Return of Service (ROS) Questions and Answers

The below are common questions and answers for ROS holders relating to specific requirements of ROS. If you have other questions not addressed below, please contact saskdocs.

The Return-of-Service Policies and Guidelines, which provide further information on deferrals, leaves, and other circumstances, are available here.

Questions or updates? Email contract@saskdocs.ca.

General Overview of ROS Agreements

What is return of service (ROS)?

Return of service (ROS) agreements provide funding in return for the provision of medical services within the province of Saskatchewan for a specified period. Alternatively, a physician may satisfy ROS requirements through financial repayment of the agreement.

Saskatchewan offers several programs that may provide funding to/for a resident doctor or practicing physician to:

• Cover the cost of medical training;
• Assist in offsetting the cost of establishing a practice;
• Incentivize a physician to establish practice in certain communities in the province (typically outside of Regina, Saskatoon, and the bedroom communities).

Funding may be provided directly to the resident doctor/practicing physician in the form of an incentive payment (bursary) or provided directly to a training institution.

I have signed a ROS agreement for a bursary or training program. Who is my ROS agreement with, and who administers it?

A majority of ROS agreements are between two parties: the Saskatchewan Minister of Health and yourself as the physician. One exception is the Saskatchewan International Physician Practice Assessment (SIPPA) ROS agreement which is a tripartite agreement between the Saskatchewan Health Authority (SHA), Minister of Health, and yourself.

saskdocs (a part of the Saskatchewan Health Authority (SHA)) administers ROS agreements on behalf of the Ministry of Health as well as the Saskatchewan Medical Association (SMA).  saskdocs is your point of contact for questions and updates regarding your ROS, regardless of which ROS you may hold.

Please email contract@saskdocs.ca to address your questions or to provide your practice updates, as they may affect your ROS.

If you misplace your agreement or require another copy, contact saskdocs and we will email one to you.
 

Which ROS agreements are administered by saskdocs?

You may receive a ROS agreement, administered by saskdocs, through one or more of the programs listed below:

Return of service agreements for postgraduate medical training:

International Medical Graduate (IMG) Postgraduate Medical Training
Successful CaRMS applicants matching through the IMG/Competitive stream to a residency position in family medicine (first and second iteration) or another specialty (first iteration) in Saskatchewan may have a ROS agreement attached to their training seat.  The ROS is one year per each year of funded training (i.e. a two-year family medicine residency has a two-year ROS). More information is available here.

Networked/Sponsored Postgraduate Medical Training Seats
The Saskatchewan Ministry of Health may fund or partially fund out-of-province training seats in programs that are not offered or only partially offered in Saskatchewan (i.e. urology, dermatology, ENT). Applicants may apply for these training seats via CaRMS. The ROS is one year for each year of training funded by Saskatchewan.

Funded Fellowship Training
In some circumstances, the Ministry of Health may provide funding for fellowship training. The return of service is one year for each year of training funded by Saskatchewan.

Saskatchewan International Physician Practice Assessment (SIPPA)
SIPPA assesses the readiness of International Medical Graduates (IMGs) to practice family medicine in Saskatchewan. Successful SIPPA candidates provide a three-year return of service to a community or area in Saskatchewan as determined by the Ministry of Health and the Saskatchewan Health Authority. More information is available here.
 

SMA bursaries with return of service:

SMA bursaries are awarded through the SMA’s Committee on Rural and Regional Practice (CORRP) and the Specialist Recruitment & Retention Committee (SR&R).

Family Medicine Resident Bursary (FMR)
Family Medicine residents can apply for a bursary of $25,000 per year for up to three years (two years of family medicine residency and one year of select R3 training programs). The duration of the ROS is dependent upon the number of years of bursary awarded and the location of practice after residency (rural, regional, or locum). More information is available here.

Rural and Regional Physician Enhancement Training (RRPET)
RRPET provides funding of up to $110,000 per year for family physicians in practice who return to complete a third year of training to enhance their skills in designated R3 programs. The ROS is two months per month of funding. More information is available here.

