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EDCDP Physician Application Form - Emergency Department Coverage

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					                    Emergency Department Coverage Demonstration Project (EDCDP)
                                                Physician Application Form

Enrich Your ED Experience!
EDCDP Physicians are committed to assisting designated, high-need Ontario hospitals cover shifts in their Emergency
Departments. When you work at an EDCDP hospital - be it in small, rural, Northern, and/or regional referral sites - you help
with maintaining ED services for communities across the province.

EDCDP was created in partnership by the Ontario Medical Association (OMA) and the Ministry of Health and Long-Term Care
(MOHLTC) as part of the government's ED Action Plan announced in October 2006. The HealthForceOntario Marketing and
Recruitment Agency (HFO MRA) developed and assumed responsibility for its implementation and ongoing operation. HFO
MRA continues to work together with system partners to support comprehensive and sustainable ED and HHR strategies.

Physician Eligibility Criteria for Recruitment
Acceptance is based on program needs and physician eligibility, in accordance with our discretion. The program engages
physicians already working in Ontario EDs to assist other hospitals in the province with high needs. To be eligible, you must
have either a or b:

a) CCFP (EM) or FRCP (EM) qualifications; or
b) The equivalent of 1 year of full-time ED experience (with your independent practice license) within the last 3 years, and
current ATLS and ACLS training; and

A Few Other Points that are Really Important!
c) You must agree to maintain your current service commitments at the ED(s) at which you currently work
d) Applicants must currently not be providing ED coverage at an EDCDP hospital/corporation, or have provided coverage for
greater than three shifts within the last six months at an EDCDP hospital/corporation.
e) Preferential selection will be given to physicians currently working full-time in an ED in Ontario.

How to Join
1. FIXED PROGRAM
(a) Provincial
· Provide coverage at any EDCDP hospital in the province
· In exchange for a commitment of 60 hours per three month period, receive a monthly stipend of $3000.
· Available in 3-month or 6-month contracts

2. FLEXIBLE PROGRAM
· For those who are interested in providing occasional ED locum coverage
· Minimum commitment of one shift per six month period
(a) LHIN
· Directed only to designated EDCDP hospitals within the home LHIN of participating physicians (Includes a cross-LHIN
variation directed to regional referral centres in southern Ontario designated for EDCDP participation).
· Receive an hourly stipend of $120
· The ED LHIN Lead determines any additional physician parameters
(b) Provincial
- no hourly stipend
- provide coverage at any EDCDP hospital in the province
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Monthly EDCDP Stipend
· Physicians in the Fixed and LHIN Flexible programs receive the monthly EDCDP stipend

All EDCDP physicians receive:
· Travel time reimbursement from the program: Travel time greater than 2 hours one-way will be reimbursed at a rate of $300.
Travel time greater than 4 hours one-way will be reimbursed at a rate of $600.
· Travel and accommodation reimbursement from hospitals: hospitals reimburse reasonable costs for travel and
accommodation
· Compensation from hospitals: pay for actual hours worked at the applicable ED AFA (alternative funding agreement) or FFS
(fee for service) rates

What Else You Should Know
· You can link directly from our password-protected website to schedule shifts at different EDs across the province up to 30
days in advance
· The program uses common credentialing (the Locum Credentialing Application Program), which enables physicians to
work at multiple hospitals after completing only one set of credentialing documentation. More information about the
program can be found online
· You will have the opportunity to work in many different hospitals and communities across the province, to assist where
there is need

More About EDCDP Hospitals
· At any given time there are approximately 20 designated hospitals from across the province on the program, with a range of
start and end dates
· To qualify for the program, hospitals must demonstrate relative highest need for ED coverage assistance

How Do I Apply?
Please take a few moments to review and complete pages 3-5 and return them by
· Email at: emerg@healthforceontario.ca
· Fax at: 416-874-4075 (local) or 1-866-535-2694 (toll-free)

Want To Know More?
Please visit our web site at http://www.healthforceontario.ca/Jobs/OntarioPhysicianLocumPrograms/
EmergencyDepartmentCoverageDemonstrationProject.aspx

