NEWFOUNDLAND REGULATION 1/98

CNR 1113/96
as amended

1. Sections 2 to 10 of the Medical Board Regulations are repealed and the following substituted:

Interpretation

2. (1) In these regulations

(a) "ACGME" means the Accreditation Council for Graduate Medical Education;

(b) "Act" means the Medical Act;

(c) "application for a licence" or "applies for a licence" means an application for a full licence or for a provisional licence;

(d) "approved faculty or school of medicine" means a medical school

(i) accredited by the CACMS and the LCME, or

(ii) recognized by the World Health Organization and which has carried out a continuous medical education program for more than 10 years during which it offered and continues to offer a medical training program of at least 48 months duration;

(e) "CACMS" means the Committee for Accreditation of Canadian Medical Schools;

(f) "Category I school of medicine" means a school or faculty of medicine accredited by the CACMS and the LCME;

(g) "Category II school of medicine" means a school or faculty of medicine in the United Kingdom, the Republic of Ireland, Australia, New Zealand or South Africa;

(h) "Category III school of medicine" means a school or faculty of medicine in a country other than one designated in paragraphs (f) and (g) which is recognized by the World Health Organization and which has carried out a continuous medical education program for more than 10 years during which it offered and continues to offer a medical training program that is at least 48 months in duration;

(i) "CFPC" means the College of Family Physicians of Canada;

(j) "FMLAC" means the Federation of Medical Licensing Authorities of Canada;

(k) "former regulations" means the Medical Board Regulations in force immediately before the commencement of this paragraph;

(l) "full licence" means a licence issued under the Act to a person registered on the medical register and does not include a provisional licence;

(m) "LCME" means the Liaison Committee on Medical Education of the American Medical Association;

(n) "Memorial University" means the Memorial University of Newfoundland established under the Memorial University Act;

(o) "primary care practice" means a general practice, family practice or other non specialist practice;

(p) "provisional licence" means a provisional licence referred to in section 22 of the Act and includes

(i) an extraordinary provisional licence referred to in subsections 5(7) and (8) for the purposes of those subsections only, and

(ii) a locum provisional licence referred to in section 6 for the purposes of that section only;

(q) "RCPSC" means the Royal College of Physicians and Surgeons of Canada; and

(r) "sponsor" means the Department of Health of the government of the province, the Faculty of Medicine of Memorial University or the governing body of a recognized hospital or agency in the province acting upon the advice of, or after consultation with the Medical Advisory Committee or other appropriate medical consultants to the hospital or agency seeking registration.

(2) Where these regulations refer to training or a course, assessment, program, requirement, performance or examination to be undertaken, completed, met or obtained by a person, the board may determine if that training, course, assessment, program, requirement, performance or examination is satisfactory to it and unless otherwise stated in these regulations may determine if a person who has undertaken, completed or obtained training or a course, assessment, program, requirement, performance or examination has met a standard in that training, course, assessment, program, requirement, performance or examination which is acceptable to the board.

(3) An application for a licence under the Act and the regulations shall be in the form required by the board and where that application is not in the required form, the board may refuse that application until it is in that required form.

(4) For the purposes of the regulations, a certificate of good standing means the document or documents required to be produced to the board under paragraph 15(e) of the Act.

(5) For the purposes of the regulations, good standing with the board means the determination by the board, based upon information disclosed or produced by or on behalf of a person at the time of his or her application for a licence or a licence renewal that the person has complied with all terms and conditions applicable to a licence held or previously held under the Act.

PART I
REGISTRATION AND LICENSING

Eligible graduates

3. (1) A graduate from an approved faculty or school of medicine may be registered by and issued a licence from the board provided that he or she meets the requirements of the Act and the regulations.

(2) The board may require proof that a person has completed final examinations of and has graduated from an approved faculty or school of medicine.

