Apply to be a sponsor - College of Physicians & Surgeons of Alberta

Sponsor expectations agreement

If approved by CPSA, this position will be posted on DoctorJobsAlberta.com (at a minimum). The sponsor is responsible for arranging this posting.

CPSA is not responsible for immigration/work permit status for sponsored positions.

As a sponsor, you are expected to meet the following conditions:

Orientation support: sponsored physicians must be adequately oriented to the practice, including electronic health records, clinic and other practice settings, and cultural sensitivity.
Legal advice: the sponsorship contract specifies that the candidate for the sponsored position will be offered the opportunity to access independent legal counsel for review of any contractual obligations that may be made to the sponsor.
Evidence of Alberta Health billing relationship (fee for service or alternate payment models as applicable).
Ability to provide names for practice supervisors: CPSA will continue to arrange for assessors required for a Preliminary Clinical Assessment.
Sponsored physician maintains membership in CMPA/other liability insurance.
If returning sponsor then update contract with addendum.
Provide the name of an oversight physician, who shall be responsible for identifying and supporting the sponsored physician's professionalism. The oversight physician must be on CPSA's General Register, whose primary/majority practice is in the clinic where sponsorship is being sought and is in good standing with CPSA (see definition on page 4 of the CPSA Bylaws).
Medical clinics must be CPSA-registered in order to become a sponsor. Medical clinic registration is at no cost to clinics. Learn how to register your medical clinic >

CPSA expects that the sponsor will allow the applicant physician to allocate up to ¼ of their practice providing services with provincial health agencies/providers where provision aligns with their service needs. A non-exhaustive list of providers would include Alberta Health Services, Covenant Health and Recovery Alberta.

If you are either a current CPSA sponsor applying for a different practice discipline position or a new sponsor applying for multiple practice discipline positions, please submit separate sponsor applications for each clinic location and discipline position. Note: Current sponsors can request multiple physician positions with each application.

Check below to agree with the sponsor expectations outlined above.*

I agree to meet the expectations outlined above.

Sponsor information

Are you:*

applying to be a sponsor for the first time
a current sponsor applying for an additional position or different practice discipline

Which best describes the type of sponsor you are:*

individual
non-profit or not-for-profit organization
for-profit corporation
Municipality, county or another legally recognized entity under the Municipal Government Act
Federal or other authority, such as a First Nation, Métis Nation of Alberta, or a Métis Settlement

Contact information

Sponsor name*

Individual who is submitting the application and responsible for signing the Sponsorship Agreement with CPSA.

Prefix First Last

Name of organization, corporation or other entity*

Address*

Street Address Address Line 2 City Province Postal Code

Phone*

Email*

Enter Email Confirm Email

Additional contact person

Person to be contacted if sponsor is unavailable. If applicable.

Financial requirements

Once we have received your sponsor application and are ready to send your application to our review committee, we will contact you to pay the non-refundable $2,000 (+GST) application fee.

If your application is approved, you will also be responsible for costs associated with sponsoring a physician through the Practice Readiness Assessment (PRA).

Note: Additional financial requirements may be identified in the sponsor contract.

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Clinical oversight

We need a current, active, in good standing physician who is on CPSA's General Register to be involved in and be responsible for identifying and supporting the sponsored physician's professionalism.

If you are a physician applying, please provide your registration number below.

If you are not a physician, please provide the name and registration number of the physician who will be involved in your sponsorship.

The physician you identify below will be contacted by CPSA to confirm their awareness of their sponsorship responsibilities.

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Registered member name*

First Last

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CPSA registration number*

About the sponsored position(s)

The next few questions ask for details about the position(s) and how they will support the patient population.

What is the sponsored position's practice discipline?*

Note: This must be a practice discipline recognized by CPSA. Find a list of recognized practice disciplines here.