Specialist Physician Enhancement Training (SPET)
SPET provides funding of up to $110,000 per year to allow practicing specialists the opportunity to obtain additional training. The ROS is two months per month of funding. More information is available here.

Specialist Recruitment Incentive (SRI)
The SRI provides $30,000 to an eligible specialist who commences a medical practice in a Saskatchewan community and remains in practice in that community for a minimum of 36 months. More information is available here.
 

Discontinued programs:

The following programs were formerly offered by the SMA but have since been discontinued. Existing agreements for the below are administered by saskdocs. If you are seeking further information, please contact saskdocs.

• Undergraduate Medical Student Bursary
• Rural/Regional Practice Establishment Grant
• Specialist Resident Bursary

The Ministry of Health may implement ROS agreements at any time. Please check with the program you are submitting an application for to determine if there is an ROS attached. This includes training seats available through CaRMS as well as training seats that are outside of CaRMS such as enhanced skills in anaesthesia or enhanced surgical skills and incentive programs.
 

Can I ask for a return of service to get a residency seat?

No. These positions are only offered through CaRMS.
 

What are the tax implications of receiving a bursary or incentive?

Payments you receive for bursaries or incentives under a return of service agreements are personally taxable and a T4A will be issued to you in your personal name (not your corporation) for each calendar year you receive funding.

For further details on tax implications, please contact the Canada Revenue Agency or an accountant.
 

Questions About Serving the ROS

How long do I have to start practice after I complete postgraduate training?

You have up to six months (‘grace period’) after your completion of training (residency or fellowship) to either establish an eligible practice in Saskatchewan, or enter into financial repayment of your ROS.
 

How long is my ROS commitment?

The length of your ROS is listed within the terms of your agreement.

• If you have an ROS for a funded training seat (IMG, Networked/Sponsored, Fellowship, etc.), the duration of the agreement is one year of service for each year of training. If the length of your training changes, please notify saskdocs as an amendment to your ROS agreement is required to reflect the change in duration.
• Physician Enhancement Training programs awarded through the SMA (Specialist or Rural/Regional) have two months of ROS for each month of funding.
• Family Medicine Resident bursaries have varying ROS durations dependent upon your practice or location. Generally, for each year of bursary funding provided the ROS is:
  • Two years of service in a regional community
  • One year of service in a rural community
  • SMA Rural Relief program, refer to your agreement
• For the purpose of the Family Medicine Resident bursary, rural is defined as those communities in which there are approximately 10,000 people or less (including Estevan and Weyburn). Regional is defined as those communities which have populations greater than 10,000 people, excluding Saskatoon and Regina. Effective March 7, 2015, Prince Albert is also excluded from the list of eligible regional communities for the Family Medicine Resident bursary.

Should program parameters be updated, the requirements in your agreement at the time of signing will apply.

Each agreement has specific terms. Please review your agreement or contact saskdocs if you have questions about your ROS agreement.
 

What if I have multiple ROS agreements?

Multiple ROS agreements are served in the order they are signed.

For example, if you are an IMG with an ROS attached to your training program, and are also later awarded a Family Medicine Resident Bursary from the SMA, your IMG return of service will be served first.
 

Is there paperwork that I need to complete to advise saskdocs that I have commenced practice?

Please email saskdocs to notify us when you have commenced practice. Commencement dates are verified through the SHA and/or Ministry of Health.

Please also update saskdocs if there are any changes to your practice that may affect the terms of your ROS (i.e. address changes, leaves, communities of practice, changes in FTEs).
 

What communities can I work in to complete the ROS?

Eligible communities for the ROS depend on the agreement. Please review your agreement to confirm what communities are eligible practice locations (e.g. rural, regional, or underserved areas of the province) for the ROS.

If you have questions about what communities you can fulfill the ROS in, please contact saskdocs.
 

Can I relocate to another community during my ROS?

Some agreements are community specific so ensure you are familiar with the terms of your agreement before you relocate.

You may need to request approval from the appropriate party.

