|ACFP||Academic Clinical Funding Plan|
|CME||Continuing Medical Education|
|CGDS||College of Graduate and Postdoctoral Studies|
|CoM||College of Medicine|
|EMR||Electronic Medical Records|
|FAM||Finance and Administration Manager|
|FFS||Fee for Service|
|FTE||Full time Equivalency|
|GST||Goods and Services Tax|
|ISA||Individual Services Agreement|
|MoH||Ministry of Health|
|OSCE||Objective Structured Clinical Exams|
|PBO||Physicians’ Billing Office|
|PGME||Post-graduate Medical Education|
|PSA||Practitioner Staff Affairs|
|RHA||Regional Health Authority|
|RQHR||Regina Qu’Appelle Health Region|
|SHR||Saskatoon Health Region|
|SMA||Saskatchewan Medical Association|
|U/DH||Unified Department Head / Department Head|
|UGME||Undergraduate Medical Education|
|WBC||Workers’ Compensation Board|
1. What should I do if I am interested in obtaining an ACFP contract?
Please contact your U/DH to express interest. The U/DH will work with the RHA/PSA and CoM to complete a position Impact Analysis so that the position can be considered within the provincial Prioritization Process. Once the position and associated funding has been approved the ACFP office will work with the MD and the U/DH to develop an ACFP contract.
2. Can I change my ACFP from a personal contract to professional corporation contract?
Yes. Once you have a professional corporation in place please notify the FAM for your department who will work with the RHA to facilitate the required information. You will need to complete new banking forms and initial the name change on the first page of your contract.
3. Does the ACFP allow for work to be completed outside of the province of Saskatchewan?
Clinical services can only be paid for when completed for residents/beneficiaries of Saskatchewan within the meaning of The Saskatchewan Medical Care Act. Academic services may at times be provided outside the province if it has been clearly identified within the ACFP deliverables and is for activities that are deemed to produce results that are of primary benefit to the CoM and/or the university (e.g., member of multi-province task force). It does not cover volunteer work. All out of province work must be approved by the U/DH in advance of the work being completed. A copy of this approval must accompany the monthly invoice or the associated hours will not be paid.
4. Can I provide part time services outside the ACFP contract, e.g., operate an outpatient clinic or have other contracts with outside organizations?
The ACFP is a whole time contract, inclusive of all insured services. Some uninsured third party services may be performed outside the stipulated weeks in your contract, as per the Payments/Third Party Policy for Uninsured Services. The incorporation of other applicable agreements may be discussed with your U/DH when developing your ACFP. As an independent contractor, you are responsible to declare all services and income and ensure that the related funding is directly assigned to the ACFP. Refer also to Q 3 and 18.
5. Do I get vacation time?
As an independent contractor paid vacation does not apply. ACFP contracts cover 44 weeks annually, leaving 8 weeks of uncontracted time per year for the contractor to use as they deem appropriate, e.g., personal time, CME, holiday.
6. I pay for overhead to cover office space, supplies and administrative assistance. Who do I contact for issues pertaining to these items?
The FAM in your department can assist you with these items.
7. What is included in the overhead I purchase such from the CoM and/or RHA?
MDs engaged through an ACFP contract may purchase the services of their current clinical staff or choose to hire their own staff. MDs may also choose to cover their own “general office expenses” or purchase them from the college.General office expenses are purchased as a package and the standard amount of $8000 is charged to cover a multitude of general office expenses such as, but not limited to, desk phones, faxes, printers, postage, couriers, paper and other sundry office expenses. This was deemed a reasonable amount when averaging expenses of this nature and is intended to reduce the amount of administrative minutia that could come from highly individualized overhead.Clinical staff salaries vary from one person to another, e.g., position, rate of pay and benefit costs). A standardized amount of $31,737/year was identified to cover the salary and employment costs for half-time clinical clerical assistance. MDs will have varying preferences for the amount of clinical clerical assistance they desire and will be charged overhead accordingly, e.g., if the MD has requested fulltime clinical assistance the related overhead charge will be $63,474 (2 times $31,737).Other related items are:
- The PBO and EMR are a cost recovery service that are billed for separately from overhead.
