-au-Renard
Je
• Murdochville
t-
• Forestville
• Senneterre GROUPE 1
in
• Gaspé ✈
Sa
• Matane
•
• Rouyn-Noranda ✈
n
• Les Escoumins
se
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•
• Malartic • Mont-Joli ✈ Secteurs isolés I et II à l’exception de Chibougamau et du territoire de la Côte-Nord
An
11
be éli
ho l ✈
à l’Est de la Rivière Moisie jusqu’à Havre Saint-Pierre inclusivement.
m n•
•
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• Rimouski • Amqui
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•
•
Ba •
• Clova
tim re
in
Al ua
Tadoussac
•
• Val-d'Or ✈
✈
ou iè
• Chandler
Sa
La i ✈
• Causapscal Secteurs isolés III, IV et V à l’exception des régions 17 et 18 et du territoire de la
ie
a
ic qu
•
tc
Ch Jon
• Trois-Pistoles
08
be
• Parent Côte-Nord à l’Est de Havre Saint-Pierre.
ta
• Paspébiac
01
Mé
• Maria ✈ ÎLES-DE-LA-MADELEINE Territoires désignés autres que les secteurs isolés à l’exception des secteurs géographiques
• Matapédia
• Casey d’Alma et de Rimouski et des MRC de Kamouraska, de Rivière-du-Loup et d’Antoine-Labelle
• Sanmaur • Rivière-du-Loup
• Ville-Marie
La Tuque
La Malbaie • Cabano excluant les municipalités de Saint-Cyprien, Saint-Hubert, Saint-François-Xavier-
•
• Baie Saint-Pascal de-Viger et Saint-Paul-de-la-Croix.
• • Notre-Dame du Lac • Cap-aux-Meules ✈
Saint-Paul • Pohénégamook
03 • GROUPE 2
• Témiscaming
04 • Qué
✈
bec • La Pocatière Secteur isolé I : Chibougamau et le territoire de la Côte-Nord à l’Est de la Rivière Moisie
Mont-Laurier • Montmagny jusqu’à Havre Saint-Pierre inclusivement.
• Lévis
L'Annonciation GROUPE 3
• Shawinigan 12 Secteurs isolés III, IV et V des régions 17 et 18 et territoire de la Côte-Nord à l’Est
Maniwaki • 14 de Havre Saint-Pierre jusqu’à la limite du Labrador y compris l’Île d’Anticosti.
15 • Trois-Rivières ✈
Chapeau • Gracefield • GROUPE 4
07 Saint-André-Avellin Joliette •
04 • Saint-Georges Secteurs géographiques d’Alma et de Rimouski.
Fort Coulonge • • Low • • Arthabaska
• Buckingham Saint-Jérôme
• Wakefield
• Sorel • Drummondville GROUPE 5
Shawville • • Gatineau
• Laval
Municipalité régionale de comté d’Antoine-Labelle.
Aylmer • • Hull ✈
• Montréal ✈
GROUPE 6
Légende • Granby
• Saint-Jean • Sherbrooke MRC de Kamouraska et de Rivière-du-Loup excluant les municipalités de Saint-Cyprien,
Aéroport Saint-Hubert, Saint-François-Xavier-de-Viger et Saint-Paul-de-la-Croix.
