Re-entering Practice


Policy Number:6-15
Policy Category: Registration
Under Review: No
Approved by Council: June 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): Re-entering Practice


Principles

  1. The College recognizes that a physician may stop practising for a variety of reasons.
  2. The College also recognizes that the public expects that they will be treated by a physician who is competent to practise.
  3. When a physician decides to re-enter practice, the College must ensure that a physician meets the standard of practice.

Purpose and Scope

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 re-enter practice.

The purpose of this policy is to clarify the College’s requirements for physicians who wish to re-enter practice after a prolonged absence from practice.

The policy applies to physicians who have been out of practice for a period of at least three years or who have practised less than a total of six months in the preceding five-year period and who intend to enter the same type of practice in which they were previously involved.

The policy applies to physicians even if they have continuously maintained their certificate of registration during their absence from practice. Physicians who plan to enter into a new scope of practice must also comply with the College’s Changing Scope of Practice policy.

College Policy

The process for re-entry will be individualized for each physician but, in general, the steps involved are needs assessment; supervised practice; and a final assessment.

For greater detail on the requirements for re-entering practice, physicians should consult the section Requirements for Re-entering Practice (see next page).

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.

Requirements for Re-Entering Practice

Step 1 – Needs Assessment

The first step in the re-entry process is to consider whether supervision and training is necessary. This will be determined, in large part, by whether the physician is returning to a practice which will involve patient care. For physicians re-entering a practice that is administrative or research focused, no supervision or training may be required.

If the College determines that a physician requires training, he or she will be required to go through the following additional steps: Supervised Practice and a Final Assessment.

Step 2 – High Level Supervision

The physician must arrange to work in another physician’s practice, who is practising in the same discipline as the physician who wishes to re-enter practice. This physician will act as clinical supervisor. The College must approve the physician’s choice of clinical supervisor and supervision must take place in accordance with the Guidelines for College-Directed Supervision.

Through direct observation and case review, the clinical supervisor will determine the physician’s learning needs. The supervised physician will continue to practise under a high level of supervision until the clinical supervisor is satisfied that all learning needs have been met.

The clinical supervisor will determine when the physician has the required knowledge and skills to practise in a less supervised environment and shall notify the College. The College must give approval for the physician to move on to Step 3.

Duration of high level supervision
The length of this evaluation period will vary depending on the circumstances of each individual physician. Factors affecting the duration of High Level Supervision include the length of time away from practice, the amount of continuing professional development that the physician has maintained while out of practice, the relative risk of the type of practice, and the degree to which the discipline has advanced during the physician’s absence. It may be brief, if the clinical supervisor is of the opinion that the physician is capable of practising independently or it may be longer if the physician’s learning needs are great.

Step 3 – Moderate And Low Level Supervision

The physician works in his or her own practice and makes decisions independently. The clinical supervisor will periodically visit with the physician to review charts and cases, and discuss patient management with the physician to ensure appropriate care is provided. The frequency of visits will initially be weekly, but will become less frequent at the discretion of the College and the clinical supervisor. Once the clinical supervisor is satisfied that the physician is practising to current standards, the clinical supervisor will notify the College. The College must give approval for the physician to move on to Step 4.

Duration of moderate and low level supervision
The length of the period of supervised practice will vary, but generally it will be longer than Step 2.

Step 4 – Final Assessment

The physician must undergo a College-directed assessment of his or her practice. The College will review the final assessment report and will make a determination as to whether the physician can return to independent, unsupervised practice.

Costs

The physician must pay for the costs related to supervision and training associated with re-entering practice. The costs of the final assessment are to be borne by the College, unless the physician is re-entering practice following a College investigation; discipline or fitness to practise hearing which led to the absence; or as part of an application to receive a certificate of registration in Ontario.

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