Lease agreements are not included in the overhead charges. They are paid to the RHA at a current rate of $30/square foot
8. What I would like more than half-time clinical support?
See Q7 - If you wish to pursue this option, please contact the FAM in your department.
9. What is the process with respect to overhead invoicing and payment?
There are numerous ways to handle overhead invoicing and payments. You will receive an invoice directly from your department for the overhead costs. The frequency of this invoice can be determined between yourself and the FAM in your department. Invoices can be sent and paid no more frequently than monthly and no less frequently than quarterly. You can pay the overhead invoice either by providing cheque or credit card. Check with your FAM as to the frequency of invoicing and the method used and in your department.
10. Do I get benefits?
As an independent contractor employee benefits do not apply. You may wish to make your own arrangements or contact the SMA to discuss benefit options they provide for Saskatchewan physicians.
11. Many funding agencies require the Principle Investigator to have a university appointment, how is this handled for an MD on an ACFP contract?
MDs engaged with the CoM have an academic appointment that represents their ongoing relationship with the university. This appointment is separate and distinct from the various forms in which MDs are remunerated. As an MD engaged with the CoM you will receive a university appointment letter from the Provost’s office that will provide you the ability to apply for and hold research funds. Granting of research funds is subject to the relevant terms and conditions of the granting agency
12. Can I supervise MSc and PhD students while on an ACFP contract?
Yes. The College of Graduate and Postdoctoral Studies oversees the provision of supervision for MSc and PhD students. Your academic appointment with the university provides you the opportunity to become a member of the CGPS. For further details please refer to their website.
13. If I am on an ACFP contract am I required to fully participate in on-call?
MDs on an ACFP are required to fully participate in providing on-call service in accordance with the call rotation(s) required of members of the department as determined by the U/DH. The scheduling of the call coverage responsibilities for the MD are arranged equitably and collaboratively among the contracted MDs, other members of the department and the U/DH.
ACFP payment rates are set based on full on-call participation. In special circumstances the U/DH may agree to waive the on call requirement and the ACFP rate would be reduced to reflect the decreased level of service provided. Please note stipends for on call service are in addition to the ACFP contract and are paid quarterly by the RHA.
14. How are the ACFP benchmarks rates determined and how often are they revised? Do benchmark rates affect when my contract level will change?
The ACFP benchmarks represent the 40th (Level 1) and 60th (Level 2) percentiles of both the Saskatchewan Fee-For-Service rates and the mean compensation rates of the western provinces. Benchmark rates will be reviewed regularly, although a timeline for review has not yet been established. ACFP rates are subject to SMA increases.Your level specified in your contract remains the same for the length of the contract period.
15. Why is my ACFP contract for 3 years and my ISA only for 1 year?
ACFPs are 3 year contracts whereas the ISAs outline annual deliverables within the context of that contract. This provides the flexibility to adjust the deliverables of the contract annually to meet fluctuating needs while providing the security of a 3 year contract.
16. What is the process to end or renew contracts?
Termination and renewal of contracts will be handled as per the terms outlined in Section 5 of the ACFP contract. Mid-way through each contact year the MD and U/DH will discuss progress against the contracted deliverables. At this time, in the final year of the contract the MD and U/DH will also discuss whether there is interest to renew or let the contract end. This will then provide several months for renewal or transition discussions to occur before the previous contract expires.
17. Can I change how my FTE is split between academic and clinical services?
Yes. Changes to your FTE may be made through discussion with your U/DH. Typically this discussion would occur during the annual ACFP review process and approved dependant on the needs of the department and available funding.