✈
Traversier 16
Isolated Regions
SECTOR I SECTOR II SECTOR III SECTOR IV SECTOR V
Chibougamau Fermont Nord du 51e degré de Wemindji Tasiujak
Chapais Territoire de la Côte-Nord, latitude incluant : Mistissini, Eastmain Ivujivik
situé à l’est de la Rivière Kuujjuak, Kuujjuarapik,
Matagami Whapmagoostui, Chisasibi, Waskagheganish Kangigsualuajjiuaq
Moisie
Joutel et s’étendant jusqu’à Havre Baie-James, Schefferville, Nemiscau Aupaluk
Lebel-sur-Quévillon Saint-Pierre inclusivement Kawawachikamach et Inukjuak Quaqtaq
Waswanipi à l’exception
Témiscaming Îles-de-la-Madeleine de Fermont et des localités Puvirnituk Akulivik
Ville-Marie spécifiées aux secteurs IV Umiujaq Kangigsujuaq
et V
Kangirsuk
Parent
Salluit
Sanmaur
Tarpangajuk
Clova
Territoire de la Côte-Nord,
s’étendant à l’est de Havre
Saint-Pierre, jusqu’à la lim-
ite du Labrador, y compris
l’Île d’Anticosti
FALL 2018 | 9
Guide to Practice 2018-2019
In other specialties
Obtaining a PEM in an Establishment • If the MSSS agrees, it issues and forwards to the establishment
Having a position in an establishment’s physician resource plan (PEM) a notice of compliance with the establishment’s PEM;
is a prerequisite for delivering care there. Doctors may obtain privileges • The establishment (integrated health and social services centre
in more than one establishment, but they will be counted only in the [CISSS], integrated university health and social services centre
PEM of the establishment where they perform most of their practice [CIUSSS], institute, etc.) must, as early as possible or within
(75%). They may also obtain associate member privileges in the another 90 days following receipt of an application for privileges,
establishment’s PEM for up to 25% of their practice. Positions in esta- send the applicant a written decision setting out his privileges;
blishments’ PEMs are announced in October each year, in the context • The reasons for any refusal must be given in writing;
of the FMRQ’s Quebec Career Day. Some positions currently remain • The physician must confirm his decision and acceptance of his
available in the physician resource plan for 2019 and 2020. These are conditions of appointment in writing within 60 days following the
posted on the Ministry site under Plans régionaux d’effectifs médicaux/ notification date in order for his privileges to be validated.
pour la médecine spécialisée/postes disponibles at
http://www.msss.gouv.qc.ca/professionnels/documents/prem/
medecine-specialisee/toutes_specialites_2018-10-01.pdf IMPORTANT
Positions on the MSSS table are now posted by establishment rather than Send your application to the establishment’s
facility (hospital), and this complicates terminating residents’ search for Director of Professional Services (DSP)
a position. Also, note that it is possible for the establishment to impose Since the adoption of Bill 10, Quebec has had 34 health care
on you the obligation of practising in two of its facilities, on the basis of establishments plus a few independent institutes or university
needs identified in the different regions covered by the establishment. health centres. These establishments bring together the 182
healthcare facilities that existed prior to the merger. If you
Note that the 2018-2020 plan presented last year will not be modified
are seeking a position in a facility (e.g., Gatineau Hospital),
this year, nor until its expiry in 2020. Establishments which consider that
they have needs exceeding the number of positions allocated to them you must forward your appointment notice application to
will have to make a waiver application to add a position to their PEMs. the Director of Professional Services (DSP) of that facility’s
Medical residents may not make such an application. The rules concer- umbrella establishment (i.e., the Outaouais integrated health
ning waiver applications are available on the FMRQ site, in the Specialty and social services centre, or CISSS). A copy can also be sent to
Physician Resource Handbook. the director/head of the department and the facility’s deputy
DSP. Meeting with the department head definitely lends greater
Process weight to your approach, and, if you can arrange it, a rotation
in the setting will help you demonstrate your knowledge
• Get in touch with the head of department or the deputy director
and get to know the team on-site, and may weigh heavily
or director of professional services (DSP);
in your favour.
• When you have made your choice, send the Director of Professional
Services of the establishment concerned the appointment notice
application form (available at the office of the DSP or on the For positions in university settings, candidates will have to perform fellowships
RAMQ site);
of 3-12 months’ duration. Fellowships of less than 6 months in length
• The application will then be evaluated by the Credentials Review do not require approval from the MSSS. A second year is possible, but
Committee, which makes a positive or negative recommendation
must be justified to the Ministry by the establishment. Note that medical
concerning your application to the Council of Physicians, Dentists
faculties sometimes require a minimum of one year of fellowship to grant
and Pharmacists (CPDP), which follows the same procedure with
respect to the establishment’s Board of Directors; these positions, owing to the teaching duties associated with them.
• If your application is accepted, the establishment’s Board submits A number of non-university establishments may also require a fellowship
an application for this position to the Ministry of Health and Social to fill a specific need that will meet the requirements of the population
Services (MSSS) to obtain confirmation that this appointment is in in their territory. For further information on fellowships, consult
compliance with the establishment’s physician resource plan (PEM); the section on page 13.
