McGill Teaching Hospital Physician Appointment form

Type of request: New Specialist Intra-regional transfer

Temporary Replacement

Inter-regional transferCross-appointment

Change of status

Other

From: To:

McGill University - Faculty of Medicine 3605 de la Montagne

Montreal, Quebec H3G 2M1 Tel.: 514-398-4668/ Fax: 514-398-4423

www.mcgill.ca/medicine

Last Name / First name:

Specialty: Name & Year of Specialization:

Name & Year of Royal College Exams:

CMQ licence No. (if applicable):

MD degree from:

Year:

Recruit Information (attach CV)

Hospital appointment

Appointment start date: Hospital:

Current Base Hosp:

Type of Hospital status requested:

Associé -

Temporary Replacement -

Actif -

Honorary Other

Formation complémentaire:Description (field of training) Site Start Date

Replacing: Start date: End date:

Department: Service:

End Date

University department: Academic rank: Status:

**Name

Male FemaleGender:

Specify

DerogationDeparture: available PEM* Name

NB. Faculty approval issued as a separate memo directly to the DPS office.

* for departures or retirements, the confirmation letter form the out-going physician must be attached

** LOA must be processed at the hospital and MSSS in order to hire a replacement

Department Chief (please print name)

Signature

Signature

Signature

LOA type:

* Minimum of 12 months of extra training beyond specialisation is required for recruitment to a teaching hospital.

Approvals

HOSPITAL APPROVALS:

Director of Professional Services (please print name)

UNIVERSITY APPROVALS:

Department Chair (please print name)

DateDate

Date2020-03

University appointment

Consultantdd/mmm/yy dd/mmm/yy

Secondary site (if remaining in same CIUSSS)

CRITERIA FOR ELIGIBILITY FOR APPOINTMENT

1. Must be eligible for and hold a full or restrictive licence from the Collège des médecins du Québec. For informationon licensure, the physician should contact the Collège des médecins du Québec at 514-933-4441. The AcademicAffairs Office assists in obtaining a restrictive licence for MD professor recruits (398-4668).

2. Formation complémentaire (mandatory extension of training) of at least one year duration is required for allspecialties. Please consult the Postgraduate Medical Education Office web site should your potential recruit be aMcGill resident who wishes to complete this training in Quebec.

3. Replacement (“jumelage”): The name of the physician being replaced by the applicant must be indicated. Whenno replacement (departure or impending retirement) can be identified, a letter of justification for this recruitmentmust be submitted by the Department Chair to the DPS office.

4. Inter-Regional Transfers and Retour de région: Candidates must have written release from the MSSS aftercompletion of a minimum of 3 years of practice or upon conclusion of their contractual agreement. In these cases, aformation complémentaire may be required. A new specialist PEM position is required.

5. Intra-Regional Transfers: the hospital of origin needs to be notified regarding this transfer request.

McGILL TEACHING HOSPITAL PHYSICIAN APPOINTMENT PROCEDURE

SPECIALIST APPOINTMENTS

1. The University Chair ensures that the Director of Professional Services of the base hospital sends the McGill TeachingHospital Physician Appointment Form along with supporting documents (Chair's cover letter, CV, and FC information),to the Vice Dean, Health Affairs.

2. A jumelage is required for all "actif" hospital appointments. No jumelage is required for "associé" statusappointments. Please consult your DPS for further information regarding the definitions and time commitment of"actif" and "associé" appointments.

3. A license (full or restrictive) must be obtained by the physician from the Collège des médecins du Québec(514-933-4441). The Faculty of Medicine assists in obtaining restrictive permits (514-398-4668). Foreign citizensalso need to obtain an employment authorization in order to hold a license and be able to work in the McGillnetwork (see Immigration section).

4. The Dean's Medical Manpower Committee meets 5 times per year, following which the dossiers of approved newspecialists are submitted to the MSSS. Only full-time (clinical or equivalent) positions are considered by the Dean inassessing new appointments.

5. If there is no jumelage available in the Department, the Clinical Chair and DPS must write a well-documented letterof justification which will be forwarded to the MSSS. A copy should be sent to the Vice Dean, Health Affairs, whowill offer the Faculty's support.

6. When the appointment is complete, Academic Affairs Office will process the McGill faculty appointment.

GENERAL PRACTITIONERS

To appoint a General Practitioner, the division director submits a request to the DPS of the hospital concerned. The DPS will in turn inform the Chair, Family Medicine, in writing, by copy of their letter of appointment, and the Chair will then inform the Agence of the jumelage for each GP appointment.

Further information is available in the Dean's office (398-4668) or on the Academic Affairs website for MD recruitment.

2017-09-20