National Resources

The CFPC’s First Five Years in Family Practice Committee

The CFPC supports members who are beginning their careers in family medicine through the First Five Years in Family Practice (FFYFP) Committee.

Some of the resources and considerations available for FFYFP members include:

  • FFYFP peer support Facebook group
  • Reduced membership fees for physicians entering their first year of practice after completing a family medicine residency program
  • Access to FFYFP sessions and events at Family Medicine Forum (FMF)
  • FFYFP members receive a discounted registration fee for FMF
  • First Five Years section in Canadian Family Physician
  • Apply for CFPC membership online
  • Fees (vary by region)

Transition From Residency to Independent Practice

Timeline and key dates for those completing family medicine residency

October:

  • Sign up for notifications for pre-application for the Medical Council of Canada Qualifying Examination (MCCQE) Part II (spring)
  • Check out job fairs, provincial/territorial job posting sites, and network for post-residency job opportunities (October to December)

December:

  • Registration open for the spring Certification Examination in Family Medicine (residency-eligible) – December 1 to February 1

January:

  • Registration open for the spring Certification Examination in Family Medicine (residency-eligible) – December 1 to February 1
  • Apply for credentialing in health authority you plan to work in

April:

  • Spring Certification Examination in Family Medicine (CCFP Special Designation): End of April
  • Applications for independent practice license begin (July start dates and beyond)
    • Can be completed a maximum of three months ahead of start date
    • Review the application process outlined by the licensing body for your province/territory

May:

  • MCCQE Part II – May/June
  • Registration open for fall Certification Examination in Family Medicine (residency-eligible) – May 1 to June 30
  • Applications for MCCQE Part II fall

June:

  • Registration open for fall Certification Examination in Family Medicine (residency-eligible) – May 1 to June 30
  • CFPC Mainpro+® credit reporting cycle annual deadline – June 30
  • Report certified credits and carry over up to 40 certified credits from residency to first Mainpro+ cycle
  • Contact the CMPA to update your coverage effective for your practice start date

July:

  • CFPC membership renewal – Rollover from residency to Active First Year in Practice
  • Apply for your billing number

October:

  • Fall Certification Examination in Family Medicine (CCFP Special Designation): End of October.
  • MCCQE Part II – Fall exam dates

CMA Joule practice management resources

Residents can attend one of the CMA Joule Practice Management sessions offered throughout the year in partnership with the medical schools. The sessions are free and presented by physicians who are subject matter experts (industry-free), covering transition to practice topics such as finances, taxes, evaluating practice options, remuneration models, principles of billing, contracts and negotiation, memberships and fees, working out of province. View the upcoming dates to attend a virtual session.

CMA Joule also offers a number of helpful online practice management resources (PDFs):

Professional Associations

The College of Family Physicians of Canada (CFPC)

  • Grants Special Designations in family medicine including Certification in the College of Family Physicians of Canada (CCFP) and Certificates of Added Competence (CACs)
  • Members report Mainpro+® continuing professional development (CPD) credits to maintain Certification and meet licensure requirements:
    • Report any certified credits completed during your residency because you can carry over up to 40 certified credits from your residency cycle to your first mandatory five-year Mainpro+ cycle (which requires 125 certified credits and 250 credits overall to be reported within the five-year cycle)
  • Apply for CFPC membership online
  • Fees (vary by region)
  • Membership renews annually July 1

The Canadian Medical Association (CMA)

Membership in the CMA provides access to a number of physician resources.

  • Membership application
  • Fees (50 per cent discount for first year in practice members)
  • Membership renews annually; date varies by province/territory

The Canadian Medical Protective Association (CMPA)

The CMPA’s mandate is to provide its members with liability protection, advice, and resources to help manage medical-legal risk in clinical practice. They can provide advice related to patients, patient care, and the doctor-patient relationship.

Contact the CMPA about flexible payment options. The CMPA allows new members to pay retrospectively for the first three and six months, to accumulate some billings before payment, or delay the start of your CMPA coverage for your practice start date.