10 | LE BULLETINGuide to Practice 2018-2019
To start out in practice, you must have at least: IMPORTANT
• Your specialist certification These positions cannot be based on a single individual,
• Confirmation of your participation and have to demonstrate a commitment from the esta-
in an ALDO-Quebec information session blishments’ medical teams and administrations to fulfil
• Your permit to practise number and registration the associated undertakings (service corridors).
on the membership roll of the Order (have paid your
yearly subscription)
Research Scientist Positions
• Your proof of malpractice insurance
There are certain situations where a physician may be hired outside the
PREM. It is, however necessary for the candidate to obtain a PEM from
Recruitment in Anticipation of a Departure Within a Year the establishment where he wishes to practise and conduct his research.
Even when an establishment’s PEM is full, a compliance notice may be The position will be then be recognized by the Ministry as being outside
issued for a recruitment in anticipation of the departure of a physician the PREM, for the purposes of hiring other candidates in the department.
who has provided written notice of his intention to cease practising in Examples include those with an exclusive, full-time practice in palliative
the establishment and whose resignation will take effect in one year. care or intra-operative assistance, and research fellows who have signed
But the recruited physician may commence his duties only six months on to the Memorandum of agreement concerning the establishment
prior to the date of the incumbent physician’s departure. of special pay terms and conditions for research scientists (Protocole
d’accord concernant la mise en place de modalités de rémunération
Temporary Replacement particulière pour les chercheurs-boursiers).
The purpose of a temporary replacement is to enable a doctor to take In the event of a change in the career of a research scientist who has
on the clinical and administrative duties of another physician who holds signed on to the Memorandum of agreement for research scientists,
a PEM, who has to take time away from his or her position (illness, sab- he will be able to stay in his facility, even if he withdraws from the
batical leave, maternity, etc.). This position is not a permanent position Memorandum of agreement. He will then be considered surplus to the
for the replacing doctor, who loses his privileges when the replacement PEM, which will be rectified when a colleague in that specialty leaves.
terminates. It is also possible in an emergency to obtain authorization The same rule applies to those with an exclusive practice in palliative
to practise in an establishment without a position in the PEM. But this care or intra-operative assistance. For further details, please consult the
measure is valid only for a maximum of three months, and cannot management rules for physician resource plans (PEMs) in specialties on
be renewed, barring exceptional circumstances determined by the the Ministry site. Searching for PREM en spécialité on the Internet will
establishment and accepted by the MSSS. take you to the appropriate page.
Network Positions Returning From the Regions (Three-Year Rule)
Some agreements allowing for the addition of positions are associated After three years’ continuous practice in a remote or isolated region, a
with a network position. These positions can be used for the recruitment physician cannot be refused entry to another region on the grounds that
of a specialist physician in the establishment holding the position or for the region’s PREM or establishments’ PEMs are full. Nevertheless, if he
the recruitment of a specialist physician in another establishment, i.e., wishes to obtain a position in a university hospital, he will have to meet
an optional network position, conditional upon the signing of a service the fellowship requirements and receive the agreement of the region’s
agreement between two establishments. Some establishments have medical faculty. A physician taking advantage of this rule will be able to
a mandatory network PEM position. These positions are generated when do so once only, within no more than 12 months from the date on which
a service corridor is established permanently between two establishments. he left the establishment in the regions. To obtain a position in a new
region, the physician will first have to fill the 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 receive a list of five establishments
determined according to Ministry priorities, from among which he may
choose. In such cases, the MSSS may authorize the PEM of the establishment
concerned to be temporarily exceeded.
FALL 2018 | 11Guide to Practice 2018-2019
Recruitment via Waiver Practising Exclusively
When an establishment’s needs warrant, the Director of Professional Services in a Private Office
may ask for its physician resource plan (PEM) to be temporarily exceeded via
Practising in private offices in specialties other than family medicine is not
waiver. A PEM waiver is an exceptional measure, and requests to that effect
governed by PEMs for the moment. Doctors wishing to practise exclusively in
have to meet strict criteria: candidate’s specific expertise; volume of activity;
an office have no steps to take with respect to obtaining a PEM position.