18. What work can I perform outside of my ISA?
All in-province insured clinical services must take place within the 44 weeks of a full-time contract. Some uninsured services (e.g. WCB) may take place outside of the 44 weeks, and payments may be retained by the MD. Certain payments, such as for reviews, performing as an examiner, honorariums, etc., can also occur outside of the contracted 44 weeks. An MD with significant third party contracts may request a reduced FTE within the ACFP to ensure they are able to meet their contract deliverables. A request to work a reduced FTE must be approved by the U/DH, the CoM and the RHA.
19. What do I do if available clinical billing codes are not reflective of my work?
ISAs are developed based on current FFS billing practices for each specialty group. Shadow billing within an ACFP contract utilizes the same codes as a FFS physician in that specialty. If there are codes you feel do not reflect your work and wish to present additional codes for consideration, this can be brought forward as an application to the SMA’s Tariff Committee.
20. What is the process to adjust ISA deliverables?
A formal process to adjust ISA deliverables is currently under-development. In the meantime, requests are being handled on a case by case, on without prejudice basis.
Generally, the expectation is that ISA deliverables will be discussed annually in conjunction with the MDs annual review. If the discussion results in the U/DH requesting a change to the MDs FTE or the FTE split between their academic and clinical deliverables then the U/DH will notify the ACFP Office (under development). The ACFP Office in turn will coordinate with the contract partners to route and track the request through the funding approval process.
21. How will I know how I am progressing toward my deliverable goals for the year?
Clinical data is tracked through your shadow billings which your billing clerk submits to the MoH. You may review this at any time through your billing clerk.
22. If I take on additional duties during the term of my ACFP contract will my ISA be adjusted to rebalance my workload?
Changes will typically be considered at the annual evaluation unless otherwise jointly determined by the U/DH and the MD.
23. What happens if inadequate work space hinders my ability to see the number of patients required in my ISA?
You are responsible to meet the identified deliverables within your contract. If issues challenge this significantly then please discuss this with the U/DH as soon as possible.
24. The ISA measures quantitative values, such as clinical volumes and time spent teaching. How will quality of academic and clinical service be measured?
Some qualitative measures are currently in place (e.g. student evaluations, resident and patient surveys) and will be shared with the MD during the annual review process. Further qualitative measures will be developed and provided in advance of year three.
25. Are no-shows or last minute cancellations counted for within my clinical service numbers?
ISA clinical targets are developed based on billed patient services that have been provided by each specialty group historically, and therefore patient cancellations are accounted for in the ISA deliverables.
26. Can I invoice for work or attendance at approved events if they occur on a weekend?
It is expected this would be a rare occurrence as most clinical activity occurs Monday through Friday. On-call services are not included as they are paid for through a separate stipend process. However, if the clinical service work requires that you are on-site for a minimum of a half day per weekend day, you may invoice for a half day Saturday, and/or a half day Sunday.
27. How do I invoice for a week that contains a statutory holiday?
Paid statutory holidays are an employment construct and do not apply to independent contractors. If you work you should invoice for this day. If you do not work it would be considered one of the days not covered within the 44 weeks of the contract.
28. Do I need to charge GST on my invoice?
The SHR has consulted with a professional accounting firm and they conclude that the separate supply of clinical services made by a licensed physician does qualify as a GSTexempt supply. They also consulted with the MoH, which indicated clinical services within an ACFP are GST exempt, similar to FFS. Therefore, invoices issued by MDs for clinical services under the ACFP agreements should not include GST.
Certain payments for non-clinical services may not be exempt from the GST. This may include, but is not limited to, administrative, advisory and teaching services provided as a result of contractual agreements or other payment arrangements with physicians, either directly with the physician or through a medical corporation. The CoM and RHA have been advised that to charge or not charge GST is a matter between the business provider and the Canada Revenue Agency. As such, we are not able to provide specific direction to you on this matter and we strongly recommend that you consult with your tax advisor.