Full registration and licence

4. (1) Registration and a full licence to practise medicine shall be granted to a person who applies for a licence and has

(a) a degree in medicine from an approved faculty or school of medicine;

(b) 2 or more years of postgraduate training and has

(i) been certified by the CFPC, or

(ii) been certified by the RCPSC, or

(iii) completed the 2 year residency training requirement of the CFPC and that training shall have met the program objectives in each of Surgery, Medicine, Pediatrics, Obstetrics/Gynaecology, Psychiatry and in either Family Practice or Emergency Medicine, or

(iv) completed 2 or more years of postgraduate training in programs affiliated with a CACMS and LCME accredited medical school, and

(A) those programs shall be accredited by the FMLAC, CFPC or the RCPSC in Canada or the ACGME in the United States of America, and

(b) the training shall include 1 year of training with 8 weeks in each of Surgery, Medicine, Pediatrics, Psychiatry, Obstetrics/Gynaecology and in either of Family Practice or Emergency Medicine plus a second year which includes 24 weeks of clinical rotations, or

(v) completed 4 years of postgraduate training and has fulfilled the training requirements of the RCPSC for eligibility to take the Certification Examination of the RCSPC;

(d) paid the required fees;

(e) satisfied the board that he or she has sufficient professional liability insurance coverage; and

(f) complied with and fulfilled the applicable requirements of sections 9 to 10.2,

and when the licence expires, that person shall fulfil the requirements for the renewal of a licence and for re-entry into a primary care or specialty care practice under the Act and the regulations.

(2) Notwithstanding subsection (1), registration and a full licence to practise medicine shall be granted to a person who applies for a licence and who

(a) graduated with a degree in medicine from an approved faculty or school of medicine in 1991 or earlier;

(b) had he or she made an application for a licence, would have been eligible for registration and full licence to practise medicine on December 31, 1992;

(d) has obtained the Licentiate of the Medical Council of Canada;

(e) has paid the required fees; and

(f) has complied with the applicable requirements of sections 9 to 10.2,

and when the licence expires, that person shall fulfil the requirements for the renewal of a licence and for re-entry into a primary care or specialty care practice under the Act and the regulations.

(3) Notwithstanding subsection (1), registration and a full licence to practise medicine shall be granted to a person who applies for a licence and

(a) graduated with a degree in medicine from a CACMS and LCME accredited school of medicine in 1992;

(b) has completed the rotating internship program required by the board or a Family Practice Training Program approved by the CFPC and that training shall meet the program objectives in each of Surgery, Medicine, Pediatrics, Psychiatry and Obstetrics/Gynaecology;

(d) has paid the required fees;

(e) has satisfied the board that he or she has sufficient professional liability insurance coverage; and

(f) has complied with and fulfilled the applicable requirements of sections 9 to 10.2,

and when the licence expires, that person shall fulfil the requirements for the renewal of a licence and for re-entry into primary care practice under the Act and the regulations.

(4) Notwithstanding subsection (1), registration and a full licence to practise medicine shall be granted to a person who applies for a licence and

(a) has a degree in medicine from an approved faculty or school of medicine;

(b) has or has previously held a provisional licence;

(c) has practised continuously with a provisional licence under the jurisdiction of the board for 3 years immediately before commencing the postgraduate training required under paragraph (e) or has practised continuously with a provisional licence for 3 years immediately before making an application for a licence and has completed the postgraduate training required by paragraph (e);

(d) has demonstrated, as a medical practitioner with a provisional licence, a clinical practice which is satisfactory to the board;

(e) has completed 2 years of post graduate training, one year of which was in a program accredited by the FMLAC, CFPC or the RCPSC in Canada or by the ACGME in the United States of America and which was affiliated with a CACMS and LCME accredited medical school and that training shall have

(i) included 8 week rotations in each of Surgery, Medicine, Pediatrics, Obstetrics/ Gynaecology, Psychiatry and in either of Family Practice or Emergency Medicine, or

(ii) been a family practice training program accredited by the CFPC and shall have met the objectives of that program in Surgery, Medicine, Pediatrics, Obstetrics/Gynaecology, Psychiatry and in either of Family Practice or Emergency Medicine;

(f) has obtained the Licentiate of the Medical Council of Canada;

(g) has paid the required fees;

(h) has satisfied the board that he or she has sufficient professional liability insurance coverage; and

(i) is in good standing with the board,

and when the licence expires, that person shall fulfil the requirements for the renewal of a licence and for re-entry into a primary care practice under the Act and the regulations.

