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Defined Licence: Requirements and Conditions for Independent Practice

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Preamble

A Defined licence is a time-limited, conditional licence that is issued to:

  • Physicians who do not have the qualifications for a Full1 or Restricted2 licence but who wish to practise medicine independently while pursuing the necessary qualifications for one of those licence types; or to
  • Physicians entering a College-approved Clinical Fellowship Program14.

Purpose

This policy describes the minimum requirements to obtain a Defined licence for independent practice, together with the practice conditions that may be imposed on Defined licensees.

Scope

This policy focuses specifically on the Defined licence for physicians who practice independently while pursuing a Full1 or Restricted2 licence. 

For information on Defined licence for Clinical Fellowships, see the College policy on Defined Licence: Requirements and Conditions for Clinical Fellowship14.

Overview of the Pathway from Defined Licence to a Full or Restricted Licence

The Defined licence is given to physicians who have a medical degree3, discipline-specific postgraduate training and be a Licentiate of the Medical Council of Canada (LMCC)4 or acceptable alternative5, but who do not have Canadian certification. 

The licence is issued for a maximum of 60 months. Defined licensees must achieve either Full1 licensure or Restricted2 licensure before their licence term expires. All Defined licensees must practise under the sponsorship and supervision of another physician.

If all other licensing requirements are met, the physician is eligible for a Full1 licence once they have obtained Canadian certification*.

* The requirement for Royal College certification is waived for candidates in the Royal College Practice Eligibility Route (PER) who have achieved a pass standing in the certification examinations.

In some cases, a physician on a Defined licence who does not obtain certification in the required timeframe may be considered for a Comprehensive Clinical Assessment of Practice (CCAP) 9. Upon successful completion of a CCAP and having met all other licensing requirements, the physician on a Defined licence would then be eligible for a Restricted2 licence.

Policy

Eligibility Criteria

All applicants for a Defined licence for independent practice must meet the eligibility criteria set out in Sections 39-45 of the Medical Practitioners Regulations10.

Required Qualifications

Further to Section 39(1)(a) and (b) of the Medical Practitioners Regulations10, applicants for a Defined licence for independent practice must have and provide proof of the qualifications listed in the table below:

QualificationsDescription
Medical DegreeApplicants must have a medical degree from a school listed in the World Directory of Medical Schools3
LMCC or acceptable alternativeApplicants must be a Licentiate of the Medical Council of Canada (LMCC) 4 or have one of the College’s acceptable alternatives to the LMCC5.
Certification Exam EligibilityApplicants must have eligibility to challenge the Canadian certification examinations via one of the following routes:
Specialties (other than Family Medicine)
– Royal College of Physicians and Surgeons of Canada6 jurisdictional route to certification
– Royal College of Physicians and Surgeons of Canada6 Practice Eligibility Route (PER) to certification
– A successful Practice Ready Assessment in a specialty (other than Family Medicine)15
– Collège des médecins du Québec8
Subspecialties with a primary specialty in Internal Medicine
– SEAP Affiliate Status with the Royal College6 granted through successful completion of a Subspecialist Examination Affiliate Program (SEAP) together with a successful Practice Ready Assessment in Internal Medicine15
Family Medicine
– College of Family Physicians of Canada7
– A successful Practice Ready Assessment in Family Medicine16
– Collège des médecins du Québec8

Conditions on a Defined Licence

In addition to other criteria outlined in Section 39-45 of the Medical Practitioners Regulations10, the Registrar or Registration Committee may impose the following conditions:

1. Length of Licence Term

By force of legislation, a Defined licence must be a time-limited licence. The duration will be determined by the Registrar at the time of issuance and outlined in the physician’s Licensing Agreement.  

In most cases, a physician is permitted to hold a Defined licence for a maximum of sixty (60) months from the date of initial issuance.

Expiration of the Defined licence occurs on December 31st of the final year established under the Licensing Agreement. For example: a physician granted a Defined licence effective July 1, 2021, would have to meet the requirements for a Full1 or Restricted2 licence by December 31, 2025, so long as they maintain eligibility for the respective certifying examination(s).

