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Note: If you have any concerns or questions please call the Postgraduate Education Office at 306-966-5557

Introduction

Moonlighting:

  • New: Resident must obtain a job description and list of competencies from the agency they wish to work for. These items must be pre-approved by the PGME Office if they haven’t already been.
  • If applying to work at more than one location, the resident requires a complete set of documents for each location (Application, CPSS form, practice plan, list of competencies, job description, etc.)

Independent Clinical Practice:

  • Resident must have CCFP/RCPSC (i.e. Internal Medicine) certification
  • Resident must hold a regular license with CPSS and provide a copy with their application
  • If requesting to work at more than one location, the resident requires a practice plan for each location

Moonlighting

Definition: Refers to extracurricular medical activities that are characterized by the following features:
  1. Usually measured in terms of shifts or hours
  2. Clear and immediate access to supervision including the availability of direct (on-site) supervision when necessary
  3. The resident functions under the direct supervision of the MRP (most responsible physician) - who retains primary responsibility for the patient. The resident is not a replacement or substitute for the MRP
  4. Examples: Critical Care Associate Shifts, House-officer shifts, RPC shifts

Independent Clinical Practice

Definition: Refers to extracurricular medical activities that are characterized by the following features:

  1. May be measured in terms of shifts or blocks of time
  2. No direct supervision
  3. The resident functions as an MRP substitute or equivalent, even if only on a temporary basis
  4. The responsibilities undertaken in the context of the Independent Clinical Practice activity would require a regular practice license (not educational license)
  5. Examples: Medi-Clinic shifts, Relief Programs where the resident replaces the usual physician.


The Postgraduate Medical Education Committee voted that Independent Clinical Practice activity in the resident’s current area of training will not be approved prior to certification by the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada.

Leave of Absence or Suspension and Moonlighting or Independent Clinical Practice

Moonlighting and Independent Clinical Practice are a privilege and are approved by the Program Director and the Associate Dean, PGME for “extracurricular” medical activities. Residents on a leave of absence or suspension from their residency training program are deemed “inactive” and are not approved to engage in Moonlighting or Independent Clinical Practice during the leave period.

College of Medicine guidelines and policies regarding moonlighting privileges

1. Residents’ primary responsibility is to their training program. Should residents wish to work for remuneration over and above the hours of training and call they are expected to do as a resident, this is generally acceptable to the College of Medicine.

2. Moonlighting is a privilege, not a right.

3. The resident must not allow moonlighting to impact negatively on their training. Examples of such impact are refusal or reluctance to take call, being late for work (or alternatively leaving early) to moonlight, creating scheduling problems in the department, “dumping” call on junior residents, being fatigued so that judgment and performance in the discharge of clinical duties or participation in educational activities are compromised.

4. Patient care - quality and safety are very important issues; therefore, the Postgraduate Office will closely monitor all moonlighting activities. Should a resident fail to adhere to an approved moonlighting plan, serious consideration will be given to withdrawing moonlighting privileges.

5. Moonlighting must not be coercive. Residents must not be required by their residency program or other agencies to engage in moonlighting.

6.Residents should not moonlight on the same unit or service to which they are currently assigned as a resident.

7. Residents must have passed the LMCC Part II in order to request moonlighting privileges.

8. The PAIRS Collective Agreement stipulates resident call is not to exceed 1 in 4 in-house or 1 in 3 home call; therefore, in the interest of resident well-being and patient safety, moonlighting plus regular residency training call should not exceed this number.

9.  a. Moonlighting will not exceed 75 hours per month in total. Individual programs have the discretion to set lower limitations. Moonlighting programs must not require/coerce residents to exceed the 75 hour limit.

      b. Residents who are on a continuous six-month block with no more than 20% mandatory clinical duties may have an increase in moonlighting hours while remaining equal to the current PAIRS Agreement guidelines  (see #8 above)

10. Scheduled resident work assignments must be preceded by a minimum non-working period of eight hours.

11. Requests for moonlighting privileges can be made for up to and including six months.

12. The resident’s duties while moonlighting are limited to clearly defined responsibilities as outlined by the Moonlighting Plan and they cannot provide specialty services as per their training.

Procedure for residents to follow to obtain moonlighting privileges

  1. The resident first discusses all moonlighting plans with the program director.
  2. The resident phones CMPA (1-800-267-6522) and ensures their type of work code coverage is changed from type 12 to type 14. They can request a fax confirmation from CMPA as proof of Code 14 coverage.
  3. The program director will approve (on the Moonlighting Application Form and the CPSS Endorsement Form) and submit the resident’s moonlighting practice plan to the Postgraduate Office for approval as per the following timelines:
  • New Application: Must be received a minimum of 2 weeks prior to requested start date. Can only be approved to the closest expiry date – April 30 or October 31.
  • Renewal Application:
    • Renewal Terms
      • May 1 to October 31 (submission deadline for this renewal term is no later than March 15)
      • November 1 to April 30 (submission deadline for this renewal term is no later than September 15)

The submission should include the following:

  • Signed moonlighting application form
  • Resident’s moonlighting practice plan
  • Completed and signed CPSS Moonlighting Endorsement Form
  • Job description and list of competencies
  • Proof of LMCC
  • Proof of CMPA type of work code 14

4. Once Postgraduate Education approval is granted, the resident is responsible for contacting the following agencies:

  • The College of Physicians and Surgeons of Saskatchewan (CPSS) to obtain the appropriate license. The resident is responsible for paying the applicable fees. The CPSS requirements for approval of moonlighting license are to be followed, which include submission of three documents, completed moonlighting application, practice plan and endorsement from the program director every time moonlighting is requested.
  • CMPA to report the CPSS license number assigned for moonlighting purposes (Failure to report the CPSS license number to CMPA may result in the loss of appropriate protection or legal counsel by CMPA. The moonlighting license number and type of work code14 go hand in hand.)
  • SRHA or appropriate regional health authority to apply for privileges, if required

5. The resident is responsible for ensuring that the Postgraduate Medical Education Office receives reports of moonlighting activities on a monthly basis.