Notice of Collection: Personal information is collected by the HealthForceOntario Marketing and Recruitment Agency (HFO MRA) under the authority of the Development
Corporations Act, Ontario Regulation 249/07, Section 3. The personal information you provide to us during our interactions is necessary for HFO MRA to provide you with
career assistance and/or assist you with your employment search. HFO MRA will use the information to contact you to discuss issues related to practising in Ontario and tell
you about health care career and job opportunities. HFO MRA may share your personal information with appropriate agencies and professional bodies, recruiters, health
care employers, the Ministry of Health and Long-Term Care, and/or community representatives for the purpose of helping you explore job opportunities and careers in
Ontario. HFO MRA may also use this information to research and evaluate our recruitment and career assistance activities. If you require further information about this
please contact our information coordinator at: HealthForceOntario Marketing and Recruitment Agency, 163 Queen St. East. Toronto, Ontario M5A 1S1. Tel: 416-862-2200 or
1-800-596-4046, Fax: 416-874-4075




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                                                  Physician Application Form
Personal Information:
please print clearly

First Name                                                              Home Phone

Last Name                                                               Mobile Phone

                                                                        Office/Business Phone

Address                                                                 Fax

                                                                        Email


How were you introduced to EDCDP? Optional and check all that apply

    HFO MRA Web site                       Professional/Recruiting Event          Other _____________________

    Colleague (Please specify so we can extend appreciation)

Which program are you applying to?

    Fixed - Provincial                         Flexible - LHIN                                    Flexible - Provincial
    minimum 60 hours/3 months                  minimum one shift/3 months                         minimum one shift/6 months

                                           Home LHIN:




When would you be available to start?                    Month:                     Year:



Certifications: Check all that apply

    Yes FRCP (EM)                                Yes CCFP                                       Yes ACLS
    No Year:                                     No Year:                                       No Year:

   Yes CCFP (EM)                                 Yes PALS                                       Yes ATLS
   No Year:                                      No Year:                                       No Year:




 Initials

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                                                   Physician Application Form

 ED Experience:
 Have you worked in an ED on a full-time basis for a total of 12 months       Yes         No
 during the past 3 years as an independently licensed physician?


Ability to work on your own in:            Rural (some local backup)                 Urban (with trauma centre)
Check all that apply
                                           Rural (no local backup)                   Urban (without trauma centre)


  Comments:


  Hospital Information: Please list all hospitals in which you have provided ED coverage in the past THREE years
  (please attach separate page if required)

  Current Home Hospital:

                                                                     Dates of Appointment (month/year)
  1. Hospital Site
                                                                     From                             To
  City
                                                                     How many hours do you cover on
  Province/Country                                                   a weekly basis (on average)?


                                                                     Dates of Appointment (month/year)
  2. Hospital Site
                                                                     From                             To
  City/Town/Community
                                                                     How many hours do you cover on
  Province/Country                                                   a weekly basis (on average)?


                                                                     Dates of Appointment (month/year)
  3. Hospital Site
                                                                     From                             To
  City/Town/Community
                                                                     How many hours do you cover on
  Province/Country                                                   a weekly basis (on average)?




   Initials

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                                                  Physician Application Form

                                                                   Dates of Appointment (month/year)
4. Hospital Site
                                                                   From                               To
City/Town/Community
                                                                   How many hours do you cover on
Province/Country                                                   a weekly basis (on average)?


Professional Information:

                                                                                                    Any restrictions?        Yes        No
CPSO NUMBER                                                Date Issued:



If yes, please describe



CMPA Number                                                Date Issued:


OHIP Billing Number                                        Date Issued:


Application Confirmation:
I confirm that the information I have provided is accurate and up-to-date, to the best of my knowledge.




Signature:                                                                Date signed:




                                                 Thank you for your interest in EDCDP.
                            Please return your completed application to the attention of the EDCDP Team by
                                         fax: 416-874-4075 (local) or 1-866-535-2694 (toll-free)
                                                  email: emerg@healthforceontario.ca




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