AIPSO News Updates

The CPSO and its so called new Pathways to Registration for IMGs.

AIPSO and the IMD community living in Ontario note that the College of Physicians and Surgeons of Ontario has once again completely left out the huge pool of qualified doctors who have migrated to Ontario and have been living here.

Recently following pressure from various parties, the CPSO announced four new pathways to registration for foreign doctors to be licensed in Ontario. Two further pathways are under discussion and will surely be passed.

NONE of these so called new pathways addresses the core issues – that there is a severe lack of doctors in Ontario, and that huge groups of qualified IMGs (some new, others highly experienced) who have passed exams are available but not utilized.

The CPSO’s pathways only help IMGs who are already in some form of practice in the USA or Canada. It helps those who jump the system by coming on visa trainee or academic licenses. They can now stay on in Ontario, many of them in violation of any return of service agreements they may have in their home countries.

Legally migrated IMGs remain doing work far below their potential and therefore unable to help address the healthcare needs of the community.

AIPSO strongly urges the government and the CPSO to stop fudging the issues when it comes to QUALIFIED IMGs who have passed all the exams and yet cannot practice. It is hard not to draw the conclusion that our exclusion is intentional and willfully done. We really hope it is not.

Below is a suggested new pathway that could really help the core issue of how to certify immigrant IMGs who are qualified and have passed Canadian licensing exams (courtesy of Dr Jerry Green MD)

Preamble

The College’s registration regulation1 sets out the requirements which must be met in order for an applicant to be issued a certificate of registration2.

If an applicant does not meet the requirements set out in the regulation it may still be possible for an applicant to qualify pursuant to one of the exemption policies.

All applicants must be able to demonstrate that their past and present conduct indicates that they are mentally competent to practise medicine; will practise with decency, integrity and honesty and in accordance with the law; have sufficient knowledge, skill and judgment to engage in the kind of practice authorized by the certificate and can communicate effectively; and will display an appropriately professional attitude.
In addition to the registration regulation and policies, all applicants will also be subject to other CPSO policies and regulations which apply to current registrants. In particular, the Changing Scope of Practice and Re-entering Practice policies, and the regulation pertaining to the use of specialist titles may have relevance for new applicants. All applicants will also be subject to the College’s expectations with respect to continuing professional development.

All applicants may choose to proceed through any other applicable registration policy, including the CPSO Registration through Practice Assessment. In such instances, the provisions in this policy will not apply.

All registrants qualified under this policy will undergo an assessment after completing a minimum of one year of practice in Ontario. Assessments ensure that physicians are practising competently and safely. All physicians in Ontario undergo assessments and it is part of the College’s vision of quality professionals that all physicians will be assessed every 10 years.

Pathway 7: Canadian or Other Country Medical Degree without CFPC Certification

The Registration Committee may direct the Registrar to issue a certificate of registration to a family medicine applicant who has a medical degree from a medical school in Canada accredited by the Council on Accreditation of Canadian Medical Schools or other medical school in another country, if the applicant has:

successfully completed:

the Medical Council of Canada Qualifying Examinations; or
an acceptable qualifying examination; and
practised in Canada or another country while holding an independent or full license or certificate of registration without restrictions.

The following conditions will be placed on the certificate of registration:

The physician must practice with a mentor and/or supervisor until he or she has successfully completed an assessment.
The physician must undergo an assessment after completing a minimum of one year of practice in Ontario. The certificate of registration automatically expires 18 months from the date of issuance, but may be renewed by the Registration Committee, with or without additional or other terms, conditions and limitations.

The College would approve any selected supervisor. The supervisor would adhere to and tailor the level of supervision according to the recently updated 24-page "Guidelines for Supervision" available on the College's website at http://cpso.on.ca/uploadedFiles/downloads/cpsodocuments/policies/Guidelines%20for%20Supervision%202008.pdf.

Since this supervision would be on a one-to-one basis in a small office looking after mostly ambulatory family practice patients with ordinary problems, it would likely be equal or superior to that received by residents in a hospital. The latter setting often has extremely ill and complicated patients where the supervision especially after hours may be minimal and where the supervisor may not be immediately available either in person or by phone.

The supervising physician would be responsible to send regular reports to the College. When the supervising physicians was satisfied that the candidate could practice safely and competently independently, he would report this to the College. If the College agreed with this assessment, the College of Family Physicians of Canada (CFPC) would be asked to allow the candidate to write its exams. If the CFPC would not accept this, then a conditional license would be issued that would allow the candidate to practice up until the time that he/she met the eligibility requirements (such as 5 years of Canadian practice-eligibility) or when the CFPC changed its policy.

The College could revoke the license at any time. The license would be for a temporary period of time only, to allow for updating, upgrading and the passing of all necessary exams for which the candidate would be required in order to eventually obtain an independent license.

The candidate would be subject to all the regulations of the College and would have to reply to any patient complaints etc. The College could inspect the practice and examine the medical records of the candidate at any time.
The candidate would be required to attend weekly family practice rounds at a local hospital. The candidate would be required to attend and get credits for continuing medical education in an amount specified by the College. The candidate would be encouraged or required to practice in an under-serviced area of Ontario, rural community, CHC or family health team model.

The supervising physician would be paid by the candidate for his time and supervisory work.

How Barriers are Reduced

This policy adds another pathway to licensure for applicants who are not certified by the RCPSC or CFPC. Eligible applicants now have the option of applying for an independent practice certificate of registration and will undergo an assessment after the first year of practice, and abide by the College’s Quality Assurance Committee (QAC) enhancement/remedial recommendations, if any, in accordance with usual QAC processes and practices.

Eligible applicants also have the option of completing the Registration through Practice Assessment (RPA) program before being approved to practise medicine in Ontario, instead of applying under this new policy.

There would be virtually no cost to the health care system for this pathway as compared to the considerable cost to set up additional hospital-based residency positions.

The candidate would be a benefit to the supervising physician, his patients and the community by allowing him/her to accept more new patients and reduce his personal workload.

Endnotes

O.Reg 865/93 under the Medicine Act, 1991.
To the extent that the College relies on accreditation or registration by external bodies, the College undertakes to continue to work with these stakeholders to ensure rigour in their attention to quality and safety.