Defined licence: requirements and conditions for supervised practice as the most responsible physician

Preamble

A Defined licence is a time-limited licence issued to a physician lacking qualifications for a Full licence. Physicians holding a Defined licence may practise medicine while pursuing long-term licensure. Being time-limited, a Defined licence can only be renewed annually within its term.

Physicians holding a Defined licence may practise medicine while pursuing the necessary qualifications for a Full or Restricted licence.

A physician holding a Defined licence practises as the most responsible physician (MRP) while subject to College-directed supervision and such other conditions and restrictions as determined by the Registrar or the Registration Committee.

Purpose

This policy sets out the minimum requirements to obtain, and the standard conditions applied to, a Defined licence in Nova Scotia.

Scope

This policy applies to all holders of Defined licenses, excluding physicians issued a Defined licence for Clinical Fellowship. For information on Defined licence for Clinical Fellowships, see the College policy on Defined Licence for Clinical Fellowship: Requirements and Conditions for Licensure¹.

Policy

Eligibility Criteria

1. Candidates must satisfy the following:

2. In addition to the above requirements, applicants must be eligible for one of the following approved pathways to Defined licensure:

* Applicants who have exam eligibility via an approved jurisdiction may be eligible for a Full licence. Please refer to the policy for Pathway to Full Licensure via an Approved Jurisdiction: Eligibility Requirements for Physicians⁵ for more information.

Conditions on all defined licences

The terms and conditions of a Defined licence will be set out in a Licensing Agreement, and will address:

1. Length of time permitted on a defined licence
   A Defined licence is time-limited. The maximum time to hold a Defined licence will be set as a condition on each Defined licence. ​Physicians issued a Defined licence will undergo a minimum of six months and a maximum of 24 months of supervised practice as the most responsible physician.
2. Participation in the College’s “welcome collaborative” physician orientation program
   Physicians who completed their training outside of Canada or the USA with no independent practice experience within Canada must participate in an Orientation Program¹² approved by the College.
3. Pathway to long-term licensure
   While on a Defined licence, the physician must work towards long-term renewable licensure. The College policy for Pathway to Long-term Licensure via a Defined Licence¹³ outlines these requirements.
4. Sponsorship
   At all times, Defined licensees must have a Sponsor approved by the College. Unless otherwise approved by the Registrar, a Sponsor must hold a Full licence and, hold a senior position with the health authority in which the supervised licensee will be practising. ​Pursuant to Section 41 of the Medical Act Regulations, the Sponsor may add conditions to the physician’s Defined licence. Withdrawal of sponsorship will result in immediate loss of licensure. Any decision to withdraw sponsorship is a personal decision of the Sponsor and is not subject to College review.
5. Supervision
   At all times, physicians on a Defined licence are subject to supervision by a College-approved supervisor in accordance with the policy for Approval of Assessors and Supervisors for Practice Ready Assessments, and College-Directed Supervision and Assessments.¹⁴​The supervision plan is determined by the Registrar or Registration Committee and can be modified by the Registrar or Registration Committee in response to physician performance. ​Physicians holding a Defined licence will be subject to Standard supervision for a minimum of six months and maximum of 24 months. For all holders of a Defined licence, the supervised physician is responsible for the costs of supervision.​While deployed outside of Nova Scotia, supervision of physician members of the Canadian Armed Forces is at the discretion of the Canadian Armed Forces.
6. Leave of absence
   At the discretion of the Registrar, a leave of absence up to one year may be granted to physicians who take a pregnancy or parental leave, medical leave, educational leave of absence, or other exceptional circumstance. ​For approved leaves, the end date of the licensing term will be moved to accommodate the leave up to the maximum allowable licensing term. Longer extensions must be referred to the Registration Committee for consideration.
7. Extensions to licence term (other than for leaves of absence)
   Under exceptional circumstances, a Defined licence may be eligible for an extension to the licensing term, with or without additional conditions and/or restrictions. ​Decisions about licence term extensions are made by the Registration Committee. To be considered for an extension to the licensing term, the physician must present reasons and request referral to the Registration Committee.
8. Scope of practice
   The College and the relevant health authority will determine the scope of practice and practice location(s) for each Defined licence physician. ​Physicians on a Defined licence must not change their scope of practice or location of practice without prior approval of the College.
9. Time required in practice
   All Defined licence physicians must practise in Nova Scotia at least 0.5 Full-Time Equivalent (FTE)* for a minimum of six months.​In exceptional circumstances, physicians who qualify for a Defined licence who wish to provide temporary coverage in Nova Scotia must have a job offer for no less than 3 months in one location. The physician will not be considered for a Restricted licence until completion of a minimum of six months of supervised practice acceptable to the Registrar. The total of six months of supervised practice must be completed within 12 months of the initial licensure date.​* where 1.0 FTE is 1800 hours annually and 0.5 FTE for 6 months is a minimum of 450 hours.
10. Practice location
    As per the Medical Act Regulations, the Sponsor determines the geographic location for the Defined licensee’s medical practice. Physicians on a Defined licence are not permitted to provide temporary coverage outside of their health zone.
11. Additional conditions or requirements
    The Registrar or Registration Committee shall impose such other conditions, restrictions or requirements as determined necessary to support safe, competent, and effective practice. Any such conditions, restrictions or requirements will be set out in the Licensing Agreement.

Resources

1. Defined Licence for Clinical Fellowship: Requirements and Conditions for Licensure
2. World Directory of Medical Schools
3. Currency of Practice Experience
4. English Language Proficiency
5. Pathway to Full Licensure via an Approved Jurisdiction: Eligibility Requirements for Physicians
6. American Board of Medical Specialties
7. Pathway to Conditional Licensure for Internationally Trained Physicians via a Practice Ready Assessment: Office-Based Primary Care
8. Pathway to Conditional Licensure for Internationally Trained Physicians via a Practice Ready Assessment: Specialists
9. Australian Health Practitioner Regulation Agency
10. General Medical Council
11. Medical Council of New Zealand
12. Participation in the Welcome Collaborative Orientation Program
13. Pathway to Long-Term Licensure via a Defined Licence
14. Approval of Assessors and Supervisors for Practice Ready Assessments, and College-Directed Supervision and Assessments