After Residency

Transitioning to a Clinical Fellowship
Transitioning To Practice
How to Apply for Independent Practice Licence
How to Apply for OHIP Billing Number
Long-Term Disability Insurance After Residency

Transitioning to a Clinical Fellowship

Thinking about applying for a Clinical Fellowship after residency? PARO is here to help you navigate the process. Below are the questions we get asked the most.

What is a clinical fellowship?

It’s a post-residency opportunity that enables you to obtain advanced training or more specialized expertise not normally acquired during your residency. Worth noting, this short-term educational experience does not lead to specialist recognition by the Royal College of Physicians and Surgeons of Canada (RCPSC).

What are the benefits of a clinical fellowship?

There are so many advantages! First off, you’ll gain experience in an area that interests you while also working with experts in your field. Additionally, it’ll improve your access to job interviews, make you more marketable, advance your chances of securing a higher paying position and provide you with a competitive advantage in your field. It may also assist you in securing an academic or research position, while developing a niche set of skills.

How do I identify a clinical fellowship opportunity?

The best way to get started is to speak with your mentor and supervisors about which fellowships they believe are the most reputable. It’s also a good idea to reach out directly to a few programs that interest you and ask for information about what opportunities are available. Networking is also helpful, ie: connecting with residents in your specialty who have done a clinical fellowship and/or attend conferences and build relationships with those in your field.

What do I need to know about the application and interview process?

Do your research and apply early.
Ask about the interview process in advance so that you can prep properly.
Talk to residents who went through the application process. Real-life stories will give you information you’ll never find elsewhere.
Obtain dates/times for applications to be submitted and for the interview.

What types of questions should I ask before accepting a position?

As a clinical fellow, you won’t be covered by the protections of a collective agreement, such as the PARO-CAHO Agreement, so it is very important to ask about wages, work conditions, benefits and vacation. Specifics include:

Work hours/call obligations
Expectations about clinical vs research time
Level of independence/relationship with supervisor
Requirement to supervise others

We also recommend that you ask about the program’s educational objectives for the fellowship. Specifically, do they match yours? And, last but not least, ask for the contact information of past fellows so you can get their feedback on the fellowship experience and the job opportunities that followed.

How do I boost my chances of securing a fellowship?

Great question! Here’s what we recommend:

Ask your staff and supervisors to provide you with a written reference
Make sure your CV showcases your accomplishments
Apply broadly and be willing to consider more than your top 1 or 2 choices
If possible, do an elective or observership with the institution/program you are interested in.

Will I get health benefits during this time?

Not necessarily, so make sure to ask about this during the interview. If you are not able to negotiate health benefits, consider signing up for OPIP (OMA Priority Insurance Program) or a similar provincial program. Of note, if you’re applying for a US fellowship, health insurance is a condition of the J1 Visa, so you should be covered. But to be safe, confirm rather than assume.

Is it difficult to obtain a US Visa?

The short answer is yes, even more so in these days of global restrictions. We recommend you start the process as soon as you accept your fellowship offer. Your University or hiring institution may be able to help you with the application process, so start there. One of your requirements will be to obtain a Statement of Need from Health Canada. This is a document that confirms you intend to return to Canada and practice medicine after the program ends. Click here for more information.

Is there a standard fellowship contract?

Typically, fellowship contracts are fairly basic, so it’s important for you to confirm key details about remuneration, benefits and responsibilities before accepting the fellowship. Check out this link from the University of Toronto’s Department of Medicine which offers Clinical and Research Fellowship Offer Letters that provide a framework for topics you might want include in your contract.

Still have questions? Please message us and we’ll do our best to get you an answer.

Transitioning To Practice

Congratulations, doctor, on completing your residency and moving on to the next phase of your career. Mixed in with the euphoria and elation at having achieved such a laudable goal, you’re probably feeling a tad overwhelmed.

There’s so much to do as you enter this next phase — whether that’s independent practice or more training in a fellowship — it’s difficult to know where to begin.

To help you, we’ve listed a few of our favourite links, as well as provided information on getting licensed and getting your OHIP number, thus ensuring you make a seamless transition.

