Dear Applicant: Regards, Registration Department

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1 Dear Applicant: Enclosed is an application package for a Postgraduate Practising Licence for external moonlighting. This package is designed for postgraduate trainees who are currently in a training program at Dalhousie University. It is recognized that moonlighting is outside the scope of an education licence. Please read the College s policy regarding resident moonlighting, complete the application in full and return to the College, along with the documentation listed on the application. Please note that you must sign the declaration at the bottom of the application indicating you have read the College s policy regarding the Postgraduate Practising Licence for external moonlighting. Confirmation of supervision can be sent directly to this office by your supervisor. Documented evidence of hospital privileges (where applicable) can also be sent directly to this office from the hospital/district health authority where you will be working. You should contact Nova Scotia s service provider (billing agency), Medical Services Insurance (MSI) at if you will require a billing number. You should also notify Doctor s Nova Scotia ( ) that you will be moonlighting. It is your responsibility to complete all the application requirements. Failure to do so could result in a delay in obtaining a Postgraduate Practising Licence which is required prior to moonlighting in Nova Scotia. Once your application is complete, please allow sufficient time for processing by the Registration Department. The Registration Department is unable to guarantee any applicant that he/she will be issued a licence by a particular date. You must not begin moonlighting until you have received confirmation from this office that you have been issued a licence to moonlight. Notification will be sent to you via the address your have supplied on the application form. Any queries regarding resident moonlighting should be directed to the Registration Department of the College of Physicians and Surgeons of Nova Scotia. Regards, Registration Department

2 Postgraduate Practising Licence (External Moonlighting) Contents Application process Policy Postgraduate Practising Licence for external moonlighting Application form with documentation list Supervision Agreement form Fee Schedule Credit card payment form

3 Registration Policies SECTION POLICY NAME APPLICABLE LEGISLATION Approved by : REGISTRATION Postgraduate Practising Licence Regulations Pursuant to the Medical Act - Sections 22 through 26 Approval Date Reviewer Review Date COUNCIL CREDENTIALS December 10, 2010 Deputy Registrar (Registration) December 2013 Purpose: The purpose of this policy is to allow postgraduate trainees, during their residency training, to provide locum tenens in areas of physician shortage in the province; and to assist postgraduate trainees in their career advancement. This policy is not intended to provide locum tenens by postgraduate trainees in a setting without supervision by their sponsor/supervisor, with the possible exception of community office practice in a solo family practice. Where applicable, when a postgraduate trainee is providing locum services, the supervisor must be available to be on site in a timely fashion (generally minutes away at any time). It is expected that the supervisor will practice within the same physical facility as the postgraduate trainee. Training Requirements: 1. Applicants must be in the final two (2) years of specialty training in a program accredited by the Royal College of Physicians and Surgeons of Canada (Royal College) or in the final year of a Family Medicine program accredited by the College of Family Physicians of Canada (CFPC) 2. Applicants must possess the LMCC. 3. Applicants must be enrolled in a postgraduate training program with Dalhousie University. Endorsement Requirements: 1. Applicants must have the written approval and endorsement of their Program Director. This endorsement must be site specific for each location in which the applicant wishes to locum. This must be sent directly to the College of Physicians and Surgeons of Nova Scotia (College). 2. Applicants must hold privileges in any district health authority (DHA) in which they wish to work/provide services (e.g. radiology residents who will provide reports on images generated in more than one district health authority.

4 Registration Policies SECTION POLICY NAME APPLICABLE LEGISLATION Approved by : REGISTRATION Postgraduate Practising Licence Regulations Pursuant to the Medical Act - Sections 22 through 26 Approval Date Reviewer Review Date COUNCIL CREDENTIALS December 10, 2010 Deputy Registrar (Registration) December The physician or physicians for whom the locum services are being provided must be accountable for the appropriate supervision of the applicant. A supervision plan must be provided as part of the application process. 4. The application and the supervision plan must be acceptable to the Registrar. Practice Requirements: 1. Applicants can only practise within the scope of training received by the applicant to date. 2. Only postgraduate trainees who have completed a minimum of three (3) months in an accredited emergency medicine residency training program, and with ACLS and ATLS and APLS or PALS, and an advanced airway management course as outlined in the Nova Scotia Emergency Care Standards, November 2010 may work in an emergency department as the designated emergency department physician under this policy. 3. Those postgraduate trainees providing obstetrical locum tenens under this policy must have completed a neonatal resuscitation course. 4. Postgraduate trainees in Family Medicine, providing locum tenens to community family physicians must not act as the duty physician in an emergency department, Collaborative Emergency Centre (CEC) or urgent care facility. 5. Applicants must provide proof of CMPA coverage for providing locum tenens. 6. Applicants should notify Doctors Nova Scotia that they have a postgraduate practising licence to provide locum tenens.

