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

Preamble

A Defined licence is a time-limited licence which may be issued to 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 may do 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 have all of the following credentials:

OR

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

2. Letter of Offer

Physicians who meet the above eligibility criteria 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.

Conditions on all Defined Licences

The terms and conditions of a Defined licence will be set out in a Licensing Agreement, 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 after September 1, 2022, will undergo a minimum of six months and a maximum of 24 months of supervised practice as the most responsible physician.

Physicians issued a Defined licence prior to September 1, 2022, will have a maximum of 60 months of supervised practice as the most responsible physician to qualify for a Full or Restricted licence.

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

Physicians issued a Defined licence after September 1, 2022, must participate in a mandatory Orientation Program⁵ approved by the College.

Physicians issued a Defined licence prior to September 1, 2022, are strongly encouraged to participate in the Orientation Program and are invited to participate in any part of that program.

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

Defined licensees must have a Sponsor at all times, who is 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.

Per 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.   Defined licensees must have a Supervisor approved by the College at all times. 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 issued a Defined licence after September 1, 2022, will be subject to concentrated supervision for a minimum of six months and maximum of 24 months.

Physicians issued a Defined licence prior to September 1, 2022, must continue the supervision plan put in place at the time of initial licensure or as modified over their time in licensure. Physicians issued a Defined licence prior to this date who wish to consider the concentrated supervision framework should contact the College directly.

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

6. Leave of Absence

A leave of absence up to one year may be granted 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. 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.

* minimum of 900 hours annually.

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.

For physicians issued a Defined licence prior to September 1, 2022:

If the physician does not hold Canadian certification at the time of initial licensure, they must maintain eligibility to challenge the Canadian certification examination with the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada during the time they hold a Defined licence.

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 Full licence if they have a pass standing in the certification examinations. Eligible physicians must provide the College with a letter of offer OR confirmation of privileges with Nova Scotia Health or the IWK Health Centre in Nova Scotia before their Full licence will be issued.
• 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). Upon successful completion of a CCAP and having met all other licensing requirements, the physician on a Defined licence is eligible for a Restricted licence.

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. College of Family Physicians of Canada
4. Royal College of Physicians and Surgeons of Canada
5. Participation in the Welcome Collaborative Orientation Program
6. Defined Licence for Clinical Fellowship: Requirements and Conditions for Licensure
7. Collège des médecins du Québec
8. Pathway to Licensure for International Medical Graduates via a Practice Ready Assessment – Family Medicine
9. Pathway to Long-Term Licensure via a Defined Licence
10. Sponsor-Only Oversight of a Defined Licence Physician
11. Guidance to Physicians Contemplating a Change in Clinical Scope of Practice
12. Comprehensive Clinical Assessment of Practice: Criteria and Outcomes for Physicians on a Defined Licence