waiting lists; development (addition of equipment); stabilization of teams
But this does not prevent them from billing the Quebec Health Insurance
(age of practising physicians); establishment of a service agreement; and, in
Board (RAMQ). At issue here is working in a private office, and not opting out
rare cases, humanitarian reasons. The waiver confers a permanent position
from RAMQ. This option affects a limited number of specialities, though,
on the candidate. The PEM will then be exceeded, and the next departure in
including dermatology, psychiatry, and rheumatology.
the specialty concerned will not be replaced. Waiver applications are reviewed
by members of the Physician resource management committee for specialties
(COGEMS), which brings together the Fédération des médecins spécialistes HELPFUL TIP: BEWARE OF PROMISES
du Québec (FMSQ) and the Ministry of Health and Social Services (MSSS). Do not count on promises of positions from your staff
The Fédération des médecins résidents du Québec (FMRQ) also sits on the physicians or department heads. Even if these are made in
COGEMS as an observer. good faith, if there is no PEM available, you will not have
access to the positions sought.
WATCH OUT FOR VIRTUAL PREMs
If you come across any virtual positions—positions available
in the physician resource plan on the Ministry site which an HOW TO CHOOSE A PRACTICE LOCATION
establishment tells you have been filled or there is no inten- Professional interests
tion of filling—we advise you to take the following steps: • Type of practice sought
1) Send in a formal appointment application anyway; • Availability of other professionals and technical platforms
2) Wait for the establishment’s response; • Existing care team (sharing of tasks, dynamics, philosophy)
• Operating time and type of surgery granted
3) If the position is denied and the letter specifies
for surgical disciplines
that the establishment does not intend to recruit
• Type of clientele served (needs)
for the position allocated by the MSSS, get in
• Hospital obligations and privileges
touch with the FMRQ so we can investigate
• Career sought (academic or other)
the situation and lobby the Ministry to have
• Time allowed and recognized for research,
the position moved.
where sought
• Responsibility for teaching
Personal interests
WATCH OUT FOR “PROFESSIONAL SUICIDE” PREMs • Social and cultural life
Some positions are located in regions where practice in a given • Quality of life
specialty is limited owing to the quantity and diversity of cases, • Access to schools for children
or because the physician will have to practise solo. These positions • Distance from family
are seen as leading to professional suicide, since they could • Part-time schedule
make it impossible for the doctor to return to practise in another
setting owing to loss of expertise, which is known to occur quite
rapidly in medicine, depending on the conditions. In such cases,
the FMRQ recommends that service corridors (network positions)
be established instead, to enable candidates for these positions
to maintain their knowledge and technical abilities while sharing
responsibility for delivering care with other physicians in the
department of the partner hospital.
12 | LE BULLETINGuide to Practice 2018-2019
Extensions of Training/Fellowships
in Quebec FELLOWSHIPS IN NON-FM SPECIALTIES—IN BRIEF
• Complete the fellowship application form;
To Obtain a Position in a University Setting
• Before having the form signed, email it to the person
To obtain a position in a university setting, a fellowship of 3-12 months’
responsible in the office of the faculty’s Associate Dean for
duration is required. For any extension of training of one year or more
Postgraduate Medical Education for validation and confirma-
paid by RAMQ, you must apply to the faculty concerned, using a special
form available on the medical faculty sites. The application must meet the tion that everything is complete and meets the requirements;
requirements of the sought-after practice setting. You must also submit a • Once the form is validated, print it out and obtain
letter from a director of professional services undertaking to host you for the required signatures;
your fellowship, along with confirmation from the facility/establishment • In cases of applications for university or non-uni-
that will be receiving you following your fellowship. versity recruitment, the MSSS requires that your PEM
absolutely must be confirmed, and that your application
Fellowships paid by RAMQ as of July 1, 2020
be accompanied by the letter of confirmation from
For those planning a fellowship as of July 1, 2020, you should note that the the DSP for your recruitment and from the Board
rules will be changing slightly next year. Fellowship applications will have to of Directors of the establishment recruiting you.
be sent to the Office of the Associate Dean in the fall (date to be determined Otherwise your application will be rejected;
by the medical faculties). This will enable the associate deans, and then the
• In the case of PEMs associated with the re-
committee responsible for evaluating applications at the MSSS, to forward the
tirement of a physician, a letter is required from the said
results to candidates by the March 1 before the fellowship starts.
