C/AFP Agreement

C/AFP Agreement

The 2023 Clinical/Academic Funding Plan (C/AFP) Agreement will see C/AFP physicians receive across-the-board increases for four years, as well as additional funding and initiatives designed to help clinical/academic departments maintain stability and build toward more clarity in and accountability for their work.

Overall investment

We anticipate that, as a result of the new Physician Agreement and C/AFP Agreement, the total annual investment in physician services will grow by at least $180 million over four years.

Across-the-board increases

All C/AFP physicians will receive across-the-board increases over the four years of the contract. These increases help bring physician remuneration closer to our national peers and make Nova Scotia a more attractive province in which to practise medicine.

These increases apply to the Minister’s funding only, but there is an additional 0.5% (about $1.5 million) for C/AFP targeted investment. This funding will be allocated by the Minister in consultation with the Committee of C/AFP Department Heads and the health authorities. Approximately $500,000 of this funding is expected to be allocated to the C/AFP Department of Family Medicine to ensure family physicians working within the C/AFP remain competitive with their peers in the community. 

The increases are as follows:

Year 1
Year 2
Year 3
Year 4
3% 3% 2% 2%

*The contract runs from April 1 to March 31. Year 1 increases will be paid retroactively to April 1, 2023.

Succession planning and transitional support

This proposal-based program allows physicians to design their own succession plan, with up to two years of cross-over supported. Learn more

New physician FTE and other resources

NewMD requirements will now be pursued through the NSH/IWK business case process. This is significant because it provides enhanced flexibility and will ensure alignment in resourcing additional physician FTEs with other operational supports needed. Almost 50 new specialist FTEs were approved through the most recent business case process, supporting access and flow, surgical access, cancer care, mental health and more. The business case process can also be used by C/AFP Departments to pursue other innovations, such as human resource, technology or operational investments that would improve the Department’s efficiency, productivity and/or quality of service.

Above and beyond

The parties have committed to establish a clear prompt and process to address payment and/or resourcing for extra work required of the C/AFP Departments. In the interim, the current process by which Department Heads can request that work be funded as “work outside the AFP” can be used to address additional work needs (such as surgery blitzes or waitlist initiatives, other after-hours needs, and so on). C/AFP physicians will now also be able to shadow bill at premium rate for after-hours work in support of the surgical strategy that is done at the request of NSH or IWK Health

Administrative and operational supports

The negotiating parties will work with C/AFP and fee-for-service Academic Departments to address additional administrative or operational supports needed to improve access and flow and other system priorities.

Travel/redeployment payments

When a physician is asked by a health authority to travel to another hospital in the province more than one hour away, the physician will have their expenses reimbursed. Learn more

Asynchronous virtual care

Fee codes that remunerate physicians for physician-to-physician consults will be expanded to cover both synchronous and asynchronous discussions, whether those are done by telephone, face-to-face or secure messaging. This will support more timely access to care for patients and provide more support to physicians as you care for patients.

Making the invisible, visible

This contract includes new fee codes that will mean physicians will be paid for some of their “invisible work” – important work they do that takes time but hasn’t always been recognized by the system. The Fee Committee will be establishing new fee codes for some of the work that physicians do that is generally unremunerated today because it happens outside of individual patient encounters. Examples include:

  • physician-to physician capacity-building, mentoring and maintenance of competency
  • quality or safety work requested by a health authority
  • shared care and co-management of patients (such as (tumour boards, neurovascular stroke rounds and multi-organ transplant rounds)

Parental leave

In a significant investment, physician parents of newborns or newly adopted children will now be eligible for $2,000 per week for up to 26 weeks of parental leave – more than double what was available in the last contract – with the option to spread over 52 weeks. This is the most generous physician parental leave program in Canada.

Professional Support Program

The DHW will increase the Professional Support Program (PSP) budget to $700,000 (an increase of over $600,000) by April 2024 so the supports available to physicians to achieve optimal wellness can be significantly enhanced. This funding will support a trained intake worker to respond to and triage initial calls to the program, and will also help provide better, funded access to counselling and psychological services. The funding will also support increased upstream wellness supports such as Balint groups and mindfulness workshops.

Physician retirement fund

The provincial government has confirmed that details about the retirement fund will be shared by March 31, 2024. Implementation will be within this government's current mandate before July 2025.

Physician wellness strategy ­

The parties agree to create a working group to better coordinate and enhance physician wellness initiatives in Nova Scotia. The working group will be mandated to inventory existing wellness initiatives, identify any gaps and make recommendations to enhance physician wellness initiatives.

Administrative burden

The provincial government will continue its work toward and support for reducing unnecessary physician administrative burden.

Get more information

If you want to understand how the contract will benefit you or about something you heard at a meeting, or if you’d like more information about how the proposed contract will affect you, please contact:


Maureen Connolly
Compensation manager, clinical/academic funding plans