Scope of Practice in a Health Emergency or Pandemic
Professional Standard on Physician Scope of Practice in a Health Emergency or Pandemic
A large-scale health emergency such as a pandemic will require many physicians to assume professional roles that are different than their usual roles. The College encourages its members to train and/or upgrade their skills in anticipation of such a crisis, recognizing that immediate upgrading may be required in some cases.
As the need for certain skills and expertise becomes more critical during these times, physicians may want to help by returning to clinical practice from non-clinical work or retirement or by working outside their usual scope of practice. Such changes to scopes of practice or return to clinical practice will be considered temporary (for a designated length of time contingent on the status of the pandemic or health emergency).
Recognizing that the return to clinical practice or engaging in work outside the usual scope of practice will raise questions for many physicians, the College of Physicians and Surgeons of Nova Scotia has produced the following set of guiding principles.
- Services undertaken by physicians should correspond to their competencies. For example, while some competencies, such as history-taking, basic physical exam and ordering basic investigations are common to all physicians, others are not. When physicians work outside their normal scope of practice, it is essential that a hierarchy of skills be applied, so that the most competent individuals available at any given time are responsible for the most complex tasks.Physicians should only practice outside their area of expertise during a health emergency if:
- the care needed is urgent;
- a more skilled physician is not available; and
- that not providing the care would lead to worse consequences than providing it.
- Physicians who are working outside their normal scope of practice must recognize when they have reached the limits of their training and experience and arrange to consult or refer.
- Physicians who are fully qualified and experienced in a particular scope of practice should ideally be available on short notice to support physicians who are temporarily working within that scope during an emergency.
- Physicians must not be conscripted or otherwise forced to work outside their normal scope of practice during an emergency.
- All physicians should ensure that they have current Canadian Medical Protective Association (CMPA) coverage for Nova Scotia or adequate liability coverage.
- The College has developed an Emergency License intended to be issued in the event of a declared health emergency and identified need. An emergency license can be active for as long as a need exists up to a maximum of three months. Extensions may be granted at the discretion of the Registrar. Sponsorship by a District Health Authority in Nova Scotia is a requirement. An emergency license is intended to be in place only during a period of emergency in Nova Scotia. Physicians granted an Emergency License wishing to practice full-time in Nova Scotia will be required to meet the College’s requirements for a Full, Defined or Temporary License.
- Physicians retired from licensed practice in Nova Scotia may be eligible to resume practice under an emergency license, without a clinical assessment, within seven years of retirement from practice (instead of the usual three years) as long as they practice within their original scope of practice in a structured setting (e.g., in a primary influenza assessment centre) with other health care providers in accordance with established protocols and clinical practice guidelines. This policy does not apply to physicians who have held a non-resident license in Nova Scotia.
- Physicians holding a license for unrestricted independent medical practice and currently in good standing elsewhere in Canada or the United States may be eligible for an Emergency License in Nova Scotia.
For further information, consult “Emergency License Policy” of the College of Physicians and Surgeons of Nova Scotia.
The College of Physicians and Surgeons of Nova Scotia gratefully acknowledges the assistance of the Canadian Medical Protective Association and the College of Physicians and Surgeons of Ontario in preparing this document.
Minor edits for clarity: July 9, 2010
Approved by the Council of the College of Physicians and Surgeons of Nova Scotia: October 16, 2009
Approximate date of next review: October 2014