Pathway to Long-Term Licensure via a Defined Licence

Preamble

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

A Full licence is a long-term licence without conditions and/or restrictions imposed by the College. A Full licence is renewable annually.

A Restricted licence is a long-term licence with conditions and/or restrictions imposed by the College. Physicians holding a Restricted licence may have all or most of the qualifications required for Full licensure, as set out in section 59 and following of the Medical Practitioners Regulations¹. A Restricted licence is renewable annually.

Purpose

This policy describes the pathway for physicians from Defined licensure to long-term licensure, either Full or Restricted licensure.

Scope

This policy applies to all Defined licensees except those holding a Defined licence for Clinical Fellowship.

For information on Defined licence for Clinical Fellowships, see the College policy on Defined Licence:  Requirements and Conditions for Clinical Fellowship².

Policy

Eligibility Criteria

All applicants for a Defined licence must meet the eligibility criteria set out in Sections 39-45 of the Medical Practitioners Regulations. Refer to the College Policy for Defined Licence: Requirements and Conditions for Supervised Practice as the Most Responsible Physician³.

Supervision

Unless they otherwise achieve the necessary qualifications for Full licensure, physicians issued a Defined licence after September 1, 2022, will undergo a minimum of six months of supervised practice as the most responsible physician.

Following six months of supervised practice, the Registrar shall make a licensing decision after consideration of the supervisory reports and any other information the Registrar deems necessary. The dispositions available to the Registrar are to:

1. Issue a Restricted licensure, restricted to the location of supervised practice, a scope of practice consistent with competence demonstrated in supervised practice, and any other conditions and/or restrictions the Registrar deems necessary to support safe and effective practice; or
2. Continue Defined licensure, for a period not to exceed an additional 18 months, with or without alteration of the intensity of supervision. The Registrar may make this decision in circumstances where the Registrar:
   • is satisfied that safe, supervised practise is possible; and
   • is not satisfied that competencies have been identified in supervised practice to support the issuance of a Restricted licence but that there is, in the view of the Registrar, a reasonable likelihood that the candidate will demonstrate the competencies necessary for Restricted licensure; or
3. Referral to the Registration Committee if there are concerns related to capacity, competence or character which may impact the ability to practise medicine safely and ethically; or
4. No ongoing licensure, where, in the view of the Registrar, there is not a reasonable likelihood the candidate has or can demonstrate the competence, character or capacity for safe, independent practice.

Licensing decisions of the Registrar made at this time may be appealed to the Registration Committee.

Physicians issued a Defined licence prior to September 1, 2022, will continue with their existing pathway and terms of their Licensing Agreement. These physicians may request the Registrar’s consideration to change licensing pathways. This will be considered at the discretion of the Registrar.

Pathway To A Full Licence

All physicians holding a Defined licence who obtain certification or a pass-standing in the certification examinations with either the Royal College of Physicians and Surgeons of Canada⁴ or the College of Family Physicians of Canada⁵ and who are a Licentiate of the Medical Council of Canada⁶ or hold an acceptable alternative⁷, will be considered for a Full licence.

Physicians issued a Restricted licence in accordance with this policy may be eligible for a Full licence after completion of a Comprehensive Clinical Assessment of Practice (CCAP). For more information, please refer to the College policy for Comprehensive Clinical Assessment of Practice: Criteria and Outcomes⁸.

The Registrar will consider all information including, but not limited to, supervision and assessment reports, complaints history and decisions of the Registration Committee.

If this review is satisfactory and all other licensing requirements are met, the physician will be issued a Full licence.

Resources

1. Medical Practitioners Regulations
2. Defined Licence:  Requirements and Conditions for Clinical Fellowship
3. Defined Licence: Requirements and Conditions for Supervised Practice as the Most Responsible Physician
4. Royal College of Physicians and Surgeons of Canada
5. College of Family Physicians of Canada
6. Licentiate of the Medical Council of Canada
7. Acceptable Alternatives to the LMCC