Appendix 1 : Glossary

Attrition
Reduction in physician resources owing to departure or death

CISSS
Integrated health and social services centre

CIUSSS
Integrated university health and social services centre

Canadian Common CV
Canadian Common CV

Waiver
Special request addressed to the MSSS by an establishment to recruit a physician beyond the number of doctors listed in the PEM. The reasons for this approach must be explained in a letter signed by the DSP (see details in the section on waivers on this site). Waivers are rare.

Establishment
A healthcare establishment is a group of healthcare facilities (hospital, CLSC, residential and long-term care facility [CHSLD], etc.) which covers services for a given region.
Following the adoption of Bill 10, the Ministry grouped the 182 existing healthcare establishments into 34 establishments. Completing the system are university health centres, and institutes. For further information, you may consult the list of Quebec healthcare establishments.

Kamikaze fellow
A physician who decides to leave Quebec to perform a fellowship outside Quebec (elsewhere in Canada or abroad), without having a confirmed position in an establishment is deemed to be a kamikaze fellow. Kamikaze fellows are therefore physicians who leave without a parachute, and could come back to Quebec and be unable to find a position in the university settings they usually hope for.

Facility
A facility is a physical site where healthcare is delivered.
Facilities are hospitals, CLSCs, residential and long-term care facilities (CHSLDs), rehabilitation centres, etc., which are grouped together under a healthcare establishment within the meaning of the law.

Opted-out physician
A physician who has opted out practises outside the public health insurance plan, but agrees to be paid in line with the rates set out in the agreement. His patients, upon presentation of the form obtained during the visit, receive from RAMQ an amount equal to the fees billed. They must then pay the opted-out physician. The latter must inform patients who consult him of this situation.

Non-participating physician
A non-participating physician practises outside the public health insurance plan, does not accept the health insurance card, and refuses to be paid in line with the rate provided for in the agreement. He determines his rates himself. He must inform the patient of the situation, as the patient alone is responsible for payment of the physician’s fees. RAMQ cannot reimburse the cost of the services of a non-participating physician.

Participating physician
A participating physician practises under the public health insurance plan, and is paid by RAMQ in line with the rates set out in an agreement. The amount of his fees is paid to him directly by RAMQ when an insured individual has presented his health insurance card or, when that is not the case, by the insured individual, who may upon request obtain reimbursement of the fees paid.

PEM
Physician resource plan of a healthcare facility/establishment.
“PEM” is used to designate positions in hospital settings.
A PEM is needed in order to work in a hospital setting. But specialist physicians who opt to work solely in an office are not required to obtain a PEM, and may work in the public system and bill RAMQ (e.g., Dermatology, Psychiatry, Rheumatology, etc.).
In family medicine, “PREM” is used to designate positions granted in a local services network (RLS), while “PEM” is used for positions in hospitals.

Suicide PEM
A position where the physician cannot maintain his knowledge or proficiency owing to a lack of cases and case variety, or because he has to practise alone.

Virtual PEM
A position which is posted as being available in a facility’s PEM, but which the facility does not wish to fill (for lack of equipment, unavailability of operating rooms, lack of personnel or sufficient physicians to ensure access to care, etc.).

N.B. It is important to report these positions to the FMRQ, so it can lobby the MSSS, where applicable.

PREM
Regional physician resource plans
Plans which include the PEMs of all facilities and establishments for each of the 18 administrative regions.
In family medicine, “PREM” is used to designate positions granted in one of the administrative regions, in a local services network (RLS), while “PEM” is used for positions in hospitals.