Notice: Effective March 2020, the Ministry of Health no longer accepts mailed or couriered documents related to application-based programs. Only applications that are sent by email to a ministry-designated account or via fax (705-564-7493) will be accepted. Applications that include electronic signatures (such as, scanned original, electronic device applications, or digital) will be accepted in lieu of original, signed documents.

Overview

The objective of the Northern and Rural Recruitment and Retention Initiative (NRRRI) is to attract physicians to establish a full-time practice in eligible underserviced communities.

The NRRRI offers taxable financial recruitment incentives to each eligible physician who establishes a full-time practice in an eligible community of the province. The grants range between $84,718 and $124,730 paid over a four-year period. The financial recruitment incentives will be awarded based on eligibility criteria and considerations related to total NRRRI budget allocations.

Physicians are entitled to receive only one NRRRI grant per career. Physicians who have previously received Free Tuition Program funding and/or NHP Incentive Grant for the full four-year duration are not eligible to receive a NRRRI grant.

For more information:

Ministry of Health
Primary Health Care Branch
Northern Health Programs

For information regarding eligibility for a certificate of registration to practice medicine in Ontario:

The Registrar
The College of Physicians and Surgeons of Ontario
80 College Street
Toronto ON M7A 1R3

Eligibility

Community eligibility for the NRRRI is based on a Rurality Index for Ontario (RIO) score, a measure of rurality that ensures funding is specifically targeted to northern and very rural communities. The RIO2008_Basic score is derived from three factors:

  • population (count and density)
  • travel time to a basic referral centre
  • travel time to an advanced referral centre. RIO scores are assigned to Statistics Canada census subdivisions (CSDs)

In order for an applicant to be eligible for the NRRRI financial recruitment incentive, the applicant must be approved by the Northern Health Programs (NHP) office, Primary Health Care Branch before the applicant establishes their practice in the eligible community. Failure to do so may result in the application being denied. In addition, the applicant must establish a full-time practice in an eligible community in which they have never previously practiced full-time. The applicant may apply once they have completed residency training, or before establishing their full-time practice and must meet all of the following requirements:

  • Has committed to establish a full-time practice (full-time is defined as a minimum of 40 hours per week spent in patient care exclusive of on-call services) in a community whose RIO score is 40 or greater, or in the five Northern Ontario Urban Referral Centre census metropolitan areas (North Bay, Sault Ste. Marie, Sudbury, Thunder Bay and Timmins) and in which they have never previously practiced full-time.
  • Holds a valid certificate of registration for practice from the College of Physicians and Surgeons of Ontario (CPSO), authorizing the holder to engage in medical practice.
  •  If a family physician, either:
    • holds a valid certificate from the College of Family Physicians of Canada (CFPC)
    • has proof that the applicant is fully recognized by the College of Physicians and Surgeons of Ontario (CPSO) in family or general practice.
  • If a specialist, either:
    • holds a valid specialist certificate issued by the Royal College of Physicians and Surgeons of Canada (RCPSC)
    • holds a specialist certificate of registration issued by the College of Physicians and Surgeons of Ontario (CPSO) based on having an advanced position/assessment position through Centre for the Evaluation of Health Professionals Educated Abroad (CEHPEA) in a recognized medical or surgical specialty other than family or general practice
    • holds a specialist certificate of registration issued on the order of the Registration Committee of the CPSO allowing the physician to practise in a recognized medical or surgical specialty other than family or general practice, where the requirements of registration are otherwise not met, and to which certificate terms, conditions or limitations may be attached.
  • Holds a valid Canadian Medical Protective Association membership number.
  • Holds Canadian citizenship or permanent resident status.
  • Holds active or associate hospital privileges in the community, or if there is no hospital in the community, in an adjacent community (as required by the community and approved by the NHP).
  • Agrees to provide ER coverage, unless an exemption is provided by the community or hospital and approved by the NHP.
  • If a family physician, has joined a primary care model and is committed to participating fully in comprehensive physician services. Refer to the comprehensive physician services section below.
  • Has not previously received the NRRRI grant through this program, or Free Tuition Program funding and/or an incentive grant through the Northern Health Programs for a full four-year duration.