5 Registration Policies SECTION POLICY NAME APPLICABLE LEGISLATION Approved by : REGISTRATION Postgraduate Practising Licence Regulations Pursuant to the Medical Act - Sections 22 through 26 Approval Date Reviewer Review Date COUNCIL CREDENTIALS December 10, 2010 Deputy Registrar (Registration) December Applicants may need to contact Nova Scotia s billing agency, Medical Services Insurance (MSI), for a billing number for payment purposes. 8. Applicants are not recognized as specialists by the College. Fees: Please refer to the College s Fee Schedule.

6 Postgraduate Practising Licence External Moonlighting NAME: _ Surname First & Middle Names MAILING _ ADDRESS: Street address, Apt/Ste #, PO Box _ City/Town Province Postal Code CONTACT PHONE #: ADDRESS: MEDICAL SCHOOL WHERE YOU ARE CURRENTLY TRAINING: TRAINING PROGRAM: YEAR OF TRAINING: PROGRAM DIRECTOR: CPSNS EDUCATIONAL LICENCE # : FOR PROGRAM DIRECTOR: THE FOLLOWING DOCUMENTATION MUST BE RECEIVED BY THE COLLEGE S REGISTRATION DEPARTMENT PRIOR TO A LICENSE BEING GRANTED: Your Programme Director s approval and endorsement for a Defined License for Postgraduate Trainees (must include date and location of moonlighting) Evidence of Canadian Medical Protective Associate (CMPA) for providing locum tenens [CMPA Code 14 - Residents with Moonlighting] Photocopy of your medical diploma/degree Photocopy of your LMCC registration certificate ACLS/ATLS/Advanced Airway Course [please refer to the accompanying policy] Neonatal Resuscitation Course (for Obstetrical locum tenens) [please refer to the accompanying policy] Confirmation of supervision from the physician or hospital (Department Head) where the locum will be performed. The plan for supervision should be submitted to the College (on the enclosed supervision agreement form) for approval prior to the locum period. Documented evidence of approved hospital privileges in Nova Scotia (if applicable) (this will come directly from the district health authority) Registration Fee [payable once per academic year] PLEASE REFER TO CPSNS FEE SCHEDULE This will confirm that I have read the policy regarding resident moonlighting and that I understand that I must receive confirmation from the College of Physicians and Surgeons of Nova Scotia that the licence is in place prior to starting any moonlighting/locum work. Signature Date 2013

7 Postgraduate Practising Licence (Resident Moonlighting ) Supervision Agreement Form (TO BE COMPLETED BY SUPERVISING PHYSICIAN) RESIDENT NAME: _ PLEASE PRINT NAME IN FULL, SURNAME FIRST I hereby confirm that I have read the policy (see attached) regarding resident moonlighting. Training Program Signature of Resident Year of Training: Date SUPERVISOR NAME: PLEASE PRINT NAME IN FULL, SURNAME FIRST USUAL WORKING ADDRESS: CONTACT PHONE #: ADDRESS: SCOPE OF PRACTICE FOR LOCUM: LOCATION of LOCUM: TIME FRAME FOR LOCUM: TO END OF CURRENT ACADEMIC YEAR_ OR START DATE STOP DATE SUPERVISION PLAN: It is generally expected that the supervisor will be located within the same physical facility as the postgraduate trainee. Direct supervision must be available in a timely fashion (generally minutes away at any time) when a postgraduate trainee is providing locum services. I hereby confirm that I have read the policy (see attached) regarding resident moonlighting. Signature of SUPERVISOR Date 2015

8 Fee Payment Information College of Physicians and Surgeons of Nova Scotia fees can be paid in the following ways: - Cheque or money order - Cash (if paying in person) - Credit Card (VISA and Master Card only) * Cheques returned by the bank for non-processing will be charged an administration fee. Replacement payments must be made by money order, certified cheque or cash and include the administration fee. Refer to the College s website for the fee schedule. IF YOU ARE PAYING BY CREDIT CARD PLEASE PRINT, COMPLETE AND SUBMIT THE FOLLOWING FORM: VISA MASTERCARD Amount of Payment: _ Credit Card Number: _ Expiry: Cardholder s name as it appears on the card:_ (please print) Signature of Cardholder: Please indicate who this payment is for if not for the card holder FOR OFFICE USE ONLY: Physician Other Received by: _ Date: For: _ Processed by: _ Date: Receipt issued by: _ Date: Receipt # Breakdown of fees: Code Amount Code Amount

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