(5) Notwithstanding subsection (1), registration and a full licence to practise medicine shall be granted to a person who applies for a licence and

(a) has a degree in medicine from an approved faculty or school of medicine;

(b) has a provisional licence;

(c) has practised continuously with a provisional licence under the jurisdiction of the board for 5 years immediately before making an application for registration and a full licence;

(d) has demonstrated, as a medical practitioner with a provisional licence, a clinical practice that is satisfactory to the board;

(e) has obtained the Licentiate of the Medical Council of Canada;

(f) has paid the required fees;

(g) has satisfied the board that he or she has sufficient professional liability insurance coverage; and

(h) is in good standing with the board,

and when the licence expires, that person shall fulfil the requirements for renewal of a licence and for re-entry into a primary care or specialty care practice under the Act and the regulations.

Provisional licence

5. (1) A provisional licence for a primary care practice may be issued to a person who applies for a licence and has

(a) a degree in medicine from a CACMS and LCME accredited medical school;

(b) completed one year of postgraduate basic clinical training or has met the requirements of paragraph 4(1)(b);

(d) paid the required fees;

(e) satisfied the board that he or she has sufficient professional liability insurance coverage; and

(f) complied with the applicable requirements of sections 9 to 10.2,

and when the licence expires that person shall fulfil the requirements for the renewal of a licence and for re-entry into a primary care practice under the Act and the regulations.

(2) A provisional licence for primary care practice may be granted to a person who applies for a licence and

(a) has a degree in medicine from an approved faculty or school of medicine;

(b) has completed one year of postgraduate basic clinical training;

(i) satisfactorily completed the evaluating examination of the Medical Council of Canada not more than 5 years immediately before the date of making the application for a licence, or

(ii) passed Part I of the qualifying examination of the Medical Council of Canada, or

(iii) been granted a degree in medicine from a medical school in the United Kingdom, Republic of Ireland, Australia, New Zealand or South Africa, or

(iv) completed one year of postgraduate basic clinical training in Canada, the United States of America, the United Kingdom, the Republic of Ireland, Australia, New Zealand or South Africa, or

(v) previously held a provisional licence from the board and has obtained an overall passing score in the evaluating examination of the Medical Council of Canada;

(d) has not taken and failed either Part I or Part II of the qualifying examination of the Medical Council of Canada more than once prior to making an application for a licence and if so, prior to making an application for a licence, has retaken and passed that part of the qualifying examination of the Medical Council of Canada which was failed;

(e) has been accepted for employment under a sponsor approved by the board;

(f) has paid the required fees;

(g) has

(i) in the opinion of the board, practised primary care without significant interruption in practice, or

(ii) a licence to practise medicine from a medical licensing authority of another province or territory of Canada, is currently engaged in a primary care practice in another province or territory of Canada, and has provided 2 letters of reference which are satisfactory to the board from physicians in Canada, or

(iii) if there has been an interruption in primary care practice for at least 12 months but not more than 24 consecutive months immediately before applying for a licence, passed Parts I and II of the qualifying examination of the medical council of Canada, or

(iv) if there has been a significant interruption in primary care practice completed a medical school affiliated training program in Canada or the United States;

(h) has satisfied the board that he or she has sufficient professional liability insurance coverage; and

(i) has complied with the applicable requirements of sections 9 to 10.2 and

when that licence expires, that person shall fulfil the requirements for the renewal of a provisional licence and for re-entry into a primary care practice under the Act and the regulations.

(3) A medical practitioner who is issued a provisional licence for entry into a primary care practice shall obtain the Licentiate of the Medical Council of Canada within 3 years of the original issuance of a provisional licence.

(4) The board shall revoke the provisional licence of a medical practitioner who does not comply with subsection (3).

(5) Notwithstanding subsections (3) and (4), where a medical practitioner has passed Part I of the qualifying examinations of the Medical Council of Canada, but has not obtained the Licentiate of the Medical Council of Canada within 3 years after being issued a provisional licence and has not written one or more of the offered sittings of Part I and Part II of the qualifying examinations of the Medical Council of Canada for a reason considered to be acceptable by the board, the board may further renew his or her provisional licence, subject to the condition that he or she write and pass Part II of the qualifying examinations of the Medical Council of Canada at the first offered sitting of those examinations immediately after the expiry of that 3 year period.

