In this state of emergency, physicians may be asked by their Health Authority to contribute to the pandemic response in ways outside their normal scope of practice.
To support the pandemic response and the physician deployment plans of the Health Authorities, the College will not hold deployed physicians to practice within a scope strictly consistent with recent training and experience.
This approach applies to:
- Physicians privileged and working within the NSHA and IWK (inpatient or outpatient settings); and
- Physicians within COVID-19 assessment centres, engaged in activities as deployed by the health authorities.
To restate: if you are deployed by your Health Authority to work outside your normal scope of practice, be advised you will not face disciplinary measures from the College.
These are uncertain and stressful times, with physicians raising their hands to help wherever needed.
Thank you for doing so.
Dr. D.A. (Gus) Grant
Registrar and CEO, College of Physicians & Surgeons of Nova Scotia
To help remove unintended barriers and to mitigate the risk of infection to vulnerable populations, the NSHA has recommended temporary changes regarding Medical Assistance in Dying. At its March 27, 2020 meeting, the Council of the College of Physicians and Surgeons endorsed the NSHA’s recommendations and have approved temporary amendments to its Professional Standard Regarding Medical Assistance in Dying (MAiD).
Recently retired Nova Scotia physicians can apply for a restricted licence to help in the pandemic response at no cost. This restricted licence is time-limited and specific to addressing the response to COVID-19 as directed by NSHA and IWK.
eligible you must:
- Have had a full licence at the time of retirement in Nova Scotia (not provisional or restricted)
- Have practised in Nova Scotia within the last 3 years
- Plan to work within your scope of practice
- Obtain Canadian Medical Protective Association (CMPA) coverage
- Provide consent to share your licensing information with the NSHA or IWK
This work is under the direction of NSHA and IWK. This licence is valid until June 30, 2020, and end date will be reviewed at that time.
staff will work with you to review your licensing history and speak with you
about your intention to work during the pandemic.
For questions contact email@example.com.
NSHA – Virtual Appointment Practice Guidelines & Implementation Guide
In response to the global pandemic declaration by the World Health Organization, implementation of these guidelines when providing care via telephone in your clinics is necessary:
- Use professional judgement to determine whether patient consult via telephone is appropriate in a particular case.
- Ensure the physical setting in which the care is provided provides for confidentiality.
- Ensure patient safety by being aware of patient’s location and proximity of services
- Request patient’s next of kin or alternate support person in the case of an emergency.
- During telephone appointments we are unable to complete a physical assessment therefore, we are relying on the patient to provide us accurate information. Keeping this in mind, documentation is vital.
- Call 911 or follow standard emergency protocols for an immediate emergency response as needed.
Please read the full Virtual Care Guideline document from NSHA.
NSHA – COVID-19 Virtual Visit Implementation Guide
This document is intended to:
- Assist providers in developing a plan to integrate virtual visits into their practice;
- Advise on the types of services where virtual visits should be considered under the current circumstances.
Please read the full Virtual Visit Implementation Guide.
Last week, Health Canada’s Office of Controlled Substances issued a short-term exemption from the Controlled Drugs and Substances Act in the public interest, made necessary by the COVID-19 pandemic.
In order to take effect in Nova Scotia, the directive of Health Canada required coordinated action from government, the NSPMP, and the regulatory colleges. The necessary steps have been taken.
- Pharmacists may extend and renew prescriptions of controlled drugs and substances;
- Pharmacists may transfer prescriptions of controlled drugs and substances to other pharmacists;
- Pharmacists may accept and practitioners may verbally provide prescriptions for controlled drugs and substances; and
- Pharmacy employees may deliver controlled substances to patients (at their homes or an alternate location).
These changes will improve access to needed medications during this state of emergency while reducing unnecessary in-person contact with health professionals.
specific changes implemented by the NSPMP are as follows:
1. Physician Prescribing
As per the March 19, 2020, Health Canada exemption, prescribers are permitted to issue verbal orders for monitored drugs. Physicians may e-prescribe within the DIS, fax or call in prescriptions of controlled substances to pharmacists.
