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Supervision Program

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The College has developed a streamlined approach to long-term licensure for physicians on a Defined licence.

The Medical Act requires physicians trained outside of Canada to practise under a Defined licence and undergo supervision. Physicians must meet the requirements and conditions required to obtain a Defined licence. There is no change to the qualification requirements.

What’s Changed

The streamlined approach for physicians on a Defined licence will enable faster decisions regarding long-term licensure.

Once a physician obtains a Defined licence, the streamlined approach will:

  • provide a comprehensive orientation program for physicians;
  • reduce the required time physicians on a Defined licence must practise under supervision; and
  • focus on demonstrated competency rather than certification.

The College’s approach has been informed by:

  • a review of the data from the last six years of working with Sponsors and Supervisors overseeing the licensing pathway of physicians with a Defined licence seeking Full licensure;
  • listening to physicians and stakeholders working with physicians on a Defined licence;
  • a review of licensing best practices in other Canadian jurisdictions to determine what elements would effectively apply to the Nova Scotia context; and
  • the College’s commitment to support the recruitment of physicians.

New Pathway to Long-Term Licensure for Physicians Trained Outside of Canada

Minimum Supervision Period

Minimum Supervision Period

The new licensing pathway reduces the required time physicians on a Defined licence must practise under supervision by 60%.

Physicians issued a Defined licence will have a minimum of six months of supervision to a maximum of 24 months.

Based on our data, we anticipate that 80% of physicians on the new pathway will be issued a Restricted licence after six months. A smaller cohort may require up to 24 months of supervision.



After six months of supervision, there will be a licensing decision by the Registrar.

Successful physicians may be moved to a Restricted Licence or remain on a Defined licence.

Restricted Licence

A Restricted licence is renewable annually and does not require supervision or sponsorship – the physician continues to practice as the most responsible physician (MPR).

  • This is a long-term licence and the physician can settle in Nova Scotia without the worry that their licence will end.
  • The physician on a Restricted licence will be expected to practice within the scope and practice location where they were supervised on the Defined licence.
    • They do not have to challenge the certification exam.
    • They do not have to obtain a Full licence.
    • They can practise on a Restricted licence as long as they wish.

This provides more licensing certainty for the physician and for the community.

Requirement for Certification

Physicians eligible to challenge the certification examination are welcome to but it is not mandatory.

Physicians trained outside of Canada who are mid-career and reluctant to challenge the certification exam are no longer required to do so. These physicians can enjoy long-term licensure in Nova Scotia without ever challenging the certification examinations.

Maximum Supervision Period

Maximum Supervision Period

If there are ongoing concerns, the physician will continue to practise on a Defined licence and will undergo customized supervision to address the concerns, deficiencies, or areas that were not previously assessed.

  • Physicians who remain on a Defined licence will do so for a maximum of 18 additional months (24 months in total).
  • They will automatically be referred to the Registration Committee and their licensing decisions will rest with the Committee.
  • The Committee will review their supervision reports after a minimum of 6 more months
  • of supervision.
  • At any point during the final 18 months, the physician could be issued a Restricted licence, an ongoing Defined licence, or the licence could end.
  • After a total of 24 months of supervision, the Registration Committee will decide whether to issue a Restricted licence and may impose additional conditions and restrictions or recommend ending the licence.

We anticipate that approximately 15-20% of physicians will fall into this stream.

Once on a Restricted Licence, the physician can request a practice location change with the College. The key is that it is a similar practice context for which they were assessed under supervision.

There is always the option to work toward a Full licence by challenging the certification exam as long as the physician is eligible to do so.

Supervision Costs

Supervision Costs

We anticipate that the supervisor will require 40 hours in six months to complete the work and they will be compensated $6000 for the six months.

The cost to the supervised physician is $7500 for six months (this includes a $1500 College administration fee). For the small number of physicians that require ongoing supervision, there will be additional costs depending upon the length of supervision required.

The current standard level supervision requires 16-20 hours of supervision per year, is $3600 per year, and lasts up to two years. For some, it can last up to five years. Most pay $7200 for supervision in total.