ROS Agreements for Canadians

[Coccinelle]

Hi guys,
I have been reading up on returning to Ontario as an IMG and have found that by being allowed to apply for residency through CaRMS you are obligated to fulfill a five-year commitment to an underserviced area. My question is this: is there any way to avoid signing the ROS agreement or are you forced into this if you are an IMG wanting to return to Ontario? Can one apply to other provinces and not have to agree to these terms?
Thanks very much for any info you can give.
Cheers,
C.

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[Trisomy 8]

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[Coccinelle]

Thanks a lot! That was some great and very helpful info.

 

[Trisomy 8]

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[Coccinelle]

Don't necessarily be afraid of the ROS contracts. If you're returning from Ireland, you've jumped through a lot of hoops to get there. This is just one more. As long as you are fully apprised of the situation and are mentally prepared to make the best of it, then going to a underserviced community and really making a difference can be surprisingly rewarding!

That's an excellent point, thanks again!

 

[maserati]

ontario has in the past couple of years made the USMLE equivalent to the canadian exams. you can find it on the ontario surgeons and physicians website.

 

[Trisomy 8]

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[roo]

Not all provinces have ROS.

Newfoundland has blended. The CaRMS slots don't have an ROS. There is some specially-funded ones that do.

 

[Trisomy 8]

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[TristanB]

Some places that are underserviced are really nice.
If Peterborough, Ontario is on the list, I would pick it! its only an hour away from downtown Toronto.

Theres probably a bunch of places that are "underserviced" but close to major city centers.

 

[med2UCC]

Some places that are underserviced are really nice.
If Peterborough, Ontario is on the list, I would pick it! its only an hour away from downtown Toronto.

Theres probably a bunch of places that are "underserviced" but close to major city centers.

In Nova Scotia the RoS is a year for year obligation, meaning if you do the 2 year family medicine program you owe 2 years, if you do internal medicine you owe the 4 years. However, and this is a big however, this is only for the IMG spots; if you match on the second round as an IMG there is no RoS unless you match into a spot specified as an IMG spot. I have friends who are applying to family medicine on the second round who, if they match, willl have no roS to Nova Scotia at all (which seems a little backwards to me, since I could only apply for the 5 IMG spots on the 1st round and owe 2 years to NS as I matched).
Also worth keeping in mind, there are a number of people looking to challenge this in court as soon as they finish their residency programs, so by the time you come to this the whole ball game may have changed. Also, if you are going to finish relatively debt free (don't laugh, there are at least 3 people in my class being entirely funded by their parents, and it must be nice) you can always buy out of the RoS at $60,000.00 per year of training. If you do family somewhere other than Ontario, it is only $120,000.00, which, if you are debt free to start, puts you on an even footing with the Canadian grads in terms of debt.
All things to think about. Cheers,
M

 

[Trisomy 8]

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[roo]

In the second round, all residents matched to the IMG stream (whether CMG or IMG) will have ROS contracts attached.

http://www.carms.ca/eng/r1_eligibility_prov_e.shtml#newfoundland

I stand corrected on that one, for the new approach. Cause and effect though, I see that this year the Family Medicine in NL didn't fill in first round.

I can see it to some degree, that among people with the threshold of competency, there should be getting people that have some interest in being in the province longer term.

Speaking with the people who are in the residency union though, a large part of all the hurdles and separate streams is politics. The local union (which I don't get annoyed at, that is what unions are supposed to do, protect the existing members) were being pretty self-protective about not having to directly compete with international grads for residency.

 

[med2UCC]

it's unethical to sign a contract that you intend to break[/COLOR]. Particularly a contract that stipulates you're going to help someone in need.

(Med2UCC this isn't directed at you, since I know you are headed straight towards Needy Central).