Financial recruitment incentives are paid out quarterly over a period of four years - 40% in year-one, 15% in year-two, 15% in year-three and 30% in year-four.

How to apply for NRRRI funding

In order to receive the NRRRI grant, the applicant must have received approval of their application from the NHP before the applicant establishes their practice in the eligible community.

To apply for the Northern and Rural Recruitment and Retention Initiative financial recruitment incentive, the applicant must submit the following documents and information:

  • A completed Application for the NRRRI grant, available from the Ministry website.
  • A valid certificate of registration for practice from the CPSO to engage in medical practice.
  • If a family physician, either:
    • a valid certificate of registration from the College of Family Physicians of Canada (CFPC)
    • has proof that they have a certificate of registration issued by the College of Physicians and Surgeons of Ontario (CPSO) based on successful completion of the Assessment Program for International Medical Graduates (APIMG) in family or general practice
  • If a specialist, either:
    • a valid specialist certificate issued by the RCPSC
    • has proof that the applicant is fully recognized by the CPSO in their area of medical specialty. See specialist Eligibility Criterion above.
  • Proof of medical coverage from the Canadian Medical Protective Association.
    • A letter of acceptance for full-time practice from the community contact.
    • Proof of hospital privileges at a hospital located in the eligible community, or in an adjacent area (as required by the community), and confirmation of participation in a primary care model, if a family physician (unless there is a waiver from the community representative).

Approval process

The following outline the steps for the approval process.

  1. The physician submits the following to Northern Health Programs (NHP):
    • an Application indicating intent to establish a full-time practice in an eligible community, and specifying their starting date
    • the documents listed on the Application form
    • a letter from the community representative supporting the physician’s Application
    • a letter from a hospital official confirming proof of hospital privileges at a hospital located in the eligible community where the applicant intends to join a primary care model if a family physician and practise full-time, or if there is no hospital in the eligible community, in an adjacent area if required by the community
  2. If NHP approves the application, NHP will send a letter of approval to the physician, along with two copies of the NRRRI Agreement form for the physician's signature.
  3. The physician signs and returns both agreement forms to NHP, along with an imprinted blank voided cheque from the bank where deposits will be made.
  4. NHP arranges for the Agreement forms to be signed on behalf of the NRRRI; and for one copy to be returned to the physician for his/her records.
  5. NHP will pay the NRRRI grant quarterly. NHP will deposit the first payment into the physician’s bank account approximately six to eight weeks after NHP has received and approved all required documentation. NHP will make subsequent deposits at three-month intervals, at the beginning of each quarter.
  6. NHP pays the NRRRI grant over a period of four years - 40% in year-one, 15% in year-two, 15% in year-three and 30% in year-four.
  7. Towards the end of each of the first three years of participation in the NRRRI, NHP will send a Confirmation of Practice Form to the physician to determine whether the physician is maintaining the ongoing eligibility criteria for the subsequent year.

It takes approximately six to eight weeks to process an application once an applicant has provided the required information. Physicians who are interested in the program are encouraged to provide as much lead-time as possible to ensure everything is in order before they commence their full-time practice in the eligible community.

NRRRI Grant values and payments

The value of NRRRI grants is based on a progressive or sliding scale. The higher the RIO score (for example, the more northern and/or rural the area), the higher the value of the available grant.

NRRRI financial recruitment incentive is payable over a four-year period, subject to the physician continuing to meet eligibility criteria, and subject to the consent of all parties concerned.

Grant values begin at $84,718 in CSDs with a RIO score of 40 and increase to $124,730 in CSDs with a RIO score of 100. To encourage both recruitment and retention, the proportion of the grant paid out will be highest in Years 1 and 4. The payment schedule is as follows:

  • year 1: 40%
  • year 2: 15%
  • year 3: 15%
  • year 4: 30%.