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What is the scope of practice for the sponsored position(s) beyond the community based clinic setting (i.e. Clinic Acute Care, Emergency Medicine, Long Term Care, Rehabilitation, etc.)?*

What is the scope of practice for the sponsored position(s) beyond the community based clinic setting? (Check all that apply)*

Clinic
Emergency department
Walk-in clinic
Acute care in-patient
Long term care in-patient
Low risk obstetrics (General Practice)
Other

If you chose "Other", please specify:*

Clinic name of practice location*

Note: We only accept one application per clinic location and one application per practice discipline. If you have multiple clinic locations or practice disciplines being recruited for, please submit one application per location/discipline.

Is the clinic currently open?*

Note: Sponsorship is only permitted to fill physician positions in clinics which are currently in operation.

Yes
No

CPSA clinic registry ID#

If applicable.

Clinic address of practice location*

Street Address Address Line 2 City Province Postal Code

Are you requesting more than one position for this location & practice discipline?*

Example: 2 internal medicine positions

Yes
No

How many positions are you requesting for this location & practice discipline?*

Desired start date of the requested positions*

Are all requested positions a full-time equivalent (FTE)?*

If no, please provide details in the following questions.

Yes
No

Desired start date of this position*

Is the position a full-time equivalent (FTE)?*

If no, please provide details in the following questions.

Yes
No

Describe the patient population (referral base or practice panel) the position(s) will be serving.*

Reference population size, rural/urban demographics, age breakdowns, etc.

How will the position(s) benefit the population described above?*

Reference clinical outcomes and objective data in supporting your intended purpose. (E.g., data drawn from PCN, CIHI or other relevant sources).

How many days per week will the physician(s) work?*

Please enter a number from 0 to 7.

Anticipated percentage of booked appointments:*

What will on-call requirements be? Describe the process for ensuring continuity of care for patients after hours.*

Describe any facility-based on-call requirements, such as through an emergency department, urgent care clinic or other after-hours requirements.

What is the physician compensation model?*

Salary, FFS, ARP or similar

Patient’s Medical Home model

The Patient's Medical Home model must be in place for all sponsored positions for family medicine physicians and specialty physicians providing longitudinal care. The next few questions are intended to help CPSA understand how this position will support the medical home model for primary care delivery, as well as specialty practice providing longitudinal care to patients.

Are you applying to sponsor either a family medicine position or specialist position that includes longitudinal care?*

Yes
No

It's expected that the practice will have a process in place for identifying patient panels. Describe the practice's process for this.*

What is the anticipated panel size for this position?*

How will the position provide after-hours coverage for paneled patients?*

Does your clinic work/consult with other non-physician healthcare providers within a PCN (e.g., pharmacists, chronic disease nurses, dieticians)?*

Yes
No

What type(s) of screening do you provide to patients?*

How does your electronic medical records (EMR) process or office charting system support notification of required screening?*

Does the practice location participate in the Community Information Integration and Central Patient Attachment Registry (CII/CPAR)?*

Yes
No

Learn about CII/CPAR >

Is there anything else you would like to share with us about the sponsored position(s) or your clinic?

Signature

Sponsor's Name*

First Last

Date (dates should be typed in the format mm/dd/yyyy, as in 03/15/2023)*

Checking this box will act as your signature:*

I have reviewed the information in this form and I confirm it is accurate.

Privacy Notice: This information is being requested under the authority provided by Section 8.2(3) of Schedule 21 of the Health Professions Act. CPSA collects, uses and/or discloses your personal information with your consent or as authorized or required by law and in accordance with our Privacy Statement. We collect and use your personal information in order to support the business of CPSA, specifically to protect the public and guide and regulate our members.

Phone

This field is for validation purposes and should be left unchanged.

Apply to become a sponsor

Before you begin

Please have the following information ready to enter into this form:

Important notes

Application examples

To support you, we have prepared examples of completed applications that contain all of the information that CPSA needs to make a decision.

Questions?

Sponsor expectations

CPSA expects all sponsors to make the following commitments:

Time & orientation support

Standards & professionalism

Financial support

Legal advice

Practice location(s)

Complete the sponsor application form

Sponsor expectations agreement

Sponsor information

Contact information

Financial requirements

Clinical oversight

About the sponsored position(s)

Patient’s Medical Home model

Signature

Questions about sponsorship?

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