[/SIZE]

I agree with your point, and I am going directly back to needy central, my choice since I grew up there and it is the best place on Earth to live (you can take the girl out of Cape Breton but you will never take the Cape Bretoner out of the girl - my siblings proudly wear t-shirts that say"Born in Cape Breton, Living in Exile - I was kind of disappointed that they didn't get me one, but they pointed out that I was coming home in 6 months and no one in Ireland would get the mickey of that one, things I couldn't argue with at the time). However, as two fine physicians also workiing in that area ponted out to me this summer, what if I meet someone and they won't live in needy central? What happens if my circumstances change such that once again I can't live in Cape Breton; then I will be well and truly screwed by the RoS (as I have confessed in other posts, I come from an extensive family of church mice and owe rather a lot of money already for my fine education in Ireland). The RoS contracts kind of suck.
The people looking to challenge them are looking to do it on human rights grounds. The contracts are actually with provincial governments (at least, mine is, don't know about you Ontario folks) and I suspect that they haven't been challenged before because no-one has tried them on citizens of Canada before; if you were in the immigration process, would you jeopardize that by challenging the conditions of your employment? Last year was the first time those particular contracts were rolled out for people born and bred in Canada (or in some cases more recently made citizens, but citizens none the less) , and some people think they are unfair.
I personally have no problem with them, since mine is forcing me to go home, something I have been wanting to do since about 1994. I still don't understand why my health board didn't rope in some sucker in the 1st round and leave me for the second round, knowing I meant to stay anyway. Ah well, who knows how these things work.
My further 2 cents,
M

 

[Trisomy 8]

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[McToole]

Does anyone else share the feeling that the whole idea of 'Return of Service' gives off negative vibes? I will gladly go work in a rural or underserviced area. However, the fact that they are telling me "you have to go live there" and "No, you are not allowed to work in these places!", makes me want leave wherever I may be as soon as I finish my ROS commitment. I don't want someone telling me where I am and am not allowed to live and work! I want the freedom to choose myself. And believe me, I am not going to be living somewhere for the rest of my career because the government told me I had to go work there. Basically, as IMGs, we are being taken advantage of, because the governments all know how desperate we are to return to practice in Canada. Just another 'kick in the pants' we suffer as Canadian IMGs. Someday I hope we will have the same rights & freedoms as Canadian graduates.

 

[med2UCC]

Usually these contracts have an "escape clause" for situations like the one you describe above. It allows the government to recoup the cost of training the resident (plus interest) through a mutally-agreed upon repayment schedule. So, at least, the government breaks even, and the resident is turned loose.

Out of curiosity, does anyone's contract include this clause? Nobody's mentioned it.

I haven't actually seen my contract yet, except for the online example that is available through CaRMS. There is a opt-out clause, but it covers you if they can't find a community for you to practice in, or if you become incapable of practicing medicine. It certainly does not cover you if your personal circumstances change. I have to say, I am not even sure at what point in the process I actually have to sign the contract; it is a bit of a worry since, in Nova Scotia at least, I have to commit to a community when signing. There's not a lot of room for you to change your mind, at least not on paper. Maybe it will be a little laxer in practice-many things are in Nova Scotia. I'd personally prefer to at least visit the community first, meet some doctors, talk to people and find out what it is like before i have to commit. Cheers,
M

 

[Badkarma25]

ROS agreements are a kick in the pants but you know about them up front and don't have to match to a place that has them. furthermore in ontario they don't choose your community, you choose it. this is what a government guy who came to dublin last year said (he was the HR manager of healthforce ontario who is responsible for all this crap). so i think it's definitely a provincial thing. my roommate who matched into anesthesia at the university of saskatchewan had to sign one but all it stipulated was that he had to remain in the province of saskatchewan so he can pick wherever he wants to go. as much as the ROS's do suck, they are pretty up front about the terms and conditions so you are going in with your eyes open. they do suck though. you have to do your homework.

 

[Trisomy 8]

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[pattycanuck]

as much as the ROS's do suck, they are pretty up front about the terms and conditions so you are going in with your eyes open. they do suck though. you have to do your homework.

Very true - very up front. You sign - you have acknowledged the agreement in its entirety.

I have no problem with ROS agreements - each community/province has to tackle its unique situation. It prevents those who come into a province just for the education and take off knowing that they have just abused the locals' tax money. I know individuals who in recent years have told me that they have signed onto an "unnamed province that has only one med school" that once they are finished, they can leave that hell-hole of a province. I just feel sorry for the tax payers of that province so more power to them for sticking it to those individuals.

What is the big problem with ROS's anyway? The vast majority of people want to settle down and with many of these places offering massive incentives, what's the beef? In Ontario for summation of the LADAU list, really only the GTA, Kingston and Ottawa are the only places that AREN'T underserviced.

 

[Arb]

Unless you're not in Family Medicine. Then it's north of the French River for you...Some people may not like that especially if their spouses are in specific careers or if they want to raise their kids in a certain environment.

