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Transition to Practice Guide

TPP guide screenshot 1The Ontario College of Family Physicians Residents Committee developed the following resources to support you during the transition to independent practice. Scroll below for a step-by-step guide to help you feel confident during this time. This is also available in PDF.

Table of Contents 

Key Resources for Transition to Independent Practice

Exams Prior to Practice

Professional Membership

Insurance

Email

Family Medicine Models

OHIP Billing Number

WSIB Ontario Number

Moonlighting (PGY3s/Fellows)

Rural Family Medicine Incentives

Hospital Privileges

Finding a Job

Key Resources for Transition to Independent Practice 

The Ministry of Health and Long-Term Care (MOHLTC) is responsible for the administration and provision of public healthcare in Ontario.

The ministry’s must-read Online Resource Manual for Physicians contains important information, including the following:

  • How to register to receive an OHIP billing number.
  • An overview of the Schedule of Benefits, monitoring of physician claims and the claims submission process.
  • Details on registering for Ontario health coverage.
  • Lists of applicable acts and regulations.
  • Description of interrelated programs.

“TiPS” Toolkit

Health Force Ontario (HFO) Marketing and Recruitment Agency is now part of Ontario Health. HFO has developed a comprehensive Transition into Practice Service (TiPS) toolkit.  The chart below lists select modules from the TiPs toolkit you may find especially helpful as you start your independent practice in Ontario:

Countdown to Practice: Guidance for the paperwork and steps necessary to begin to practise independently

Finding Your Ideal Practice: Details on how and where to search for practice opportunities, resources to help you evaluate practice opportunities, tips for developing your CV and interview advice.

Compensation, Incentives and Benefits: For both new graduates and established physicians, an overview of the types of compensation, incentives and benefits available to Ontario physicians

The Business Side of Medicine: An overview of personal and professional planning, legal services, electronic medical records, building your practice and improving service quality for Ontario physicians

Providing Locum Coverage in Ontario: An overview of the locum experience, how to find locum opportunities in Ontario and a summary of different provincial locum programs

Teaching as Part of Your Practice: How physicians can become involved in educating medical learners as faculty for medical schools in Ontario or in a distributed medical education program

Physician Well-Being: Resources for Ontario physicians to support various aspects of health, including physical, mental and spiritual wellness

Physician Resources: A compilation of vital physician resources covering a wide variety of topics relevant to practising medicine in Ontario

Taking Over a Family Practice: Joining a Group Patient Enrollment Model: A step-by-step guide to ensure a smooth transition when taking over an established family practice

Additional Practice Management Resources

Joule is a Canadian Medical Association (CMA) subsidiary focused on assisting physicians in the pursuit of clinical excellence by accelerating physician-led innovation and adoption of advances that deliver quality health and patient care. Joule is a Canada-wide company and focuses on all medical specialties. It offers general practice management resources (accessed via your CMA account) and checklists, such as these:

The Ontario Medical Association (OMA) offers several resources to help you get started. It has prepared a guide that provides advice on starting and managing a practice, general principles of OHIP billing, professional obligations, how to avoid common mistakes, handy practice checklists, guidelines on the timing of necessary steps and more. The guide is not specific to family medicine, but it does focus on establishing a community practice. 

OMA early career seminars expand on these topics and are hosted throughout the year. Interactive eLearning modules are also available on a variety of topics relevant to physicians’ everyday practice. Several practice-based discounts are also available through the OMA’s exclusive affinity program:

Exams Prior to Practice

You must pass examinations before completing your residency to be eligible to receive an independent practice licence in Ontario through the CPSO, as follows:

Medical Council of Canada Qualifying Examinations (MCCQE)

You can apply for both MCCQE Part I and Part II through your ca account. Find more information about the exams here.

  • Part I is a written summative examination typically completed at the end of medical school (or during residency if necessary) that assesses both medical knowledge and clinical decision-making.
  • Part II is a two-day clinical examination completed during PGY1 or PGY2 that assesses your ability to apply medical knowledge, therapeutic plans and professional behaviour. You must have passed Part I before you attempt Part II.

