POSTGRADUATE PROGRAM
Department of Family and Community Medicine
Faculty of Medicine, University
Bruce Mines, ON
500 University Ave.
Toronto, Ontario, M5G 1V7
416-978-8530
http://www.dfcm.utoronto.ca/prospectivelearners/prosres/reslearnini/rnip.htm
Rural Northern
Initiative
CONTACT INFORMATION
TABLE OF CONTENTS
Background Information
Pg. 1
Administrative Contact
How to prepare for your RNI experience
Pg. 2
Fadia Ayoub
ACLS & ATLS Information
Pg. 3-4
416-978-8530
CMPA Coverage
Pg. 5
dfcm.rni@utoronto.ca
Applying for Hospital Privileges
Pg. 5
Book a Date
Pg. 6
Faculty Contact:
Putting your Toronto Life on Hold
Pg. 6
Dr. Nadia Incardona
Choosing a Community
Pg. 7
nadiaincardona@gmail.com
Finding a Resident
Pg. 10
Travel and Accommodations
Pg. 10
Resident Learning Objectives
Pg. 11
Tips on on Working with Residents
Pg. 12
Preparing to Work in the ER
Pg. 13
Preparing to Work with Inpatients
Pg. 14
Preparing to Work in Clinic
Pg. 15
Resources
Pg. 16
Getting your Cheque
Pg. 16
Expenses
Pg. 17
Expense Form
Pg. 18
Contact Information
Pg. 19
Iroquois Fall, ON
BACKGROUND INFORMATION
The Rural Northern Initiative (RNI) is a joint project between the Ministry
of Health and Long-Term Care (MoHLTC) and Department of Family and
Community Medicine (DFCM) at the University of Toronto.
We provide medical care in small northern Ontario communities facing a
physician shortage and expose DFCM residents to the exciting and rewarding work available in northern Ontario.
DFCM faculty members visit participating communities for 2-week “locum” style visits along with a PGY2 family medicine resident from UofT.
Faculty members are remunerated for their participation by the Ministry
of Health.
The RNI also gives Family Medicine residents important exposure to potential job opportunities in rural northern communities.
Most visits begin on a Monday morning (which means travelling on Sunday) and finish the following Friday afternoon. Work includes clinic-based
family medicine, inpatient coverage, and some ER coverage. Obstetrical
coverage and Minor Surgical Services (“lumps and bumps”) are optional.
ACLS is required and ATLS strongly recommended.
As this is a DFCM initiative, local chairs have committed to helping ensure coverage of Toronto practices while participating faculty are away.
EXPENSE FORM EXPENSES •
ticket or a copy of the electronic ticket;
•
The kilometer rate for use of a personal vehicle is .47/km; and
•
Accommodation charges for a basic single room [to a maximum of $120/night].
HOW TO PREPARE FOR YOUR RNI EXPERIENCE
A step-by-step approach:
1.
Ensure your ACLS and ATLS are up to date
2.
Ensure your CMPA coverage is adequate
3.
Apply for hospital privileges
Non-allowable expenses include meals, incidentals and personal long
distance telephone charges.
4.
Pick a date and tell the RNI office about it
5.
Prepare to put your Toronto life on hold for 2 weeks
For reimbursement, original receipts must be sent to the UAP with a
completed Statement of Expenses form. Copies of credit card vouchers are not acceptable receipts. For a first locum, the physician will be
asked to provide a completed Finance and Accounting Branch Confirmation of Payment Instruction form and a blank void cheque for the bank
account in which s/he wishes deposits to be made. That banking information will remain in effect until a physician advises the UAP that there
is a change and provides a blank voided cheque for the new account.
Physicians are encouraged not to close the old account until at least one
UAP deposit has been made into the new account.
6.
Select a community
7.
Select a resident and get a letter of good standing to the
10.
Gather your clinical resources together
Accounts (statements of expenses, billing forms, etc.) and inquiries must
be received by UAP within 90 days of the date of service to be eligible
for payment. Claims received after 90 days will not be paid.
11.
Set objectives with your resident and ensure they are met
12.
Practice your locum skills in the ER, inpatient and clinic
community
8.
Book travel and accommodations for you and the resident
9.
Obtain your call schedule and ensure the resident schedule is
reasonable.
environments
SUBMITTING YOUR RECEIPTS All travel and accommodation costs are covered through the program.
Expenses with original receipts should be submitted to the Ministry of
Health office in Sudbury using the specific expense form that can be obtained through the RNI office. Most expenses will be reimbursed within a
few weeks.
13.
Enjoy the outdoors! – hike, fish, ski, snowshoe
14.