physician confirming the effective date of his retirement;
• When you have all the signatures, send the form
IMPORTANT by email, in a single PDF file also containing the
Your fellowship must be carried out in a facility in a university letter and other required documents;
network other than the network where you will be
• Any incomplete application will not be considered;
practising. If you have obtained a position in the McGill
University network, for instance, you will not be able to • Confirmation of your fellowship will be emailed to you
perform your fellowship there. In the case of a fel- by the MSSS;
lowship for recruitment in an establishment with • Upon receipt of this positive reply, you will be invited by
a university designation, the faculty submitting the Office of the Associate Dean for Postgraduate Medical
your application is the one where you will Education to complete your admission application online and,
be recruited upon completion of that training. where applicable, to forward the documents required
for your admission file.
To Obtain a Position in a Non-university Setting
Fellowships performed to obtain a position in a non-university setting TIMETABLE FOR FELLOWSHIP POSITION
may be for less than 12 months. They must be supported APPLICATIONS 2018-2019
by a faculty of medicine, and the candidate must hold a position in
• Deadline for submitting application to faculties:
a PEM to be able to perform this training in Quebec. In the case
February 1, 2019
of a fellowship for recruitment in a non-university setting,
• Review of all applications by associate deans
the faculty submitting the application is the one where
for postgraduate medical education: February 2019
the candidate will be performing his training.
• Publication of review results/Transmittal to MSSS:
N.B. Training of less than six months’ duration does not To be confirmed
require confirmation of a PEM.
• Review of files by MSSS (8 weeks): March-April 2019
• Dissemination of results to candidates by MSSS
via email: May 2019*
* The MSSS undertakes to convey confirmation of fellowship positions
to applicants eight weeks before said fellowships begin.
FALL 2018 | 13Guide to Practice 2018-2019
Extension of Training
FELLOWSHIPS NOT PAID BY RAMQ
Any application for an extension of training other than for a fellowship must
be addressed to the Office of the Associate Dean for Postgraduate Medical Doctors having performed their postgraduate education (residency)
Education of the medical faculty where you intend to carry out your extension of in medicine in Quebec who do not obtain a fellowship position paid by
training and, where applicable, to the home faculty of the hospital establishment RAMQ cannot perform a fellowship in Quebec, even if they could receive
which will be recruiting you when this extension of training is completed. It is a bursary, or if they have the funds necessary to subsidize their training.
not necessary to hold a PEM to be authorized to perform this training, but a These doctors will therefore have to perform their fellowships in
place has to be available for you in line with the quotas imposed by the MSSS, another province, in the United States, or elsewhere. Note that the
without exceeding the maximum number of positions authorized in each number of fellowships paid by the Ministry of Health and Social Ser-
program, category and subcategory, as determined by the government order. vices is not necessarily equal to the number of positions in university
Exceptions settings allocated the same year. So it is possible that, although you
have obtained a position in an establishment’s physician resource
Extensions of training involving the pursuit of enhanced skills in Emergency
plan (PEM), you might have to perform your fellowship outside
Medicine and Adult Critical Care Medicine, along with specialized training in
Quebec if your application has been denied by the MSSS.
pediatrics where the matching is ensured by CaRMS, are not subject
to this procedure. In addition, no fellowships paid for by RAMQ may be performed in a
private practice (clinic) setting in obstetrics-gynecology.
To access the instructions and application form for extension of training,
you may consult the following sites:
University of Montreal
Career in Research
https://medpostdoc.umontreal.ca/etudiants/reglement-et-politiques/
poursuites-de-formation-et-demandes-de-formation-complementaires/ Clinician Investigator Program (RCPSC)
Applications for admission to the Royal College of Physicians and Surgeons of
McGill University Canada (RCPSC) Clinician Investigator Program do not require the DSP’s
https://www.mcgill.ca/pgme/admissions/formation-complementaire signature or confirmation of a position in a PEM. But they are subject
to a specific process, the rules for which vary slightly from one faculty
Laval University
to another. This program offers integrated, structured, rigorous research
Contact the Advisor, Postgraduate Medical Education, training during residency, with a view to a career as a clinician investigator.