For starters, check out the Ontario Health-Health Force Transition into Practice Service. Their online modules provide practical, career-focused information sourced from experts throughout Ontario’s healthcare sector. In addition, HFO advisors can help you with all aspects related to practising in Ontario, from CV development and paperwork timelines to finding suitable job opportunities. Contact Ontario Health at practiceontario@ontariohealth.ca to learn more.

Also, if you’re looking for work, please check out HFOJobs. Their site offers an up-to-date listing of locum and permanent positions in communities across Ontario.

Joule, a CMA Company offers a number of tools and resources to help you build a thriving practice and maintain a healthy personal life. Take some time to review their practice management resources which include helpful guides and checklists. Also, don’t miss the Practice Management Curriculum (PMC) seminar at your university.

The Ontario Medical Association (OMA) wants you to start your practice on the right foot and make the transition process as seamless as possible.

Check out the OMA’s Resident Transition Wednesday webinar series recordings.

Residents transitioning to practice face an increasingly multifaceted spectrum of opportunities for medical practice. This program was designed to provide residents with the fundamental and practical skills needed to build a successful professional career.

Click here to view the 11-part series.

Interested in other practice management topics?
Starting your practice can be exciting, rewarding, and overwhelming. There are many things to consider when opening your practice, including financing, accounting, billing, and staffing.

Click here to view the list of upcoming OMA webinars. More dates and topics will be added throughout the year!

Check out the OMA Education Network, an e-learning platform that provides interactive modules, videos, and quizzes on a variety of practice management topics. You can access the materials on any device, and all eLearning sessions can be paused and resumed at your convenience.

The OMA has created an online learning series for hospital-based physicians to help them better understand the context of hospital-based practice and support them with information to be effective in their roles. The first unit is available now and the remaining 3 units are in development for release later this year. Unit 1: Rules explores rules relevant to hospital-based practice, including provincial legislation; hospital bylaws; and professional staff rules, regulations, and policies. The unit is the first in a series of modules that use plain language to explain concepts relevant to the physician-hospital relationship, examine case-studies, and provide practical guidance. The modules are available to OMA members for free on the OMA Education Network.

The OMA also provides members with billing advice, support, and resources on OHIP. For more information, visit the Practice and Professional Support section of their website.

OMA Legal Services will assist with a variety of practice-related issues on a complimentary basis for OMA Members, so be sure to take advantage of this benefit.

OMA Legal Services can assist with:

General medical-legal matters
Health legislation
Group practice agreements for FHNs, FHTs, FHGs, CCMs and fee-for-service arrangements
Unincorporated associations, partnerships and practice plan development and support
Alternative funding and payment plan negotiation assistance
Review of contracts with hospitals, universities, clinics, or other institutions as employees or independent contractors

You can contact OMA Legal Services at: Legal.Affairs@oma.org. You should sent them a brief description of your question and any relevant documentation.

DISCLAIMER: OMA staff lawyers provide general information and support on a variety of practice-related issues only. These services are not intended to provide specific professional medical or legal advice or an opinion nor do they establish a lawyer-client relationship. They are not intended to be a substitute for direct consultation with legal professionals or other professional advisors with regard to specific medical-legal issues.

OntarioMD, a wholly owned subsidiary of the OMA, supports Ontario physicians to realize increasing clinical value from their certified electronic medical records (EMRs). It offers award-winning services such as Health Report Manager (HRM), eNotifications, and other health technologies integrated with EMRs, trusted advice from Peer Leaders and practice advisors that enable physicians to deliver patient-centred care. To learn more about OntarioMD products and services, click here.

There are a few other items you need to cross off your to-do list before moving into full-time practice:

Applying for a licence
Getting your OHIP number

How to Apply for Independent Practice Licence

If you are planning to enter practice in Ontario you need a licence for independent practice from the College of Physicians and Surgeons of Ontario (CPSO). You can request an application directly from the CPSO’s Registration Department and find out more information here.

Applications for final-year residents are available in April on-ine or by telephone (416) 967-2617, ext. 221 or toll free at 1-800-268-7096. When you call you will need to identify yourself as a graduate of a Canadian medical school and say that you are completing residency in an Ontario program.

