Transition to Practice


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Transition to Practice


Guide to Getting Started as a New Physician

  • Clicking here will bring you to the Online Resource Manual for Physicians, which describes important acts and regulations and how to submit claims to get paid, among other things.
     
  • CMA’s New in Practice Guide, published annually, provides residents with the information they need to know before entering practice. The guide covers topics such as evaluating practice opportunities, selecting an EMR system, insurance basics and more. There is also CMA’s Practice Hotline, where CMA members get a free 60-minute consultation with a practice management expert. Find more information about both here
     
  • Missed a CMA PMC session at your school? Start your practice off on the right foot by consulting a series of 15 Practice Management modules. Learn more about contract negotiations, staffing, insurance basics and much more here

CPSO Number (Certificate for Independent Practice)

  •  Needed to engage in independent, unsupervised practice upon graduation.
  • Applications are usually available for download here in April of your graduating year. 

  • Follow the Registration link from the main page, then select Applications and Forms. Under the section Applications for Certificate of Registration Authorizing Medical Practice, ensure to download the application package titled “Final Year Residents in Ontario”. 
     
  • Cost of Member Fee

CMPA Number (Canadian Medical Protective Association)

  • You can download the application and complete the online membership from the website; it is very user-friendly. 
     
  • Cost: Fee is based on practice type.

WSIB Number

  • Apply here
     
  • Your CPSO number is required and processing time is 4–6 weeks.

OHIP – Ontario Billing Number

  • You must have your CPSO number to apply for your OHIP number.
     
  • The good news is that you can start working without your OHIP number and bill retroactively (up to six months) but you will need this number to get paid, regardless of the type of the practice conditions (i.e., locum vs. non-locum).
     
  • Application (Form 014-3384-83)
     
  • Cost: Free
     
  • Processing time: approximately one month

Hospital Privileges

  • Call the hospital where you intend to work: ask about their application process (it varies). 
     
  • In general, you will need photocopies of medical licenses, malpractice certificates, immunization records, CV, Certificate of Good Standing and Certificate of Adult Criminal Convictions.

Other Things to Consider

  • To make the transition to practice as smooth as possible, it is important to build a team of individuals that will help you navigate through the transition (ask around to get a few suggestions):
     
    • Find an accountant
    • Find a financial planner
    • Find a lawyer (to review contracts, etc.) 
    • Find a billing agent
       
  • Membership in Canadian and Provincial/Territorial Medical Association (CMA, OMA) 
     
  • Membership in the CFPC and OCFP
     
  • Change of Address – keep your address current

Useful Resources

Practice U (HealthForceOntario)Information on transition to practice, finding work etc. 

CMA Practice Management toolsStep-by-step guides to practice management separated into high yield modules.

CMA Practice Management Modules:  Practice modules discussing common personal and professional issues in practice.

CFPC – First Five Years in Family Practice


CFPC – First Five Years in Family Practice


Since 2009, the First Five Years in Family Practice (FFYFP) Committee has been working to address the interests and concerns of residents and new family doctors who, at the end of their training program, experience an “off-the-cliff” feeling. Like many others, you will have lots of questions about starting to practice and being out on your own as an independent practitioner in the ever- changing world of family practice. 

As a new family physician, let us know what you need to help support your career

Last year, we asked the FFYFP Committee members what they needed from us, and where they wanted the committee to dedicate its efforts. They told us that they want more practice management and leadership training in residency, and more support in these areas during the early years of practice. With that information, we are now developing new programs to best meet your needs. We’re excited to be establishing FFYFP provincial chapters that will provide province-specific programs for you at the CFPC’s Annual Scientific Assemblies. 

How can you get involved? 

The full membership of the FFYFP Committee is our most valuable resource. Together, we work to support one another. Our Facebook group has over 1,100 members, including many residents and medical students. We have lots of active discussions on a number of practical topics.

Here are a few examples: 

  • “I am taking over a retiring doctor’s practice in an Ontario FHN with a FHT in 6 months. Does anyone have any advice or any leads on how to do this (i.e., how many patients should I roster, should I do income stabilization, any stipulations I should put on the practice as I start up)? Any advice would be appreciated!” 
     
  • “I’m planning to start my own practice. What are the things I have to look out for? And how much should I put aside for start-up expenses? Any ideas/suggestions are welcome.” 
     