After receiving advice from your tax advisor should you determine that GST will be charged for the non-clinical services, your invoice is required to contain the following information:
- Your GST number
- Amount of the invoice subject to GST
- Applicable GST
29. You forgot to input a calculation for GST. (Added March 20, 2017)
The stakeholders have been advised that to charge GST is a matter between a business provider and the Canada Revenue Agency. As such, the university and RHA are not able to recommend whether you should be charging GST or specific calculations for you on this matter. We strongly recommend that you consult with your tax advisor for assistance in this matter. If you and your tax advisor determine that you are to charge GST on the academic and administrative deliverables, the GST cell will allow you to enter the required amount.
30. What is the expectation for oversight with respect to information provided on the MDs invoices? (Added March 20, 2017)
There is a requirement that the information provided is in sufficient detail and verifiable such that it would meet the expectations of our accreditors, auditors and other interested agencies, e.g., Canada Revenue Agency. Due to the nuances of each department’s services the U/DH and the FAM will work together to develop practices that ensure the necessary degree of certainty is reached.
31. When can I invoice for time to attend a conference?
You may invoice for your time to present a lecture and/or paper on original research related to the deliverables within your ISA. Time for personal or professional development, networking or personal interest cannot be invoiced for. If you are unsure, prior to attendance please check with the FAM in your department who can facilitate, if necessary the U/DHs preapproval.
32. I plan to present a paper at several conferences throughout the year. Is there a limit to the number of times I can invoice for a presentation of the same paper?
There is no defined maximum number of times you may invoice for a presentation of the same paper. The number of times will be limited by the protected time available within your ACFP and the degree to which the presentation supports delivery of the research outcomes identified within your ISA. If you are unsure, prior to attendance please check with the FAM in your department who can facilitate, if necessary the U/DHs preapproval.
33. I am presenting a paper on one day of an upcoming three-day conference. The paper is based on my own research and part of the research deliverable that has been identified within my ISA. How much time do I invoice for this work?
There is no pre-defined number of days you may invoice. The total amount of supported time to present research must be seen to be reasonable when taking into account the portion of your FTE related to this work and the expected outcomes. If you are unsure, prior to attendance please check with the FAM in your department for guidance. If necessary they will elevate your request to the U/DH for preapproval.
34. Can I invoice for time and expenses associated with CME?
CME is a requirement for MDs to keep their clinical skills current and therefore attendance at such an event is outside the contract and should not be invoiced for. This may be taken during the eight weeks of non-contracted time.
Academic Meetings and Committees
35. When can I invoice for time taken to attend meetings?
Most ISAs have provided a standard 5% to attend clinical and academic meetings and it is expected you will invoice for time up to this amount. If you have significant meetings to attend outside of this 5% as a result of an identified deliverable within your ISA you may also invoice for this time. If you are unsure, prior to attendance please check with the FAM in your department for guidance. If necessary they will elevate your request to the U/DH for pre-approval.
36. Do I need to invoice separately for prep and/or assessment time associated with each hour of didactic teaching I provide?
Yes, you should invoice for teaching including prep time. Up to half-hour of prep time per hour of teaching time has been allocated for in your ISA.
37. Do I invoice for bedside teaching?
No. Bedside teaching is important teaching that involves or is related to a specific patient and occurs in conjunction with clinical service. It is compensated for as part of the clinical service deliverables identified within your ISA.
38. Do I invoice for teaching related to medical student electives?
No. Elective teaching is important clinically based teaching for jursis and residents and occurs in conjunction with clinical service. It is compensated for as part of the clinical service deliverables identified within your ISA.
39. Do I invoice for Objective Structured Clinical Exams (OSCE)?
Yes. OSCEs are provided as part of the UGME and PGME academic teachings and should be identified on your monthly invoice.
40. Do I invoice for time taken to provide feedback to the residents?(Added March 20, 2017)
No. Resident feedback is defined as specific feedback provided to residents for the purpose of supporting their development and success. It can happen formally and informally. If a resident is having difficulty and formal intervention is needed this is the role of the Program Director. Informal resident feedback happens on a daily basis and is expected to occur as a normal practice in conjunction with clinical service. It does not need to be invoiced for as it is compensated for as part of the clinical services identified within your ISA.
