Supervision Levels for College-Directed Supervision - Registration Policies College of Physicians & Surgeons of Nova Scotia

Preamble

The objects of the College of Physicians and Surgeons of Nova Scotia (the College) are:

To serve and protect the public interest in the practice of medicine, and
To preserve the integrity of medical professions and maintain confidence of the public and the professions in the ability of the College to regulate the practice of medicine.

In accordance with the Medical Act and its regulations¹, some licence types require the holder to practise under supervision. Additionally, the College may require that a physician’s practice be supervised if there are concerns related to their capacity, competence, or character for safe and ethical practice.

Further information on College-directed supervision is provided in the Guidelines for College-directed Supervision² and Responsibilities of Supervisors and Physicians Under Supervision³.

Purpose

This policy outlines the different levels of College-directed supervision, the reasons and circumstances that supervision may be required, and the circumstances under which supervision levels may change.

There are three levels of supervision defined in this policy: Standard, Customized, and High level supervision.

Scope

This policy applies to all physicians who are subject to College-directed supervision.

Policy

In accordance with the Medical Act and Medical Practitioners Regulations, physicians may be required to undergo College-directed supervision under the following set of circumstances:

Physicians issued a Defined licence and following the Pathway to Long-Term Licensure via a Defined Licence⁴ will be subject to a minimum of 6 months, and a maximum of 24 months, of Standard level supervision, unless referred to the Registrar or Registration Committee for further review and consideration.
Notwithstanding the above, supervision may be imposed at any level, including Customized and High level, for a physician on either a Defined licence or Restricted licence in any of the following circumstances:
1. As an interim sanction/condition imposed by an Investigation Committee; or
2. As imposed by or agreed to in the resolution of an Investigation or Hearing; or
3. As directed by the Registrar, Registration Committee, or the Registration Appeal Committee in response to a concern regarding a physician’s capacity, competence, or character⁵.

A Customized supervision plan may be developed in cases where the physician is seeking a significant change in their scope of practice or when context-specific competencies need to be assessed. Physicians subject to Customized supervision practise as the most responsible physician while under supervision.

High level supervision is imposed when significant patient safety concerns have been identified that would affect the physician’s ability to safely and ethically practise medicine or when a physician does not meet the currency of practice experience requirements.⁶ Physicians subject to High level supervision are never the most responsible physician.

Appealing the Registrar’s Decision Regarding Supervision

In accordance with section 14 of the Medical Act Regulations, the Registrar has the authority to impose conditions and/or restrictions on a physician’s licence. This includes the authority to change the level of supervision if deemed necessary for safe and ethical practice.

If the physician does not accept the Registrar’s decision to impose conditions and/or restrictions, the decision may be appealed to the Registration Committee.

When the decision regarding the supervision level is made by the Registration Committee, the physician may appeal the decision to the Registration Appeal Committee. All decisions of the Registration Appeal Committee are final.

Resources

Applicable Legislation:	Section 14(3), 45 of the Medical Act Regulations
Approved by:	Registration Policy Committee & Council
Approval Date(s):	November 28, 2024 & December 13, 2024
Review Date:	November 2027