Types of positions
Some agreements allowing for the addition of positions are associated with a network position. These positions may be used to recruit a specialist physician in the establishment holding the position, or to recruit a specialist physician in another establishment, i.e., an optional network position, provided a service agreement has been reached between two establishments. Some establishments have a mandatory network position PEM. These positions are generated when a service corridor is created permanently between two establishments. Note that positions are now posted in the table of PREMs in specialties by establishment. Details concerning the facilities are no longer available on the MSSS site. It is now the establishments (CISSSs, CIUSSSs, institutes) which grant the positions on the basis of needs which they establish. It is therefore necessary to get in touch with the DSPs to have this information.
N.B. These positions cannot be based on a single individual, and have to demonstrate a commitment from the medical team and establishments’ administrations to fulfil the associated undertakings (service corridors).
Recruitment in anticipation of a departure/Overlapping PEMs
Even if an establishment’s PEM is full, it may issue a compliance notice for the recruitment of a specialist physician to replace a doctor registered in the PEM who is planning to retire. Resolutions of the establishment’s Board of Directors confirming the acceptance of the departure and the successor’s name are required. Issuance of a compliance notice is conditional upon a written undertaking from the end-of-career physician to leave his position within no more than a year. The departing physician and his successor will be able to hold the same (overlapping) PEM for a maximum of six months.
1 year in advance
1 year in advance
Take up position
6 months prior to the departure or on the departure of the physician holding the position
Locum (3 months)
The purpose of a locum (temporary replacement) is to enable a doctor to take on the clinical and administrative duties of another physician who holds a PEM, who has to take time away from his or her position (illness, sabbatical leave, maternity, etc.). This position does not constitute a permanent position for the replacing doctor, who loses his privileges once the locum is over. It is also possible in an emergency to obtain authorization to practise in an establishment without a position in the PEM (temporary privileges). But this measure is valid only for a maximum of three months, and cannot be renewed. Since the beginning of 2017, however, replacement and temporary privileges have been granted only in exceptional cases, and upon approval by the MSSS.
Temporary privileges of three months’ duration, non-renewable, can be granted in urgent cases. It is the establishments or facilities that are responsible for checking with the Ministry that they can to do so.
Privileges for a locum of longer duration (maternity or extended leave) can be granted solely in special situations, and then only if the team in place cannot guarantee access to care owing to this leave. For instance, a team of at least 10 physicians in a department will not be able to replace the 11th member of the team who is going on maternity leave, because the Ministry considers that the team can provide coverage for the department anyway. Note also that locum requests are made to the Ministry by the establishments/facilities and not by individuals.
Returning from the regions (three-year rule)/Guaranteed PEM
After three years’ continuous practice in a remote or isolated region, a physician cannot be refused entry to another region on the grounds that the region’s PREM or establishments’ PEMs are full.
Nevertheless, if he wishes to obtain a position in a university hospital, he will have to meet the fellowship requirements and receive the agreement of the region’s medical faculty. A physician taking advantage of this rule will be able to do so once only, within no more than 12 months from the date on which he left the establishment in the region. 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.
Recruitment via waiver
When an establishment’s needs warrant, it may apply for its physician resource plan (PEM) to be exceeded temporarily via waiver. A PEM waiver is an exceptional measure, and requests to that effect have to meet strict criteria: candidate’s specific expertise; volume of activity; waiting lists; development (addition of equipment); stabilization of teams (age of practising physicians); establishment of a service agreement; and, in rare cases, humanitarian reasons.
The waiver confers a permanent position on the candidate. The next departure will not be replaced, so as to bring the PEM back to its desired level. Waiver applications are reviewed by the members of the Physician resource management committee for specialties (COGEMS), which brings together the Fédération des médecins spécialistes du Québec (FMSQ) and the Ministry of Health and Social Services (MSSS). The Fédération des médecins résidents du Québec (FMRQ) also sits on the COGEMS as an observer.
The waiver application must be made to the Ministry by the establishment. All applications are reviewed by the Physician resource management committee for specialties (COGEMS), which brings together the MSSS and FMSQ. The COGEMS draws up a recommendation, and the final decision lies with the Associate Deputy Minister with the Health Services and University Medicine Branch (DGSSMU) at the MSSS.
Elements generally required with any waiver application are the following:
A) General information
Region/Name of establishment/Specialty
B) Information on the PEM
Number of positions authorized; number of resources in place; number of positions vacant; departures announced in the team (if yes, explain); recruitment under way, as applicable.
C) Information on the candidate
Name; permit number; type of permit; expected date of arrival; summary of career path; special expertise; resumé to be attached as required.
D) Detailed description of grounds for application
Description of the exceptional nature of the application, and how it could not be predicted during the planning process; reasons for and added value of recruitment; link with establishment’s mission; considering current physician resources, how this recruitment is necessary;statistical data on volume of activity, waiting lists; description of current service offering, and future offering should the candidate arrive; letter(s) of support to be attached as applicable (affiliated university, department head, etc.).