Association Abbreviation Summary Website
The College of Family Physicians of Canada CFPC Certification Examination in Family Medicine, Certificates of Added Competence (CAC), and continuing professional development (CPD) credit reporting for family physicians (Mainpro+). https://www.cfpc.ca
Provincial Chapter of the CFPC Varies (e.g., British Columbia College of Family Physicians (BCCFP)) Provincial Chapters of the CFPC support members living and practising in the province/territory, as well as local leadership and advocacy initiatives and opportunities for CPD. https://www.cfpc.ca/en/provincial-chapters
Provincial and territorial medical regulatory authorities Varies (e.g., College of Physicians and Surgeons of Ontario (CPSO)) Licensing body and regulatory authority for physicians See https://fmrac.ca/members/ for a list of provincial and territorial authorities
Canadian Medical Protective Association CMPA The CMPA provides advice and assistance when medical-legal difficulties arise, as well as resources to help manage risk and contribute to safe medical care. https://www.cmpa-acpm.ca/en/home
Canadian Medical Association CMA The CMA provides resources for physicians, focuses on advocacy, and seeks to inform and shape public policy with the perspective of Canada’s physicians.  https://www.cma.ca/
Provincial and territorial medical association Varies (e.g., Alberta Medical Association, Doctors Manitoba) The provincial and territorial medical associations are autonomous divisions of the CMA, with responsibilities specific to their provincial and territorial jurisdictions that can include negotiations for compensation, access to legal review services, and insurance and financial programs. https://www.cma.ca/provincial-and-territorial-medical-associations

Certification Examination in Family Medicine (CCFP Special Designation)

Registration deadlines for residency-eligible candidates

  • Spring exam (April) – Apply in December to January

  • Fall exam (October) – Apply in May to June

Exam results

  • You will receive an email notification when the results are available online (approximately eight weeks after the examination); you can access results through your CFPC member portal under “My Account” then “Exams”

  • You will also receive an exam result letter by mail approximately two weeks after your results are available

  • You will be granted the CCFP Special Designation upon successful completion of your exam and proof of completion of training from your residency program

  • Your official certificate will arrive in the mail within 12 weeks of your certification date

Failed Certification Examination in Family Medicine information

  • If you receive an unsuccessful result and are still within your exam eligibility (i.e., three full exam attempts or three years from the date of completion of training, whichever happens first) you may apply to re-sit the exam using the online exam application on the CFPC website. The deadline date to register to re-sit the family medicine examination is February 1st for the spring exam, June 30th for the fall exam.

  • Some provinces/territories will allow you to practice under a provisional or restricted license until you receive your certification. To confirm the specific licensing requirements, contact the medical regulatory authority (MRA) for the province/territory where you plan to practice. The list of MRAs in Canada is available at https://fmrac.ca/members/.

Detailed information, key dates, and deadlines are available on the CFPC website.

Starting Your Medical Practice

Getting started

You can find more specific information about licensing, billing, hospital privileges, insurance billings, etc., on the dedicated resources page for each province and territory.

Getting started will depend on how and where you decide to practice; however, in general you must:

  • Apply for licensing with your provincial/territorial medical regulatory body

  • Advise the CMPA you are practising independently (no longer a resident) and request your proof of coverage

  • Apply/arrange for provincial/territorial insured billings

  • Apply for a workplace compensation billing number

  • Register with your provincial/territorial medical association

  • Apply for hospital privileges if you are planning to work in a hospital or locum/work in a clinic where you require hospital privileges

    • Application may be through the health authority or the hospital themselves, and will require forms to be completed, such as medical diploma, resume, medical license, CMPA proof of insurance, CCFP Special Designation or its related exam result, MCCQE Part II result, and confidentiality agreement (process can be started before all documents are received)

Your advisory team

Your team may include some or all of these people or services. Consider taking the time to meet with several people to find the right fit for you.

