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POSITION DESCRIPTION

By Samantha Gordon,2014-06-16 19:39
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POSITION DESCRIPTION ...

    SOUTHEASTERN ONTARIO HEALTH SCIENCES CENTRE

    PHYSICIAN RECRUITMENT IMPACT ANALYSIS FORM

To check the appropriate category, please click on box:

     Permission to recruit Preliminary Needs Assessment for Physician Recruitment ? begin at Part 2.

     Permission to appoint Detailed Physician-Specific Impact Analysis ? complete Part 1 AND update all other sections

    as applicable to identified candidate.

     Permission to recruit, waive advertising AND appoint (when candidate is known) Detailed Physician-Specific Impact

    Analysis ? complete all parts.

     Other (specify)

    PART 1 APPOINTMENT INFORMATION

1. Name of Appointee:

2. Citizenship:

     Canadian Permanent Resident: date of landing

     Other (specify Work Permit Required

3. Licensure Status:

    Medical Degree: Year University

    Postgraduate Training: Date Location

    RCPSC/CCFP Fellowship: Date Specialty

    Expected Category of License: Independent

     RCPSC Academic License (for Associate and Professors)

     CPSO Academic Practice Certificate (for Associate and Professors)

     CPSO Restricted Certificate of Registration for Assistant Professors

     Other (specify)

4. Expected Date of Appointment:

5. Recommended Rank:

6. Clinical Locations:

     HDH KGH Prov Care Other (specify)

7. University Department(s) of Cross-Appointment being recommended:

     N/A

8. Role Description:

    A copy of the role description that has been signed by the appointee and the Department Head is attached.

9. Mentorship:

    Identify the individual(s) responsible for providing mentorship to the appointee.

    PART 2 BACKGROUND DATA

1. Position # (if known):

     New position

     Replacement if Yes, for whom

     Other (describe)

     Revised May 07, 2009

2. SEAMO Status:

     Full Part Non N/A

    Comments:

3. Primary Department, Division and Program:

    Secondary Department, Division and Program:

     N/A

4. Relationship to University:

     GFT Adjunct-1 Adjunct-2 Other (describe)

5. Position Description:

    Identify for each institution affected by this recruitment the specific programs or services in education, research/scholarly

    activity and clinical service identified in that institution’s strategic plan, strategic direction, mission or objectives that will be

    addressed by this recruitment. Identify, the priority placed on these programs or services by the institution.

6. For appointees with reduced responsibilities, what are the succession plans for replacement if there is a need for

    the position to continue:

     N/A

7. Funding:

    Describe the means by which this recruitment will be funded.

    Is funding currently available? Yes No

    If No, explain.

8. Hospital Privileges Required:

     Attending Associate Consulting

     Regular Term Regular Term Regular Term

     HDH

     KGH

     Providence Care

     Other (specify):

9. Anticipated Time Commitments:

    For this position, what are the expected percentage time commitments for

    Clinical Service

    %

    Teaching

    %

    Research/Scholarly Activity

    %

    Administration

    %

    Other (describe)

    %

    Total FTE contribution (not to exceed 100%)

    %

     Revised May 07, 2009 2

10. Describe the job or role to be played by this recruitment in respect to the individual missions of each institution:

    a. Clinical Service. Be specific with respect to volumes, practice type, method of service delivery, on-call responsibility,

    relationships to other clinical and hospital programs. Reference to identified specialty standards where possible should

    be made. Identify unmet regional needs and current coping strategy.

b. Teaching. Describe programs to which this recruit will contribute and the current method for provision. Where possible,

    provide specific numbers of student contact hours.

c. Research/Scholarly Activity. Identify programs to be supported/developed. Describe how this recruitment relates

    to/supports/enhances this and other programs. Describe any linkage external to the program/division/department.

d. Administration/Other. Describe management responsibility in relation to other management structures in the centre.

     PART 3 HOSPITAL IMPACT OVERVIEW

    1. Briefly outline the clinical services/programmatic alignment to be provided by the appointment:

Where are these programs currently provided?

    HDH KGH Prov Care Other

If Other, please describe.

    2. Will this appointment require access to any additional medical services, e.g. anesthesiology, interventional radiology, critical care, etc.? Yes No N/A

    If Yes, please describe.

3. What new or increased services will be required to support this appointment? N/A

     HDH KGH Prov Care Allied Professionals Occupational Therapy Physical Therapy Social Work Nursing Clinical Nutrition Respiratory Therapy Other (describe below)

What new or increased procedures/diagnostics will be required to support this appointment? N/A

     HDH KGH Prov Care Cystocopy Diagnostic Imaging Endoscopy EMG/Nerve Conduction Testing Laboratory Other (describe below)

Please list new or increased requirements for any of these services/procedures.

     Revised May 07, 2009 3

    4. In-Patient Space and Equipment:

a) Will this appointment require in-patient/critical care/enhanced care unit beds in addition

    to those currently allocated to the program? Yes No N/A

    If Yes, how many? Prov Care HDH KGH In-Patient

     Critical Care

     Enhanced Care Unit

    b) Estimated number of admissions per year. N/A

     HDH KGH Prov Care

     Number

     Average length of stay

    c) Will there be need for specialized equipment to support the in-patient beds? Yes No N/A

    If Yes, where? HDH KGH Prov Care Other

    Please specify.

    d) Will this appointment require access to Intensive Care/Enhanced Care Units at KGH? Yes No N/A

    If Yes, please detail equipment and cost.