Véronique Gagné-Bergeron, at gestionempd@fmed.ulaval.ca There are three possible streams or pathways:
or etudes-postmd@fmed.ulaval.ca
• Continuous training pathway, involving 24 months of continuous
University of Sherbrooke research starting in the final year of the specialty program (R5
Contact Jean-François Duval, of the Office of the Associate Dean for for a 5-year program, R6 for a six-year program) and running
Postgraduate Medical Education, at coordopostdoc@USherbrooke.ca for one year after the end of the specialty program;
• Discontinuous training pathway, involving research distributed over
The deadline for submitting your application is February 1 a 27-month period that can begin from the first year of residency,
for the academic year starting the following July 1. for residents who already have an MSc or PhD;
• Fractionated training pathway, involving 24 months of training
in blocks of 3 months or more starting in the second or third year
of residency, and one continuous 1 year block after the end
of the specialty program.
14 | LE BULLETINGuide to Practice 2018-2019
Research fields do not concern only the traditional aspects of clinical and Fonds de recherche du Québec – Santé (FRQS)
laboratory-based biomedical research, but also cover such disciplines as Research Scientists
economics, management, social science, and behavioural and information Research scientist positions are intended for specialist physicians signing
science as they apply to health and disease. Medical residents success- on to the Memorandum of agreement concerning the establishment
fully completing this program receive a Diploma of Specialized Studies of special pay terms and conditions for research scientists (Protocole
(Diplôme d’études spécialisées) from the university and a Certificate d’accord concernant la mise en place de modalités de rémunération
from the RCPSC. Candidates have to register in an MSc or PhD program particulière pour les chercheurs-boursiers). Any doctor wishing to perform
to do this training, unless they have already obtained such a degree a fellowship to obtain such a position must hold a compliance notice
in the past. Medical residents are paid normally during the specialty from the establishment where he wishes to practise. As soon as a doctor
program and during the year of extended training. withdraws from the Memorandum of agreement, he must take a position
available in his original specialty or subspecialty. If the PEM is full, he will
Procedure be considered surplus to the PEM until the next departure of a physician
• Complete the admission form for the Clinician Investigator Program; resource in the same specialty.
• Forward the form and the required documents to the Office
of the Associate Dean for Postgraduate Medical Education
by the deadline (January 15 for the academic year beginning
Fellowships Outside Quebec
the following July 1); The MSSS does not fund fellowships outside Quebec. Candidates for
• The documents will be sent on to the program concerned; that type of fellowship must obtain funding through their own devices
(establishment where they will be training, hospital department where
• The program admission committee will review the application, determine
they intend to return to practise, foundations, bank loans, etc.).
whether it grants an interview, and make its recommendation to the
Nevertheless, to ensure that you have a position on your return, it is
faculty, which notifies the candidate of the decision.
preferable to obtain a compliance notice prior to your departure confirming
Required documents for such a fellowship include a letter of intent, your integration in an establishment in Quebec. Otherwise, you cannot
an application form for admission to the Clinician Investigator Program, be guaranteed a position on your return.
a letter from the specialty program director, a letter from the professor
Fellowships Elsewhere in Canada
who undertakes to direct the candidate, a copy of the candidate’s
up-to-date Canadian Common CV (CCV), and an official transcript Those planning to pursue further training in another province enjoy certain be-
nefits. In some cases, their fellowship will be recognized by the Royal College
of university courses taken, excluding the MD.
of Physicians and Surgeons of Canada. Also, such training may be paid,
either through non-taxable bursaries from the establishment or from funds
IMPORTANT awarded by the fellowship director. It is also much easier to obtain a permit
The terms and conditions presented here correspond to what is to practise in the province in question, owing to the recognition of the Royal
posted on the University of Montreal medical faculty site. They College specialist certification across Canada. You can thus practise—perform
largely represent what is required by all Quebec medical moonlighting—part-time, and that provides an additional source of funding.
schools. We do, however, invite you to consult the Website Do make sure, though, that your training site knows about your moonlighting,
or contact the Office of the Associate Dean for Postgra- to avoid any misunderstandings. Also, health insurance coverage for you and
duate Medical Education of the faculty where you wish to your loved ones is much simpler to confirm, in view of the provincial health
do this training to ensure that you follow the steps specific insurance programs that are recognized Canada-wide, and the school system is
to each faculty. easily accessible for children.