Specialist Recruitment Incentives may specify a community of practice in the agreement. Physicians who have a valid reason for wishing to move to a new community must receive approval from the Specialist Recruitment & Retention Committee. This may be done by writing a letter to the Committee (sent to saskdocs) requesting that the new community qualify as a location where the existing agreement remains valid. Approvals will be made at the discretion of the Committee. An amendment to the existing agreement will be made following approval for relocation by the Committee.

SIPPA agreements may specify a community or communities of practice. To request a relocation, physicians may submit a request in writing to the SIPPA Relocation Adjudication Committee (sent to saskdocs). An amendment to the existing agreement will be made following approval for relocation by the Committee.

You may change your location of practice if your agreement is not specific to a community. Please notify saskdocs in advance of finalizing your plans to ensure that the community meets the terms of your ROS.
 

My agreement specifically excludes Regina, Saskatoon, and the bedroom communities as eligible practice locations. Are there conditions under which I can practice in Regina or Saskatoon?

Please keep in mind that ROS agreements are legally binding. We trust that each physician who signs a return of service agreement does so in good faith with the intention of honouring it. Should your agreement stipulate that you must practice outside of Regina, Saskatoon and the bedroom communities, we do expect you to honour that commitment.
 

What is the definition of “full-time practice”?

For the purposes of Family Medicine Resident bursaries (SMA) full-time practice is defined as:

• A full time alternate payment contract, including a SHA Primary Care Contract, Northern Medical Services Contract (itinerant or traditional), SMA Locum Program, or SHA Locum Program; or,
• Fee for service billings of no less than 60% of the previous year’s average family physician earnings with 75% of the earnings from a single remote/rural/regional catchment area.

The current definition of full-time practice for SMA bursaries seeks to incentivize practice in a single location for continuity of care. A catchment area is defined as practices within 100km of each other; all communities in the three former northern health regions are considered one service area.

If you signed a Family Medicine Resident bursary agreement prior to 2016 please contact saskdocs for the definition of full-time practice before this date.

For the purposes of other Ministry of Health agreements (IMG, SIPPA, etc.) full-time practice is as follows:

Fee-For-Service (FFS) Physicians

• Volume of services are consistent with the other physicians in the community
• FFS billings in each quarter (three months) equal to one fourth of 75% of the previous year average same-specialty billings (as published in the Medical Service Branch (MSB) Annual Report)

Non-Fee-For-Service (NFFS) Physicians

• NFFS physicians are required to fulfill the terms of their contract (i.e. a full-time contract is also full-time for the purposes of ROS).
• NFFS physicians may only be employed by or under contract with Saskatchewan Health Authority. Any other NFFS arrangement will require written approval of the Minister.

All Physicians (FFS and NFFS) must participate equitably in any on-call/after-hours call rotation as part of the local physician call for that specialty. Any Physician that does not meet full service requirements during a biannual review will have their billing and service levels reviewed quarterly.

Please note: These definitions stipulate what is considered full-time within the required ROS period. The duration of the ROS is listed in the agreement (number of months or years). The ROS is not shortened by billing above average or by working contracts with greater than 1.0FTE.

Your agreement will include the duration of the ROS. If you practice less than full-time, the ROS credit will be prorated accordingly.

These definitions may be subject to change dependent on when the parties to the agreement signed. Please contact our office to confirm the definition.
 

What happens if I practice less than full time?

We will prorate your return of service to reflect your decision to practice less than full time. Prorations are calculated according to contractual FTE and/or percentage billings out of the minimum threshold.
 

Why are there variations in the terms of each agreement and definitions of full-time practice?

While saskdocs administers ROS agreements, the program parameters are set by the sponsoring/funding organization (Ministry of Health and SMA). Organizations/committees create program parameters that may be influenced by varying factors, including a desire to incentivize different practice programs or continuity of care.

Financial support provided for residents and physicians through these programs varies from $25,000 to hundreds of thousands of dollars. Therefore there are different expectations for service or financial repayment which depend on the program and the level of investment.
 

Deferrals, Leaves, or Other Circumstances

I would like to pursue fellowship or enhanced skills (R3) training after I complete my residency. Can I do so and how will this affect my ROS?