(6) If a medical practitioner referred to in subsection (5) does not write and pass Part II of the qualifying examination of the Medical Council of Canada at the first offered sitting referred to in that subsection, the board shall revoke his or her provisional licence and that medical practitioner shall not apply for a provisional licence or for a renewal of a provisional licence except in accordance with subsection 10.3(6).

(7) Notwithstanding that a medical practitioner cannot comply with subsection (3), (5) or (6), the board may, in its discretion and on the terms, conditions and limitations that it considers necessary or desirable, issue to that medical practitioner, an extraordinary provisional licence where

(a) a sponsor has made a request, in writing, that that licence be issued because the medical practitioner's services cannot be readily replaced by the sponsor; and

(b) the request made under paragraph (a) is approved by the minister before being submitted to the board.

(8) An extraordinary provisional licence issued under subsection (7) may be issued for not more than 2 consecutive years.

(9) For the purposes of paragraph (2)(c), where a person makes an application for a licence when a clinical assessment and enhancement program has not been established by the Faculty of Medicine of Memorial University, that person is considered to have satisfactorily completed the evaluating examination of the Medical Council of Canada where he or she has obtained a grade of not less than 50% in each of the Medicine, Pediatrics, Psychiatry, Obstetrics and Gynaecology, Preventive Medicine and Community Health sections of that evaluating examination.

(10) For the purposes of paragraph (2)(c), where a person makes an application for a licence when a clinical assessment and enhancement program has been established by the Faculty of Medicine of Memorial University, that person is considered to have satisfactorily completed the evaluating examination of the Medical Council of Canada where he or she has obtained

(a) a grade of not less than 60% in each of the Medicine, Pediatrics, Psychiatry, Obstetrics and Gynaecology and Surgery sections of that evaluating examination; and

(b) a grade of not less than 50% in the Preventive Medicine and Community Health section of that evaluating examination; and

(11) For the purposes of paragraph (2)(c), a person shall not be considered to have satisfactorily completed the evaluating examination of the Medical Council of Canada where he or she has obtained an overall passing grade in that examination but has not met the requirements of subsections (9) and (10).

Locum provisional licence

6. (1) The board may issue a provisional licence to be known as a locum provisional licence for a period and on terms and conditions that the board may establish, to a person who applies for a licence and

(a) has a degree in medicine from an approved faculty or school of medicine;

(b) has been accepted for employment under a sponsor approved by the board;

(d) has satisfied the board that he or she has sufficient professional liability insurance coverage;

(e) he or she will provide a locum service in the province; and

(f) he or she meets the requirements for a provisional licence under subsections 5(1) or (2) or section 7.

(2) Where a person has been issued a locum provisional licence under subsection (1), that licence shall not be issued for an aggregate period that is greater than 4 months in a year.

(3) A person who applies for a provisional licence under this section need not comply with subsections 5(3), (4), (5) and (6).

Provisional licence for a specialty practice

7. (1) A provisional licence may be issued to a person who applies for a licence for entry into a sponsored practice in a specialty of medicine and has

(a) a degree in medicine from an approved faculty or school of medicine;

(b) completed 4 years of postgraduate training in the United States of America, the United Kingdom, the Republic of Ireland, Australia, New Zealand or the Republic of South Africa and as the board may require, has passed a specialist higher qualification examination administered by a medical authority responsible for specialist training in each of those countries; or

(c) completed 4 years of postgraduate training accepted by the RCPSC as providing eligibility to take a certification examination of the college; or

(d) completed 3 years of postgraduate training in one of the following areas, Internal Medicine, Pediatrics or Emergency Medicine, in the United States of America in a program accredited by the ACGME and acquired by examination board certification in the specialty from the appropriate American Board; or

(e) completed a period of postgraduate training in the United States of America, the United Kingdom, the Republic of Ireland, Australia, New Zealand or the Republic of South Africa and

(i) has completed and passed a specialist higher qualification examination acceptable to the board,

(ii) has been granted an academic appointment at the professorship level in a medical school in one of those countries, and

(iii) is recognized by the board as holding a full specialist or consultant status in the country where postgraduate training was completed.

