HealthForceOntario Northern and Rural Recruitment and Retention Initiative Guidelines

General Description

The Northern and Rural Recruitment and Retention (NRRR) Initiative offers taxable financial incentives to each eligible physician who establishes a full-time practice in an eligible community of the province. The grants range between $80,000 and $117,600 paid over a four-year period. The grants will be awarded based on eligibility criteria and considerations related to total NRRR Initiative budget allocations

Objective

Attract physicians to establish a new full-time practice in eligible communities.

Eligibility

Community eligibility for the NRRR Initiative is based on a Rurality Index for Ontario (RIO) score, a measure of rurality that ensures funding is specifically targeted to northern and very rural communities. The RIO2008_Basic score is derived from three factors: population (count and density), travel time to a basic referral centre, and travel time to an advanced referral centre. RIO scores are assigned to Statistics Canada census subdivisions (CSDs).

In order for an applicant to be eligible for the NRRR Initiative grant the applicant must be approved by the Northern Health Programs (NHP) office, Primary Health Care Branch before the applicant establishes his/her practice in the eligible community. Failure to do so may result in the application being denied. In addition, the applicant must be establishing a full-time practice in an eligible community in which they have never previously practiced full-time. The applicant may apply once he/she has completed residency training, or before establishing their full-time practice and must meet all of the following requirements:

Has committed to establishing a full-time practice (full-time is defined as a minimum of 40 hours per week spent in patient care exclusive of on-call services) in a community whose RIO score is 40 or greater, or in the five Northern Ontario Urban Referral Centre census metropolitan areas (North Bay, Sault Ste. Marie, Sudbury, Thunder Bay and Timmins) and in which they have never previously practiced full-time.
Holds a valid certificate of registration for practice from the College of Physicians and Surgeons of Ontario (CPSO), authorizing the holder to engage in medical practice.
1. If a family physician, holds a valid certificate from the College of Family Physicians of Canada (CFPC) OR if the applicant does not hold a valid CFPC certificate, proof that the applicant is fully recognized by the College of Physicians and Surgeons of Ontario (CPSO) in family or general practice.
2. If a specialist,
  
  holds a valid specialist certificate issued by the Royal College of Physicians and Surgeons of Canada (RCPSC)
  
  OR
  
  holds a specialist certificate of registration issued by the College of Physicians and Surgeons of Ontario (CPSO) based on having an advanced position/assessment position through Centre for the Evaluation of Health Professionals Educated Abroad (CEHPEA) in a recognized medical or surgical specialty other than family or general practice
  
  OR
  
  holds a specialist certificate of registration issued on the order of the Registration Committee of the CPSO allowing the physician to practise in a recognized medical or surgical specialty other than family or general practice, where the requirements of registration are otherwise not met, and to which certificate terms, conditions or limitations may be attached.
Holds a valid Canadian Medical Protective Association membership number.
Holds Canadian citizenship or permanent resident status.
Holds active or associate hospital privileges in the community, or if there is no hospital in the community, in an adjacent community (as required by the community and approved by the NHP).
Agrees to provide ER coverage, unless an exemption is provided by the community or hospital and approved by the NHP.
If a family physician, has joined a primary care model and is committed to participating fully in comprehensive physician services. Refer to Appendix B for a description of comprehensive physician services.
Has not previously received the NRRR Initiative grant through this program, or Free Tuition Program funding and/or an incentive grant through the Northern Health Programs for a full four-year duration.

Grants are paid out quarterly over a period of four years - 40% in year-one, 15% in year-two, 15% in year-three and 30% in year-four.

How to Apply for the NRRR Initiative Funding

In order to receive the NRRR Initiative grant, the applicant must have received approval of his or her Application from the NHP before the applicant establishes his/her practice in the eligible community. To apply for the Northern and Rural Recruitment and Retention Initiative grant, the applicant must submit the following documents and information:

A completed Application for the NRRR Initiative grant, available from the Ministry website.
A valid certificate of registration for practice from the CPSO to engage in medical practice.
1. If a family physician, a valid certificate of registration from the College of Family Physicians of Canada (CFPC), OR if the applicant does not hold a CFPC certificate, proof that he/she has a certificate of registration issued by the College of Physicians and Surgeons of Ontario (CPSO) based on successful completion of the Assessment Program for International Medical Graduates (APIMG) in family or general practice.
2. If a specialist, a valid specialist certificate issued by the RCPSC, OR, if the applicant does not have a valid RCPSC specialist certificate, proof that the applicant is fully recognized by the CPSO in his/her area of medical specialty. See Eligibility Criterion, Item # 3b above.
Proof of medical coverage from the Canadian Medical Protective Association.
A letter of acceptance for full-time practice from the community contact.
Proof of hospital privileges at a hospital located in the eligible community, or in an adjacent area (as required by the community), and confirmation of participation in a primary care model, if a family physician (unless there is a waiver from the community representative – refer to Eligibility Criterion, item # 6 above).