    5. Out-Patient Allocation and Equipment

    a) Will this appointment require dedicated assigned clinic time? Yes No N/A

     HDH KGH Prov Care Off-Site

     If Yes, indicate hours/week:

     Number of examining rooms:

    If off-site, state location:

    Will these be available within current programmatic allocation? Yes No N/A

    If No, please describe requirements and funding sources.

    b) Estimated number of out-patient visits per year. N/A

     HDH KGH Prov Care Off-Site

    c) Will new or additional procedures be performed beyond those currently available? Yes No N/A

    If Yes, where? HDH KGH Prov Care Other

    Please specify.

    6. Operating Room Time and Equipment:

    a) Will this appointment require Operating Room time? Yes No N/A

     If Yes, indicate hours/week: HDH KGH Prov Care

     Revised May 07, 2009 4

    Will these be available within the hours currently allocated to the program? Yes No N/A

    If No, please describe requirements and funding sources.

b) Estimated number of surgical procedures per year. N/A Prov Care HDH KGH

c) What percentage of patients will require specialized post-operative monitoring or placement in Intensive Care or

    Enhanced Care Unit? N/A

     HDH KGH Prov Care

    Please specify specialized needs.

    d) Will specialized equipment be required for the Operating Room? Yes No N/A

     If Yes, indicate hours/week: HDH KGH Prov Care

    If Yes, please specify.

    e) Will new or additional procedures be performed beyond those currently available? Yes No N/A

    If Yes, where? HDH KGH Prov Care Other

    If Yes, to what extent provide volume.

    7. Endoscopy:

    Anticipated number of procedures per year and location. N/A

     HDH KGH Prov Care

    8. Additional Comments/Information: N/A What additional implications can you identify that might result from this appointment?

    PART 4 OFFICE

    Note: Priority for office space is given to GFT physicians or others whose role remains central and essential.

    1. Will the appointee require GFT office space? Yes No N/A If Yes, where (HDH, KGH, Providence Care, Queen’s, elsewhere)?

    If appointee is a replacement, will previous office space be assigned? Yes No N/A If Yes, identify specific location (e.g. room number, building).

If No, describe sources of funding for new space.

    Will renovations be required? Yes No N/A If yes, describe sources of funding for renovations. N/A

    Additional comments: N/A

     Revised May 07, 2009 5

    2. Will the appointee require office furniture? Yes No N/A

    If appointee is a replacement, will previous office furniture be assigned? Yes No N/A

    If No, who will provide?

    Describe sources of funding for office furniture. N/A

    Additional comments: N/A

    3. Will the appointee require space for a secretary? Yes No N/A

    If Yes, where (HDH, KGH, Providence Care, Queen’s, elsewhere)?

    If appointee is a replacement, will previous space be assigned? Yes No N/A

    If Yes, identify specific location (e.g. room number, building).

    If No, describe sources of funding for new or renovated space. N/A

    Additional comments: N/A

    4. Will secretary be shared? Yes No N/A

    If Yes, with whom?

    5. Describe other specialized needs and sources of funding: N/A

     PART 5 INFORMATION TECHNOLOGY

    1. If an office is requested, will the appointee require a computer? (excludes laptops) Yes No N/A

    If Yes, where will routine connections be required (HDH, KGH, Providence Care, Queen’s, elsewhere)?

    If appointee is a replacement, will previous computer be used? Yes No N/A

    Additional comments: N/A

    2. Describe any special needs required and the source(s) of support for the above: N/A

    PART 6 RESEARCH/SCHOLARLY ACTIVITY

    1. Describe field/area of appointee’s research/scholarly activity and source(s) of funding: N/A

     Is this an:

    Existing program?

    New program?

     Revised May 07, 2009 6

    2. Will a Research Initiation Grant be requested? Yes No N/A

     (Adjuncts are not eligible. For non-SEAMO GFTs, any support requested

     for RIG funds must be discussed with the Faculty Office in advance)

    If Yes, please identify the amount being requested and identify the source of any funds in excess of $30,000:

    Describe the nature of the program as per the Faculty Policy on Research Initiation Grants for GFT faculty members

    adopted March 20, 2006:

    3. Will establishment funding be requested from the Canada Foundation for Innovation? Yes No N/A

    If Yes, ensuing discussions will be required with the Vice-Dean Research.

4. Will this appointment require dedicated research space? Yes No N/A Prov Care Other If Yes, where? HDH KGH

    If Other, please describe. N/A

    If it can be accommodated in the space currently assigned to the department, identify specific site and room(s). If not,

    please describe space requirements and funding sources of space and equipment. N/A

    5. Will it be required for patients to have access to the research space? Yes No N/A

    If Yes, where? HDH KGH Prov Care Other

    If Other, please describe.

    PART 7 APPROVALS

    Please check the appropriate category:

     Approval to recruit (first submission)

     Approval to appointment (second submission)

     Approval to recruit, waive advertising AND appoint (simultaneous submission)

     Other (specify)

DEPARTMENT OF

     Head of Department

     Signature

     Date

     Revised May 07, 2009 7

     PROGRAM

     Program Operational Director Program Medical Director

     Signature Signature

     Date Date

HOSPITAL

     Chief of Staff/Medical Director CEO/Executive Director

     Signature Signature

     Date Date

FACULTY OF HEALTH SCIENCES

     Vice Dean Research & VP Research Development/ Dean/Vice-Dean Academic/Associate Dean, Clinical Director of Research

     Signature Signature

     Date Date

     Revised May 07, 2009 8

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