(2) A provisional licence to practise medicine may be issued to a person who meets the requirements of subsection (1) provided that he or she has

(a) been accepted for employment under a sponsor approved by the board;

(b) paid the required fees;

(d) complied with the applicable requirements of sections 9 to 10.2,

and when the licence expires, that person shall fulfil the requirements for the renewal of a provisional licence and for re-entry into a specialty care practice under the Act and the regulations.

Assessment and enhancement

8. (1) The board may issue a provisional licence to a person who applies for a licence and has

(a) applied for entry into a primary care practice, has not been in active practice for at least 12 months but not more than 24 consecutive months immediately before making that application and has not passed Parts I and II of the qualifying examinations of the Medical Council of Canada; or

(b) as determined by the board, had a significant interruption in primary care or specialty practice; or

(d) if applying for entry into a primary care practice, not satisfactorily met the requirements of paragraph 5(2)(c) but has obtained an overall passing score on the evaluating examination of the Medical Council of Canada; or

(e) if applying for entry into a primary care practice, not satisfactorily met the requirements of paragraph 5(2)(g),

and has otherwise met the requirements for a provisional licence, under the Act and the regulations, provided that he or she completes a clinical assessment in a medical school affiliated assessment program.

(2) The board may issue a provisional licence to a person who applies for a licence and who, in the opinion of the board, has not obtained a satisfactory performance in a clinical assessment in a medical school affiliated assessment program referred to in subsection (1) but has otherwise met the requirements for a provisional licence under the Act and the regulations provided that he or she completes a medical school affiliated clinical training program in Canada or the United States of America.

Interrupted practice

9. The board may issue a full or a provisional licence to a person who applies for a licence where he or she has had an interruption in active primary care practice of 24 or more consecutive months but has otherwise met the requirements for a full or a provisional licence under the Act and the regulations provided that he or she has completed a medical school affiliated training program in Canada or the United States of America and provided that the required content of the medical school affiliated training program shall be determined by the board following a clinical assessment of that person in a medical school affiliated assessment program.

Board not obligated

10. These regulations shall not be considered to have placed an obligation upon the board to establish or make available a medical school affiliated assessment or medical school affiliated training program.

Certificate of good standing

10.1 (1) A person who applies for a licence shall provide to the board a certificate of good standing from each licensing authority under whose jurisdiction he or she has held a licence to practise medicine.

(2) A certificate of good standing from the jurisdiction in which an applicant last practised shall be dated not more than 6 weeks before making an application for a licence and all other certificates of good standing shall be dated not more than 6 months before making that application.

(3) Where the board is satisfied that a person who applies for a licence has been unable to obtain a certificate of good standing under subsections (1) and (2), the board may waive the requirement for those certificates.

(4) The board may require recommendations from appropriate authorities in another jurisdiction where the applicant has practised medicine and may require references which are acceptable to the board from not fewer than 3 physicians in that other jurisdiction.

Language

10.2 (1) A person who applies for a licence whose first language is not English shall demonstrate to the board a reasonable fluency in the English language.

(2) Documents forwarded to the board under these regulations shall be in English or presented with an English translation made by a person who is acceptable to the board.

Expiry and renewal

10.3 (1) A full licence shall expire annually on January 15 and a provisional licence shall expire on the date specified in the conditions of that licence or under these regulations.

(2) The full licence of a medical practitioner shall be renewed by the board provided that the medical practitioner

(a) is in good standing with the board;

(b) has submitted an application for the renewal of the full licence;

(d) has satisfied the board that he or she has sufficient professional liability insurance coverage; and

(e) in the year immediately before making an application for the renewal of his or her licence, held a full licence and was in active clinical practice or was exempted from active clinical practice under subsection 10.4(2).

