Annual Report 2014 June 2014

Transcription

1 Annual Report

2 The annual report bears the date of the fiscal year in which it was presented at the College s annual meeting. It reports on events of the preceding fiscal year (January 1 to December 31). The report may include references to events that occurred in the following year. Rev 27 Jun The College of Physicians and Surgeons of Newfoundland and Labrador 2

3 The College s Mandate The making and enforcing of measures necessary for the regulation and practice of medicine and the protection and preservation of life and health so that those seeking medical care may have every confidence in the care they receive Powers of the Newfoundland Medical Board as established in the Newfoundland Medical Act (Passed by the Legislative Council and House of Assembly of the Colony of Newfoundland, May 24, 1893) 8. (1) The college is authorized to regulate the practice of medicine and the medical profession in the public interest. (2) The objects of the college include (a) the promotion of (i) high standards of practice, and (ii) continuing competence and quality improvement through continuing medical education; (b) the administration of a quality assurance program; and (c) the enforcement of standards of conduct The Medical Act,

4 Table of Contents Message from the Registrar 5 About the College 9 Major Initiatives 11 The Council of the College 17 Licensing and Registration 19 Legislative and Regulatory Affairs 25 Complaints Resolution 29 Quality Assurance 31 Appendices 35 4

5 Message from the Registrar Put simply, the role of the College can be succinctly stated as protection of the public and regulation of the profession. It has been my privilege, indeed an honour, to have had the opportunity to serve the public and the profession from the position as Registrar of the College. Surprisingly, there have been only eight Registrars in the 121 years since 1893 when the Newfoundland Medical Board (now continued as the College) was established as a statutory body by the Legislative Council and the House of Assembly of the Colony of Newfoundland. The legislation stated the following powers for the Medical Board: The making and enforcing of measures necessary for the regulation and practice of medicine and the protection and preservation of life and health. so that those seeking medical care may have every confidence in the care they receive The longest serving Registrar was Dr. Cluny Macpherson who held the position for 30 years from Dr. Macpherson is renowned for his participation in the development of the gas mask in 1916 during World War I. In October past, I notified Council that I would be retiring in Council struck a committee to conduct a search for my replacement. The committee engaged the services of Knightsbridge Robertson Surrette, an executive search firm. Following a confidential and rigorous search, Council announced on May 28, 2014 that Dr. Linda Inkpen had accepted the position as Registrar effective September 15, Dr. Inkpen is highly respected within the College, throughout the medical profession, as well as the community at large, for her knowledge of the profession, her business experience and her strong leadership skills. On a personal note, I welcome Dr. Inkpen s appointment and I know I leave the College in excellent hands. The past year has been an active one at the College. Activities have included the drafting of amendments to the regulations under the Medical Act, 2011 regarding registration and licensure of physicians as well as regulations for educational registration. These regulations are almost finalized and ready for enactment. A policy which speaks to guidelines and standards of practice for physicians who test positive for blood borne pathogens was finalized and circulated to members of the profession earlier this year. This policy addresses specifically the hepatitis B virus, the hepatitis C virus and the 5

6 human immunodeficiency virus. All physicians are expected to be familiar with the policy and to follow the guidelines and standards as applicable to their individual circumstances. The College also consulted with the Faculty of Medicine at Memorial University concerning the development of the faculty s policy regarding blood borne pathogens. An advisory and interim guideline was also released to physicians further to the provision of the federal Marihuana for Medical Purposes regulations. The advisory explained the College s position on the use of marihuana for medical purposes. The guideline explained the College s expectations of physicians regarding prescribing, as well as dispensing, of marihuana. Implementation of the Methadone Maintenance Treatment Policy is a work in progress with regular consultations of the College with physicians, patients and the Pharmacy Board regarding interpretation of the standards and guidelines. Physicians continue to notify the College regarding patients who are entered into, or removed from, treatment. There are currently over one thousand (1,000) names on the patient list who are receiving methadone maintenance treatment. For more information regarding all of the above matters and other activities of the College during the past year, please read the entire annual report which was prepared, further to the Medical Act, 2011, for submission to the Minister of Health and Community Services. This is my last annual report to College. Before closing, I do want to take the opportunity to express my sincere appreciation to my assistant, Carmelita O Brien as well as the other members of the staff at the College for their competent work and dedication in performing the duties of the College in a professional and confidential manner. I also want to express my appreciation to Dr. John Collingwood, the Deputy Registrar, as well as Dr. Nigel Duguid and Dr. Robert Williams, the Assistant Registrars. They have fulfilled, in a superb manner, their responsibilities concerning the complaints and discipline process, as well as registration and licensure. Finally I would like to thank members of the Council, who have faithfully attended the many meetings of Council and Committees, often on short notice and at inconvenient times. Many thanks to you all. 6