College of Family Physicians of Canada (CFPC) Certification Examination in Family Medicine

This two-part examination is completed over two days, with opportunities to undertake the exam every spring and fall.

  • The written component is a four-hour computer-based exam composed of short-answer management problems (SAMPs).
  • The oral component is composed of five 15-minute simulated office oral exams (SOOs).

You can apply for the spring or fall sitting through the CFPC platform. Find more information about the exam here.

 Sources: CFPC: Certification Examination in Family Medicine, Health Force Ontario

Exam Preparation

The OCFP offers a preparatory workshop for the CFPC Certification Exam. The workshop allows practice-eligible candidates an opportunity to train for and participate in mock exams, learn about the test components of the CFPC Exam and become familiar with the marking criteria before they sit for the actual exam through CFPC.

Your Professional Advisory Team

To help make your transition to practice as smooth as possible and to support you in business matters, it is important to have support from a team of professionals with expertise in areas outside of medicine.

These professionals charge for their services so carefully consider the value you are getting. Ask for recommendations from colleagues and friends, search your local area and do not hesitate to interview several candidates to ensure good rapport before deciding on your team members.

Here are the most common service providers and what you can expect from a professional:

Accountant

  • Setting up your business, including advice on structure and incorporation.
  • Bookkeeping and tracking your finances.
  • Preparing personal and corporate income tax returns (including tax deductions and credits and how to use them effectively).

Lawyer

  • Drafting and reviewing contracts when you’re starting a practice (consider legal advice before signing any contract).
  • Advising on incorporation.
  • Choosing and assigning your Power of Attorney (POA).
  • Drafting your will.
  • Reviewing real estate purchase agreements.

Insurance Advisor

  • Reviewing and advising on your need for insurance for disability, life, personal liability, home, auto, office, overhead and critical illness).
  • Advising on consideration of your debt, financial responsibilities and dependents (including children).

Financial Advisor

  • Guiding you on saving, budgeting, investing and developing a debt reduction strategy.
  • If you are considering doing these tasks on your own, it’s essential to first become informed (The Physician Financial Independence Facebook group is one source for advice and resources).

Banker

  • Setting up chequing, savings and investment accounts; credit cards; and, as needed, a professional line of credit, which can offer a preferential interest rate (prime minus 0.25% is typical). 

Sources: OMA: Starting a Practice: A Guide for New Physicians, Joule: Checklist – Getting Started as a Professional

Professional Memberships

You need to know about the professional membership associations, regulatory and legal protection/insurance organizations that serve family physicians in Ontario. Many of these memberships are mandatory to practise in Ontario.

Provincial and National Medical Associations 

Ontario Medical Association is a membership organization that represents physician interests at the provincial level and provides members with physician-centred resources, opportunities and supports. 

What You Get: Access to various resources, including exclusive discounts and offers, billing resources, legal incorporation support, advocacy tools, health policy guidance, insurance, legal affairs support and a retirement savings program. Opportunities to network, build relationships and engage in leadership roles through member-run committees and elected positions.

Membership Requirement: Mandatory to practice in Ontario

Of Note: Since this membership is mandatory, the membership fee will be collected from OHIP billings or direct payment to the OMA.

More information: 

•  Sign up through the OMA’s website.
•  Fees website

Canadian Medical Association is a national voluntary association of physicians. It represents and advocates for physicians and healthcare across Canada.

 What You Get: Access to various clinical resources, medical journals, textbooks, exclusive discounts for clinical tools and services, physician wellness resources and advocacy opportunities.

Membership Requirement: Optional

Of Note: The CMA is the national organization; the OMA is the provincial branch.

More information: 

Regulatory College

College of Physicians and Surgeons of Ontario is the regulatory body of medical practice in Ontario.

What You Get: A CPSO number (Certificate of Independent Practice), which is required for independent, unsupervised practice upon graduation from residency.

Membership Requirement: Mandatory to practise in Ontario.