2. Leave of Absence

Extensions of up to one year to the initial licensure term may be considered at the discretion of the Registrar for those physicians who take a maternity/paternity/parental leave, medical leave, educational leave of absence, or other exceptional circumstance. Longer extensions must be referred to the Registration Committee for consideration.

3.  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.

4. Scope of Practice

The Registrar may place restrictions on a physician’s practice location and scope of practice following review of their training, practice experience, assessment reports and/or certifications.

A physician must not change their scope of practice11 without prior approval of the College.

5. Sponsorship

At all times, a Defined licensee must have a Sponsor who is approved by the College. A Sponsor must hold a Full1 licence and unless otherwise approved by the Registrar, hold a senior position in the health authority in which the supervised licensee will be practising.

Withdrawal of Sponsorship will result in immediate loss of licensure.

6. Supervision

A Defined licensee must have a Supervisor who is approved by the College. The Supervisor must hold a Full1 licence, Academic12 licence or Defined licence on Sponsor-only Oversight13. The Supervisor must be engaged in a scope of practice similar to the supervised licensee. The initial level of supervision is determined at the time of initial licensure.

Lack of a Supervisor will result in loss of licensure.

7. Eligibility for Certification Examinations

Defined licensees must maintain their eligibility to challenge the certification examination with the Royal College of Physicians and Surgeons of Canada6, the College of Family Physicians of Canada7, or the Collège des médecins du Québec8 for the duration of their term. Provisional exam eligibility will not satisfy the Registrar. 

8. Certification

Defined licensees must achieve certification before their licence term expires. If all other licensing requirements are met, the physician is eligible for a Full1 licence once they have obtained Canadian certification.

This requirement is subject to the following exceptions:

  • The requirement for Royal College certification is waived for physicians in the Royal College Practice Eligibility Route (PER) who have achieved a pass standing in the certification examinations.  If all other licensing requirements are met, a physician in the PER is eligible for a Full1 licence if they have a pass standing in the certification examinations.
  • A physician on a Defined licence who does not obtain certification in the required timeframe may be considered for a Comprehensive Clinical Assessment of Practice (CCAP) 9. Upon successful completion of a CCAP and having met all other licensing requirements, the physician on a Defined licence is eligible for a Restricted2 licence.

9. Additional Conditions or Requirements

Defined licensees must adhere to any additional conditions or restrictions imposed by the Registrar. The following are examples of conditions and restrictions that may appear in a physician’s Licensing Agreement:

  • I must practice in a practice context with access to experienced physicians, either onsite or virtually; and
  • must work under a remuneration model, care model and practice size that supports time to study for certification examinations.

Resources

  1. Full Licence – College of Physicians and Surgeons of Nova Scotia
  2. Restricted Licence – College of Physicians and Surgeons of Nova Scotia
  3. World Directory of Medical Schools
  4. Licentiate of the Medical Council of Canada
  5. Acceptable Alternatives to the LMCC
  6. Royal College of Physicians and Surgeons of Canada
  7. College of Family Physicians of Canada
  8. Collège des médecins du Québec
  9. Comprehensive Clinical Assessment of Practice
  10. Medical Practitioners Regulations
  11. Guidance to Physicians Contemplating a Change in Clinical Scope of Practice
  12. Academic Licence – College of Physicians and Surgeons of Nova Scotia
  13. Sponsor-Only Oversight of a Defined Licence Physician
  14. Defined Licence: Requirements and Conditions for Clinical Fellowship
  15. Pathway to Licensure for International Medical Graduates via a Practice Ready Assessment: Specialists and SEAP Status Affiliates (with a primary specialty of Internal Medicine)
  16. Pathway to Licensure for International Medical Graduates via a Practice Ready Assessment – Family Medicine

Applicable Legislation: Secions 5, 39 – 45 of the Medical Practitioner Regulations

Approved by: Registration Policy Committee, Executive Committee

Approval Dates: February 10, 2022 & February 22, 2022

Review Date: February 2023