Bring home your cheque
15.
Submit your expenses
ACLS AND ATLS INFORMATION
For faculty who commit to a minimum of 2 visits over a one-year span,
the RNI will pay the cost of ACLS and ATLS recertification.
For those who wish to take the full course rather than simply recertifying,
it is expected that the difference in cost will be covered by the learner.
To be eligible for a recertification course, participants must have taken
ACLS in the past 24-30 months.
ACLS
RESOURCES DONT LEAVE HOME WITHOUT
THEM
•
PEPID/Tintanalli
•
UptoDate
•
Pregnancy wheel
•
Anti-infective guidelines
•
Poison Control 1-800-268-9017
•
Therapeutic choices
•
A paediatric resources book
Location:
ACLS Courses will be held at the Sunnybrook (Bayview Campus) and at
Humber College (North Campus)
GETTING YOUR CHEQUE For further information please contact:
Faculty participants are paid between $800 and $925 per day, depending on the rurality of the community and the level of need. In addition to
this an hourly rate is paid directly by the community for ER work.
Terry G. Smith, ATLS Program Coordinator Sunnybrook,
terryg.smith@sunnybrook.ca
telephone: 416-480-4943
http://sunnybrook.ca/content/?page=acls_advanced_cardiac_life_support_courses_toronto
Sonia Deleo, Humber Program Advisor,
sonia.deleo@humber.ca,
telephone: 416-675-6622 ext. 5325
The money to pay you will be transferred to the community before you
even arrive. You will be asked to sign a contract on arrival that outlines
the services to be provided, and a detailed invoice listing which services
were provided for how many hours and days will need to be signed and
sent directly to the Ministry as confirmation of the service you provided.
Make sure you check in with the administrative person in your community before you leave to ensure that the contract and invoice have been
signed by you and the community representative, and that they will get
the originals to Lison Breton (the Ministry of Health contact for the RNI)
PREPARING TO WORK IN CLINIC
ATLS
•
Know your community a little in advance. Ask the local docs about what kinds of problems are commonly seen in the commu-
nity so you are prepared. Find out what the local industry is as this will tell you a lot about the types of work-related injuries you can expect to see.
Location: ATLS at McMaster Health Sciences Centre, Hamilton, ON
•
Find out how records are kept. Some communities have electronic health records and you will need a computer orientation prior to starting in clinic.
Donna Allerton, RN
•
Ensure bookings are done appropriately for you and the resident. Don’t let clinic staff book you both 4 patients per hour or you will fall behind!
•
Opportunistic screening and wellness is key. Do not assume people have a “regular” family doc. Do not assume they have had a pap, mammogram, FOBT, etc. Don’t just tell them to book a physical as it may be months before they can get in for one, if at all. Do what you can while they are there!
•
Do not assume regular follow-up. If someone needs to be man-
aged aggressively, consider seeing them yourself a second time before you leave.
•
Take time to read the chart. Very often people who have been get-
ting locum care have test after test ordered but very little follow-
up on the results. Problems fall through the cracks and abnormal results get missed. Tests get repeated over and over but manage-
ment doesn’t get changed. The few minutes you spend reading the chart can really assist you in maximizing each patient encoun
ter.
•
You can book patients in for procedures in the ER during your shift or at the beginning or end of your clinic day. This is a great opportunity for residents to practice “lumps and bumps” prepar-
ing to work in clinic
•
You can book patients in for procedures in the ER during your shift or at the beginning or end of your clinic day. This is a great opportunity for residents to practice ”lumps and bumps”
For further information please contact:
donnalle@sympatico.ca,
telephone: 905-521-5030 ext. 1288
http://www.hhsc.ca/body.cfm?id=1746
ALTS
Location: ATLS courses will be held at Sunnybrook (Bayview Campus)
Further information please contact:
Terry G. Smith, ATLS Program Coordinator Sunnybrook,
terryg.smith@sunnybrook.ca,
telephone: 416-480-4943
http://sunnybrook.ca/content/?page=ATLS_Advanced_Trauma_Life_Support_Course_Toronto
ENSURE YOUR CMPA COVERAGE IS ADEQUATE
Prior to commencing a locum it is the responsibility of the participating physician to ensure that his or her CMPA coverage is up-to-date and
adequate.
Physicians providing ER and obstetrical coverage in particular must ensure their CMPA code is appropriate for this purpose. This can easily be
done with a simple phone call to the CMPA.