Of Note:  Supporting documents required to obtain CPSO number:

  • Copy of medical degree
  • Proof of Canadian citizenship/Permanent Resident status
  • Criminal record check, valid for six months
  • Confirmation of Completion of Training letter from program director
  • Testing for HIV and hepatitis B and C within 12 months

Apply through physiciansapply.ca:

  • You must obtain authorization from CPSO to apply through the portal by emailing [email protected] with confirmation that you are taking the CFPC exam +/− MCCQE.
  • For out-of-province residents, additional documentation is required.
  • Applying online is advantageous if you are planning to apply to multiple provinces for independent practice.
  • You must reapply for a CPSO number (even if you are a current family medicine resident in Ontario and already have your resident CPSO number). You will need an up-to-date police record check, blood work (HIV, hepatitis), CV, proof of training, etc.

More information: 

Medical Legal Protection and Insurance

Canadian Medical Protective Association is a membership-based, not-for-profit organization that provides members with resources, legal advice and services.

What You Get: Liability protection for meeting the ethical expectations of a physician.

Membership Requirement: Mandatory to practise in Ontario.

Of Note: 

  • Application processing time is around 2 weeks.
  • You must transition your insurance to cover you for independent practice. Here are the steps for making the change from a resident to an independent licence:
    • Call the CMPA if you already have a CMPA number to notify CMPA of the change and the date it will take place to ensure you have the correct coverage.
    • Additional documents and/or formal application are not generally required.
  • You can defer payment of CMPA membership fees for up to 6 months.
  • Pay either once per year (Option A) or by monthly automatic payment (Option B):
    • Option A: you receive your reimbursement from MOHLTC, as part of its Medical Liability Protection Reimbursement Program, in advance of paying your CMPA fees.
    • Option B: you receive four quarterly reimbursement payments.

More information:

National and Provincial Family Medicine Associations

College of Family Physicians Canada is the professional organization responsible for establishing standards for the training, certification and lifelong education of family physicians and for advocating on behalf of the specialty of family medicine, for family physicians, and for their patients.

What you get: Access to up-to-date research, resources, Mainpro+ programs, continuing professional development, advocacy/leadership opportunities and more.

Membership Requirement: Automatic once you complete your accredited training program. Optional later on.

Of Note: Every July 1, you can renew your membership (no associated fee).

More information: 

Ontario College of Family Physicians is the only organization focused exclusively on the value and experience of being a family physician in Ontario. It advocates for family medicine and provides continuing professional development tailored to the needs of family doctors and supporting the delivery of quality care in Ontario. More than 15,000 family physicians and residents are members of OCFP because of the work the College does to support family physicians through education and practice supports, celebrating excellence and advocating for the role family physicians play in the health system and in patients’ and communities’ overall health and wellbeing.

What you get:

Access to member-only updates and information for Ontario family physicians, resources, Mainpro+ programs, continuing professional development, advocacy/leadership opportunities and more:

Of Note: You are automatically assigned membership through the CFPC.

Level of Requirement: Automatic once you complete your accredited training program. Optional later on.

More Information: 

Insurance and Email

Insurance

Remember to renew your disability insurance so there is no gap between the end of residency and the start of your practice. Also consider group medical and dental and term life insurance, the latter especially if you have dependents.

Email

  • Apply for a OneMail email account if you don’t already have one.
  • OneMail is an encrypted email service for secure communication and is a database of physician email addresses.
  • To sign up for an account, visit OneMail.

Family Medicine Models

You can practise family medicine in Ontario in a number of models. Figure 1 illustrates the types of practices and, with the following descriptions, can help guide your decision on what model best suits you.Family Medicine Models Chart  

Figure 1. Various practice and payment models for family physicians.

Payment Models

Fee-for-Service (FFS)

  • Description: The simplest and most common form of payment. Used by all practice models, but the percentage of the fee paid to the physician may differ across models. FFS physicians receive 100% of the Schedule of Benefits fee value.
  • Details: The physician or billing agent bills OHIP according to the Schedule of Benefits (updated April 1, 2020).

Enhanced Fee-for-Service

  • Description: Payment model for Comprehensive Care Model and Family Health Group practices – see below.
  • Details: Physicians are paid primarily through FFS, with additional payment through bonuses and premiums.

Blended Capitation

  • Description: Payment model for Family Health Network and Family Health Organization practices – see below.
  • Details: Physicians are paid a base rate for each patient on their roster (adjusted for age and sex), a percentage of FFS billings, and bonuses and premiums.