Additional Northern and Rural Recruitment and Retention Initiative (NRRRI) information

Additional funding

If you received free tuition funding or an incentive grant through the NHP for the full four-year duration, you are not eligible for the NRRRI grant.

If you have only previously received funding under the Free Tuition Program, and establish practice in an eligible community, you may be entitled to the difference between the free tuition funding you received and the amount of funding available under the NRRRI.

If you have previously received NRRRI funding for less than the full four years, you may apply for the balance of the grant that you did not previously receive, if you return to practice full-time either in the community you left, if it is still an eligible community, or in another eligible community located at least 100 kilometres from the eligible community you left and where the RIO score of the new community is at least nine (9) points higher than the previous community.

Full-time practice

The NRRRI grant is available only to a physician who works full time within the eligible community. A physician is considered full-time if they provide at least 40 hours per week of patient care exclusive of on-call services and, if a family physician, participates fully in comprehensive physician services in an eligible community.

Furthermore, if you are a family physician you must join an existing practice/clinic (versus setting up a solo practice). This requirement may be waived in writing by the community representative based on input from physicians practicing in the community.

Locating a practice opportunity

Physicians interested in the NRRRI are encouraged to contact the NHP by email.

The NHP administers a Community Assessment Visit Program that may assist you (and your spouse, if applicable) to travel to eligible communities to assess practice opportunities. Please contact NHP by email for more information.

In addition, you may wish to contact the Health Workforce Advisory Services at Ontario Health.
There are no provisions in the NRRRI to provide funds for relocation expenses, or to assist in obtaining spousal employment. However, some communities may assist in securing employment for the physician’s spouse.

Hospital privileges

In a community that has a hospital, you are required to have hospital privileges and associated on-call obligations for the duration of the grant. If you choose to cancel your hospital privileges, your NRRRI grant will be discontinued. If the community does not require hospital privileges or associated on-call obligations, this arrangement must be made and agreed upon by the community/hospital, physician and the NHP, before the NHP will approve your application.

If there is no hospital in the community, but there is one located in an adjacent community, you will be required to obtain hospital privileges there, if the community wishes you to do so and has the approval of NHP for that requirement.

Payments

NRRRI payments are made quarterly. The first payment will be deposited into your account within six to eight weeks of the NHP receiving all the required documentation. Subsequent payments will be made at three-month intervals at the beginning of each quarter. Towards the end of each of the first three years of grant participation, the NHP will send you a Confirmation of Practice Form for you to complete and submit to NHP.

Taxes

You may be required to pay income tax on the grant. You may contact Canada Revenue Agency for further information regarding income tax.

Moving

It is the responsibility of the physician to keep the Ministry informed of any change of address while they are participating in the NRRRI.

You may be eligible to continue your Return of Service commitment in a new community if the new community is not only eligible but is also located at least 100 kilometres from the community that does not meet your needs, and has a RIO score at least nine (9) points higher than the current community, subject to prior written approval from the NHP. All eligibility criteria continue to apply.

Pregnancy and parental leave

During pregnancy or parental leave, payments on your grant are temporarily withheld. When you return to full-time practice, the grant is re-instated. You will need to notify the Ministry in writing when you start your pregnancy/parental leave and when you resume practicing. You will be eligible for the remaining portion of your four-year NRRRI grant upon returning to work full-time.

Terminating your agreement

A physician could terminate their association with the program by giving 15 business days written notice to the NHP. Physicians who do not remain in the sponsoring community for the full four years would be required to repay the grant on a prorated basis. In such cases, payments would be stopped and the physician would be required to repay any money advanced for any part of the payment period not worked for in the eligible community.

The NHP staff will advise you of the amount owing, if any, and will require you to forward a cheque in that amount within 30 days, made payable to the “Ontario Minister of Finance”.