  • “Just wondering if anyone has any suggestions/tips on personal health insurance. I’m debating between OMA group (individual) vs. OPIP extended health presently. Any experiences with either of these or other good options out there? Thanks!” 
     
  • “Quick poll – I’m wondering what the average starting panel size is for family docs around the country. Particularly for salaried practice +/- inpatient coverage.”

Our Facebook page is a great way to get quick answers to your questions from someone who has been through it before.
Search “First 5 Years in Family Practice – Canada” and join the discussion today! 

Great Practice Management Resources

Our webpage includes some great resources for starting up your practice, as well as links to clinical practice tools and guidelines. Think about making First Five Years your browser homepage in clinic for easy access to these tools! 

Find us on Facebook, email and the FFYFP website

We hope to hear from you! 

Scott MacLean, MD, CCFP
Chair, First Five Years in Family Practice Committee 

How to Find a Job


How to Find a Job


Similar to applying for residency, the prospect of finding a job, or jobs, may be daunting. Thankfully, there is help! 

Some of the Key Things You Should Do 

  • To find a job, visit the HealthForceOntario website at www.healthforceontario.ca and click on “HFOJobs” 
     
    • Click on "Physician Jobs "􏰁select" Not Registered? Click here to register!" After registering, you can search the site and have new job listings sent straight to your inbox.
       
    • HealthForceOntario Marketing and Recruitment Agency: For those who are Canadian residency trained, this may be of interest to you. There are three Ontario Physician Locum Programs: Rural Family Medicine, Northern Specialist and the Emergency Department Coverage Demonstration Project. They have been set up to help cover remote locations, thus providing opportunities to new graduates who may otherwise not have pursued such jobs.
       
  • To discover other options that may influence your choice or location of job, click on “Practice Ontario, Where in Ontario do you want to practice?” at the bottom left hand corner of the main home page.
     
  • Practice U is another very useful tool provided by HealthForceOntario. Visit Health Force Ontario
     
    • Finding your Ideal Practice is a brochure that outlines helpful resources for finding a job.
       
    • Regional Advisors work with communities and local health-care organiza- tions within Ontario’s 14 Local Health Integration Networks (LHIN) regions. They can be contacted here.
       
  • Practice Ontario is a free career-planning service for postgraduate medical residents that was created by HealthForceOntario Marketing and Recruitment Agency. They can help explore locum and permanent job opportunities in Ontario (from urban to rural settings), assist with resume preparation and arrange visits to interviews with potential employers. They can also be contacted at 1-800-596-4046 ext. 3697. 
     
  • The Resident Loan Interest Relief Program was negotiated as part of the 2008 Physician Services agreement. It provides eligible Ontario medical residents with repayment assistance on government student loans during their residency program. For more information, visit the following website. 

Family Practice Models and Compensation Schemes


Family Practice Models and Compensation Schemes


Comprehensive Care Mode

  • Fee-for-service + some incentives and bonuses
     

  • Designed for solo primary care physicians 
     

  • Regular office hours plus one three-hour session of extended hours 
     
  • Sign agreement to join

Family Health Groups (FHG)

  • Fee-for-service + some incentives for patient enrollment and bonuses
     

  • Three or more physicians practicing together
     

  • Regular office hours plus three to five sessions of extended hours (at least three hours in duration) based on number of physicians in group
     

  • Sign agreement to join

Family Health Networks (FHN)

  • Blended capitation model: age- and sex-adjusted base rate remuneration plus bonuses and incentives
     
  • Three or more physicians practicing together
     
  • Physicians commit to enroll patients
     
  • Regular office hours plus three to five sessions of extended hours (at least three hours in duration) based on number of physicians in group
     
  • Sign governance and FHN agreements to join
     
  • FHNs can apply to the MOHLTC for funding to add allied health professionals if they are successful in their application for a Family Health Team (FHT)

Family Health Organizations (FHO)

  • Blended capitation model: age- and sex-adjusted base rate remuneration plus bonuses and incentives
     
  • Three or more physicians practicing together
     
  • Physicians commit to enroll patients
     
  • Regular office hours plus three to give sessions of extended hours (at least three hours in duration) based on number of physicians in group
     
  • Sign governance and FHN agreements to join
     
  • FHOs can apply to the MOHLTC for funding to add allied health professionals if they are successful in their application for a FHT
     

  • The major difference between an FHN and an FHO is their defined basket of services for enrolled patients

