Through IMG Ontario, over 200 training and assessment opportunities are made available each year for IMGs wanting to practice medicine in the province. Ontario also offers up to 40 positions annually to experienced, practising physicians and surgeons in other provinces and the United States through the Registration through Practice Assessment (RPA) operated by the College of Physicians and Surgeons of Ontario (CPSO).

The Ministry of Health and Long Term Care will provide $26 million in 2004/05 to support these IMG assessment and training programs. By providing this significant financial support, the MOHLTC wants to ensure that a large percentage of these IMGs are fully utilised in our healthcare system, especially in underserviced communities where they are most needed.

Return-of-Service (ROS) agreements ensure that IMG participants fill the need for physicians in communities considered underserviced by MOHLTC. Through these ROS programs, participants in the PGY-1, PGY-2, Practice Ready Assessment and Registration through Practice Assessment programs are required to work in Ministry-approved underserviced communities for 5-years. In exchange, the MOHLTC supplies the money necessary to support, assess and train the participants.

Provided the 5-year ROS agreement is successfully completed with an underserviced community, the investment paid for by the Government of Ontario is considered recovered and no monies need to be paid back to the Government of Ontario by the participant.

• What do IMG candidates need to do to secure their return-of-service (ROS) agreement?
• What communities are eligible for ROS?
• What happens if a participant cannot fulfil the Return of Service Agreement?
• What happens if a community no longer requires a participant's services prior to their return-of-service?

What do IMG candidates need to do to secure their return-of-service (ROS) agreement?

Once a participant is offered a position with IMG Ontario, or an assessment through RPA, the participant must complete 2 separate documents :

1. ROS Agreement :  Prior to accepting a position with IMG Ontario, or the RPA, the participant must sign a ROS agreement and return it to the MOHLTC. The agreement is an MOHLTC document that confirms with the candidate that they will honour the terms and conditions stipulated by MOHLTC.
   The ROS Agreement is due AS SOON as a participant accepts a position with IMG Ontario or the RPA.
2. ROS Addendum :  The addendum to the ROS is the piece of the ROS that indicates which underserviced community the participant has chosen. The participant, community, and MOHLTC sign the addendum prior to the completion of the candidate's postgraduate training or assessment.

What communities are eligible for ROS?

The eligible communities are those listed on the MOHLTC "List of Areas Designated as Underserviced" (LADAU). For specialists, the LADAU list is limited to northern communities however if a community is on the list for family medicine in the south, and can demonstrate to the ministry that it has been unable to recruit a physician to fill a vacant position, the southern location would be considered.

If a specialist wishes to practice in southern Ontario, he/she is required to select a community on the LADAU list for general practitioners. The community must provide proof of its need for the specialist and submit their case to the ministry for approval. Specialists interested in making a case for a southern community must work with the community to demonstrate the community's need by completing a template provided by the Ministry of Health and Long Term Care.

What happens if a participant cannot fulfil the Return of Service Agreement?

If a participant cannot fulfil the contract and/or must move to a new community due to extenuating circumstances, the Ministry of Health and Long-Term Care will evaluate the circumstances on a case by case basis.

In some situations, it may be necessary for the participant to arrange a new contract with another ministry-approved underserviced community for the balance of their five-year commitment. The Minister will consider approving a participant's ROS in a different community from the community originally approved, or in a different facility from the location originally approved, only if the participant makes the request in writing beforehand. If the approval is given, the participant shall return service in the new community and the ROS agreement will continue to apply.

Other situations, such as accidents or long term sickness may require more compassionate solutions.

In situations where extenuating circumstances have not interfered with the participant's ability to return service, the participant will be considered in breech of the ROS agreement when :

• He or she fails to complete his/her post-graduate medical training
• He or she fails to apply to the CPSO for a certificate of registration, or upon applying for a CPSO certificate, has his/her certificate revoked or suspended
• He or she fails to submit a ROS addendum, or fails to complete the ROS in the agreed community

If any of the above breeches occur, the agreement will be terminated without penalty, cost, or liability on the part of the Minister. The participant will be required to repay the Minister the full salary and benefits plus any stipend provided by the Minister for each year of his or her Post-Graduate Medical Training. Interest will also be calculated and charged on the outstanding balance monthly, on the first day of every month.

What happens if a community no longer requires a participant's services prior to their return-of-service?

If the community no longer requires a participants services at any time prior to the 5- year period of return-of-service (as indicated in writing), the participant must arrange a new contract with another ministry approved underserviced community for their specialty.