To assist with verbal prescribing,
under NSPMP, prescribers will not be required to complete or maintain a prescription
form, however, will be required to relay appropriate content required for a
prescription, and maintain a record consistent with their College requirements.
2. Pharmacists Authority to Prescribe Controlled Substances Expanded
As per the March 19, 2020, Health Canada exemption, pharmacists may extend or renew a monitored drug prescription without the use of an NSPMP Prescription Form/duplicate pad, if it meets the requirements of a prescription and the conditions set out under Health Canada’s exemption s56(1) dated March 19, 2020.
As per the March 19, 2020, Health Canada exemption, pharmacists may dispense a monitored drug prescription extended or renewed by a Pharmacist, not written on an NSPMP Prescription Form/duplicate pad, if it meets the requirements of a prescription and the conditions set out under Health Canada’s exemption s56(1) dated March 19, 2020.
are requested to refer to the Nova Scotia College of Pharmacists for all requirements
relating to prescribing and dispensing.
Please also refer to Health Canada’s FAQs regarding this class exemption.
Advice to the Profession Regarding Virtual Care During the Pandemic
COVID-19 is putting tremendous pressure on our health care system, in particular those working on the frontlines. While the College expects physicians will practice within the scope of their training and expertise and act in the best interest of their patients, it also recognizes these are extraordinary times. The adoption of virtual/telemedicine care will be called for in the days and weeks ahead. A fee for this service is now in place for physicians, for details contact Doctors NS.
The College wants to ensure physicians can deliver patient care in the face of the pandemic. Central to this effort is the importance of limiting viral spread by:
- Reducing all unnecessary patient and physician travel;
- Reducing unnecessary patient visits to health facilities, and;
- Enabling physicians to provide remote patient service within Nova Scotia or from other jurisdictions.
Care for patients with
- Use virtual means to keep contact with patients who have symptoms and who you are monitoring.
- Reassess patients virtually, and if worsening arrange appropriate follow up.
Care for regular patients
by virtual means whenever possible for the following reasons:
- To avoid unnecessary trips to the office.
- To manage patients with chronic disease.
- To manage other acute illness that may not require a physical exam.
For further guidance please review Professional Standards Regarding the Provision of Telemedicine Services.
The College recognizes the growing role of telemedicine or virtual medicine in our pandemic response. As such, the College wishes physicians to be aware of the following:
- For physicians licensed in Nova Scotia, there is no requirement for College approval for this field of practice.
- Any physician licensed in Canada may deliver telemedicine services in Nova Scotia, unless specifically restricted from doing so by their licensing body;
- The regulation of the medical services you provide into Nova Scotia rests with your licensing college.
- All physicians delivering telemedicine services in Nova Scotia should refer to the College’s Professional Standards for the Provision of Telemedicine Services.
These are extraordinary times, giving rise to many questions from physicians about their ongoing responsibilities. We wish to acknowledge the tremendous efforts of physicians around the province.
encourage physicians to review CMPA’S
COVID-19 guidance which provides a succinct outline of the CMPA’s
expectations of physicians, including:
the challenging conditions of a pandemic/catastrophic event, physicians will be
expected to continue to act professionally on behalf of their patients.”
The College understands that physicians know to exercise sound professional judgement when caring for their patients in the midst of this pandemic. As such, the College expects reasonable measures to be undertaken to minimize risk and maximize your ability to help patients. These measures might include altering your schedule regarding patient encounters, increasing your use of phone or virtual consultations, and limiting physical examinations only to the most necessary.
considering the closure of practice must adhere to the College Standards on Temporarily
or Permanently Closing a Medical Practice and Reducing
the Size of a Medical Practice.
The College wishes to thank all physicians who are called upon during this pandemic. We ask that you use your professional judgement to stay well while caring for your patients.
province, doctors are providing excellent care and meaningful leadership during
these challenging and extraordinary times.