Other

  • Complement-based base remuneration + bonuses and incentives. Applies to Rural and Northern Physician Group Agreements (RNPGA).
  • Blended salary model (BSM). Applies to Community-Sponsored Family Health Teams.
  • Salaried model. Applies to Community Health Centres.
  • Alternate funding plan. Applies to GP Focused Practices such as HIV, palliative care and care of the elderly.

Practice Models

Walk-in Clinic

  • Description: Episodic care of patients in a community.
  • Details: Patients are enrolled under another family physician or do not have a family physician. These clinics are usually attended for convenience or after-hours care.
  • Compensation: 100% FFS.

Solo Practice

  • Description: Independent physician practice.
  • Details: Physician provides continuity of care for their patients. Physician is not tied to any physician group and there are no financial incentives to provide comprehensive or after-hours care.
  • Compensation: 100% FFS (few additional fees are available).

Comprehensive Care Model (CCM)

  • Description: An enhanced model of care for solo physician practices.
  • Details: Designed to incentivize independent physicians to provide comprehensive healthcare (such as preventive screening) to their patients. Must provide at least three hours of after-hours care once a week.
  • Compensation: 85% FFS + 15% incentives and enhanced fees.

Family Health Group (FHG)

  • Description: A FHG (pronounced “fig”) is a collaborative model that requires a minimum of three physicians (not necessarily in the same location).
  • Details: Designed to incentivize groups of physicians to practise comprehensive healthcare. Must provide after-hours coverage.
  • Compensation: 85% FFS + 15% incentives and enhanced fees.

Family Health Network (FHN)

  • Description: A FHN (pronounced “fin”) is a collaborative model that requires a minimum of three physicians.
  • Details: Comprehensive primary care is provided in an “area of high physician need” (as determined by MOHLTC). Must provide after-hours
  • Compensation: 75% through capitation (guaranteed income) and 25% other (including 15% of FFS billings + bonuses and premiums).

Family Health Organization (FHO)

  • Description: A FHO (pronounced “foe”) is a collaborative model that requires a minimum of three physicians.
  • Details: Comprehensive primary care is provided in an “area of high physician need,” similar to a FHN. Must provide after-hours coverage.
  • Compensation: 75% through capitation (guaranteed income) and 25% other (including 15% of FFS billings + bonuses and premiums). Differs from a FHN in base rate, basket of core services and bonus amounts.

Family Health Team (FHT)

  • Description: These community-centred comprehensive primary care organizations aim to provide services and programs to specific communities.
  • Details: Interprofessional health teams comprise family physicians, registered nurses, nurse practitioners, social workers, pharmacists and dieticians.
  • Models: FHOs, FHNs and RNPGAs may be organized as FHTs.

 Sources: Ontario Ministry of Health and Long-Term Care, OMA Primary Care Model Overview, OMA Primary Care Comparison Chart, Health Force Ontario Chart

OHIP Billing Number

Your Ontario Health Insurance Plan (OHIP) billing number is required to submit claims for the insured services you provide. Note the following:

  • You can apply for a billing number once you have been approved for an independent practice certificate by the CPSO.
  • You can begin practising while you await your billing number, as long as you have your CPSO independent practice licence. You can then bill retroactively for the services you provided for up to six months. However, it’s important to realize payment for your work in this period would be delayed.
  • You may submit an OHIP billing number application form before receiving a CPSO independent licence, but your OHIP application will not be processed until your CPSO licence is confirmed.
  • Generally, it takes a couple of months for the application to be processed and to receive your billing number.
  • Requirement: Your CPSO independent licence number (in order to apply). Your application can be emailed, faxed or mailed through the MOHLTC website.
  • Cost: Free
  • Processing time: 4 to 8 weeks
  • Tips:
    • Download the OHIP billing/fee schedule before beginning to practise and keep it handy.
    • Think about setting up your EMR/billing software and whether you will do your own billing or hire someone to do it. You can pay a billing agent to bill OHIP on your behalf (which can help ensure full payment for the services you provide) or you can save money by doing it yourself if you have the time and inclination.