Are IMGs eligible for the certain perks that accompanys working in an underserviced area? I seem to recall a year ago the Ontario official said that only Canadian grads are eligible for certain monetary incentives offered by the government. IMGs just go and be happy about it haha!

 

[pattycanuck]

Are IMGs eligible for the certain perks that accompanys working in an underserviced area? I seem to recall a year ago the Ontario official said that only Canadian grads are eligible for certain monetary incentives offered by the government. IMGs just go and be happy about it haha!

Only for the free tuition of $40k/3-4 years. You are eligible for the $15k/3-4 years of working in an underserviced area. Other incentives come from the communities themselves - in many cases much more than that of the government's offers above. SO really government incentives are relatively small for FM - in some specialties, they can be large, but alas not as large as FM non-govt incentives.

 

[McToole]

Okay, ROS agreements are 'up front'. We already knew that. Yes, you do have the option of buying them out. Also, if you don't like the contract, then you always have the choice of not signing it. ...Not really an option for Canadian IMGs trying to return home.
The point I was trying to make is that, ROS brings a 'negative vibe'. Again, it makes me want to leave wherever I do my ROS, as soon as I finish. I don't want to work somewhere because I had to, but rather I would prefer to work somewhere where I chose to. I believe I would be more inclined to stay, if the ROS wasn't in place. Maybe I am the only one that feels this way...

 

[Trisomy 8]

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[rugbyMD]

Hey guys, I'm too lazy to read all this thread so I'll just throw some info out there for ya'll. There is a town in Manitoba (Thompson maybe The Pas) that will pay for all of your tuition if you go to Trinity. Of course the catch is you have to work there for X amount of years but there are probably other bonuses if you sign with them. Check it out if you can.

 

[Trisomy 8]

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[rugbyMD]

Here is the article

http://www.cbc.ca/canada/manitoba/story/2008/01/14/irish-doctors.html

"The Pas Mayor Herb Jaques said the consortium will cover tuition expenses of Canadian medical students attending Trinity University if they agree to be doctors in northern Manitoba" Quote from the article...

Enjoy.

 

[Thewonderer]

"If you successfully completed an American residency and passed the board exams, the Royal College (and Ontario) will accept your USMLEs in place of MCC Part I and II."

Slight corretion. Royal College wouldn't care about your USMLE's or MCC Part I and II. Royal college just cares that you have sat and passed the American board certification exam and possess an unrestricted medical license in U.S. (which means most likely you have passed USMLE's.).

However, simply going to the U.S. for residency and then come back to Canada to be an attending is not such a simple issue.

1) If you are only a Canadian citizen, you need a work visa to do residency in the States. Most likely you will be offered a J visa which means that you need a letter, "Statement of Need from the Ministry of Health of the country of most recent legal permanent residence."

2) As someone alluded above, if the Canadian residency in that speciality is longer, then you need to extend your training in the U.S. by doing some fellowship to make up the years.

3) Most likely you still need to pass MCCEE, MCC QE part I and Part I so you qualify for as a Licentiate of Medical Council of Canada (LMCC). Outside of Ontario, almost all the other provinces want to see that you hold LMCC before granting you unrestricted license (they won't even consider your USMLE's as equivalents).

4) In the U.S., you can't take your board exam until AFTER you have finished residency. And only when you pass your American speciality board exam (and make up for the difference in years of training on the Canadian front v.s. the U.S. front), can you TAKE the specialty board of exam offered by Royal College.

So when you add the above up, it takes a lot of money (taking both USMLE's and MCCEE, QE's), effort, and time (after all, you can't even take the Canadian specialty exams until AFTER you pass the American specialty exams, which you can't take until AFTER your residency is done. so 1-3 extra years easily) to go the American route just to go back to Canada.

 

[goose121a]

4) In the U.S., you can't take your board exam until AFTER you have finished residency. And only when you pass your American speciality board exam (and make up for the difference in years of training on the Canadian front v.s. the U.S. front), can you TAKE the specialty board of exam offered by Royal College.

College of Family Physicians of Canada will let you sit their board exam before completing American AGCME approved family med residency (from CFPC website):

3. Applicants from ACGME accredited family medicine residency programs are eligible to sit the examination during the last six months of their training programs.

And US family med residence is 3 years, obviating the length of residency issue.