Issue 3: October 2022

The College has instituted a number of important changes to licensing for physicians on a Defined licence, particularly in Royal College specialties.

The Royal College has deemed training from 29 jurisdictions in seven countries as acceptable. Physicians from those jurisdictions were immediately granted exam eligibility, while physicians from other jurisdictions could not immediately obtain exam eligibility. The Royal College is now in the process of ending this approach amid concerns it was arbitrary and discriminatory. The Royal College will now grant exam eligibility to physicians with training from anywhere in the world who can demonstrate adequate discipline-specific post-graduate training.

Essentially, the pool of potential candidates for licensure has increased exponentially.

In anticipation of this change, we examined our experience with the licensure of IMGs. Our quantitative and qualitative research found the following:

• Physicians arriving in Nova Scotia are often set up to fail, with insufficient orientation and few longitudinal supports.
• The period of supervision is too long, with few new concerns or findings being identified after the first year.
• Many physicians provide competent and valuable care within the scope of their practice, despite being unsuccessful at obtaining certification.

Going forward, exam-eligible physicians will be issued a Defined licence and undergo concentrated supervision for a period of six months.

Going forward, exam-eligible physicians will be issued a Defined licence and undergo concentrated supervision for a period of six months. After six months, physicians who have performed well will be issued a Restricted licence, restricted to the place they have been practising and the scope of practice for which they have been assessed. Restricted licences may be renewed annually and physicians holding a Restricted licence are not subject to ongoing supervision. These physicians will not be required to obtain Royal College certification but will be free to do so and if successful will be eligible for a Full licence.

There will be challenges to implementing this new approach, especially in the availability of Fully licensed physicians to complete assessments. Physician assessors will be trained and the work will be well-compensated.

The College will be working with stakeholders to set up a welcoming program for IMGs. If they are to succeed, they need effective practice and longitudinal supports and to be made welcome and appreciated.

Our new approach to the licensure and welcome of IMG physicians has met with enthusiastic support from important stakeholders like Doctors Nova Scotia, Immigrant Services Association of Nova Scotia (ISANS), and the provincial health authorities.