WSIB Ontario Number

  • WSIB Ontario (the Workers’ Safety and Insurance Board) provides wage-loss benefits and medical coverage in certain cases when injury or illness occurs in the workplace.
  • Why apply for a WSIB number: Physicians who treat injured and ill workers must be registered with WSIB Ontario to bill WSIB Ontario for such services.
  • Requirements for registration:
    • Your CPSO number
    • Your OHIP billing number
  • Timelines:
    • Apply after your residency
    • Processing generally takes 4 to 6 weeks.
  • Apply: Register online or complete and mail or fax this application form. Learn more about becoming a WSIB healthcare provider.

Setting up Online WSIB Billing (eBilling)

  • The WSIB can process invoices for services through its eBilling system, which is administered by Telus Health Solutions through a secure server. Online WSIB billings pay you more and are quicker than paper billing.
  • To register for WSIB’s eBilling service and to receive your provider billing number, visit the Telus Health website. You can also call Telus at 1-866-240-7492 for more information (number may be subject to change). This WSIB physician billing wizard can help you determine when to bill WSIB.

Moonlighting (PGY3s/Fellows)

First, speak to your program director

  • Talk to your program director (ideally before PGY3 starts) about policies on moonlighting. For example, most will want to ensure you follow Professional Association of Residents of Ontario (PARO) guidelines for duty hours, breaks between shifts, educational activities, etc.
  • If your school or program allows moonlighting and you are interested, discuss it with your program director, who can help clarify your goals and readiness for a moonlighting job. The director will also help structure your curriculum to prepare you and to accommodate your moonlighting position. Here are a few considerations:
    • While moonlighting can be financially rewarding, bear in mind that PGY3 programs are busy and, in themselves, offer significant learning opportunities. Be careful not to over commit.
    • Practising at a position with higher risk could hinder you in the long run. For example, you may encounter challenges you are not trained for that can put you at medico-legal risk and cause significant stress during PGY3 training.
    • Moonlighting may undermine your confidence as a growing independent practitioner. Your program director may be able to provide important insight on locations, including feedback from previous graduates.
    • You are responsible for connecting with the CMPA and CPSO with respect to any moonlighting activities you plan to participate in during PGY3.
    • Many positions require references when you apply. Your program director can assist you with obtaining these as well.

Start seeking opportunities

  • Approach your search for moonlighting opportunities as you would any job search, while understanding that your ability to search may be limited by your academic commitments.
  • Speak with colleagues, previous grads, program directors, leaders at locations where you previously enjoyed training, rural hospital recruiters, etc. This is the best way to make connections.
  • Make sure you are ready to take on the role you are signing up for. You will have the responsibility of an independent practitioner, practising with your own CCFP license.

Ensure your paperwork is complete

  • If you want to moonlight, you must be set up for independent practice, similar to colleagues who graduate after PGY2.
  • You must have obtained your CCFP licence/number and your OHIP billing number.
  • Change your CMPA coverage to Code 14.
  • Obtain hospital privileges as needed.

Consider these additional tips

  • Ensure you are prepared for and comfortable with the role! Know your comfort level and be prepared to turn down opportunities where you would not be able to practise safely.
  • Before stepping into a moonlighting role, you can always take additional courses and complete rotations in the areas of medicine where you would benefit from more training.
  • Because you will be remunerated as a staff physician, you will likely need to do your own billing. Practising this task during PGY1/2 may help ease the transition.

Rural Family Medicine Incentives

Canada Student Loan Forgiveness for Family Doctors and Nurses

What’s available:

  • Forgiveness of up to $8,000 per year, to a maximum of $40,000 (at time of writing, may be subject to change), over five years toward the national portion of your OSAP loans

Eligibility:

  • Be a family doctor or family medicine resident in Canada
  • Have outstanding Canada Student Loans, on which payments are up to date
  • Have been employed for 12 months in a designated community (does not apply to family medicine residents) and provided in-person services for 400 hours (or 50 days); see information page for details on “designated communities” 

Requirements:

  • CPSO registration number
  • Signature of immediate supervisor to verify time employed/period of service

Timeline:

  • Apply after completing 12 months of employment

For details and to apply:

Northern and Rural Recruitment and Retention Initiative (NRRRI)

What’s available

  • Grants from $80,000, up to $117,600 (may be subject to change), with amounts paid quarterly over a four-year period; amount determined by the Rurality Index for Ontario (RIO) score of the intended community of practice (RIO score is a measure of how rural a location is to ensure appropriate funding.).

