Clinical Associate Appointments at Fully Affiliated Teaching Hospitals, Department of Medicine, University of Toronto

What is a Clinical Associate?

Clinical Associates (CAs) are qualified, licensed physicians who are appointed by a hospital to the hospital to provide clinical service. They may be appointed for up to 12 months, with potential for renewal. However, CA positions should be considered temporary or short term.

The CA appointment is NOT a university appointment.

CAs generally fall into the following groups:

1. Physicians brought on to fill a temporary clinical or academic need, such as coverage for a faculty member on parental leave (i.e., locums)
2. Physicians brought on to provide clinical service coverage, e.g., nocturnist coverage; and,  
3. Physicians completing advanced training, e.g., trainees in the Clinician Scientist Training Program or Master Teacher Program, who wish to generate income and maintain their clinical skills while on a pathway to academic appointment.

Can Residents and Fellows that are enrolled in Royal College Residency Training Programs work as Clinical Associates to do extra clinical work for pay?

Yes.

Residents enrolled in postgraduate medical education programs leading to certification with the Royal College of Physicians and Surgeons of Canada, including the Royal College Clinician Investigator Program (CIP), may do extra clinical work as a CA for pay provided they hold a “Restricted Registration” certificate. Restricted Registration Program – For Ontario Medical Residents (restrictedregistrationontario.ca)

Clinical and research fellows who are enrolled in postgraduate medical education programs may do extra work for pay as a CA provided the work aligns with their CPSO licensure. However, depending on the site where the fellowship is being completed, there may be restrictions on the sites where CA work may be performed. Fellows should seek approval from their fellowship program director as work for pay must not interfere with the work requirements of the training program. They should also check with their fellowship site regarding any CA site restrictions.

What should a CA expect?

The CA appointment is for a maximum duration of 12 months, with potential for renewal. But, as stated above, these appointments are meant to be to enable temporary clinical coverage.

The CA appointment is a HOSPITAL appointment. Appointment as a CA does not indicate an intent to recruit an individual to full-time faculty in the DoM. All recruitment in the DoM is the result of a formal search process to ensure transparency and attention to inclusiveness.

CAs should be provided and agree to a written contract that clearly stipulates:

1. 1. Minimum and maximum clinical activity (to enable the CA to plan appropriately, including expected time to pursue academic activities)
   2. Billing arrangements
   3. Overhead tax to the hospital or practice plan
   4. Time frame for the appointment (maximum is 12 months)
   5. Role in teaching/education. See below for details.

Engagement of CAs in Medical Education

On appointment of a CA at a university-affiliated teaching hospital, the scope of work and level of interaction with UofT learners must be considered. Provision of clinical or formal teaching to MD students, residents or fellows does not require a clinical faculty appointment at the university. However, to be eligible to formally assess a trainee, e.g., completing an Entrustable Professional Activity (EPA) as part of Competency-Based Education, requires a faculty appointment.

Thus, CAs who are expected by the Physician-in-Chief or Hospital Division Head to provide evaluations of UofT undergraduate or postgraduate medical learners must be appointed to the Department of Medicine as Adjunct Clinical Faculty members (<20% time spent in academic activities); this will generally be at the rank of Lecturer.

CAs who are enrolled in post-residency training, e.g., Master’s, Doctoral or post-doctoral programs ARE ELIGIBLE for Adjunct Lecturer appointment provided they are not PGME-registered fellows or residents, except for those holding a CIHR training award. These individuals should clarify their eligibility to hold a faculty appointment with the funding body.

If you are registered ONLY with the School of Graduate Studies at UofT or another university completing graduate research training, you are eligible to work as a CA and to hold an Adjunct Clinical Faculty appointment at the rank of Lecturer. If you are in this group AND you hold a CIHR training award, e.g., doctoral fellowship award, you need to confirm your eligibility to hold a faculty appointment at Adjunct Lecturer level with the funding agency. This does not preclude appointment as a CA, however.