Complaints, investigations and discipline
College Quality assurance and performance management: committees and programs requirements
Reporting requirements and information sharing
We have attempted to summarize in our discussion the collective picture created by the multiple layers of regulation applicable to physicians through the RHPA, the Code, the Medicine Act and the regulations made under the Medicine Act.
Registration/Licensing of Ontario Physicians
The purpose of the Registration Committee and registration requirements and processes is to ensure that only qualified individuals are granted a certificate of registration (sometimes referred to as a licence) to practise medicine in Ontario, and to prevent unqualified individuals from performing potentially harmful medical acts.
Registration matters are governed primarily by sections 15 to 24 of the Code, as well as the Registration Regulation made under the Medicine Act.
General Requirements for Registration
Requirements for registration are set out in s. 2 of the Registration Regulation. S. 2(1) of the Regulation provides that it is a non-exemptible standard and qualification for issuing a certificate
133 of registration that the applicant’s past and present conduct afford reasonable grounds for belief that the applicant:
is mentally competent to practise medicine;
will practise medicine with decency, integrity and honesty and in accordance with the law;
has sufficient knowledge, skill and judgment to engage in the kind of medical practice authorized by the certificate; and
can communicate effectively and will display an appropriately professional attitude.
This non-exemptible requirement applies to every class of certificate.
Registrants must also meet certain basic requirements including requirements relating to citizenship or immigration status, establishing identity through supporting documentation and liability protection.
Application forms require information regarding the Applicant’s education, credentials, qualification, experience, as well as responses to questions that relate to conduct, competence and personal and professional history (e.g., previous suspensions by a licensing authority, etc.).
An applicant who makes any false or misleading representation or declaration on or in
connection with an application, by commission or omission, is deemed not to have (and not to have had) the standards and qualifications for a certificate of any class.
Classes of Certificates of Registration
The College has a number of classes of Certificates of Registration:
Independent Practice
Academic Practice
Academic Visitor
Supervised Practice of Short Duration
Public Service Practice
Practice in an Underserviced Area
Hospital Practice
Restricted Certificate
Certificates Authorizing Postgraduate Education (General, Fellows, Advanced Standing, Electives, Exchange Resident
134 Specific requirements, terms and conditions, exemptions, etc., relating to each class of certificate are set out in the Registration Regulation.264 For example, the requirements for a Certificate of Registration for Independent Practice – which authorizes the holder to engage in independent, unsupervised medical practice – are as follows:
1. A medical degree from an accredited Canadian or US medical school or from an acceptable medical school listed in the World Directory of Medical Schools.
2. Successful completion of Parts 1 and 2 of the Medical Council of Canada Qualifying Examination.
3. Certification by examination by either the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC).
4. Completion in Canada of one year of postgraduate training or active medical practice, or completion of a full clinical clerkship at an accredited Canadian medical school.
5. Canadian Citizenship or permanent resident status.
The holder of the Independent Practice Certificate may only practise in the areas in which he or she is educated and experienced.
Unlike an Independent Practice Certificate, many of the other classes of certificates have very specific terms, conditions and limitations attached.
Assessing Credentials
The College’s Registration Department coordinates the review and verification of credentials of physicians seeking a Certificate of Registration. As in other provinces, several bodies
independent of the College play a role in the process of establishing and verifying that physicians have the credentials required for registration in the class for which the physician has applied.
These organizations include the Medical Council of Canada, the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada. Roles played by external organizations include:
developing and administering qualifying examinations;
acting as the accreditation body and providing certifications; or
verifying education and registration credentials for physicians who completed their medical education outside Canada.
264 See s. 3 to 15 of the Registration Regulation.
135 Out-of-Province Licence Holders: Labour Mobility and the Agreement on Internal Trade Physicians who hold a licence or certificate to practise medicine in another Canadian province or territory (except Nunavut) may apply for an equivalent certificate of registration in Ontario.
Their applications are assessed under the labour mobility provisions in the RHPA Code relating to the AIT.
The AIT became law in Ontario in December 2009. The AIT allows unrestricted mobility between provinces for anyone licensed to practise medicine in Canada. It requires Ontario to license physicians coming from anywhere else in Canada, applying the same restrictions on their certificate as were present in their prior jurisdiction, if any. The applicable provisions in the Code265 allow application to the College on the basis of holding a current Canadian out-of-province licence, as opposed to having the specific postgraduate Canadian qualifications that would otherwise be required. There are currently numerous combinations of qualifications that entitle individuals to be licensed as physicians in the various jurisdictions across the country.
While most registration requirements ensure safe practitioners, some of the qualifications acceptable in some regions are not as stringent as those in place in other jurisdictions.
There are two types of applications used for this purpose in Ontario: one for physicians who have full unrestricted undefined licences; and the other for physicians who have defined, provisional, special (or similar) licences.
International Medical Graduates
To practise medicine in Ontario, whether as a family practitioner or specialist, international medical graduates (IMGs) must have all the Canadian postgraduate qualifications required for an independent practice certificate.
However, the CPSO has demonstrated its commitment to reducing barriers to registration for qualified candidates by finding new and creative ways to evaluate the competence and
performance of physicians who wish to practise in Ontario. In an effort to improve access and reduce barriers for qualified physician’s, in 2008, the College’s Council approved four new registration pathways. The new registration pathways vary depending on the source of the applicant’s medical degree, where the applicant is currently practicing and where the applicant received postgraduate training.
The College also allows physicians to proceed through Registration through Practice Assessment (“RPA”) Program which assesses the skills and abilities of internationally trained medical
265 See s. 22.15 to 22.23.
136 graduates with extensive practice experience outside of Ontario. The RPA pathway is authorized to assess doctors with experience and in active medical practice in a jurisdiction in Canada or the United States. It allows the applicant who is not certified as a specialist by one of Canada's national colleges to gain access to registration through an evaluation of his or her clinical and practice skills.
The Registration Committee
The College’s Registration Committee reviews the applications of physicians who apply to become members of the College, but who do not fulfill the requirements for the issuance of a certificate of registration. The Code contains a number of provisions directed at ensuring appropriate procedural protections (e.g., notice, disclosure, etc.). After considering an application, the Registration Committee may make an Order directing the Registrar:266
to issue a certificate of registration;
issue a certificate of registration if the applicant successfully completes examinations set or approved by the panel;
to issue a certificate of registration if the applicant successfully completes additional training specified by the panel;
to issue a certificate of registration with terms, conditions and limitations; or
to refuse to issue a certificate of registration.
Orders of the Registration Committee may be appealed to the Health Professions Appeal and Review Board.267 The Applicant can request either a written review of the application and documentary evidence in support of it, or an oral hearing of the Application by giving notice within 30 days of the date of the Registration Committee’s decision. A party may appeal from a decision of the Board to the Divisional Court of Ontario.268
266 S. 18(2) of the Code.
267 S. 21(1) and (2) of the Code.
268 S. 70(1) of the Code.
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