| 1. What is a Restricted Registration? |
The Council of Ontario Faculties of Medicine have defined moonlighting, another term for Restricted Registration, as: Residents registered in postgraduate medical education programs leading to certification with the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada who provide clinical services for remuneration outside of the residency program.
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| 2. What are the objectives of the Restricted Registration Program for Residents? |
There are a number of objectives that have been identified by the various stakeholders involved in the project. They are:
- provide Residents additional practice, collaborative and managerial experience and develop RCPSC and CFPC roles;
- provide physician resources to the Ontario health care system in both academic and community locations to help meet service needs, including on-call and weekends;
- improve the financial well being of Residents
- provide evidence as to the impact of Restricted Registration activity on the well being of Residents and their families, significant others and personal relationships
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| 3. Who are the stakeholders who are participating in the RR Program? |
The stakeholders who have participated in the design of the pilot project are:
- Professional Association of Interns and Residents of Ontario
- Post Graduate Education Committee of the Council of Ontario Faculties of Medicine
- College of Physicians and Surgeons of Ontario
- Council of Academic Hospitals of Ontario
- Health Force Ontario
- Ministry of Health and Long Term Care
- Individual Ontario faculties of medicine and their programs
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| 4. Who is eligible? |
Residents enrolled in participating Ontario Schools of Medicine are eligible to take part in the Program.
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| 5. Which schools and programs are participating? |
At the moment, the following Schools and Programs within each School are participating.
Click on the links above to view the domain of practice for each program in their respective site.
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| 6. What are the eligibility criteria for a Restricted Registration? |
Eligibility is determined by each School and Program based on the Resident's performance to date and program assessment of ability to perform semi-independently. At a minimum a Resident must have successfully completed the MCCQE Parts I and II, 18 months of residency training, be in good academic standing and be actively involved in their residency training program (not on leave). Pool C Residents/Visa Trainees have been precluded from access to Restricted Registration due to arrangements about income tax and personal revenue that have federal legal implication.
Program Directors, in conjunction with their education committees, shall determine the guidelines specific to the individual postgraduate program. A program gains entry into the RR Program by submitting all the required documents, including guidelines specific to the postgraduate program in question, and a copy or link to the program's rotation goals and objectives. Templates of guidelines are available from the Office of Restricted Registration.
Residents wishing to work in Emergency Departments must have successfully completed training in Advanced Trauma Life Support and Advanced Cardiac Life Support. Residents wishing to work in Intensive/Critical Care Units must have successfully completed training in Advanaced Cardiac Life Support. Those working in comparable pediatric settings must have completed training in Pediatric Advanced Life Support and in Neonatal Advanced Life Support.
All Programs and Postgraduate Deans reserve the right to refuse eligibility if a Resident is not performing at the required standards in their program.
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| 7. What are the Resident's responsibilities? |
Once an employment opportunity has been found and an offer has been made by the employer, the Resident is responsible for completing the RR Program application form on this site accurately and must sign an agreement to the undertakings listed on the application; i.e., that he/she will
- abide by the terms and conditions of the PAIRO/CAHO Collective Agreement (i.e. not work more than the hours/shifts stipulated by the contract, TBD)
- have obtained/will obtain the necessary CMPA coverage for Restricted Registration activities (CMPA Code 14 - Residents for Moonlighting)
- restrict activities to the scope of services and sites indicated by the registration
- practice only within the scope of training received to date
- not allow the Restricted Registration activities to interfere with the requirements and responsibilities of his/her training program (including not undertaking activities during residency work hours including on-call periods that are defined by the program)
- agrees to provide information and data for the purposes of tracking and evaluating the Program on Restricted Registration.
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| 8.
What are possible
repercussions for a Resident failing to meet one or more of the
responsibilities listed above? |
Failure to comply with the terms of the agreement (abiding by the Collective Agreement, obtaining necessary CMPA coverage, and working within the scope of the Restricted Registration) may constitute unprofessional conduct and may warrant further action by the CPSO under the Act or Rules.
If the Resident does not maintain good academic standing or if the Restricted Registration activities negatively impact on his/her academic and/or clinical obligations in his/her residency program, the Program Director and Postgraduate Dean (or delegate) reserves the right to withdraw their approval for the Restricted Registration, and/or inform the College requesting that the Restricted Registration be terminated.
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| 9. What are the Program Director's responsibilities? |
The Program Director must attest that the information provided by the Resident regarding his/her training and academic standing in the application is correct. Furthermore, the Program Director must ensure that the Resident has fulfilled the eligibility criteria set by the Program for each service type and site. If the Resident fulfills these criteria, the Program Director attests to this fact.
Should the Resident fail to maintain academic standing, the Program Director will notify the CPSO and the Postgraduate Dean of these concerns and recommend cessation of the registration. This will be effective immediately and there is no appeal of this decision.
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| 10. What are the Post Graduate Medical Education (PGME) Dean's responsibilities? |
The PGME Dean reviews the application and provides approval for the Resident to apply for a Restricted Registration to provide clinical services outside his/her program
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| 11. What are the Employer's/Supervisor's responsibilities? |
The employer/supervisor must:
- recruit potential Resident applicants for a position
- satisfy himself that the Resident's training and experience meets the requirements of the Restricted Registration activities and attest to that fact.
- make a tentative offer of employment to the Resident pending the issuance of a Restricted Registration by the CPSO.
- Must complete Section D - Employer/Supervisor portion of the RR Program application indicating:
- the service type and location of the activities,
- the potential duties of the Resident,
- the name of the supervising physician,
- attesting that the employer will abide by the PAIRO/CAHO Collective Agreement
- attesting that the Resident's activities will be restricted to the scope of services and sites listed on the registration issued by the CPSO,
- agreeing to inform the CPSO and the Resident's Program Director of any unprofessional conduct or failure to abide by the terms of the Restricted Registration on the part of the Resident, and
- agreeing to provide information and data as required by the RR Program for the purposes of tracking and evaluation
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| 12. What are the steps for getting a Restricted Registration? |
- The Resident must find and be offered a contract for work, which is provisional upon a licence.
- The Resident must then complete the application form found on the website for the Restricted Registration Program at www.rrapp.ca.
- The Resident must ensure that s/he complies with the eligibility criteria of both the RR Program and your program
- When the Resident has completed his/her section of the application, it will be electronically forwarded in the following order to the potential Supervisor, the Program Director, the PGME Dean, and your School's Restricted Registration Review Committee for completion.
- The Resident will be notified when the Restricted Registration Review Committee at your School has reviewed the application. If it attests that the application is complete and meets your program's requirements, the application will be forwarded by the Office of Restricted Registration to the CPSO for processing.
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| 13. How often and what data and information will I have to provide to the RR Program? |
Program Directors will be asked to participate in a brief online survey. Program Directors may also be asked to participate in a focus group via teleconference.
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| 14. Does the Restricted Registration Program pay Residents for RR activities, or provide funding to healthcare sites where RR activities are taking place? |
| The Restricted Registration Program funds administration, infrastructure (for example, the online application and the website) and the evaluation of this pilot project. This funding enables Residents and health care sites to participate in the Program. There is no funding for remuneration for a Resident engaged in RR activities. Remuneration for Residents is determined directly between the Resident and the employer. If physicians will be billing for services provided by Residents in the RR pilot project, they will need to observe the requirements in the OHIP fee schedule page.
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