 

College of Medicine guidelines and policies regarding Independent Clinical Practice privileges:

1. Residents’ primary responsibility is to their training program. Should residents wish to work for remuneration over and above the hours of training and call they are expected to do as a resident, this is generally acceptable to the College of Medicine.

2. While registered in a residency training program Independent Clinical Practice is a privilege, not a right.

3. The resident must not allow Independent Clinical Practice to impact negatively on their training. Examples of such impact are refusal or reluctance to take call, being late for work (or alternatively leaving early), creating scheduling problems in the department, “dumping” call on junior residents, being fatigued so that judgment and performance in the discharge of clinical duties or participation in educational activities are compromised.

4. Patient care - quality and safety are very important issues; therefore, the Postgraduate Office will closely monitor all Independent Clinical Practice activities. Should a resident fail to adhere to an approved Independent Clinical Practice plan, serious consideration will be given to withdrawing Independent Clinical Practice privileges.

5. Independent Clinical Practice must not be coercive. Residents must not be required by their residency program or other agencies to engage in Independent Clinical Practice.

6. Residents should not work on the same unit or service to which they are currently assigned as a resident.

7. Residents must have their CCFP/RCPSC, passed the LMCC Part II, and hold a regular license with CPSS in order to request Independent Clinical Practice privileges.

8. The PAIRS Collective Agreement stipulates resident call is not to exceed 1 in 4 in-house or 1 in 3 home call; therefore, in the interest of resident well-being and patient safety, Independent Clinical Practice plus regular residency training call should not exceed this number.

9. a. Independent Clinical Practice will not exceed 75 hours per month in total. Individual programs have the discretion to set lower limitations. Independent Clinical Practice programs must not require/coerce residents to exceed the 75 hour limit.

     b. Residents who are on a continuous six-month block with no more than 20% mandatory clinical duties may have an increase in Independent Clinical Practice hours while remaining equal to the current PAIRS Agreement guidelines (see #8 above)

10. Scheduled resident work assignments must be preceded by a minimum non-working period of eight hours.

11. Requests for Independent Clinical Practice privileges can be made for up to and including six months.

12. The resident’s duties while performing Independent Clinical Practice work are limited to clearly defined responsibilities as outlined by the Independent Clinical Practice Plan and they cannot provide specialty services as per their training.

Procedure for residents to follow to obtain Independent Clinical Practice privileges

  1. The resident first discusses all Independent Clinical Practice plans with the program director.
  2. The resident phones CMPA (1-800-267-6522) and ensures their type of work code coverage is appropriate for the proposed Independent Clinical Practice work. They can request from CMPA a fax confirmation as proof of coverage.
  3. The program director will approve (on the Independent Clincial Practice Application Form) and submit the resident’s Independent Clinical Practice plan to the Postgraduate Office for approval as per the following timelines:
  • New Application: Must be received a minimum of 2 weeks prior to requested start date. Can only be approved to the closest expiry date – April 30 or October 31.
  • Renewal Application:
    • Renewal Terms
      • May 1 to October 31 (submission deadline for this renewal term is no later than March 15)
      • November 1 to April 30 (submission deadline for this renewal term is no later than September 15)

The submission should include the following:

    • Signed Independent Clinical Practice application form
    • Resident’s Independent Clinical Practice plan
    • Proof of LMCC
    • Proof of appropriate CMPA work code
    • Copy of CCFP/RCPSC Certification
    • Copy of Regular CPSS License

4.  Once Postgraduate Education approval is granted, the resident is responsible for contacting the following agencies:

  • CMPA to report the CPSS license number assigned for Independent Clinical Practice purposes (Failure to report the CPSS license number to CMPA may result in the loss of appropriate protection or legal counsel by CMPA).
  • SRHA or appropriate regional health authority to apply for privileges, if required.

5. The resident is responsible for ensuring that the Postgraduate Medical Education Office receives reports of Independent Clinical Practice activities on a monthly basis.

 

 

Moonlighting and the College of Physicians and Surgeons of Saskatchewan

Should a resident fail to adhere to the approved plan or appears to be in academic difficulty, serious consideration will be given to withdrawing moonlighting privileges. It is the responsibility of the Program Director to advise the resident to cease moonlighting/locum activities.

The resident will first be asked to voluntarily withdraw their moonlighting privileges (resulting in no penalty with the CPSS) in writing, copied to the Postgraduate Office, within a deadline prescribed by the Program Director but not more than 30 days.

If a resident fails to voluntarily withdraw their moonlighting privileges within this deadline, the Postgraduate Office will request the termination of the moonlighting endorsement with the College of Physicians and Surgeons of Saskatchewan. This will then remain as part of their record with the CPSS. The resident should be aware this may have long-term ramifications.

Independent Clinical Practice

Should a resident fail to adhere to the approved plan or appears to be in academic difficulty, serious consideration will be given to withdrawing Independent Clinical Practice privileges. It is the responsibility of the Program Director to advise the resident to cease Independent Clinical Practice activities.

June 2003
October 8, 2003 – Approved by Full PGE
September 15, 2004 – Revisions approved by Full PGE
November 22, 2006 – Latest Revisions approved by Full PGE
April 14, 2010 – Content added for explanation
October 6, 2010 – Revisions approved by Full PGE
March 27, 2014 – Revisions approved by Full PGE
October 8, 2015 – Updated and circulated to PGME