Frequently Asked Questions about Change of Scope and Re-entry
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Can my COSRE application be expedited?
No, the COSRE Program does not expedite any application as complete applications with no outstanding requirements are reviewed on a weekly basis. Once all documentation including any additional requirements specific to your case have been received, your application will be tentatively scheduled for review at a COSRE meeting. A requirement will appear under your schedule of requirements, titled “Scheduled for Review”, and clicking into this requirement will enable you to view the date of review, and when you may expect a decision.
For information regarding process and timelines, please refer to this link.
How do I find an application? How do I apply?- Log into the Portal, click on the “Registration” tile, and complete a self-screening questionnaire.
- Depending on your intended scope of practice and the type of certificate of registration you hold, you may begin an application or may be asked to contact CPSO to discuss your eligibility.
- Click on the application provided, go to the Schedule of Requirements, and select the application form.
- Copy and paste the URL link provided to complete the pdf form, then upload to the requirement, and click Submit.
- Check back often to review your application’s Schedule of Requirements as requirements may be added/updated. Please click into the individual requirements to review specific details/instructions
What is the Schedule of Requirements?
The schedule of requirements section of your application is a list of documents needed for review by the COSRE Program. Click into each requirement to view the associated notes and to upload the required document or send a portal message. Frequently checking the notes associated to all outstanding requirements is an important part of ensuring your application can be processed in a timely manor.
When can I begin training/supervision for my COSRE Program?
Prior to scheduling any shifts in an area or scope of practice that you have not yet been approved, you must apply for a change of scope of practice, comply with the requirements in force at the time, and await for approval from the College indicating you may begin practising in a new scope of practice.
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What does supervised practice mean?
Where the College determines that supervision is required, physicians must find one or more physicians who will act as their Clinical Supervisor. The Clinical Supervisor must be approved by the College and the supervision must take place in accordance with the Guidelines for College-Directed Supervision.
As competency is gained and demonstrated, the level of supervision will decrease and the physician will be afforded a greater level of autonomy. There are three levels of supervision. Physicians often start out under high level supervision, and then will move on to moderate, followed by low level supervision. The level and duration of supervision will be at the discretion of the College with input from the Clinical Supervisor.
High Level Supervision
During high level supervision the Clinical Supervisor is the Most Responsible Physician (MRP) for all patients. The physician will continue to practise under a high level of supervision until the Clinical Supervisor is satisfied that the physician can work as the MRP under a moderate level of supervision.
Moderate Level Supervision
Under moderate level supervision the physician makes decisions independently and is considered the MRP. The Clinical Supervisor will periodically meet with the physician to review charts and cases and discuss patient management to ensure appropriate care is provided. The frequency of meetings with the Clinical Supervisor is initially weekly but will transition to biweekly. The Clinical Supervisor will be immediately available to the physician, in person or by phone, should there be questions or concerns.
Low Level Supervision
Under low level supervision the physician makes decisions independently and is considered the MRP. The Clinical Supervisor will meet with the physician to review charts and cases and discuss patient management to ensure appropriate care is provided. The frequency of meetings with the Clinical Supervisor monthly. The Clinical Supervisor will be available to the physician, in person, by phone, or by email, but not necessarily in real time. Low level supervision remains in place until such time as the College approves the physician to practise independently.
How do I transition to lower levels of supervised practice?
The Clinical Supervisor will notify the College when they are of the view that the physician has the required knowledge and skill to practise in a less supervised environment (transition to moderate and low level supervision). The College will review the recommendation from the Clinical Supervisor and determine whether the physician may move on to a lower level of supervision. Transition to lower levels of supervision are not permitted without written direction from the College.
An acceptable supervisor is a physician who:- currently practices in the clinical area in which you intend to practice
- has 5 current/consecutive years of independent practice in the scope of practice to be supervised
- is in good standing with the CPSO
- meets the requirements set out in the Guidelines for College-Directed Supervision
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Why has an assessment of my practice been directed?
An assessment may be directed following a period of supervised practice to ensure the physician is competent to practice independently in the scope for which they have been supervised.
Who will assess my practice and how is an assessor chosen?
Assessors are physicians supportive of and interested in quality assurance. They perform an independent contract for service to conduct assessments of physicians. Every effort is made to ensure the closest possible match between the physician’s and assessor’s specialty and scopes of practice. Assessors provide feedback that validates appropriate care is being provided and supports opportunities for practice improvement.
What are the components of a practice assessment?
Assessors gain insight into a practice through the following:- review of patient records (this may be done in advance through EMR)
- observation of patient encounters and/or procedures
- interview of 2 referring colleagues
What happens on the day of the assessment?
Assessments typically take a full day to complete and the assessor will observe the physician providing care to patients and performing procedures, if applicable.
What happens after the assessment?
The assessor conducting your practice assessment prepares a written report on the assessment and submits it to the CPSO within three weeks of the assessment. The assessed physician receives a copy of the assessment report.
When will I be notified of the outcome of the assessment?
Physicians who undergo a practice assessment will be notified of the outcome in writing within 3 weeks of the College’s receipt of the assessment. For applicants who hold a restricted certificate of registration, or if significant concerns are noted in the practice assessment, review by the Registration Committee may be required.
Is there a cost associated with a COSRE assessment?
Physicians who wish to change their scope of practice or re-enter clinical practice must pay for all costs associated with their assessment.
What is the average cost of a COSRE assessment?
Every effort is made to minimize the assessor’s travel time and reduce expenses incurred. All assessments are unique; however, the average assessment cost is typically in the $5,000 range.
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Will my approved scope of practice appear on the public register?
Only specialty designations through the Royal College of Physicians and Surgeons of Ontario or the College of Family Physicians of Canada appear on the public register. Approved clinical scopes of practice will be noted internally, and you will be provided with a decision letter from the College, noting that you may practise independently in your new scope of practice.
GP Focused Practice Designation
The GP Focused Practice Designation is a program that’s jointly run by the Ontario Medical Association (OMA) and the Ministry of Health and Long Term Care. It exists solely to allow GPs who are working in a designated area the ability to access extra funding when they are working in an area of practice that typically is performed by specialists. It also allows other GPs to refer to the focused physician without penalty (in the case of Family Health Teams, etc.). The OMA administers this program.
This designation would be useful for physicians who change their scope of practice to a clinical area that would have them manage patients referred by other GPs, including skin disorders, sleep medicine, and sport and exercise medicine, etc.
