Defined Licence: Requirements and Conditions for Supervised Practice as the Most Responsible Physician

Preamble

A Defined licence is a time-limited licence for physicians without the qualifications for a Full licence. A Defined licence is registered on the Conditional Register maintained by the College.

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

A physician practising on a Defined licence does so as the most responsible physician (MRP) but must be 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 a Defined licence.

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 Licensure⁶.

Policy

Eligibility Criteria

1. Credentials

Candidates must satisfy the following:

OR

In lieu of Canadian certification exam eligibility, the College will accept applicants who are registered and currently licensed in specific jurisdictions listed below. The College will continue to review this list.

2. Letter of Offer

Physicians who meet the eligibility criteria for Defined licensure must provide the College with a letter of offer from Nova Scotia Health or the IWK Health Centre before their Defined licence will be issued.

Physcian members of the Canadian Armed Forces who meet the above eligibility criteria must provide the College with a letter confirming their military appointment before their Defined licence will be issued.

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. Mandatory participation in the College’s “Welcome Collaborative” Physician Orientation Program

All physicians issued a Defined licence must participate in an Orientation Program⁵ approved by the College.

3. Pathway to Long-Term Licensure

While on a Defined licence, the physician must work toward the qualifications for a Full or Restricted licence during their licensing term. The College policy for Pathway to Long-Term Licensure via a Defined Licence⁶ outlines these requirements.

4. Sponsorship

At all times, Defined licensees must have a Sponsor approved by the College. A Sponsor must hold a Full licence and, unless otherwise approved by the Registrar, hold a senior position with the Health Authority in which the supervised licensee will be practising.

Pursuant to Section 41 of the Medical Practitioners 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 not subject to College review.

5. Supervision

All physicians holding a Defined licence must be subject to supervision. At all times, Defined licensees must have a Supervisor approved by the College. The Supervisor must hold a Full licence, Academic licence or Defined licence on Sponsor-only Oversight⁷. The Supervisor must be engaged in a scope of practice comparable to the supervised licensee.

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.

While deployed outside of Nova Scotia, supervision of physician members of the Canadian Armed Forces is at the discretion of the Canadian Armed Forces.

For all holders of a Defined licence, the supervised physician is responsible for the costs of supervision.

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 Registrar or the Registration Committee will determine the scope of practice and practice location for each Defined licence.

A physician on a Defined licence must not change their scope of practice or location of practice⁸ 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 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 Practitioners 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. Eligibility for Canadian Certification Examinations or Registration and Licensure in an Acceptable Jurisdiction

Defined licensees must have successfully obtained or have eligibility to challenge the certification examination with the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada, or the Collège des médecins du Québec at the time of initial licensure. Successful completion of a Practice Ready Assessment will satisfy this criterion. 

Alternatively, the applicant must be registered and hold a licence without restrictions or conditions on the General Practitioner or Specialist Register in the United Kingdom, the Specialist Register in Australia or the Vocational Scope Register in New Zealand.

12. Additional Conditions or Requirements

The Registrar or Registration Committee shall impose such other conditions, restrictions or requirements as they determine 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. Pathway to Licensure for International Medical Graduates via a Practice Ready Assessment: Specialists
4. Pathway to Licensure for International Medical Graduates via a Practice Ready Assessment – Family Medicine
5. Participation in the Welcome Collaborative Orientation Program
6. Pathway to Long-Term Licensure via a Defined Licence
7. Sponsor-Only Oversight of a Defined Licence Physician
8. Guidance to Physicians Contemplating a Change in Clinical Scope of Practice
9. Comprehensive Clinical Assessment of Practice: Criteria and Outcomes