Family Health Team (FHT)

  • Blended capitation model or blended salary model
     
  • Work in interdisciplinary teams
     
  • Patient enrolment strongly encouraged
     
  • Regular and extended hours
     
  • Must become a member of a primary care group (FHN, FHO) affiliated with an existing FHT to join

Rural-Northern Physician Group Agreement (RNPGA)

  • Complement-based remuneration plus bonuses and incentives
     
  • Serves rural and northern communities with a complement of one to seven physicians
     
  • Regular hours and one to five sessions of extended hours based on the size of the RNPGA
     
  • Nurse-staffed, after-hours Telephone Health Advisory Service provides advice to enrolled patients

Community Health Centres 

  • Salaried model
     

  • Interdisciplinary teams serve hard-to-serve communities and populations that may have trouble securing health services
     

  • Focus on addressing the underlying conditions that affect people’s health, such as social determinants of health, poor diet and literacy
     

  • Regular extended hours

     

For further information on Family Practice Models, CLick Here

 

Incorporation


Incorporation


In recent years, physicians have been allowed to incorporate, meaning they create a distinct legal entity. There are many advantages to incorporating in the right circumstances. The two main advantages are that you can 1) defer taxes (and lower total tax paid) by leaving money in the corporation and taking it out when you are in a lower tax bracket, and 2) split income between family members (significantly decreasing amount paid in taxes). An additional advantage is the option to pay yourself in dividends as opposed to a salary. The main advantage of dividends is that you are taxed at a lower rate. However, the disadvantage is that, because it is not a salary, you will not build up RRSP room. 

As an example to illustrate both income splitting and dividends, once incorporated you can give your 18-year-old son a $40,000 dividend as a shareholder of the corporation. He is taxed minimally or not at all, both because he is in a low tax bracket and because he is being paid dividends. He can then gift the money back to you such that you have paid significantly less taxes than if you weren’t incorporated. 

Tips

  • Speak to an accountant or financial consultant to see when it may be right to incorporate. If you incorporate and are considering which combination of salary and/or dividends to pay yourself, speak to a tax specialist to see the best option for you. 
     
  • The decisions to incorporate and manage the affairs of a corporation are complex matters. Financial advisors have the knowledge and experience to help you maximize the wealth-generation potential of your corporation and can ensure that your corporation is integrated with your overall wealth management plan. Financial professionals can also provide referrals to tax, legal or other advisors you need to realize the maximum benefits of your corporation. One available option is an MD Management advisor. Information about MD incorporation services for physicians can be found here

References and Resources

Investing in Residency


Investing in Residency


As you move forward in your career, you’ll need to continue to repay your debts while keeping in mind the tax and investment opportunities now available to you. Your MD Advisor can help you develop a total wealth management plan that includes a well-diversified investment portfolio. 

You may want to consider contributing to a RRSP or a Tax Free Savings Account (TFSA) or both. Contributions to your RRSP grow tax free and reduce your taxable income. TFSAs allow Canadian residents to contribute up to $5,500 annually. Although the contributions are not tax deductible, the investment income earned within a TFSA, as well as any dividends or capital gains, are tax free. 

If children are part of your family, you’ll want to consider a Registered Education Savings Plan (RESP). An RESP offers generous government grants and tax-deferred growth to help maximize education savings. 

A financial advisor can help you identify your financial goals, risk tolerance and capacity and determine your financial priorities. Together, you can decide how much you should be allocating to debt repayment, building an investment portfolio and planning for life events such as purchasing a home or starting a family. 

Tips 

Many financial advisors are available to guide your investments, including those from MD Management. Find out more about what services MD Management offers residents here

Resources 

MD Management

CMA Practice Management Curriculum (PMC)


CMA Practice Management Curriculum (PMC)


Find out about the next CMA PMC session at your school. Click here and go to Schedule of Events. These sessions are an introduction to practice management issues you will face as you navigate through job opportunities and transition to practice. 

Physician Salaries


Physician Salaries


Calculating the average physician salary is very complex and is influenced by many factors. Although there is no clear data on physician salaries, some studies have attempted to estimate average salaries. 

A study by Petch et al. (2012) used data from the 2010 National Physician Survey as well as public data from the Institute for Clinical Evaluative Sciences (ICES) Report on Payments to Ontario Physicians from the Ministry of Health and Long-term Care Sources 1992/93 to 2009/10 (CFPC et al., 2010; Henry et al., 2012).