Approval Process

The physician submits the following to Northern Health Programs (NHP):
1. An Application indicating intent to establish a full-time practice in an eligible community, and specifying his/her starting date.
2. The documents listed on the Application form.
3. A letter from the community representative supporting the physician’s Application.
4. A letter from a hospital official confirming proof of hospital privileges at a hospital located in the eligible community where the applicant intends to join a primary care model if a family physician and practise full-time, or if there is no hospital in the eligible community, in an adjacent area if required by the community.
If NHP approves the Application, NHP will send a letter of approval to the physician, along with two copies of the NRRR Initiative Agreement form for the physician's signature.
The physician signs and returns both Agreement forms to NHP, along with an imprinted blank voided cheque from the bank where deposits will be made.
NHP arranges for the Agreement forms to be signed on behalf of the NRRR Initiative; and for one copy to be returned to the physician for his/her records.
NHP will pay the NRRR Initiative grant quarterly. NHP will deposit the first payment into the physician’s bank account approximately six to eight weeks after NHP has received and approved all required documentation. NHP will make subsequent deposits at three-month intervals, at the beginning of each quarter.
NHP pays the NRRR Initiative grant over a period of four years - 40% in year-one, 15% in year-two, 15% in year-three and 30% in year-four.
Towards the end of each of the first three years of participation in the NRRR Initiative, NHP will send a Confirmation of Practice Form to the physician to determine whether the physician is maintaining the ongoing eligibility criteria for the subsequent year.

Maximum Number of Grants per Career

Physicians are entitled to receive only one NRRR Initiative grant per career. Physicians who have previously received Free Tuition Program funding and/or NHP Incentive Grant for the full four-year duration are not eligible to receive a NRRR Initiative grant.

NRRR Initiative Grant Values and Payments

The value of NRRR Initiative grants is based on a progressive or sliding scale. The higher the RIO score (i.e. the more northern and/or rural the area), the higher the value of the available grant.

Grant values begin at $80,000 in CSDs with a RIO score of 40 and increase to $117,600 in CSDs with a RIO score of 100 (please see Appendix C). To encourage both recruitment and retention, the proportion of the grant paid out will be highest in Years 1 and 4. The payment schedule is as follows: Year 1: 40%; Year 2: 15%; Year 3: 15%; Year 4: 30%.

General Information

NRRR Initiative grant is a four-year grant, subject to the physician continuing to meet eligibility criteria, and subject to the consent of all parties concerned.

It takes approximately six to eight weeks to process an application, once an applicant has provided the required information. Physicians who are interested in the program are encouraged to provide as much lead-time as possible to ensure everything is in order before they commence their full-time practice in the eligible community.

For more information, please call (705) 564-7280, 1-866-727-9959, fax (705) 564-7493 or write to :

Ministry of Health and Long-Term Care
Primary Health Care Branch
Northern Health Programs
159 Cedar Street, Suite 402
Sudbury ON P3E 6A5

For information regarding eligibility for a certificate of registration to practice medicine in Ontario, please contact the CPSO at :

The Registrar
The College of Physicians and Surgeons of Ontario
80 College Street
Toronto ON M7A 1R3
Telephone: (416) 967-2617
Fax number: (416) 961-3330

Appendix A - Northern and Rural Recruitment and Retention (NRRR) Initiative Questions and Answers

Am I eligible to apply for the NRRR Initiative grant if I have received free tuition funding and/or a full four-year incentive grant from the NHP?

No. If you received free tuition funding and/or an incentive grant through the NHP for the full four-year duration, you are not eligible for the NRRR Initiative grant.

If I have only received free tuition funding from the NHP, am I eligible to apply for the NRRR Initiative grant?

If you have only previously received funding under the Free Tuition Program, and establish practice in an eligible community, you may be entitled to the difference between the free tuition funding you received and the amount of funding available under the NRRR Initiative.

Is the grant available to a physician who works part-time? What is the definition of full-time?