The Chief Medical Officer, Dr. Strang, is overseeing our public health response. He has asked the College to directly communicate to physicians on an important matter.
In support of our Chief Medical Officer, and pursuant to the advice of our experts in Infectious Diseases, please be advised that, effective immediately:
Only physicians recognized as specialists in Infectious
Disease may prescribe or initiate treatment with lopinavir/ritonavir (Kaletra), and/or hydroxychloroquine.
Patients already taking these medications may be maintained on their regime by
their regularly prescribing physician
This restriction supplements the approach adopted by the College of Pharmacists, which has instructed its pharmacists not to dispense these medications.
We all need to work together. Each of us has a role to play in keeping Nova Scotians safe. Thank you to the tremendous work of physicians working on the front lines to do just that.
(The following was published in the Chronicle Herald March 14, 2020)
These are nervous times. As we await the first case of COVID-19 in our province, fear and confusion could easily overwhelm us. There are, however, important reminders and reassurances to offset our anxiety.
Unlike many other countries affected by this pandemic, Canada has a robust public health system. In Nova Scotia, we have the necessary expertise and infrastructure to respond well to this challenge.
It is now time to rely on expertise. We must summon the discipline to resist the inexpert advice that is abundantly available through any number of unreliable information sources. Those of us who are not experts must be careful to avoid offering opinions. If our province’s response to the inevitable arrival of COVID-19 is going to be effective, it is incumbent on all to follow the advice of our public health experts. They are providing the leadership; it is our responsibility to follow.
First and foremost, we must embrace the common-sense recommendations from the experts. Wash your hands, well and often. Resist or limit touching your face with your hands. Disinfect surfaces. Observe social distancing. Avoid large, close gatherings. If you can, work from home. If you are sick, do not go into work. If returning from travel, observe the self-isolation recommendations. These measures might seem small and inconsequential in the face of a pandemic. The experts tell us otherwise.
Patients are encouraged to pursue advice from 811. This service provides important triage, directing patients to the appropriate next step. By bypassing 811 and pursuing direct care or in-person advice, patients put the community at risk, the health professionals themselves at risk, and threaten to overwhelm the system. Bypassing the simple step of calling 811 might heighten the problem and weaken the collective response.
Patients should not worry about their medications. The College of Pharmacists and the province will have contingency plans in place, allowing for access to prescription medications in the event that some pharmacies need to close.
Although there is appropriate concern that a rapid outbreak may overwhelm our health-care physical and human resources, physician mobility will not be an issue in our country’s response to the pandemic. The College has activated its business continuity plan to ensure the licensing of physicians will continue to be carried out in a thorough and timely manner.
With respect to emergency medical licensing, the provincial colleges have reached a consensus. Nova Scotian physicians seeking to help in pandemic response in other provinces may do so without hassle. Similarly, physicians from other provinces wishing to support our local response can be licensed on an emergent basis immediately. Physicians recently retired in Nova Scotia wishing to participate in the pandemic response should contact the College to determine if their licences can be reinstated for this purpose. Physicians travelling to respond to the pandemic elsewhere in the country should be aware that their liability coverage will remain in place.
The College is aware that the Medical Council of Canada, the Royal College of Physicians and Surgeons of Canada, and the College of Family Physicians of Canada all are contemplating making changes to their examination schedules. The licensure of physicians in training and provisionally licensed physicians will not be affected by any examination changes. They will be maintained in provisional licensure.
The situation is fluid. Both physicians and patients are well advised to stay current with the latest developments of the pandemic through public health at: https://novascotia.ca/coronavirus/.
The Nova Scotia Health Authority is maintaining active updates at: www.nshealth.ca/news. It is also providing information regarding COVID-19 assessment centres at: www.nshealth.ca/coronavirus.
Nova Scotians are good at preparing for storms. We heed the weather warnings. We batten down the hatches. We stay safe. We do the right things. I am confident we can apply this approach to COVID-19.
Dr. Gus Grant is registrar & CEO of the College of Physicians and Surgeons of Nova Scotia.