Petch et al. estimated that Family physicians and general practitioners had a mean net income of $207,600. The means that family physicians made on average $207,600 after accounting for overhead costs, but before taxation. The mean net income from public payments for all physicians in Ontario, after adjusting for overhead, was $240,400.” The authors cautioned that “self-reported overhead varies substantially both within and between specialties, and has a substantial effect on physician income. Mean net income from public payments varies more than twofold between specialties. Given the lack of comprehensive data, it is difficult to construct a complete account of physician income in Ontario.” 

A second available estimate published by the CMA used Canadian Institute for Health Information (CIHI) data (Buske 2004; CIHI 2004). This study estimates net average physician income (all specialties) nationally at $148,700 in 2004, which is much lower than the $240,400 estimated by Petch et al. in 2010. There are several methodological reasons for this discrepancy, as outlined by Petch et al. in their study. A third source includes data from the CIHI Average gross fee-for-service payment per family physician in Ontario for 2011–11.” This data suggests that the average gross fee-for-service payment per family physician in Ontario for 2011–12 was $240,615, which represented 47.3% Database Table A.5.A: “ of total physician clinical payments. It should be noted that this data did not include alternative forms of reimbursement, such as salary and capitation. 

The past few years have seen the emergence of novel compensation models, such as the blended salary model or blended capitation model, where payment can vary greatly based on the number of patients, complexity of patients and ability of a physician to meet a wide variety of applicable bonus incentive payments. Information on these types of payment models is available through the Ontario government here.

Additional information is available through HealthForceOntario 

Given the variability and limitations on currently available data regarding physician compensation, it is clear that it is difficult to calculate a true physician salary. Factors that influence physician income include, but are not limited to: 

  • Type of compensation scheme (e.g., fee-for-service or blended capitation or blended salary) 
     
  • Revenue from other clinical work (e.g., obstetrics, emergency room coverage or hospitalist)
     
  • Private (e.g., non-OHIP, WSIB, private billings) revenue 

The proportion of total income derived from clinical work (e.g., funds for teaching and administrative work). These include: 

  • Applicable incentives for practicing in rural areas
     
  • Applicable incentives for preventative care
     
  • Applicable incentives for care of chronic diseases
     
  • Total time worked (part-time vs. full-time)
     
  • Overhead costs

Sources

 

“Physician Billing Highest in Ontario, Lowest in Quebec.” CMAJ 170(5):776. 

Canadian Institute for Health Information. Analytical Bulletin Physician Expenditures 2004. http://www.cihi.ca/CIHI-ext- portal/pdf/internet/PDF_BUL_NPDB_28MAY2004_EN 

Canadian Institute for Health Information. National Physician Database Table A.5.A: Average Gross Fee-for-Service Payment per Family Physician in Ontario from 2010– 11. https://secure.cihi.ca/estore/productSeries.htm?pc=PCC476 

College of Family Physicians of Canada, Canadian Medical Association and Royal College of Physicians and Surgeons of Canada. 2010 National Physician Survey. Accessed Sept 2012. http://www.nationalphysiciansurvey.ca/nps/2010_Survey/methods/weights-e.asp 

D.A. Henry, S.E. Schultz, R.H. Glazier, S. Bhatia, I.A. Dhalla, A. Laupacis. Payments to Ontario Physicians from Ministry of Health and Long-Term Care Sources 1992/93 to 2009/10. Toronto: Institute for Clinical Evaluative Sciences. Accessed Sept 2012. http://www.ices.on.ca/Publications/Atlases-and-Reports/2012/Payments-to- Ontario-Physicians 

J. Petch, I.A. Dhalla, D.A. Henry, S.E. Schultz, R.H. Glazier, S. Bhatia, et al. “Public Payments to Physicians in Ontario Adjusted for Overhead Costs.” Healthc Policy 2012;8(2):30–6. 

Practice Profiles


Practice Profiles


 

The next few paragraphs highlight the practice profiles of four different Ontario family physicians. There is incredible diversity amongst these featured practices. Family physicians are in a fortunate position to evolve their skills and experiences to cover a wide variety of medicine. We hope that in reading on, you feel inspired and start to envision the practice you hope to have one day! 