The NRRR Initiative grant is available only to a physician who works full time within the eligible community. A physician is considered full-time if he/she provides at least 40 hours per week of patient care exclusive of on-call services and, if a family physician, participates fully in comprehensive physician services in an eligible community.

How can the NRRR Initiative help me locate a practice opportunity?

Physicians interested in the NRRR Initiative are encouraged to contact the NHP at the address listed above, or visit the Northern Health Program.

The NHP administers a Community Assessment Visit Program that will assist you (and your spouse, if applicable) to travel to eligible communities to assess practice opportunities. Please contact NHP at the above address for more information.

In addition, you may wish to contact the Regional Advisor Services office at HealthForceOntario, Marketing and Recruitment Agency.

What can I expect in the way of relocation expenses and assistance to help my spouse find employment?

There are no provisions in the NRRR Initiative to provide funds for relocation expenses, or to assist in obtaining spousal employment. However, some communities may assist in securing employment for the physician’s spouse.

Do I have to join an existing practice/clinic or can I set up a solo practice?

You have to join a primary care model, if you are a family physician. This requirement may be waived in writing by the community representative based on input from physicians practising in the community.

Do I need to have hospital privileges?

Yes, in a community that has a hospital, you are required to have hospital privileges and associated on-call obligations for the duration of the grant. If you choose to cancel your hospital privileges, your NRRR Initiative grant will be discontinued. If the community does not require hospital privileges or associated on-call obligations, this arrangement must be made and agreed upon by the community/hospital, physician and the NHP, before the NHP will approve your application.

If there is no hospital in the community, but there is one located in an adjacent community, you will be required to obtain hospital privileges there, if the community wishes you to do so and has the approval of NHP for that requirement.

If I decide the eligible community I chose does not meet my needs, can I relocate to another community and continue receiving the NRRR Initiative grant?

Yes, if the new community is not only eligible, but is also located at least 100 kilometres from the community that does not meet your needs, and has a RIO score at least nine (9) points higher than the current community, and subject to prior written approval from the NHP. All eligibility criteria continue to apply.

If I am currently receiving an incentive grant from the NHP Incentive Grant Program, can I transfer to the new NRRR Initiative?

No. However, if you are currently receiving funding under the NHP Incentive Grant Program, your incentive grant will be continued for the balance of the 4 years.

When do I sign my NRRR Initiative Agreement?

The NHP will send you a letter when it has received the completed Application and required documentation and approved it. Along with this letter, the NHP will enclose two NRRR Initiative Agreement forms for your signature. You must sign and return both copies of the Agreement to the NHP, along with an imprinted blank voided cheque from the bank for the account to which you wish deposits to be made. The NHP will sign the Agreement forms, return one original to you for your records and retain the second original in your file. The Ministry finance unit will then set up your deposits in accordance with the Agreement.

When can I expect to receive my NRRR Initiative payments?

NRRR Initiative payments are made quarterly. The first payment will be deposited into your account within six to eight weeks of the NHP receiving all the required documentation. Subsequent payments will be made at three month intervals at the beginning of each quarter. Towards the end of each of the first three years of grant participation, the NHP will send you a Confirmation of Practice Form for you to complete and submit to NHP.

Do I have to pay income tax on the NRRR Initiative grant?

You may be required to pay income tax on the grant. You may contact Canada Revenue Agency for further information regarding income tax.

Do I have to let you know if I move?

Yes, it is the responsibility of the physician to keep the Ministry informed of any change of address while they are participating in the NRRR Initiative.

What happens to my grant if I take pregnancy/parental leave?

During pregnancy/parental leave, payments on your grant are temporarily withheld. When you return to full-time practice, the grant is re-instated. You will need to notify the Ministry in writing when you start your pregnancy/parental leave and when you resume practising. You will be eligible for the remaining portion of your four-year NRRR Initiative grant upon returning to work full-time.

Do I need to remain in the community for the full four years?

The grant is for a four-year term. In accordance with Section 5 of the NRRR Initiative Agreement, the physician may terminate his/her participation in the Initiative by giving 15 business days written notice to the NHP.

If I leave before the end of my agreement, do I need to return the NRRR Initiative grant I received?

A physician could terminate his/her association with the program by giving 15 business days written notice to the NHP. Physicians who do not remain in the sponsoring community for the full four years would be required to repay the grant on a prorated basis. In such cases, payments would be stopped and the physician would be required to repay any money advanced for any part of the payment period not worked in the eligible community.

The NHP staff will advise you of the amount owing, if any, and will require you to forward a cheque in that amount within 30 days, made payable to the “Ontario Minister of Finance”.

