Supervision Levels for College-Directed Supervision

Preamble

The College, through the Medical Act¹ (2011) and Medical Practitioners Regulations², or its Committees and policies, may require that a physician’s practice be supervised. The College’s general expectations and processes for physicians engaged in College-directed supervision are administered under the Guidelines for College-Directed Supervision.³

The intensity or level of supervision required is administered according to the College’s five-level supervision framework: College-Directed Supervision Framework – Responsibilities and Outline by Level.⁴ The framework outlines the indications for the various levels, as well as the supervision activities and reporting responsibilities of the Supervisor.

Purpose

This policy outlines the reasons and circumstances that supervision may be required and provides indications as to when supervision levels may change.

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:

1. Physicians issued a Defined licence to practise medicine prior to September 1, 2022, and on their original licensing pathway*:
   1. will be subject to a minimum of 24 months of Standard level supervision unless referred to a College Committee or the Registrar for further review and consideration.
   2. Low level supervision may be permitted in the following circumstances:
      1. 24 months of Standard level supervision has been completed and deemed satisfactory to the Registrar, including all required supervision reports and activities;
         AND
      2. The Defined licensed physician’s Sponsor and the College agree that no outstanding concerns exist preventing Low level supervision.
   3. Sponsor-only oversight may be appropriate for physicians whose Defined licence was first issued prior to January 1, 2015, and in accordance with the College’s Sponsor-only Oversight for a Defined Licence Physician⁵.
      
      *Former relevant policy Defined Licence: Requirements and Conditions for Independent Practice and current policy called Defined Licence: Requirements and Conditions for Supervised Practice as the Most Responsible Physician.⁶
2. Physicians issued a Defined licence to practise medicine following the Pathway to Long-Term Licensure via a Defined Licence⁷:
   1. will be subject to a minimum of 6 months and a maximum of 24 months of concentrated Standard level supervision, unless referred to a College Committee or the Registrar for further review and consideration.
3. Notwithstanding the above, supervision may be imposed at any level, including Intermediate 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 Investigations Committee;
   2. As imposed by or agreed to in the resolution of an Investigation or hearing matter;
   3. As ordered by the Registrar, Registration Committee, or the Registration Appeal Committee in response to a concern regarding a physician’s capacity, competence, or character.
      
      Under article 2(d), the Registrar may change the supervision level. Under Section 14(3) of the Medical Practitioners Regulations, if the Registrar imposes conditions or restrictions on the licence, the Registrar must notify the physician with a written decision with reasons and inform the physician of the appeal process. The decision may be appealed to the Registration Committee. It is also open to the Sponsor to withdraw sponsorship if the physician is not willing to participate in the recommended level of supervision, where the Sponsor has complied with the provisions of subsection 44(3) of the Regulations.
4. When the decision of supervision level is made by the Registration Committee, the physician may appeal the decision to the Registration Appeal Committee. A decision of the Registration Appeal Committee is not subject to further review under the Medical Act.

Resources

1. Medical Act 2011
2. Medical Practitioners Regulations
3. Guidelines for College-Directed Supervision
4. College-Directed Supervision Framework – Responsibilities and Outline by Level
5. Sponsor-only Oversight of a Defined Licence Physician
6. Defined Licence: Requirements and Conditions for Supervised Practice as the Most Responsible Physician
7. Pathway to Long-Term Licensure via a Defined Licence