The four featured practices are located, as shown below, throughout Ontario: 

 

 

Dr. Christine Richardson, London, Ontario 

Special Interests: Education and third world medical service

Residency: University of Ottawa

Practicing since: 2006 

Practice description: Full-time emergency medicine — three to four shifts per week — seeing patients as well as working with and teaching students and residents. Additionally spending about 4-8 hours/week on administrative duties and the same on teaching outside of the department. 

What you love most about your work: The challenge of acute care medicine - it is mentally stimulating so you don't get bored of what you do. 

What you love least about your work: Working "antisocial" hours (evenings, nights and weekends). 

Advice to residents: Seek to get the most learning out of every rotation you do - You realize, in retrospect, how valuable it can be. Enjoy your time establishing rapport with patients, no matter how brief that interaction may be. 

Personal interests: I'm one of those crazy busy people - I play in a concert band and love to get out cycling (road and mountain) and running. I love to read and belong to a great book club that has expanded my network of women physician friends (who are not in emerg). I travel as much as possible. 

Typical salary range: About $300,000 per year. 

Dr. Michael Kirlew, Sioux Lookout and Ottawa, Ontario; Daquini, Haiti 

Special Interests: First Nations, global health and medical simulation in education 

Residency: University of Ottawa 

Practicing since: 2007 

Practice description: It depends on where I am. In Ottawa, I do a fair bit of medical education as well as hospitalist work on our inpatient family medicine hospital service. In Sioux Lookout, I practice both Family and Emergency Medicine as well as hospital work. In Haiti, I work mostly in HIV care and Tropical Medicine. 

What you love most about your work: I thoroughly enjoy working with the patients. They are all truly inspiring. Also, I love the fact that my clinical practice is flexibility and diverse. 

What you love least about your work: The least pleasant part of my work is the times I have spent away from my family. The time I spend away from them is usually as a result of the traveling I do. As such, traveling can be very taxing at times. 

Advice to residents: First, family medicine is a great field of medicine and I can think of few others that offer the diversity of clinical practice that family medicine does. Second, enjoy your residency experience and relax. Third, don’t forget to spend as much time as possible with your family and friends during residency. It will set the right tone for your personal life and work after residency. 

Personal interests: I most enjoy spending time with my family. Additionally, I am a huge football fan. Being able to watch a game now and then is always nice. 

Typical salary range: Here In Ontario, a Family Physician can typically make a salary within the range of 220,000 - 300,000 annually depending on scope of practice. 

Dr. Kendall Noel, Rockland, Ontario

Intérêts spéciaux: Enseignement médical, actuellement inscrit au doctorat en médecine familiale à l’UWO

Résidence: Hôpital Montfort à l’Université d’Ottawa 

Pratique depuis: 2002 

Description de la pratique: Le lundi matin, je m’occupe des tâches administratives et je travaille l’après-midi et en soirée. La journée de mardi est dédiée à l’administration académique. Les mercredis et vendredis matins, je vois les patients et j’applique les procédures en après-midi (mes patients et ceux en consultation). Le jeudi est réservé aux soins cliniques de routine. Je suis sur appel pour le département psychiatrique de mon hôpital tous les autres jeudis. 

Votre aspect favori du métier: J’aime le fait que nous jouions un rôle important dans la vie des gens dans les moments critiques. J’aime également le fait que nous ayons le droit d’entretenir un lien longitudinal avec les patients. J’aime voir un nouveau-né dans le cadre de ma pratique et je crois qu’il s’agit de mon devoir (même si cela m’effraie parfois) d’être aux côtés d’un patient en soins palliatifs au moment de son décès. 

La responsabilité qui nous incombe en tant que médecins de famille de conseiller nos patients est plus importante que ce qu’on peut croire durant notre résidence. À un grand nombre de reprises, j’ai dirigé quelqu’un vers un autre spécialiste qui est revenu pour me dire: « Voici ce que l’autre médecin a dit, qu’est-ce que ça signifie et quel est votre avis à ce sujet? » 

Votre aspect le moins favori du métier: Je n’apprécie pas qu’on m’incite à être « efficace » ou rentable quitte à passer moins de temps avec mes patients. Il existe des personnes qui aiment savoir que leur médecin prendra le temps de les rencontrer. Je crois qu’un grand nombre d’entre eux cherchent à recevoir des soins par des médecins qui vont prendre plus de temps pour rencontrer leurs patients en plus de fournir d’excellents soins. Je ne connais pas la réponse à cette question. Il semblerait que l’efficacité et la rentabilité soient la voie de l’avenir. 

