Licensing Competent Physicians

Close up of a physician in scrubs wearing a stethoscope

Responding to Challenging Times

These are challenging times for Nova Scotians seeking access to care in the face of physician shortages. The College is continuously monitoring national and international policy responses that address access to care and assist our province in recruiting competent physicians. Nova Scotians depend on the College to ensure that only qualified, competent, and ethical physicians are licensed to practise medicine.

The College’s Registration Policy Committee, composed of physicians and public representatives, sets licensing policy. The committee is keenly aware of the need to provide flexible pathways to licensure while ensuring competent practice. The College thanks the committee for undertaking this important work which regularly expands access to safe care for patients.

Whether applicants for licensure received training in Nova Scotia, another province, or another country, our registration team reviews their education, training, and experience. Our duty is to ensure there are no concerns about their conduct, character, health, or performance that would prevent them from safely caring for patients.

Physicians Trained Outside of Canada

With the change in approach, the pool of potential candidates for licensure has increased exponentially.

The College has instituted important changes to licensing physicians on a Defined licence, particularly in Royal College specialties.

The Royal College has long recognized training from jurisdictions within seven countries as acceptable. Physicians from those jurisdictions were (and are) immediately granted exam eligibility. Internationally trained physicians from outside those jurisdictions were not. The Royal College is now in the process of dismantling this approach, amid concerns it was arbitrary and discriminatory.

The Royal College will now grant exam eligibility to physicians with training from anywhere in the world who can demonstrate adequate discipline-specific postgraduate training. The Royal College review of a physician’s international training, done to assess for exam eligibility, remains a cumbersome and rate-limiting step. Regardless, with the change in approach, the pool of potential candidates for licensure has increased exponentially.

Pathway to Long-Term Licensure

Nova Scotia has built a streamlined approach for physicians eligible for a Defined licence. Family physicians qualify for this pathway by successfully completing a Practice Ready Assessment. Other specialists qualify by confirming eligibility to challenge the Royal College certification examination. Once on a Defined licence, the physician undergoes concentrated supervision for a period of six months. 

After six months, physicians who have performed well are issued a Restricted licence, restricted to the place they have been practising and the scope of practice for which they have been assessed.

Restricted licences may be renewed annually, and physicians holding a Restricted licence are not subject to ongoing supervision. These physicians will not be required to obtain Royal College certification but will be free to do so and, if successful, will be eligible for a Full licence. This approach represents the shortest pathway to long-term licensure in Canada.

Streamlined Approach

Our new approach to the licensure and welcome of internationally-trained physicians has been met with enthusiastic support from important stakeholders like Doctors Nova Scotia, Immigrant Services Association of Nova Scotia (ISANS), and provincial health authorities.

Physicians on the old licensing pathway were invited to transition to the new pathway. So far, this has resulted in 17 moving to the new pathway. Of those, ten have been issued a long-term licence in the form of a Restricted or Full licence. 

The first cohort of six physicians that began on the new pathway at the start of licensure have completed six months of supervision. All but one has been issued a Restricted licence as a result.

Recognizing American Certification

The College now issues a Full licence to American Board-certified physicians, provided they meet the eligibility criteria. The requirement for Royal College certification is waived for these physicians. We are the first province to do so.

When this policy came into effect, the College reviewed currently licensed physicians known to hold American Board certification. So far, this has resulted in issuing a Full licence to 18 physicians who previously held a Defined licence or Academic licence.

The College now issues a Full licence to American Board-certified physicians if they otherwise meet the eligibility criteria.

Licensing Subspecialist Examination Affiliate Program (SEAP) Designates

The College’s new Subspecialist Examination Affiliate Program (SEAP) Designates: Requirements for Full Licensure policy waives the legislated requirement for Royal College certification for these physicians. SEAP designates will be eligible for a Full licence, assuming standard criteria are met.

The College is confident these physicians have demonstrated sufficient knowledge to support Full licensure within the sub-specialty. It is expected that this policy change will give Nova Scotia an advantage when seeking to recruit international subspecialists.

Atlantic Registry

As of May 1, the Atlantic Registry is available to all physicians in an Atlantic province licensed to practise without conditions, restrictions, undertakings, or supervision.

Physicians who wish to opt into the Atlantic Registry will do so by advising their home College and providing their consent. The annual cost is $500 and replaces all fees associated with temporary or locum licences. Physicians on the Atlantic Registry can practise throughout the region as of right. 

The creation of the Atlantic Registry is the result of a collaboration over several months between all four Atlantic provinces.

Provincial Collaboration

The creation of the Atlantic Registry is the result of a collaboration over several months between all four Atlantic provinces. 

It is built upon substantial agreement by all Colleges on the criteria for licensure and advances the spirit and intent of the Canadian Free Trade Agreement.