Physician Peer to Peer Recruitment Fund Form Physician Peer to Peer Recruitment FundPhysician Peer to Peer Recruitment Fund Required fields are marked with asterisks (*) Peer-to-peer recruitment is an effective and efficient strategy for building teams, leveraging inherent trust, credibility, and authenticity between peers to aid in the recruitment process. Thunder Bay CEDC’s physician peer-to-peer recruitment fund will award up to $1,000 each to local physicians who refer a physician candidate from outside Northwestern Ontario to take part in a site visit to Thunder Bay. A site visit for the purpose of this award consists of travel to Thunder Bay to assess practice opportunities and explore the community, pursuant to the Ministry of Health and Long-Term Care’s Community Assessment Visit Program (CAVP). Thunder Bay CEDC will allocate up to 10 awards per year of $1,000 each. Up to six (6) awards will be allocated to physicians who refer family physician candidates and up to four (4) awards will be allocated to physicians who refer physicians of all other specialties. Eligibility Referring physician must be actively working on a permanent, fulltime basis within the City of Thunder Bay Physician candidates must meet all requirements of the CAVP, including licensure or eligibility for licensure with appropriate regulating bodies (the College of Physicians and Surgeons of Ontario (CPSO) as well as the College of Family Physicians Canada (CFPC) or Royal College of Physicians and Surgeons of Canada (RCPSC)) within one year of the site visit date Candidates being referred for a site visit must reside outside of Northwestern Ontario, or at least 500 kilometers from Thunder Bay Candidates must be specialized in family medicine or in an area of medicine for which Thunder Bay Regional Health Sciences Centre and/or St. Joseph’s Care Group are currently recruiting The site visit must be approved by the Ministry of Health and Long-Term Care and completed by the candidate before the referring physician is granted the award. Process: Local physician submits application for the Peer-to-Peer Recruitment Fund (below). If eligibility is met, Thunder Bay CEDC earmarks one of the awards for that applicant The physician candidate is contacted to initiate the site visit. The appropriate party attains approval from the Ministry for funding of the site visit and the site visit is conducted. Thunder Bay CEDC confirms that the site visit took place and gathers appropriate documentation. The referring physician is contacted to arrange payment of the award. Applicant InformationNamePhone NumberEmailEstablishment of PracticeSpecialtyAre you affiliated with NOSM in a teaching capacity?- Select -YesNoReferred Candidate InformationNamePhone NumberEmailLocation (city)SpecialtySpecialty- Select -Practicing PhysicianResidentIf you selected Resident above, please indicate the year of residencySchool or Establishment of PracticePlease verify that you have this person’s permission to provide their contact information to Thunder Bay CEDC for recruitment purposes I verify that I have this person’s permission to provide their contact information to Thunder Bay CEDC for recruitment purposesHas this physician already inquired about practice opportunities in Thunder Bay? Yes NoIf yes, which organization(s) have they contacted?Please provide any related context regarding your referral of this physician (how you know them, why they are interested in Thunder Bay, etc.)Any collection of personal information is made under the authority of the Municipal Act, 2001. Personal information is collected in compliance with the Municipal Freedom of Information and Protection of Privacy Act. Personal information is collected for contact purposes. Any questions about this collection should be directed to: Lexie Penko Community Health Sciences Recruiter Email: healthrecruitment@thunderbay.ca None of your personal information will be shared, rented, sold or otherwise released to any third party without your consent. Submit