(3) The provisional licence of a medical practitioner may be renewed by the board provided that the medical practitioner

(a) is in good standing with the board;

(b) has submitted an application for the renewal of the provisional licence;

(d) has satisfied the board that he or she has sufficient professional liability insurance coverage;

(e) was employed under a sponsor approved by the board within 3 months immediately before making that application;

(f) has complied with section 10.1 with respect to a period during which that person did not have a licence under the Act and the regulations;

(g) has, at the time of making that application, been accepted for employment under a sponsor approved by the board; and

(h) has

(i) if originally issued a provisional licence for entry into a primary care practice on or after October 1, 1994 but before the commencement of this section, complied with subsection 6(4) of the former regulations, or

(ii) complied with subsection 5(3).

(4) Where a full licence issued to a medical practitioner expires and is not renewed or may not be renewed under subsection (2), the board may renew that licence provided that the medical practitioner

(a) is in good standing with the board;

(b) has submitted an application for the renewal of the full licence;

(d) has satisfied the board that he or she has sufficient professional liability insurance coverage;

(e) has complied with section 10.1 with respect to a period during which that person did not have a licence; and

(f) complies with subsections 10.4 (4) or (5).

(5) Where a provisional licence issued to a medical practitioner is not renewed or may not be renewed under subsection (3), the board may renew that licence provided that the medical practitioner

(a) is in good standing with the board;

(b) has submitted an application for the renewal of the full licence;

(d) has satisfied the board that he or she has sufficient professional liability insurance coverage;

(e) has complied with section 10.1 with respect to a period during which he or she did not have a licence under the Act;

(f) has, at the time of making the application, been accepted for employment under a sponsor approved by the board;

(g) has complied with subsection 5(1) or (2) or section 7, 8 or 9; and

(h) has

(i) if originally issued a provisional licence for a primary care practice on or after October 1, 1994 but before the commencement of this section, complied with subsection 6(4) of the former regulations, or

(ii) complied with subsection 5(3).

(6) Where a provisional licence issued to a medical practitioner is revoked under subsection 5(4), the board may renew that licence provided that the medical practitioner

(a) is in good standing with the board;

(b) has submitted an application for the renewal of the provisional licence;

(d) has satisfied the board that he or she has sufficient professional liability insurance coverage;

(e) has complied with section 10.1 with respect to a period during which he or she did not have a licence;

(f) has been accepted at the time of making that application for employment under a sponsor approved by the board;

(g) has complied with subsection 5(1) or (2) or section 7, 8 or 9; and

(h) has passed Parts I and II of the qualifying examination of the Medical Council of Canada.

Medical practice inactivity

10.4 (1) A medical practitioner who has not been in active clinical practice for 24 or more consecutive months and who applies for a licence is not eligible for a renewal of a licence.

(2) The board may exempt from subsection (1) a retired or totally disabled medical practitioner or a medical practitioner employed in an administrative or academic position.

(3) A medical practitioner who has been exempted from subsection (1) under subsection (2) who intends to re-enter a primary care or specialty practice shall first fulfil the requirements of subsection (4).

(4) A medical practitioner registered with the board who has not been in active clinical practice for a period of 24 months or more and who applies for a licence to re-enter a primary care or specialty practice shall complete re-entry training in a program acceptable to the board, the content and duration of which shall be determined by the board following an assessment of that medical practitioner.

(5) A medical practitioner who has for 24 months or more been in specialty practice or training or has been practising public health or occupational medicine and who intends to enter a primary care practice, shall, before commencing that primary care practice, complete retraining in a program acceptable to the board and the content and duration of that program shall be determined by the board following an assessment of that medical practitioner.

Temporary licence

10.5 (1) The board may issue to a person a registration and temporary full licence or a temporary provisional licence for a period and on terms and conditions that may be established by the board for each person who applies for a licence, provided that the person

(a) has a degree in medicine from an approved faculty or school of medicine;

(b) has been certified by the RCPSC;

(d) has satisfied the board that he or she has sufficient professional liability insurance coverage;

(e) is sponsored by a hospital for the purpose of providing or maintaining a unique provincial specialist medical service; and

(f) has otherwise complied with and fulfilled all the requirements for either registration and a full licence or provisional licence under the Act and the regulations.

(2) Where a medical practitioner has been granted registration and issued a temporary full licence or a temporary provisional licence under subsection (1), the period of temporary licence shall not exceed 30 days.

(Includes February 6 and March 6, 1998 corrections )