Return of Service (ROS) Agreements for International Medical Graduates in Ontario

International Medical Graduates (IMGs) who accept a physician residency position in Ontario are required to enter into a Return of Service (ROS) agreement with the Ontario Ministry of Health and Long-Term Care. 

The basic premise of a Return of Service agreement is that the Ministry will pay the IMG physician’s residency salary in exchange for the IMG physician’s promise to practice in an underserviced community for a minimum of five years following completion of the residency program. 

The Ministry’s stated purpose in requiring Return of Service agreements is to ensure that IMG physicians fill the need for physicians in Ontario communities.  

Currently, physicians are able to complete their Return of Service obligations anywhere in Ontario except in Ottawa, Toronto, Pickering, Markham, Vaughan, Brampton and Mississauga. Return of Service must commence within a year of graduating from the residency program. IMG physician can seek a deferral if pursuing additional training. In order to commence Return of Service, the IMG physician must have their Practice Location Agreement approved by the Ministry. 

IMG Physicians who do not fill their Return of Service obligations are in breach of the Return of Service agreement and are potentially liable to repay their residency salary to the Ministry, with interest. 

Situations arise in which an IMG Physician subject to a Return of Service agreement has difficulty complying with their Return of Service obligations. This can happen for any number of reasons, including illness, disability, lack of employment opportunities, change in profession or specialty, or parental leave. In such situations, the Ministry may grant deferrals or other accommodations on a case-by-case basis. 

Since breaching the Return of Service agreement could have significant financial consequences, IMG physicians who are having issues complying with their Return of Service obligations are encouraged to seek legal advice on how best to handle their particular situation.