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8 Council of the College Dr. John Campbell Dr. John Collingwood Dr. Nigel Duguid Ms. Gail Hamilton Dr. James Hickey Dr. Susan MacDonald Dr. Gurmit Minhas Dr. William Moulton Dr. Vinod Patel Dr. Arthur Rideout Ms. Paula Rogers Mr. John White Dr. Robert W. Young Officers of the College Dr. Gurmit Minhas Dr. Robert W. Young Dr. John Collingwood Chair Registrar Deputy Registrar Senior Staff Dr. Nigel Duguid Dr. Robert Williams Mr. Ed Hollett Mr. Jamie Osmond Assistant Registrar Assistant Registrar Director of Communications Director of Quality Assurance Legal Counsel Stewart McKelvey, LLP Auditor Sharon M. Dunn, CA 8

9 About the College Council of the College of Physicians and Surgeons of Newfoundland and Labrador, Seated, left to right, Dr. Vinod Patel, Dr. John Collingwood, Deputy Registrar, Dr. Robert Young, Registrar, Dr. Gurmit Minhas, Chair, Ms. Paula Rodgers, Dr. Nigel Duguid. Standing, left to right, Ms. Gail Hamilton, Mr. John White, Dr. John Campbell, Dr. William Moulton, Dr. James Hickey, Dr. Arthur Rideout, Dr. Linda Inkpen, Dr. Susan MacDonald. Randy Dawe photo The College is governed by a 14 member Council, including the Registrar who is an ex-officio Council member appointed by the Council. Of the remaining 13 members, seven are licensed physicians elected by their peers. Six members of Council are appointed by the Minister of Health and Community Services. Two of the Ministerial appointees are nominated by the Newfoundland and Labrador Medical Association. Three are not physicians and are appointed by the Minister to represent the public interest. One is appointed from a list submitted by the Board of Regents of Memorial University. The appointee nominated by Memorial University may or may not be a physician. The College meets its objectives through three main lines of business: Licensing and Registration, Complaints Resolution, and Quality Assurance. Licensing and Registration reviews the credentials of every physician who applies for a license to practice medicine in Newfoundland and Labrador to ensure that those who hold a license have the necessary qualifications, training and experience. Complaints Resolution responds to both formal and informal complaints regarding physi- 9

10 cians behaviour and competence. Quality Assurance is the ongoing support to licensed physicians to ensure that they continue to practice to the highest standard. QA encompasses peer review, ongoing professional development, and the maintenance of standards of practice. Quality Assurance is also responsible for the Methadone Maintenance Treatment standards and guidelines for physicians as well as administering the provincial registry of patients receiving methadone in the province to treat addictions. 10

11 Major Initiatives Regulations The College and the Department of Health and Community Services worked throughout 2013 on new regulations covering registration and licensure, educational registration, continuing education, quality assurance, disclosure, and non-hospital surgical facilities. The new regulations were the result of changes to the Medical Act in The complexity inherent in each set of regulations led the College and the Department to agree to postpone further discussion of three sets of regulations quality assurance; disclosure; and non-hospital surgical facilities and to finalize the other three. The College and the Department exchanged drafts of the regulations throughout While the College and Department originally anticipated completing the regulations by the end of 2013, worked continued into The process has been lengthy and involved many detailed meetings both at the College and with government officials. The FMRAC Standards for Medical Registration in Canada During the past year, the College has worked closely with the Department of Health and Community Services and the Legislative Council to put into place under the Medical Act, 2011, amended regulations concerning registration and licensure. These amendments were developed subject to the FMRAC Standards for Medical Registration in Canada and the Federal/ Provincial/Territorial Agreement on Internal Trade. The FMRAC document, identified as Standards for Medical Registration in Canada, is a consensus-based document agreed upon by the Medical Regulatory Authorities. The CPSNL has adopted the Canadian Standard for Full Licensure as presented in the FMRAC document. The Canadian Standard has also been adopted by all provincial and territorial regulatory authorities. Under the new regulations, physicians applying for the first time for full licensure will be required to: have graduated from an acceptable allopathic or osteopathic medical school; hold the licentiate of the Medical Council of Canada; have completed a discipline-appropriate postgraduate training program in allopathic medicine; and, have received certification from either the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada. 11