CMPA Website: http://www.cmpa-acpm.ca/
Telephone number: 1-800-267-6522
APPLY FOR HOSPITAL PRIVILEGES
All participating RNI communities accept hospital credentialing through
the Ontario Hospital Association (OHA) Locum Credentialing Application
Program (LCAP) .
The Locum Credentialing Application Program (LCAP) streamlines the
administrative process to help physicians acquire appointments and
privileges as a locum tenens in multiple public hospitals in Ontario.
The program was initially developed in 2005 by the Ontario Hospital Association (OHA) and the Professional Association of Internes and Residents of Ontario (PAIRO), in consultation with the College of Physicians
and Surgeons of Ontario (CPSO), the Ontario Medical Association (OMA),
and the Ontario Region of the Society of Rural Physicians of Canada
(SRPC).
To participate, physicians are required to complete one LCAP form annually, including accompanying documentation. At the request of a participating hospital which specifically identifies a physician, this completed
LCAP document will be sent to the hospital by HFO MRA. Hospitals
then process these applications in accordance with the provisions of the
Public Hospitals Act, the regulations thereunder, and the by-laws of the
hospital.
More information and application forms are available at http://www.
healthforceontario.ca/Jobs/OntarioPhysicianLocumPrograms/EmergencyDepartmentCoverageDemonstrationProject/credentialing_application.
aspx
PREPARING TO WORK WITH INPATIENTS
•
Often you will be responsible for patients you admit while on call in the ER. On arrival in the community, check to see if any pa
tients are being transferred to your care.
•
Find out whether you need to dictate admission and discharge notes for the chart, and if so what codes are used for the dictation system. Give the resident a chance to dictate!
•
Don’t hesitate to admit patients you are concerned about, and don’t feel rushed to discharge them. In smaller community hospi
tals the pressure to rush people out the door is not as high and you can ensure people are truly well enough to go home.
•
Find out what other health professionals are available – OT, PT, SW and others are often in the hospital. Pharmacists rarely are but often the community pharmacist will be happy to help.
•
Know which resources you like – UpToDate is often used online or on Palm.
•
Nurses in small communities are often very cautious about “both
ering the doctor”. If they call you about a patient, assume they are very worried!
PREPARING TO WORK IN THE ER
CONTACT INFORMATION
Ensure your ACLS and ATLS are up to date. If you have flash cards or
other resources from these courses, bring them with you as a security
blanket. Small-town ER acuity does not tend to be high, but you want to
be prepared for anything that could come through the door.
Emergency Department Coverage DemonstrationProject
Health Force Ontario Marketing and Recruitment Agency
163 Qeen St. East Toronto, Onatrio M5A 1S1
North America: 1-800-596-4046
Fax: 416-874-4075
Toll Free Fax: 1-866-535-2694
Email: emerg@healthforceontario.ca
•
Look for the library when you arrive. Most ERs have a shelf of use
ful resource books, especially McRae (fracture and dislocation management), Tintinalli (general ER resource), the orange com
munity acquired infection guidelines, etc. Know what you have and what you don’t – and find the nearest computer with internet access.
•
Ensure you take a tour prior to starting so you know where every
thing is. Resist the urge to walk right in and start seeing patients get oriented first!
•
Know the closest referral centre and how to reach a consultant for advice or transfer. Just because you don’t have specialists in your community doesn’t mean you can’t get specialist advice! Call if you are unsure how to manage a patient in the ER or if you think they may be too acute to manage in your centre. Fax ECGs for advice or ask radiologist for verbal reports. Speak with the internist or pediatrician on call at your referral centre for ad
vice.
•
Know what time the lab closes, and how to reach them on call for urgent cases.
•
Know what radiology is offered in your community and at what hours.
•
Don’t hesitate to ask for help! Call another MD for backup if a serious case comes in.
BOOK A DATE
This is the hardest part of getting started – it may seem impossible to
find a 12-day span in your calendar, but once you commit everything
else will fall into place. Just do it! Any 2-week period (12 days from a
Monday to the following Friday) qualifies for an RNI rotation. Give us
your dates as soon as you have them so we can find you a community.
PLAN TO PUT YOUR TORONTO LIFE ON HOLD
1.
Get your chief on board! All the site chiefs know about the RNI and have pledged to help support the program. Please let your chief know that you are thinking about participating in the pro-
gram and ask for his or her help and support.
2.
Get your practice covered - Ensure that the people who book your clinical and teaching schedules know right away. We find that 6 weeks notice is the ideal amount of time in order to avoid having to cancel commitments.
3.
