Changing Scope of Practice


Policy Number:5-15
Policy Category: Registration
Under Review: No
Approved by Council: November 2000
To be Reviewed by: December 2016
Publication Date: Dialogue, Issue 4, 2015
Reviewed and Updated: April 2008, December 2015
College Contact: Physician Advisory Service

Downloadable Version(s): Changing Scope of Practice


Principles

  1. The public is entitled to be treated by physicians who are competent to practise.
  2. The College recognizes that, over time, physicians may change the focus of their practice.
  3. Physicians are responsible for being appropriately trained to practise competently.
  4. The College is charged with the responsibility of ensuring that physicians practise competently to meet the standard of practice for their chosen area of practice.

Purpose

In accordance with by-law, when asked by the College, whether in the annual renewal form or elsewhere, physicians must report to the College when they have changed their scope of practice or intend to change their scope of practice. The College will oversee the process for changing scope of practice if the College determines that the change in scope of practice is significant and the physician does not have the training and/or experience to practise competently in the new area of practice. This policy outlines the College’s requirements of physicians in demonstrating their competence in the new area of practice.

Definitions/Examples

  1. Every physician’s scope of practice is unique.
  2. A physician’s scope of practice is determined by the patients the physician cares for, the procedures performed, the treatments provided, and the practice environment.
  3. A physician’s ability to perform competently in his or her scope of practice is determined by the physician’s knowledge, skills and judgment, which are developed through training and experience.
  4. A change in scope of practice occurs when there have been significant changes to any of the elements set out in part 2 of the definition. If a physician has changed practice such that he or she is practising outside of what would be considered the usual scope of practice for the discipline, then his or her scope of practice may have changed significantly.

Performance of innovative techniques or procedures within the context of a specialty or family medicine, while new, may not constitute a change in scope of practice. For example, a family physician who, within his or her general area of training, decides to narrow the focus of his or her practice to women’s health issues; or, a general surgeon who learns to perform laparoscopic cholecystectomies would not be considered to have changed their scope of practice.

Examples of changes in scope of practice include:

  • a family physician who wishes to perform cosmetic surgical procedures; or
  • a specialist, such as a surgeon, who wishes to practise primary care medicine.

A change in scope of practice may also occur when a physician moves to Ontario from a place where the health-care system is significantly different from the health-care system in Ontario.

College Policy

All physicians who have undergone a significant change in scope of practice or who will be changing their scope of practice significantly and who do not have the training and/or experience to practise competently in the new area of practice, will have to participate in a process to ensure that they have the necessary competence to do so. This process will be individualized for each physician but, in general, the core activities involved are training; supervision; and assessment.

For greater detail on the College’s expectations in ensuring that physicians are appropriately trained and experienced in their area of practice, physicians should consult the section entitled Expectations for Practising Competently in a New Practice Area.

Professional Misconduct

It is a term, condition and limitation of a certificate of registration that the holder practise only in the areas of medicine in which he or she is educated and experienced. Under the regulations to the Medicine Act, it is professional misconduct for a physician to contravene a term, condition or limitation on his or her certificate of registration. 

Expectations for Practising in a New Practice Area

These expectations apply to physicians when the College determines that:

  • a physician has changed or wishes to change his or her scope of practice;
  • the change in scope of practice is significant; and
  • a physician does not have the training and/or experience to practise competently in the new area of practice.

Training

A physician will usually be required to participate in training for the new area of practice. If the physician has undergone training, he or she must provide the College with evidence of the training in the new area.

If the physician has not undergone any training or the training completed is not acceptable to the College, the physician must provide the College with an Individualized Education Plan (IEP), to be approved by the College.

For areas of clinical practice where there are no recognized Canadian specialty training programs, and for which there is an increasing demand from physicians who wish to change their scope of practice, the College may establish Expert Working Groups to develop frameworks for minimum training or processes to be used by College staff to guide decisions about training, supervision and assessment for physicians interested in changing their scope. These documents can be accessed at www.cpso.on.ca.

Clinical Supervision

A physician will usually be required to undergo supervised practice for a period of time and must find one or more physicians who will act as his or her clinical supervisor. The clinical supervisor must be acceptable to the College and the supervision must take place in accordance with the Guidelines for College-Directed Supervision. The level and duration of supervision will be at the discretion of the College with input from the clinical supervisor, and will be dependent on the content and duration of the training completed.

The clinical supervisor will send written reports to the College throughout this process, and submit a final report when the clinical supervisor is of the opinion that the physician is ready to practise independently in the new area of practice. The College will review the supervisor’s report and determine whether the physician needs ongoing supervision, requires an assessment of his or her new area of practice, or is ready to enter independent practice.

Assessment

A physician may be required to undergo a College-directed assessment of his or her practice. Upon its completion the College will review and determine whether the physician can perform competently in the new area of practice.

Costs

The physician must pay for the costs related to training, supervision and the College-directed assessment.