Postgraduate practising licence (external moonlighting)

Preamble

The College of Physicians and Surgeons of Nova Scotia (the College) understands that postgraduate trainees may wish to provide time-limited clinical services that fall within their demonstrated scope of practice, for remuneration outside of their training program.

Purpose

This policy describes the criteria that must be met when a postgraduate trainee applies to provide staff coverage or “moonlight” at a facility or health care centre external to their primary site of training.

Scope

Postgraduate training Program Directors and trainees have a shared responsibility to ensure that moonlighting must not:

1. interfere with the ability of the trainee to achieve the goals and objectives of their postgraduate training program;
2. interfere with the trainee’s fitness to train; or
3. compromise patient safety.

This policy applies to postgraduate trainees satisfactorily and actively participating in a Canadian postgraduate training program approved by the Registrar.

Policy

Postgraduate trainees must only practise to the extent that is justified by their competence and experience.

1. Most responsible physician
   Trainees with a Postgraduate Practising licence are the most responsible physician and ultimately responsible for the patient's care.​Trainees must have clear and immediate access to supervision including the availability of direct (on-site) supervision when necessary.
2. Practise requirements
   1. Postgraduate trainees must only practise within the scope of training received by the trainee upon the date of application. The postgraduate trainee’s duties while moonlighting are limited to clearly defined responsibilities as outlined by the Site Lead (Appendix A).
   2. The scope of practice for external moonlighting activities cannot require ongoing care of patients after the moonlighting coverage period has ended.
   3. Trainees must have access to a supervisor. The supervising physician must be available within 15-20 minutes from the hospital or site. See Appendix B.
3. Eligibility
   Applicants must submit an application approved by the Registrar satisfying all of the following criteria to be deemed eligible for a Postgraduate Practising licence:
   1. Be in good standing in their postgraduate training.​Postgraduate trainees on a leave of absence or suspension from their training program are not eligible to engage in moonlighting during the leave/suspension period. At the discretion of the Registrar, exceptions may be granted for trainees on a pregnancy, parental, or adoption leave.​Postgraduate trainees in a remedial training program or those who appear to be in academic difficulty are not eligible for a Postgraduate Practising licence.
   2. Be a Licentiate of the Medical Council of Canada (LMCC) or hold an acceptable alternative to the LMCC.³
   3. Be deemed competent by their Program Director. The College must have written confirmation and approval from the Program Director confirming the postgraduate trainee has demonstrated the required competence to practice independently as outlined in Appendix A. The approval must be site-specific for each location in which the applicant wishes to provide staff coverage. This confirmation must be sent directly to the College of Physicians and Surgeons of Nova Scotia (the “College”). Approval may be revoked at any time if there is any indication that the trainee is in academic difficulty or may compromise patient safety.
   4. Provide a satisfactory certificate of professional conduct from the jurisdiction of their home training program if they are not a postgraduate trainee at Dalhousie University.
   5. Have a College approved Supervisor. The trainee is expected to put forward a Supervisor.
   6. Responsibility to obtain privileges with Nova Scotia Health (NSH) or the Izaak Walton Killam (IWK) Health Centre rests with the postgraduate trainee.
   7. Provide evidence of appropriate liability protection⁴.

At the discretion of the Site Lead of the Health Care Centre/Facility seeking staff-physician coverage, postgraduate trainees may be required to provide confirmation of the following if required by the health authority:

• Advanced Cardiac Life Support (ACLS) – Adult Medicine
• Pediatric Advanced Life Support (PALS) – Pediatric Medicine
• Neonatal Resuscitation Program (NRP) – Neonatal Medicine
• Advanced Trauma Life Support (ATLS) – Trauma Medicine

Resources

• Appendix A – Roles and Responsibilities Questionnaire
• Appendix B – Terms and Guidelines of Supervision: External Moonlighting
• Acceptable Alternatives to the LMCC
• Liability Protection Requirements