41. How do I invoice for PGME teaching when it is usually done on a rotation and hard to track? (Added March 20, 2017)
All PGME rotational based teaching is compensated under the clinical portion of your ISA as part of your overall clinical duties.
42. Can I invoice for time to attend mandatory training such as iPBL, TEMES, orientation for Clinical Integration, etc. (Added March 20, 2017)
Yes. Mandatory attendance at training is recognized as billable time. However, prior to attendance ensure that your U/DH is in agreement. The FAM in your department can facilitate, if necessary, the U/DHs pre-approval.
43. Can I invoice for attendance at a workshop on teaching skills? (Added March 20, 2017)
Professional development related to the improvement of teaching skills is something the CoM encourages. If you wish to invoice for this time please obtain U/DH agreement prior to attendance.
There are a number of factors the U/DH may consider when determining approval
- MD’s years of experience
- Relevancy to expected deliverables
- Needs of the department
Leadership and Administration
44. Can I invoice for participating in clinical and academic leadership activities? (Added March 20, 2017)
Clinical and academic leadership activities must be related to deliverables identified within your ISA.
Participation in leadership roles beyond those required by departmental mandate must be pre-approved by the U/DH if you are intending to invoice for the activity. It is expected that invoiced amounts will proportionally reflect the leadership activity undertaken.
45. Can I invoice for reimbursement of expenses associated with attending meetings or conferences?
Unless alternate arrangements have been made and approved by the U/DH in advance, the MD is responsible for all expenses associated with the delivery of their contract.
46. Will CPP and income tax come off my pay automatically?
As an independent contractor, no deductions will be taken from your payment or remitted on your behalf.
47. Do I get a pay stub?
No. When your invoice has been received and processed you will receive an e-mail confirming that payment has been made. If you are not receiving this confirmation please contact your departments FAM to ensure the correct email address is on file.
48. When do I receive my stipend for call?
On call stipends are paid quarterly (March, June, September and December).
49. How long will it take for me to receive my monthly payment after submitting my invoice?
Effective January 1, 2017, invoice submissions will be processed on the 5th and the 15th of each month (or the next working day if these dates fall on a weekend) with payment issued net 30 days from receipt of the invoice. Direct deposit timeframes may differ depending on the contractor’s financial institution.
50. Why is the payment issued now net 30 days from receipt of the invoice vs. 10 business days? (Added March 20, 2017)
Given that there will now be two different payments being issued (one for services by the RHA and one for GST by the university), payment processing will now align with the university and RHA payment policies.
University payment policy is that payment is issued net 30 days from receipt of invoice. This is a maximum timeframe for payment and we will continue to process and issue payment as quickly as possible.
51. Why do I receive two payments? (Added March 20, 2017)
Effective January 1, 2017, your academic and clinical service components are paid by the RHA and payment for GST on the academic portion of deliverables will be provided by the university, resulting in two payments.
The RHA is not responsible for the GST payments on academic services therefore the university will be issuing the payment for this.
52. As an independent contractor do I have academic freedom?
Yes. Academic freedom is provided under The University of Saskatchewan Act and granted for any related academic duties as part of an individual's appointment with the university, regardless of compensation model.
53. Will the university support individual physicians if they are named in legal action such as a human rights complaint that is centered on academic decisions?
Any MD formally engaged with the CoM, will have general liability protection and will be supported by the university through any potential claims centered on academic decisions.
54. Can the college/university logo be used in conjunction with clinic and other logos on business cards, fax sheets, letterhead and other relevant materials?
Yes. We encourage all MDs to include the college/university logo in their materials.
Logos and usage guidelines are available online.
If you did not find the answer you are looking for here you are encouraged to reach out to the appropriate contact listed below or e-mail with any questions or concerns.