  • Financial planner/accountant: Helps with debt management, budgeting, investment strategies, retirement planning and incorporation. Characteristics of a good financial planner:

    • Respects your vision, goals, and risk tolerance

    • Is accessible

    • Provides advice, and answers your questions

    • Is transparent

    • Works collaboratively and makes you feel comfortable

    • Has your best interests in mind

  • Tax consultant: Helps with tax planning, advice for deductions, and credit strategies

    • Your taxes will not be automatically deducted from your salary, so you need to plan ahead to avoid a surprise bill at tax time

  • Insurance adviser: Helps plan for disability insurance, life insurance, overhead insurance, critical illness insurance, and extended health and dental insurance

  • Lawyer: Helps with professional contracts, corporate/business structure, negotiations and agreements, and incorporations

  • Banker/banking partner: Provides advice on financing options, risk management, and professional banking services

  • Colleagues and mentors: People you can rely on to help with medical or business questions

CMA Joule practice management resources

Practice Options Overview

Practice Type

Advantages

Disadvantages

Solo

More autonomy and control, staff dedicated to supporting you, you are the sole decision maker

Increased costs (start-up/ongoing), more responsibilities, potential coverage issues (critical labs, vacation), no on-site peer support

Partnership/Group

Cost-sharing/economy of scale, task sharing (e.g., on-call), possible coverage for vacations, second opinions easily available

Less autonomy, differences of opinions, potential for space issues, need for legal agreements and organization structures

Options for transitioning to practice

Route

Advantages

Disadvantages

Locums

Easier transition to practice, less paperwork, identify pros/cons of practice types and settings, less expensive overhead

Less routine, no guarantee to have work, potential billing issues, need legal support (contracts), following policies of the other doctor, limited control over practice environment (such as staff, call setup)

Take over existing practice

Office is already set up, patient roster and charts are available, possible mentor for the first months during transition

Hard to change existing rules/policies, quicker transition than building a practice, potentially large patient roster, possible differences between you and outgoing physician

Start your own practice

Determine own policies and processes, transition at your own pace

Significant work/costs to set up everything, slower income

increase, may be hard to find opportunities in some provinces/territories, steeper learning curve

CMA Joule practice management resources (PDFs)

Resident Doctors of Canada new-in-practice profiles

Each profile on the website includes details about the clinical life, weekly schedule, and transition to practice experience of the profiled physician.

Remuneration (Payment) Models

CFPC Best Advice Guide: Physician Remuneration in a Patient’s Medical Home

Common models and payment mechanisms in Canada include:

  • Fee-for-service (FFS): Physicians are paid by the insurer (the government) per service rendered (e.g., office visit, procedure, etc.)
  • Salary: Physicians receive a wage, similar to other workers, often based on units of time, and paid in regular instalments
  • Capitation: Physicians receive a set fee for each patient on their roster (assigned patient panel), which may be adjusted by age, sex, morbidity, or other modifiers
  • Mixed/blended models: Payment arrangements are available through different model combinations, including capitation, FFS, and salary

The full guide and summary are available on the Patient’s Medical Home website.

Specific details may also be available on the provincial/territorial resource pages.

Locums

First Five Years Essentials: A brief guide to locuming in family medicine

This guide created by the FFYFP Committee includes tips for locum contracts, policies, and finding a job.

Locum job opportunities

Note: For information only. This list is not comprehensive or endorsed by the CFPC.

Provincial and territorial agencies

Locum job banks and advertising services

Considerations when agreeing to locum

  • What is the scope of practice that you are covering? (Any extra activity the host doctor is doing that you will need to take on?)
  • What is the practice style of the hosting doctor? How is it similar and different to your own?
  • What are the clinic’s regular hours/schedule? On-call schedule? Are you expected to follow the same schedule?
  • What are the office policies (cancellations, prescription renewals, patient contracts, etc.)?
  • What is the office physical environment? What is provided (e.g., medical supplies, computers, printing supplies)?
  • Is there an electronic medical records (EMR) system and if so, which one? Legible and organized paper charts? Are the charts complete?
  • Do you have important contact information? (e.g., call group, consultants, hospital investigations, allied health care)
  • Who can address technical questions?
  • Confirm your hospital privileges and billing number
  • Who will be responsible for billing?
  • How experienced is the staff you will work with? What are their usual tasks? Who is available to answer questions?
  • Is there a handover list for in-patient and special needs/difficult patients?
  • Are you familiar with the local emergency department and procedures, in case of a clinic emergency?
  • Is your contract fair for both parties and signed by both parties?
  • If the locum is outside of your community, think about transportation, parking, place to stay, orientation to community

