Adult Gastroenterology Training Program

Moonlighting

OVERVIEW

Moonlighting is defined as residents registered in postgraduate medical education programs leading to certification with the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada who provide clinical services for remuneration outside of the residency program. Moonlighting has been more recently called “restricted registration for residents”.

POLICES ON MOONLIGHTING

The Ontario Faculties of Medicine does not support resident moonlighting. Moonlighting compromises postgraduate programs and undermines the educational environment. McMaster Postgraduate Medical Education (PGME) supports this policy. It is recognized that McMaster PGME cannot restrict, from a practical point of view, those residents with an independent practice certificate from participating in this practice, but this activity must not interfere with the training program and the Program Director should be informed by the resident of this activity so that s/he can monitor its effect on the resident as well as the program.

It is recognized that there is a manpower problem within health care in Ontario but it is not under the mandate of McMaster PGME to solve this problem. The McMaster Postgraduate Medical Education Program wishes to maintain an environment in which there is:

  1. a positive balance between education and service
  2. a strong academic focus in our training programs
  3. no confusion regarding the resident’s role in the clinical setting

The Royal College of Physicians and Surgeons of Canada neither condemns nor condones the practice of moonlighting during residency training. However, it does suggest that the following principles be considered if this practice does occur:

  1. Moonlighting must not be coercive (i.e. a requirement of the residency program).
  2. The moonlighting workload must not interfere with the ability of the resident to achieve the educational goals and objectives of the residency program (i.e. the Program Director should be informed when a resident chooses to moonlight and must monitor resident performance to ensure that neither learning nor patient safety are compromised because of increased fatigue).
  3. If residents do moonlight, it should not occur on the same unit or service to which they are currently assigned as a resident.
  4. Confirmation of licensing, credentialing, and appropriate liability coverage is the responsibility of the employer, not the Residency Training Program.

Restricted Registration

There is a process whereby residents are able to practice medicine with a certificate of Restricted Registration. “Restricted Registration” is a certificate offered by the College of Physicians and Surgeons of Ontario (CPSO) to Residents who meet agreed on criteria.

The Council of Ontario Faculties of Medicine have defined “Restricted Registration”, another term for Limited Licensure, as “Residents registered in postgraduate medical education programs leading to certification with the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada who provide clinical services for remuneration outside of the residency program.”

Responsibilities of the Resident

The following criteria must be met before approval for participation in the Restricted Registration Program will be granted:

  1. Abide by the terms and conditions of the PAIRO/CAHO Collective Agreement (i.e. not work more than the hours / shifts anticipated by the contract)
  2. Have obtained / will obtain the necessary CMPA coverage for Restricted Registration (CMPA Code 14 – Residents for Moonlighting)
  3. Restrict activities to the scope of services and sites indicated by the registration
  4. Practice only within the scope of training received to date
  5. Not allow the Restricted Registration activities to interfere with the requirements and responsibilities of his/her training program (including not undertaking activities during residency work hours including on-call periods that are defined by the program). “Moonlighting” activities cannot interfere with Program call requirements.

Restricted Registration activities cannot interfere with the educational requirements of the Program.Therefore, for each rotation in the preceding 12 months, there can be no provisional or unsatisfactory evaluations. Residents must at least “meet expectations” in all criteria and have at least 50% “exceeds expectations” in all criteria in all CanMEDS domains. Residents must also be in good standing overall in the Program. This includes satisfactory attendance at mandatory educational events and satisfactory progress with respect to their research projects. If the Resident does not maintain good academic standing or if the Restricted Registration activities negatively impact on his/her academic and/or clinical obligations in his/her residency program, the Program Director and Postgraduate Dean reserves the right to withdraw their approval for the Restricted Registration, and/or inform the College requesting that the Restricted Registration be terminated.

Failure to comply with the terms of the agreement (abiding by the Collective Agreement, obtaining necessary CMPA coverage, and working within the scope of the Restricted Registration) may constitute unprofessional conduct and may warrant further action by the CPSO under the Act or Rules.

For details, please refer to Restricted Registration Program for Ontario Medical Residents website.