If I left before receiving the full four years of NRRR Initiative support, can I pick up where I left off?

Yes, you may apply for the balance of the grant that you did not previously receive, if you return to practise full-time either in the community you left, if it is still an eligible community, or in another eligible community located at least 100 kilometres from the eligible community you left and where the RIO score of the new community is at least nine (9) points higher than the previous community.

Appendix B - Description of Comprehensive Care / Services

Health Assessments

When necessary take a full history, including presenting complaint if any, past illnesses, social history, family history, review of systems and perform a complete physical examination.
Periodically take a specific history and perform a physical examination as required to screen patients for disease.
Regularly take a specific history and perform physical examination as required to respond to patient complaints and/or to manage chronic problems.

Diagnosis and Treatment

Assess and plan for patients’ care based on the outcome of a history and physical examination aided by investigations and consultations as determined to be appropriate according to the results of complete, periodic or regular health assessments. Care for and monitor episodic and chronic illness or injury. In the case of acute illness or injury, offer early access to assessment, diagnostic, primary medical treatment and advice on self-care and prevention.

Primary Reproductive Care

Provide primary reproductive care, including counselling patients on birth control and family planning, and educating about, screening for, and treating sexually transmitted diseases.

Primary Mental Health Care

Offer treatment of emotional and psychiatric problems, to the extent that the physicians are comfortably able to provide such treatment. Where appropriate, refer patients to and collaborate with psychiatrists and appropriate mental health care providers.

Primary Palliative Care

Provide palliative care, or offer to provide support to the team responsible for providing palliative care, to terminally ill patients. Palliative care shall include offering office-based services, referrals to Community Care Access Centres or to such other support services as are required, and making home visits, where appropriate.

Support for Hospital, Home and, Where Applicable, Long-Term Care Facilities

Where applicable and where possible, assist with discharge planning, rehabilitation services, out-patient follow-up and home care services.

In northern and rural areas, physicians must have active or associate in-patient hospital privileges and involvement, with discharge planning, rehabilitation services, out-patient follow-up and home care services, unless otherwise agreed to by the community, hospital and the ministry.

Service Co-ordination and Referral

Co-ordinate referrals to other health care providers and agencies, including specialists, rehabilitation and physiotherapy services, home care and hospice programs, and diagnostic services, as appropriate. Co-ordinate referrals for secondary and tertiary care, where and when required. Monitor the status of patients who have been referred for additional care and collaborate on the medical treatment of such patients.

Patient Education and Preventive Care

Use evidence-based guidelines to screen patients at risk for disease, to attempt early detection and institute early intervention and counselling to reduce risk or development of harm from disease, including appropriate immunizations and periodic health assessments. Where disease is detected, institute early intervention and counselling, including appropriate immunizations and periodic health assessments, to reduce risk or development of harm.

Access to Pre-Natal, Obstetrical, Post-Natal, and In-Hospital Newborn Care

Provide maternal services, including antenatal care to term, labour and delivery, and immediate maternal and newborn care. If the physicians do not offer full maternal care, they shall make best efforts to arrange for patients to receive these services.

Arrangements for 24/7 Response

Provide service to patients through a combination of regular office hours, extended office hours, and the THAS which allows twenty four hours a day, seven days a week response to patient health concerns.

Appendix C - Grant Level By RIO Point

RIO Score	Four Year Grant Level	RIO Score	Four Year Grant Level
40	$80,000	71	$111,800
41	$80,200	72	$112,000
42	$80,400	73	$112,200
43	$80,600	74	$112,400
44	$80,800	75	$112,600
45	$81,000	76	$112,800
46	$81,200	77	$113,000
47	$81,400	78	$113,200
48	$81,600	79	$113,400
49	$81,800	80	$113,600
50	$83,280	81	$113,800
51	$84,760	82	$114,000
52	$86,240	83	$114,200
53	$87,720	84	$114,400
54	$89,200	85	$114,600
55	$90,680	86	$114,800
56	$92,160	87	$115,000
57	$93,640	88	$115,200
58	$95,120	89	$115,400
59	$96,600	90	$115,600
60	$98,080	91	$115,800
61	$99,560	92	$116,000
62	$101,040	93	$116,200
63	$102,520	94	$116,400
64	$104,000	95	$116,600
65	$105,480	96	$116,800
66	$106,960	97	$117,000
67	$108,440	98	$117,200
68	$109,920	99	$117,400
69	$111,400	100	$117,600
70	$111,600

Northern Health Programs