CMA Joule practice management resources

Starting Your Own Clinic

Clinic pamphlet

A pamphlet/welcome letter to provide to your patients, to explain your clinic rules. Samples are available online. The pamphlet may include:

  • Brief introduction to you/the clinic
  • Clinic address
  • Phone number
  • Hours of operation
  • Clinic particularities (after hours, medical education, hospitalization rounds, etc.)
  • Appointment expectations
  • No-show policy
  • Services not covered by provincial health insurance plan
  • Steps for prescription renewal or test results
  • Confidentiality and respect policies

Office set-up expenses overview

  • Office/clinic:
    • Rent for exam rooms and office space
    • Utilities
    • Maintenance
  • Medical supplies and equipment
  • Office supplies and equipment
  • Phone, fax, and internet service
  • Parking fees
  • EMR software (initial cost, plus monthly fee)
  • Property insurance
  • Disability insurance
  • Medical protection insurance
  • Association fees
  • Payroll services
  • Employee salaries, benefits, bonuses, etc.
  • Worker’s compensation payments (based on staff salaries)
  • Other fees (e.g., bank fees, gifts, legal services, computer programs, etc.)

Hiring staff and building your professional team

Staff roles at your clinic may include:

  • Medical office administrator: Key part of your team and the face of your practice. Look for an individual who takes initiative, is professional, has strong people skills, and is someone you trust.
  • Nurse: Helps with medical tasks such as vaccinations, vitals, initial intakes, forms to be filled, and patient education. May be a source of income.
  • Clinic manager: Responsibilities include overseeing the management of the clinic and day-to-day operation. May also be responsible for liaising between patients and health care providers, budgets and billing, and managing staff. Can save a lot of administrative time if you practice in a large group.
  • Medical assistant: More cost-effective than employing a nurse but needs more supervision
  • Others: Could be engaged for specialized tasks (billing, scanning, charting, cleaning, etc.)

Staff employment contracts

You should ensure that you receive a signed contract from new employees before notifying other candidates that they were not selected for the job. All employment contracts should be reviewed by a lawyer and include:

  • Start date
  • Hours of work/schedule
  • Salary
  • Provisions for sick leave/personal days
  • Overtime policy
  • Vacation entitlements
  • Probation period
  • Termination clause
  • Attachments:
    • Confidentiality agreement
    • Job description and office policies

Reminders for employers

  • There is an additional cost to staff salaries that employers pay to the receiver general
  • Nearly all employers are required to register with their provincial/territorial workers’ compensation board and pay workplace compensation insurance premiums
  • The Employment Standards Act guides the rules of payment, notice of dismissal, termination, paid public holidays and vacation pay, parental leave, and other leaves of absence. Review the federal standards and those in your province or territory.
  • Plan for staffing emergencies (e.g., agreement with colleagues, etc.)
  • Ensure payroll is completed on time to keep your team happy
  • Consider how you will manage days of recognition (e.g., Administrative Professional’s Day, Nurse’s Day), performance bonuses, gifts for holidays, performance reviews and raises, etc.

CMA Joule practice management resources (PDFs):

Contract Basics

Contracts overview

In general, all contracts should be reviewed by a lawyer for your protection. Many of the provincial/territorial medical associations provide contract review at no cost to members (potential for longer wait times).

Employment contracts should include the following details:

  • Start date (and end date if applicable)
  • Hours of work/schedule requirements (e.g., on-call arrangements, etc.)
  • Salary or payment structure
  • Provisions for sick leave/personal days
  • Overtime/lieu time policy
  • Vacation policy
  • Probation period
  • Termination clause

Locum contracts should have additional details, including:

  • Length of the locum
  • Patient scheduling and host doctor’s expectations
  • Additional responsibilities (e.g., on-call arrangements or other)
  • Fee-sharing arrangements
  • Reciprocal fee payment schedule
  • Billing arrangement for insured services
  • Office materials and staff support provided
  • Application/procedure for hospital privileges
  • Host doctor’s responsibilities prior to handover/after locum ends
  • Locum doctor’s responsibilities at end of agreement (e.g., billing, patient test results, etc.)
    • You are legally responsible for anything billed using your personal practitioner/billing number and as such should always get a copy of what is going to be submitted and review to make sure it is appropriate
  • Non-performance (i.e., consequences for host/locum physician if the contract is cancelled or broken)

CMPA resources

The CMPA can offer support for legal matters related to patients and patient care (e.g., access to EMRs/patient records after leaving a clinic, doctor/patient relationship, etc.).

