Nurse and nurse practitioner scheduling in an FMG: who decides, and how to build it.

Why it is not built like the physicians' schedule

FMG physicians are nobody's employees. They commit to a number of half-days, choose their activities, negotiate on-call with colleagues, and the manager fits all of it into a grid. The physicians' schedule is built by agreement between peers.

A clinical nurse holds a position. Her hours, time off and replacements follow rules written outside the clinic, and not always in the same place depending on who hired her. The nurse practitioner sits in between: she practises autonomously within her specialty, but her hours are set by contract with the physicians she collaborates with.

One grid therefore carries three logics. The trouble is that it often gets filled with only one, the physicians', and the rest of the team is treated as a column to complete at the end.

Three statuses, three ways the schedule gets set

The MSSS funding and professional support program for FMGs provides several ways to have a nurse on the team. Knowing which applies to each person is the first question to settle, because it decides who has the last word on her schedule.

The nurse assigned by the establishment

This is the most common arrangement. The FMG's level sets how many full-time equivalents it receives, one to ten clinical nurses and one to five psychosocial workers. These people remain employees of the CISSS or CIUSSS, which assigns them to the FMG.

They practise under the functional authority of the FMG's physicians and under the administrative authority and clinical supervision of their establishment, under section 4.5.3.1 of the program. The text tasks the responsible physician with adapting their schedules to patient needs. The responsible physician can therefore ask for a Tuesday evening presence, but cannot set aside the collective agreement that governs this nurse's time off, schedule posting or overtime.

In practice, the FMG manager builds the schedule, but within a framework she did not write. Since administrative authority stays with the establishment, a vacation request may have to go through it before it appears in the FMG's grid. It is worth knowing in advance who approves it.

The nurse hired directly by the FMG

An FMG whose site is not operated by a network establishment can ask for the support to be paid to it in cash, in part or in full, and hire directly. The person then works in the FMG's premises, under the functional and administrative authority of the group's physicians.

The FMG gains flexibility, since it sets its own time-off and scheduling rules within labour standards. It also takes on the responsibility that comes with it, because arranging cover during absences is now its job. This arrangement calls for a schedule that shows gaps ahead of time, because no establishment will fill them.

The primary care nurse practitioner (IPSPL)

Since 2021-01-25, Quebec specialized nurse practitioners can, according to their specialty class, diagnose diseases and determine treatments, acts that now fall under their own legislation rather than the Medical Act. In an FMG, the IPSPL follows her own patients and sees them without a physician in the room.

Her hours are not born in the grid. Since 2024-11-01, letter of agreement 389 has governed collaboration between family physicians and IPSPLs, and the collaborating physicians' lump sums are allocated in proportion to the weekly hours set in the collaboration agreement. The schedule has to reflect that contract. An IPSPL working 28 hours when the agreement says 35, month after month, is a gap someone will have to explain.

Visits with the group's IPSPL also count toward the attendance rate, whose target is 80 %. An IPSPL block cancelled for lack of an office does more than move patients around, it pushes some of them toward another clinic.

The other professionals

Psychosocial workers follow the same arrangement as assigned nurses. The pharmacist is bought by the hour: funding varies with the FMG's level and the hourly rate was capped at $85 for the 2025-2026 fiscal year. You buy a number of hours, then have to place them in the week, ideally when physicians have medication questions for the pharmacist.

Status	Who sets the schedule	What governs it	Who replaces an absence
Nurse or worker assigned by the establishment	The responsible physician adapts, the manager places	FMG program section 4.5.3.1 and the establishment's collective agreement	The establishment, after four weeks of continuous absence
Nurse hired by the FMG	The FMG's physicians	Employment contract and labour standards	The FMG itself
IPSPL	The collaboration agreement with the physicians	Letter of agreement 389, in force since 2024-11-01	To be set in the agreement, nothing automatic
Pharmacist	The FMG, based on hours purchased	Funding by FMG level	The FMG

The four-week gap

For an assigned resource, the program provides that the establishment replaces her during a continuous absence of more than four weeks: from day one if the absence was foreseeable, and by the first day of the fifth week otherwise. A three-week absence opens no right to a replacement.

That is where most of the puzzles happen. One nurse off for two weeks, another in training for three days, a third on vacation at the same time: none of these absences triggers anything on the establishment's side, and all of them land on the FMG's schedule. Shared follow-up patients, planned vaccinations and blood-draw blocks have to be redistributed internally.

A schedule that shows nurses' absences in the same place as physicians' lets you see those overlaps before they happen. A schedule where nurses live in a separate tab finds out on Monday morning.