Licensure for independent practice requires two key elements:

Licentiate of the Medical Council of Canada
Certification by either the College of Family Physicians of Canada (CFPC) or the Royal College of Physicians and Surgeons of Canada (RCPSC)

We suggest being proactive on this. The CPSO recommends that applications be submitted approximately six weeks in advance of your planned starting date for independent practice.

Although you will not have received certification at this time, the CPSO will wait to receive confirmation of certification by either the CFPC or RCPSC. This confirmation will be transmitted directly to the CPSO as soon as it is permitted. This usually takes place around mid-June for the CFPC but no earlier than June 30th for the RCPSC.

Once confirmation is received, your application can be fully processed and you will be issued an Independent Practice Certificate. The CPSO cannot promise that you will be licensed by a particular date, but early submission of the application will greatly facilitate the process. It’s worth a phone call, to make sure that everything has been approved, before you start working.

And remember, that your CPSO annual membership fee and the one-time application fee must be enclosed with the application. These fees are subject to change (usually in March). The CPSO will accept payment by VISA or MasterCard, and the application package contains all necessary forms for this. In addition, your application form will need to be signed in the presence of a notary, lawyer, or commissioner of oaths.

If you plan to work in another province, you will have to contact that region’s provincial licensing authority for relevant timelines and documentation.

Also remember that your practice licence is completely different from either your CMPA coverage or your OHIP billing number. Each of these is arranged through different organizations and processes. You must have both your CMPA number (it’s the same one you’ve had since you started residency) and your CPSO number if you want to start working after graduation.

How to Apply for OHIP Billing Number

You can only apply for a billing number once you have a licence for independent practice. However, the good news is that you can begin working as soon as you have a licence and OHIP will pay you for insured services, so long as you keep clear records and submit them within six months of providing the care.

To obtain your billing number application, call the OHIP office at (416) 314-7495 or find the application online. For this, you will need document 014-3384-83 — the Registration for Regulated Health Professions.

Typically, it takes 4-6 weeks to be issued a billing number. Once you receive that, you can then submit claims. If you submit by mid-month, you will likely see payment around the middle of the following month.

Long-Term Disability Insurance After Residency

Upon completion of your residency, you may choose to work as a self-employed physician. It’s important to think about what type of benefits are important to you because you will be relying on yourself to provide the package many employed individuals take for granted.

Disability insurance is one of the most important benefits anyone can have and PARO, in conjunction with the Ontario Medical Association, has developed the Essentials Insurance offer to help you make the transition from your residents’ group plan to your own Association Group Life and Disability Insurance program.

For those who commenced their Residency Program before September 1, 2021:

The Essentials program allows you to purchase Life, Disability Income and Professional Overhead Expense coverage, without any medical or financial underwriting within 120 days of completing your residency program. In addition, the Step Rate premiums for Professional Overhead Expense coverage will be reduced by 50% for the first two years under Essentials.

Here’s what the Essentials program allows you to purchase:

Up to $5,000 per month of Disability Income Insurance. Benefits are subject to a 90-day elimination period. You can also request:
Own Occupation Rider;
Retirement Protection Rider (RPR)
Cost of Living Adjustment (COLA) Rider, and;
Guaranteed Insurability Benefit (GIB) Rider.

In addition, you may also apply to exercise the GIB option at the time of application and increase your monthly disability benefit, without medical evidence or financial documentation to:

$7,000 (from all sources) for Family Physicians
$10,000 (from all sources) for Specialists
Up to $5,000 per month of Professional Overhead Expense Insurance, subject to a 30-day elimination period.
$100,000 Group Term Life Insurance

For those who commenced their Residency Program on or after September 1, 2021:

The Essentials program will allow you to purchase Life, Disability Income and Professional Overhead Expense coverage, (Disability and POE coverage will be issued based on your answers to a simplified medical questionnaire) within 120 days of completing your residency program. In addition, the Step Rate premiums for Professional Overhead Insurance coverage will be reduced by 50% for the first two years under Essentials.