You may defer your ROS for up to one year to complete fellowship or R3 training upon completion of residency. To defer your ROS for fellowship or R3 training:

1. Notify saskdocs once you have been accepted to a fellowship or R3 program; and,
2. Provide saskdocs with a copy of your acceptance letter into the program.

If a position is not available in the subspecialty area in an eligible community in the ROS agreement, the expectation is that you will practice in the most general area of specialty training.

Upon receipt of all necessary information we will send you an amendment to your agreement with the new end date of your training.

Deferrals for fellowship and R3 training do not lengthen the ROS commitment unless the fellowship/R3 is funded by the Ministry and has an additional ROS attached to it.
 

I would like to take a maternity/paternity/parental leave of absence. How do I proceed?

If you are taking a parental leave while in residency:
Please advise saskdocs of the start and end dates of your leave. We will send you an amendment to your ROS to adjust the education end date in your agreement. Your grace period would continue to be six months following date of completion of your training. Deferrals for parental leave while in residency do not extend your ROS commitment.

If you are taking a parental leave while in practice:
Please advise saskdocs of the start and end dates of your leave. Your ROS will be put on hold and will continue upon your return to practice.
 

I have other circumstances I would like to bring forward for consideration.

If a decision needs to be made regarding the ROS (e.g. requests for deferral or consideration), saskdocs will work with appropriate decision-making parties to adjudicate your request (i.e. the Ministry of Health, Saskatchewan Health Authority, SMA’s Committee on Rural and Regional Practice, or SMA’s Specialist Recruitment & Retention Committee (where appropriate)).

Please review the Return-of-Service Policies and Guidelines for more information here.
 

Questions About Financially Repaying the ROS

If I decide to repay my bursary/training, how much would I owe?

If you do not wish to complete the ROS commitment through service, you may fulfill your obligations through financial repayment. You would repay all or part of the costs paid to you (or for you) under the agreement, plus interest.

For funded training (IMGs, Network/Sponsor/Fellowship seats):
If you elect to repay your agreement before starting your ROS, you would repay the total amount plus interest from the date the monies were advanced to/for you. Funded training repayment includes all costs paid to you (or for you) by the institution for your training for the duration of your residency. Interest is also calculated at the rate specified in your agreement. Funded training repayment is approximately $120,000 (actual costs will be determined at the time of repayment) per year of training.

For most other agreements:
If you elect to buy-out the agreement, you would pay back the total that was paid to you plus interest. Depending on the agreement, if you have completed part of the ROS through service the repayment may be prorated.

Proration of the ROS Repayment:
ROS repayment may be prorated for partial service provided, or the entire amount may be owed back under the agreement. Please refer to your agreement to confirm specific terms.

Repayment is prorated for partial service provided under the following agreements:

• Family Medicine Resident Bursary
• International Medical Graduate Training
• Network/Sponsored seats, funded fellowships
• Specialist Physician Enhancement Training
• Rural/Regional Practice Enhancement Training

The following agreements do not prorate the repayment for partial service provided, therefore full repayment is required:

• SIPPA
• Specialist Recruitment Incentive

I have decided not to fulfill the ROS agreement through service. How do I financially repay the ROS?

Contact saskdocs if you have questions about repayment, or to notify us you will be entering into repayment for your ROS. We will provide you with the total amount owing with interest, and a letter with repayment instructions.

If you are buying out a funded training seat (IMG, Network/Sponsored Seat, Fellowship, etc.), a summary of your training costs will be compiled and provided to you.

You can repay your agreement in one lump-sum payment. In some cases, saskdocs may work with you to set up a payment plan. Monthly repayment plans will result in the settlement of your account in one to six years (depending on the amount to be repaid). Repayment plans are based on a payback schedule of approximately one year per $100,000 owing.  

Currently, only payments by cheque or bank draft can be accepted.

You will receive a statement each month you are in repayment of your agreement. These statements can be used as receipts for tax purposes.

How is the interest rate determined?

Your agreement uses the current indicative interest rate as provided by the Ministry of Finance. The rate is listed in your agreement. In the case of repayment, the rate specified in your agreement will be used.