The holidays, when everyone wants the same week

The program sets two holiday periods, 22 to 28 December and 29 December to 4 January, during which the FMG must still offer at least 44 hours of services over six days. Those hours are not held with physicians alone. Someone also has to be at triage, at vaccinations and on the follow-ups that cannot wait until January.

Among physicians, the holiday rotation is often settled in June, between colleagues. For assigned nurses, holiday leave follows the establishment's rules, with its own request dates and its own order of priority. If the FMG waits until November to cross the two calendars, it finds a week where three physicians work and no nurse, then another where it is the reverse.

Putting both rotations in the same grid over the summer, even provisionally, is enough to see those lopsided weeks while there is still time to negotiate. The full method, with the rotation that settles Christmas for three years, is in our article on the FMG holiday schedule.

What ties the two schedules together

Keeping nurses in a separate grid looks simpler, especially when part of their rules comes from the establishment. It holds until the first change, because a nurse's schedule almost always depends on a physician's, in three specific places.

1. Pairing

A clinical nurse in shared follow-up works with one or a few specific physicians. If the physician leaves on vacation for two weeks, her follow-up meetings with that physician go too, and her day has to be reorganized. Nothing flags it when the two schedules are kept apart: the nurse finds out when the first patient asks where their physician is.

Writing the pairing into the schedule, even as one line (Ms X works with Dr Y and Dr Z), is enough for a physician's absence to raise the question of their partner right away.

Pairing also feeds the accounting. When the FMG bills physicians back for the time of the nurses who work with them, someone has to reconstruct every month who worked with whom, and for how long. If the pairing lives in the schedule, that tally comes straight from the actual grid. Otherwise it gets rebuilt from memory, emails and a spreadsheet kept on the side.

2. The office

Nurses, nurse practitioners and physicians share the same rooms, and it is often the nurse who loses hers when an extra physician shows up. An IPSPL without an office means patients who cannot be seen. A schedule that assigns offices to every category at once refuses the double booking instead of leaving it to be settled in the hallway.

Preferences count too. A physician who wants the office next to their follow-up nurse's is not being fussy: they save trips back and forth all day.

3. Presence during opening hours

The program requires at least 68 hours of services per week over seven days, with a family physician or an IPSPL present at all times. A Saturday morning where only an IPSPL is scheduled therefore counts toward that presence, as long as the schedule shows it clearly.

The reverse happens too. The IPSPL swaps her day with a colleague, the change is settled in person, and the Saturday still shows as covered while nobody eligible is scheduled. A physicians-only grid cannot see that gap, since the Saturday was never in it. Every opening hour must carry the name of whoever ensures presence, physician or IPSPL, in the same grid as everything else.

The two mistakes that keep coming back

The first is building the physicians' schedule first and filling in the nurses with whatever is left. You end up with days where three nurses have no paired physician, and others where a physician needs support and has none. The order that works better is to place everyone's fixed blocks first (IPSPL hours set in the agreement, assigned nurses' positions), then build the physicians around them.

The second is tracking fairness only among physicians. Nurses' evenings and Saturdays are shared out too, sometimes by the collective agreement, sometimes by habit. When nobody counts them, they land on the same people, and that is often what comes before a departure.

Where to start this month

1. Write down the status of each non-physician professional. Assigned, hired by the FMG, IPSPL under agreement. One line per person, with who approves her time off.
2. Pull the hours set in the collaboration agreements and compare them with the last three months of actual schedule.
3. Write down the pairings. Who works with whom, in one sentence. That is what lets a physician's absence raise the right question immediately.
4. Put everyone in the same grid, with views filtered by category if the team prefers, but a single source.

Where Synchro fits in

Synchro places physicians, nurses, nurse practitioners and psychosocial workers in a single team calendar, with views filtered by category. Offices are assigned to every category at once, walk-in blocks carry the name of whoever holds them, and each person writes their own constraints in plain language, IPSPLs and nurses included. When a physician is away, their nurse sees it in the same grid, at the same moment. Synchro also keeps track of which nurse worked with which physician, and for how many minutes: its team accounting splits that time among the physicians present and produces an Excel export per physician. The calculation starts from the actual schedule, so a cancelled activity drops out of the count without anyone removing it. The price is $10 CAD per user per month.

The limits, to be clear. Synchro does not run payroll, does not calculate letter of agreement 389 lump sums or RAMQ billing, and does not apply a collective agreement's rules for you: if the establishment has to approve a leave request, it still approves it. Synchro does not replace the EMR, holds no patient data and does not calculate the attendance rate.

Further reading

• Holiday schedule in an FMG: how to build it without a fight
• The 27 real constraints in an FMG schedule
• Scheduling and staff retention in an FMG
• 8 moments that wreck your FMG schedule
• Team calendar for medical clinics
• Office assignment
• Pricing