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

Sponsor expectations

This section outlines what CPSA expects from you as a sponsor.

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.
Integrated paneled patient care (not walk-in or episodic care): sponsors must demonstrate the current patient panels that are not attached to a family physician and are to be assigned to the sponsored physician. Information (PCN sources and similar) supporting the need should be provided.
Reporting: HQCA report, quarterly confirmation of chart review for first year from clinical lead, performance evaluation confirmation.
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.

CPSA may require that the sponsored position will include appointment with Alberta Health Services/Covenant Health (alternative as determined by CPSA, appropriate to the community setting) to support the provision of care in related areas (one or more of acute inpatient care, long-term care, urgent/emergency room care as examples).

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
renewing your sponsorship agreement
a current sponsor applying for an additional position

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

Name*

Individual submitting the application

Prefix First Last

Name of organization, corporation, or other entity

if applicable

Address*

Street Address Address Line 2 City Province Postal Code

Phone*

Email*

Enter Email Confirm Email

Additional contact person

if applicable

Financial requirements

Once we have received your sponsor application, we will contact you to pay the non-refundable $3,500 (+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.

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.

Registered member name*

First Last

CPSA registration number*

About the sponsored position

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

What is the sponsored position practice discipline and how many positions are you requesting for this location?*

Desired start date:*

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

Yes
No

Describe the patient population this position will be serving.*

How will this position benefit the population described above?*

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

How many days per week will the physician work?*

Please enter a number from 0 to 7.

Anticipated percentage of book appointments:*

What will on-call requirements be?*

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. The next few questions are intended to help CPSA understand how this position will support the medical home model for primary care delivery.

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?*

Is there anything else you would like to share with us about this sponsored position 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.

Email

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

Apply to become a sponsor

Expanded sponsorship rollout

Before you begin

Important notes:

To support you, we have prepared an example of a completed application that contains all of the information that CPSA needs to make a decision.

Questions?

Complete the sponsor application form