You may apply for the balance of the grant that you did not previously receive, if you return to practice full-time either in the community you left, if it is still an eligible community, or in another eligible community located at least 100 kilometres from the eligible community you left and where the RIO score of the new community is at least nine (9) points higher than the previous community.

Description of comprehensive care and services

Health assessments

When necessary, take a full history, including presenting complaint if any, past illnesses, social history, family history, review of systems and perform a complete physical examination.

Periodically take a specific history and perform a physical examination as required to screen patients for disease.

Regularly take a specific history and perform physical examination as required to respond to patient complaints and/or to manage chronic problems.

Diagnosis and treatment

Assess and plan for patients’ care based on the outcome of a history and physical examination aided by investigations and consultations as determined to be appropriate according to the results of complete, periodic or regular health assessments. Care for and monitor episodic and chronic illness or injury. In the case of acute illness or injury, offer early access to assessment, diagnostic, primary medical treatment and advice on self-care and prevention.

Primary reproductive care

Provide primary reproductive care, including counselling patients on birth control and family planning, and educating about, screening for, and treating sexually transmitted diseases.

Primary mental health care

Offer treatment of emotional and psychiatric problems, to the extent that the physicians are comfortably able to provide such treatment. Where appropriate, refer patients to and collaborate with psychiatrists and appropriate mental health care providers.

Primary palliative care

Provide palliative care or offer to provide support to the team responsible for providing palliative care, to terminally ill patients. Palliative care shall include offering office-based services, referrals to Community Care Access Centres or to such other support services as are required, and making home visits, where appropriate.

Support for hospital, home and, where applicable, long-term care facilities

Where applicable and where possible, assist with discharge planning, rehabilitation services, out-patient follow-up and home care services.

In northern and rural areas, physicians must have active or associate in-patient hospital privileges and involvement, with discharge planning, rehabilitation services, out-patient follow-up and home care services, unless otherwise agreed to by the community, hospital and the ministry.

Service co-ordination and referral

Co-ordinate referrals to other health care providers and agencies, including specialists, rehabilitation and physiotherapy services, home care and hospice programs, and diagnostic services, as appropriate. Co-ordinate referrals for secondary and tertiary care, where and when required. Monitor the status of patients who have been referred for additional care and collaborate on the medical treatment of such patients.

Patient education and preventive care

Use evidence-based guidelines to screen patients at risk for disease, to attempt early detection and institute early intervention and counselling to reduce risk or development of harm from disease, including appropriate immunizations and periodic health assessments. Where disease is detected, institute early intervention and counselling, including appropriate immunizations and periodic health assessments, to reduce risk or development of harm.

Access to pre-natal, obstetrical, post-natal, and in-hospital newborn care

Provide maternal services, including antenatal care to term, labour and delivery, and immediate maternal and newborn care. If the physicians do not offer full maternal care, they shall make best efforts to arrange for patients to receive these services.

Arrangement for 24/7 response

Provide service to patients through a combination of regular office hours, extended office hours, and the THAS which allows twenty-four hours a day, seven days a week response to patient health concerns.

Grant level by RIO point

RIO scoreFour year grant levelRIO scoreFour year grant level
40$84,85171$118,579
41$85,06372$118,791
42$85,27573$119,003
43$85,48774$119,215
44$85,69975$119,427
45$85,91176$119,639
46$86,12377$119,851
47$86,33578$120,064
48$86,54879$120,276
49$86,76080$120,488
50$88,32981$120,700
51$89,89982$120,912
52$91,46983$121,124
53$93,03984$121,336
54$94,60885$121,548
55$96,17886$121,761
56$97,74887$121,973
57$99,31888$122,185
58$100,88789$122,397
59$102,45790$122,609
60$104,02791$122,821
61$105,59792$123,033
62$107,16693$123,245
63$108,73694$123,458
64$110,30695$123,670
65$111,87596$123,882
66$113,44597$124,094
67$115,01598$124,306
68$116,58599$124,518
69$118,154100$124,730
70$118,367N/AN/A