Get your call covered - If you are part of a call group, make sure you tell the person who makes the schedule when you will be away. Take the time to explain to your group where you are going and what you are doing
TIPS ON WORKING WITH RESIDENTS
Hailey Bury
Iroquois Falls
SAMPLE COMMUNITY DETAILS
Some communities are not accustomed to having residents and it is a good idea to tell the nurses in the ER and ward who to call first and find out whether you need to co-sign all orders or not
•
If you can arrange it, request separate accommodation. Living with most residents is do-able but it is a LOT of togetherness.
•
Use your judgment about “sharing” learners with other MDs in the community. We are responsible for our learners and our role is to lighten the load of community docs, not increase it. How-
ever if someone is doing an interesting procedure don’t hesitate to ask if the resident can participate.
CHOOSE A COMMUNITY
•
Ensure the resident’s call schedule complies with the PAIRO-
CAHO agreement. In communities where the on-call is busy it may be safest not to have the resident booked in clinic post-call.
The greatest need, physicians can request to visit a particular community and repeat visits are encouraged to build continuity and relationships.
Participating communities include: (Subject to change pending community needs as determined by the Minitstry of Health)
•
Residents don’t have CMPA coverage for emergency medical evacuations, so if a patient needs to leave the community with an MD you should accompany the resident for transport
250km
Sault St.
Marie
10-15
4
5km
Thunder
Bay
14
5
Thunder
Bay
27
2
2.5
1.5
North Bay
59
3
1
Timmins
30-35
3
2.5
Thunder
Bay
10
3
Timmins
Sudbury
2.5
Average ER
volume per 24
hours
5
Nearest Referral Centre
Wawa
•
Distance from
Airport (hour)
Marathon
Let your resident take first call in the ER, OBS, etc but make sure you are always accessible! Some communities only have one pager for the on-call physician so see if you can arrange a second one or a cell phone to ensure you are easy to reach
Geraldton
•
Atikokan
Most PGY2 FM residents are much stronger in the clinic than in the ER and inpatient environments. We recommend that you review EVERY patient seen in the ER and every change made to inpatient management
Chapleau
•
# of MDs in
the community
AtikokanChapleau Emo
Pickle LakeHaileyburyWawa
Iroquois FallsRainy RiverEnglehart
RESIDENT LEARNING OBJECTIVES
The following objectives, adopted for the DFCM Teaching Practice experience, serve as a useful guide for establishing resident objectives for
the 2-week elective RNI rotation. We recommend that you sit down with
the resident at the beginning of the rotation to establish specific learning objectives and review these as the locum progresses to ensure they
are being met.
Following the placement, faculty and residents will be asked to evaluate
each other through POWER.
•
The resident will demonstrate ability in caring for both hospital-
ized inpatients and ambulatory community patients concurrently
•
The resident will have participated in the care of patients in a variety of settings in a practice pattern similar to the preceptor’s
•
The resident will demonstrate an understanding of the role and lifestyle of family physicians in a community setting
•
The resident will show a basic understanding of the business and management aspects of family medicine
Iroquois Fall, ON
•
The resident will show measurable gains towards the goals set in consultation with the preceptor at the intake and mid-rotation interviews
•
The resident will show demonstrate proficiency in common family practice procedures
•
The resident will demonstrate competence in caring for an ad
equate patient volume on a daily basis
Schreiber, ON
FINDING A RESIDENT
TRAVEL AND ACCOMMODATIONS
Faculty members are welcome to propose a resident in their home program to accompany them. Residents must be in their PGY2 year and on
an elective or core family medicine rotation with permission from their
program director.
Faculty is responsible for booking their own travel. As a courtesy to our
residents, we ask that faculty book and pay for flights, rental cars and
accommodation for themselves and the resident. If this is too difficult
please let our office know and we can try to assist.
Bringing a resident you know and trust can make the experience much
more fun for both of you. However, we would be pleased to help find a
resident for faculty members who would prefer this. If you are going with
a resident you don’t know, take the time to speak with his or her local
For most communities you will need to book both flights and rental cars.
We recommend separate cars for you and the resident as you may be
staying in different locations and have different schedules.
Accommodation ranges from bed and breakfast-type to houses provided
by the hospitals. The presence of other locums and learners in the community sometimes means that shared accommodation is necessary but
private bedrooms and appropriate washrooms etc. are always provided.
The RNI office will put you in contact with the administrative contact
person in the community to arrange accommodation.
In some communities there is locum accommodation owned by the hospital which is free for locums, but in many others you will be asked to
pay for your accommodation. The program will reimburse you for these
costs. Make sure you ask questions about where you will be staying –
shared vs single, internet access, distance from hospital, availability
of kitchen facilities, etc. Most are totally furnished apartments or even
Wawa, ON