Eligibility

  • A community is eligible if its RIO score is 40 or greater or if it is in one of five urban referral centres: North Bay, Sault Ste. Marie, Sudbury, Thunder Bay or Timmins.
  • Physician must commit to a full-time family practice in a primary care model (i.e., minimum 40 hours per week).
  • Physician must agree to provide ER coverage, unless exempted by community or hospital.
  • You cannot receive the NRRRI and NPRI financial incentives concomitantly.

Requirements

  • CPSO number and certificate of registration.
  • CFPC certificate of registration.
  • Proof of CMPA coverage.
  • Letter of acceptance from the community for full-time practice establishment.
  • Proof of hospital privileges in the eligible community.

Timeline

  • Application must be received and approved before establishing practice within the community.

For details and to apply

Northern Physician Retention Initiative (NPRI) 

What’s available

  • $7,000 taxable incentive distributed at the end of the fiscal year (may be subject to change).

Eligibility

  • Physician must have completed at least four years of family practice in Northern Ontario and must continue to provide care until the end of that fiscal year.
  • Communities in Northern Ontario are eligible: districts of Algoma, Cochrane, Kenora, Manitoulin, Nipissing, Parry Sound, Muskoka, Rainy River, Sudbury, Thunder Bay and Temiskaming.
  • You cannot receive the NRRRI and NPRI financial incentives concomitantly.

 Requirements

  • CPSO number and certificate or registration.
  • CFPC certificate of registration.
  • OHIP billing number with billing privileges.
  • Proof of active hospital privileges within the community.

 Timeline

  • Applications are usually due before the end of the fiscal year; deadlines can be found on the MOHLTC website.

 For details and to apply

Family Physician Outreach Program

  • This program offers compensation for physicians willing to provide either
    • Primary care clinics in outlying communities with Underserviced Area Program–funded clinics or nursing stations, or
    • Physician telephone back-up to RNs or NPs working in Underserviced Area Program–funded clinics or nursing stations.
  • For details visit the Outreach Program information page.

Rural Family Medicine Locum Program

  • Locums in rural Ontario are available through the Rural Family Medicine Locum Program.
  • Accommodation, travel expenses and course reimbursement (ATLS & ACLS within 12 months) are usually covered for locum physicians.
  • Visit the Health Force Ontario website to learn more about this program.

Hospital Privileges

Please note that you should speak with the hospital(s) where you will be applying to get specific guidance regarding the application process.

In general, you must apply to a hospital to secure an appointment as professional staff before you can provide patient care there. In addition to a completed application form, requirements include the following:

  • Proof of registration with the CPSO
  • Proof of professional liability protection/malpractice insurance (e.g., through the CMPA)
  • Medical education and training certificates
  • Up-to-date CV
  • Vulnerable sector or criminal record check
  • Current photograph
  • Banking information
  • Evidence of current immunization status
  • Copy of work visa and proof of landed immigrant status, if applicable

Reference Letters

Professional references are generally required for each hospital you apply to. In most, but not all, circumstances, a hospital’s application process will require you to provide at least one reference from all hospitals where you have held or hold privileges.

If you intend to work in multiple hospitals, it can become cumbersome to sequentially apply as you will generally be required to obtain a new reference at each hospital for application to the next one. You can reduce your administrative burden by instead applying at the same time to all hospitals where you intend to work. Doing so allows you to use the same references for each application.

Finding a Job

  • Check with your supervisors, department and university for available locums and job opportunities.
  • For regularly updated locum and permanent job postings, visit Health Force Ontario.
    • Check physician-centred Facebook groups for possible locum opportunities; for example, Ontario/Canada First 5 Years of Practice group, Physician Locums Canada group
  • OMA Legal Services will review employment contracts for free for OMA members. Contact your regional OMA representative for details.