Moonlighting, locum and replacement
Moonlighting—replacement in other specialties and locums in family medicine—was to all intents and purposes abolished in December 2016. The Ministry of Health and Social Services issued directives to establishments limiting the use of locums (médecins dépanneurs). Thus, establishments may no longer grant temporary privileges (three months, non-renewable, in emergencies) for replacements for a few days/weekends, or replacement privileges for longer periods (maternity or extended sick leave), unless they obtain a waiver from the MSSS.
Nevertheless, moonlighting remains possible, but it is more the exception than the rule.
Eligible medical residents
Holders of regular permits (R5s in Internal Medicine and Pediatrics, and doctors on fellowships holding a first certification from the RCPSC)
Medical residents holding a regular permit to practise, i.e., R5s in postgraduate education (subspecialties of Internal Medicine and Pediatrics), and R6s and higher who have completed a first certification may perform replacement/moonlighting activities.
Medical residents returning to residency after having been in practice can also moonlight, as they have a regular permit to practise. They must comply with the same rules as their colleagues in training as to the conditions established in this regard.
- Have a regular permit to practise (which you will be able to obtain once you have passed your certification exam and completed all your rotations);
- Be registered on the membership roll of the Collège des médecins du Québec and have paid your annual membership fee;
- Hold malpractice insurance in addition to your medical resident coverage. The Canadian Medical Protective Association (CMPA) will need your permit number to finalize the file. You may apply online for coverage. To that end, you must contact the CMPA;
- Register with the Quebec Health Insurance Board (RAMQ) for your billing, when you have your permit and insurance coverage. The Collège will forward a copy of your permit to practise to RAMQ, which will send you a personal identification number (PIN), and you will be able to register online.
Note that your pay when you perform moonlighting will be subject to withdrawal of a membership fee intended for the Fédération des médecins spécialistes du Québec. The deductions are prorated to your billing, up to a maximum amount.
It is very important not to perform moonlighting in a facility where you are on rotation. The law prohibits you from holding medical resident status and staff physician status in the same facility at the same time.
Where to perform moonlighting
You may perform replacements only when positions are vacant, i.e., in settings which have positions (PEMs) that are not filled, or positions in remote or poorly served regions.
WORKING ON ONE’S OWN PEM DURING POSTGRADUATE EDUCATION/FELLOWSHIP
Any doctor performing a fellowship but already holding a position (PEM) in an establishment may moonlight there in the position he was granted, in the specialty of that PEM. For instance, a terminating resident performing a fellowship in Electrophysiology may take on part of his hospital task within the facility or establishment that will be hosting him in Cardiology. It is essential that the hospital/establishment in question previously confirm his privileges to him, and that the privileges be in effect before the candidate takes up the position.
If you decide to take steps to obtain your permit to practise and perform moonlighting, make sure you will be able to obtain privileges in that site. The fees associated with the permit to practise are paid only once during practice (except for those obtaining a second certificate, who will have to pay a fee for converting their permit). In any case, the membership fee (initial registration on the Collège membership roll) is payable once a year.