Fellowships in the United States
To perform a fellowship in the United States, you must find out from
the Medical Board (College of Physicians) of the state concerned what
the requirements are for doctors from outside the United States. If you
have to perform medical acts, you will also have to make sure you have
the permit appropriate to this practice, and to obtain the malpractice
insurance coverage that will enable you to practise without any concern.
FALL 2018 | 15Guide to Practice 2018-2019
United States Medical Licensing Examination (USMLE) Other Aspects to Consider
The basic exam you must pass to obtain a permit to practise medicine Permit to Practise and Malpractice Insurance
in the United States, the USMLE can be required of doctors performing To deliver care in another jurisdiction, you will have to obtain a permit to
further training in the U.S., but this is not mandatory in all states. practise. Contact the Medical Board or College of Physicians in the country
For more information on the requirements concerning the exam, concerned, or the establishment, to find out the requirements in this
consult the 2018 Bulletin of Information on the USMLE site at regard. You will also have to take out malpractice insurance coverage that
https://www.usmle.org/pdfs/bulletin/2018bulletin.pdf meets the requirements of the state or country concerned. Unfortunately,
the Canadian Medical Protective Association (CMPA) does not cover
To find out the requirements for practising in the U.S. state where you
medical acts performed outside Canada. The medical authorities in the
will be performing your fellowship, you may get in touch with the Medical
country or the establishment will be able to guide you in this regard.
Board (College of Physicians) of the state concerned. Medical boards are
listed on the Federation of State Medical Boards site at Health Insurance Coverage
http://www.fsmb.org/policy/contacts Find out from the Quebec Health Insurance Board (RAMQ) whether you
Fellowships in France will be covered during your stay abroad. Although RAMQ‘s coverage is
inadequate, it is still necessary. To cover any additional costs, you can
The procedure for performing a fellowship in France involves steps specific
take out health insurance coverage on-site, through the department or
to that country. Indeed, since the adoption of the Mutual Recognition
establishment where you will be pursuing your training. They can usually
Arrangement whereby physicians trained in France can come to practise
include you in the insurance programs in effect for medical residents
in Quebec and those trained in Quebec can obtain a permit to practise
or staff physicians on-site, as applicable.
in France, the terms and conditions for obtaining a permit for Quebec phy-
sicians performing a fellowship in France have changed. A “notwithstan- Work Visa
ding clause” specific to Quebec “students” has been adopted, enabling You will need a work visa in the country where you will be performing
candidates to obtain a permit that allows them to perform diagnostic and your fellowship. The application procedure must be carried out in advance
therapeutic medical acts and obtain malpractice insurance. The duration via the consulates concerned, as well. Also, if your spouse is to accompa-
of this fellowship is usually one year. ny you on your fellowship, make sure he or she has a visa allowing him
For further information, please consult the France Visas site at or her to stay there with you beyond the period allowed for a tourist—
france-visas.gouv.fr/en_US/web/france-visas/salaried-employment six months in the U.S., for instance. You will also have to find out about
under Internships/Associate intern doctor or pharmacist. You may also the rules concerning the possibility of you or your spouse working during
get in touch directly with the Consulate General of France in Montreal, this visit. Some countries, such as the U.S., are very strict about this,
by calling 514 878-4385, or by faxing an application to the Visa Section and a job that does not comply with the rules could lead to your expulsion
at 514 878-6272. As a physician, you will also have to obtain your from the program—and from the country.
temporary permit from the National Council of France’s Order of Physicians Home and Automobile Insurance
(Conseil national de l’Ordre des médecins). For details, visit
You will also have to insure your property in the host country. Check with
www.conseil-national.medecin.fr/node/1499.
your insurance company whether there are comparable firms in the host
Fellowships in other countries country, or get in touch with SOGEMEC Assurances, who offer special
As with the United States, we suggest you initiate matters quite far services in such cases. They can be reached at 514 350-5070
in advance if you want to perform a fellowship abroad. Each site has or 1 800 361-5303.
different rules. Ideally, we suggest you visit, to meet ahead of time Driver’s Licence
with the fellowship director and the team with whom you will have
You will also have to obtain a driver’s licence from the jurisdiction where
to work in the context of your further training.
you will be pursuing your further training. You could be asked to pass
a new driving test.
16 | LE BULLETINYou can also read