Échelle de salaire: entre 200 000 et 300 000 $ par année.

Dr. Michelle Homer, Locums in Ontario

Special Interests: Low risk obstetrics, acute care and palliative care 

Residency: North York General Hospital, University of Toronto 

Practicing since: July 2009 

Practice description: As a locum, I don't have a typical workweek! Some weeks are very routine (i.e., office 3-4 days a week). Others are filled with urgent care/walk-in shifts. When working in Northern Ontario, I have typically split my time between office, 24-hr ER shifts and in-patient care. 

What you love most about your work: In terms of working as a locum, the freedom to choose where, when, and what I want to do. In terms of family medicine, I enjoy interacting with patients as well as the variety of clinical cases. 

What you love least about your work: I have formed an intense dislike of paperwork over the past few months as an independent doctor. As a locum, it can be frustrating to have each patient be new to you. There is definitely something to be said for the doctor-patient relationship! I have also found it frustrating to find locums, which allow me to pursue my interests, such as OB, at least in the GTA. 

Advice to residents: Don't sign up for the first staff position or locum available "just to have something". Take your time to find out details re: clinics/staff, what is expected of you and also what compensation is being offered. Soak up as much information as possible about practice management! Also, don't close the proverbial door too early on options within Family Medicine. Even if you dread a particular rotation in residency or can't envision yourself ever using those skills again, you never know what clinical pearls you may retain that might come in handy down the line. You also never know how your practice may change over the next fifty years. 

Typical salary range: Working typically 3-4 days a week (and taking a couple of months off at a time once or twice a year) my annual salary would be in the range of $120K before tax, after overhead. 

New Entry Graduate Program


New Entry Graduate Program


Introduced in October 2015, The Ministry of Health and Long-Term Care is offering a voluntary New Graduate Entry Program (NGEP) to new family medicine graduate physicians who wish to join a Family Health Network (FHN) or Family Health Organization (FHO) that is not located in a ministry identified high physician needs area.  It is anticipated that there will be changes made to this program based on family medicine physician feedback thus far.

To join the NGEP program, eligible New Graduate Physicians must sign and deliver to the ministry:

• an “NGEP Application”

• an application to join an existing FHN/FHO group or form a new FHN/FHO group

• all other necessary documentation required to register in a FHN/FHO group.

The NGEP program requires a minimum of 3 years and candidates must performance expectations have been met/exceeded (“NGEP Period”).  If a candidate has met those two criteria, they may transition to compensation under the FHN/FHO agreement.  Physicians who do not meet noted conditions will continue in the NGEP until such time as the conditions are met, and will continue to be compensated at the Year 3 level.

 

New Graduate Physicians participating in the NGEP are required to adopt an approved Electronic Medical Record. The NGEP is available to both full time and part time physicians. A full time equivalent (FTE) position will be based on a 40 hours per week commitment to the FHN/FHO group. The New Graduate Physician must declare their FTE commitment as part of the application process (allowable commitments range from 0.5 to 1.0 FTE in 0.1 FTE increments. Changes in the FTE level will be approved during the NGEP period at the discretion of the ministry.

                                        

Annual Compensation: Annual compensation levels will be prorated based on the physician’s commitment (between 0.5 and 1.0), and are distributed on a monthly basis.

Annual compensation levels for a 1.0 FTE position are as follows:

• 1st Year – Maximum of $162,000

• 2nd Year – Maximum of $178,000

• 3rd Year – Maximum of $207,000

Monthly compensation amounts will be prorated based on based on the percentage of the monthly enrolment target achieved. This calculation will be conducted monthly. Exceeding monthly enrolment targets will not result in payment above the maximum monthly rate.

 

Suspension of agreement: Eligible New Graduate Physicians participating in the NGEP may request the NGEP Period to be temporarily suspended due to an absence from their practice as long as they provide 30 days notice. The ministry will consider such request on a case-by-case basis.

 

Termination of agreement: New Graduate Physicians participating in the NGEP must provide a minimum of 30 days prior written notice to the ministry of their intention to terminate their participation in the NGEP. New Graduate Physicians who end their participation in the NGEP prior to completing the minimum 3-year term and the exit requirements, will also terminate their affiliation as a signatory physician with the FHN/FHO group.