CMA Joule practice management resources

Negotiating Contracts

Tips and tricks for negotiating:

  • Negotiate for yourself. Know what you want and be prepared:
    • What is your goal?
    • Available options – plan A and plan B?
    • What you are willing to bargain for/let go of?
    • What is a deal-breaker?
  • Be fair to both parties
  • Control your emotions and reactions
  • Be polite and confident
  • Think long-term

CMA Joule Practice Management Resources

Negotiation Checklist (PDF, one page)

Financial Management

Financial management basics

  • Organization and keeping records (personal/corporate) is very important
  • Choose your financial planner/accountant and discuss:
    • Incorporation: Now, later, or never?
    • Tax planning for what you will owe in April. (In general, when starting out a good rule is to set aside 30 per cent of your income for taxes and deductions.)
  • Keep business and personal information separate to simplify your records for tax purposes:
    • Set up a separate bank account for business expenses and payments (even if you are not planning on incorporating) and pay yourself from your business account
    • Get a corporate credit card for all business expenses
  • You want to be paid for what you do and make the most of your billing (which comes with experience)
    • Connect with the family medicine section/group at the medical association of the province/territory you are practising in, as many have billing tools or tips to share
    • Create a billing “cheat sheet” of your most used billing codes. More experienced colleagues may be willing to share this with you when you are starting out, so ask around!

Resources to learn more about finances

Note: For information only; not endorsed by the CFPC or the FFYFP Committee members.

The White Coat Investor – Don’t Make These 10 Financial Mistakes: Podcast #191

Incorporation

Incorporation, or creating a medical professional corporation, is one strategy to pay lower taxes or defer paying taxes. It is not beneficial for everyone, so it is important to consult your financial adviser about the advantages and disadvantages for your personal situation, to help you decide if you will incorporate now, later, or not at all. In general, incorporation allows a physician to claim income to the corporation, rather than themselves personally, and then pay themselves dividends or a salary. Corporate tax rates are lower than personal income tax rates.

The process to incorporation:

  • Incorporating is a multi-step process; you can begin these steps up to two months before you receive your licence
  • Review any requirements and details set out by the regulatory College in your province/territory
  • Generally, a lawyer must create the medical professional corporation (as required by the regulatory Colleges). Expect to spend $3,000 to $4,000 to set up a medical corporation and accounting.
  • Choose your corporate name—the regulatory College will define acceptable naming conventions, and your lawyer can confirm whether the name is available
  • Once your name is confirmed and reserved, your lawyer will submit your application for a medical corporation to the regulatory College in your province/territory
  • When the application is approved, your lawyer will submit the College approval to the corporate registry to confirm your corporation name
  • Your lawyer will complete the incorporation process and the regulatory College will issue your medical corporation permit

MD Financial Management overview resources

Planning for Parental Leave

  • Look for available federal and provincial/territorial funding:
  • Consult your financial planner to discuss options for personal/business savings
  • Plan with your partner (if applicable) how you will divide your parental leave entitlements to maximize benefits
  • Review your insurance coverage and will
  • Plan for business/practice continuity. Your clinic overhead and patient roster will likely remain while you are on leave. Consider options that will work best for you including locum coverage, part-time work, progressive return to office, weeks away from clinic, etc.

Scheduling and Time Management

  • Build some flexibility into your schedule to accommodate same-day or next day appointments. This can be easier in a group practice where the team can share the load (e.g., policy that patients can get same-day appointment if necessary but may not be with their physician).
  • Plan your year in advance and block your annual vacation time. This will ensure you are able to take your vacation and allow time to find coverage if needed and provide notice to colleagues to help them plan.
    • Set aside additional time before and after vacations for additional paperwork, emails, and prep/catch-up tasks

Resources

Physician Wellness

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