12 Also under the new regulations, all physicians applying for a provisional license are expected to satisfy the seven (7) screening requirements identified by FMRAC, including: completion of the Medical Council of Canada Evaluating Examination; demonstration of language proficiency; certification of professional conduct; producing verifiable credentials; demonstration of currency of practice; demonstration of fitness to practice; and establishing that there has been no significant length of time away from practice. All documents must be source verified. All candidates applying for a provisional license to enter family practice must have: either or or graduated from an accredited allopathic or osteopathic medical school; completed the Medical Council of Canada Evaluating Examination with satisfactory scores; and have evidence of completion of two (2) years of postgraduate training in family medicine and registration as a family practitioner in the jurisdiction where they are practicing; have completed at least one (1) year of family practice training and three (3) years of independent family practice outside Canada; have a ruling from the College of Family Physicians of Canada that the applicant is eligible to receive the CCFP based on training and certification outside Canada. Certain applicants for entry to family practice may also be required to complete a Practice Ready Assessment. Physicians applying for a provisional license to enter practice in a medical or surgical specialty as a non-canadian trained specialist must have: a medical degree from an accredited allopathic or osteopathic medical school; and have satisfactorily completed at least four (4) years of discipline specific postgraduate training; hold a verifiable document of completion of specialist training; and have been recognized as a specialist authorized to practice independently as a specialist in the country where the postgraduate training was completed. 12

13 As a consequence of the above, in this province: provisionally licensed physicians will no longer be eligible for a full license after five (5) years of practice and having obtained the LMCC; applicants will no longer be eligible for licensure to enter general practice after a one (1) year rotating internship; applicants to enter non-certified specialist practice will not be required to pass the Medical Council of Canada Evaluating Examination. For a more detailed and specific explanation of registration and licensure requirements, physicians are referred to the FMRAC document, Standards for Medical Registration in Canada. When the new regulations are enacted, it is intended that physicians, who are provisionally licensed to enter practice, will, before entering practice, be required to complete an orientation at the College as well as a practice-based orientation at the regional health authority. Also on entering practice, all provisionally licensed physicians will first enter supervised practice for a varying period of time. They will then advance to independent practice with support from a colleague. At the discretion of the College and the sponsoring Regional Health Authority, physicians will continue independent practice with oversight of their practice performance with periodic reports sent to the College and to the regional health authority. These reports will continue until the physician has been granted the licentiate of the Medical Council of Canada and certification from either the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada. At this point physicians will be eligible for a full license. However, after five (5) years of continuous licensure and practice, a provisionally licensed physician will be eligible for a full license without achieving the Canadian Standard provided the physician has: successfully completed the Medical Council of Canada Qualifying Examination Part I; and obtained Certification from either the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada. *Applicants for a provisional license to enter practice in a medical or surgical specialty may not be required to have completed the Medical Council of Canada Evaluating Examination. 13

14 Blood Borne Pathogens During the past year, the College developed a policy with guidelines and standards of practice for physicians who tested positive for blood borne pathogens. The policy speaks specifically to infection with the hepatitis B virus; the hepatitis C virus; and the human immunodeficiency virus. All physicians, including medical students and residents, are expected to be familiar with the policy and to follow the guidelines and standards as applicable to their individual circumstances. This policy is intended to safeguard the health of both patients and physicians in relation to blood borne virus infections, and to minimize the risk of exposure to blood borne pathogens during the provision of care. As a guideline, all physicians and in particular all physicians performing or assisting in the performance of exposure-prone procedures * have an ethical obligation to know their serological status for these blood borne pathogens. They also have an ethical obligation to be tested as recommended by a physician familiar with the treatment of blood borne pathogens if they have engaged in personal at risk behaviors or have had potential exposure to a blood borne pathogen. As a standard of practice, if a sero-positive physician wishes to continue performing or assisting in exposure-prone procedures, the physician must report to the Director of the Quality Assurance Program (the Director ) of the College. The physician will be referred to the Expert Blood Borne Pathogens (BBP) Committee of the College, to evaluate the physician s practice and health information and to determine what precautions and restrictions, if any, are required to safeguard patient health. Referral by the Director to the Quality Assurance Committee and to the Expert BBP Committee will be on a non-nominal anonymous basis. The Expert BBP Committee is appointed by the Council of the College and will be comprised of experts in public health, infection prevention and control, and other experts as required. The Blood Borne Pathogens Expert Panel of the College of Physicians and Surgeons of Nova Scotia has agreed, for the present, to fulfill this role for the College. The College requires, as a standard of practice, that all physicians, both sero-positive and seronegative, adhere to routine practices, formerly referred to as universal precautions, and if sero -positive, to also take other measures as advised by their treating physician and as required by this policy. As a standard of practice, a sero-positive physician who wishes to perform or assist in the performance of exposure-prone procedures must be under the care of a treating physician who has expertise in the management of the specific infection and must follow the recommenda- 14

15 tions of the Expert BBP Committee. As a guideline, it is strongly recommended that all practicing physicians be immunized against hepatitis B virus, unless a contraindication exists, or there is evidence of prior immunity. Marihuana *For a definition of exposure-prone procedures, please visit the College s website at and review the policy on Blood Borne Pathogens. Appendix B of the policy provides examples of exposure-prone procedures. In 2013, the Government of Canada introduced new regulations governing the use of marihuana for medical purposes as well as interim policy that covered the period before the new regulations came into force on April 01, The Federation of Medical Regulatory Authorities of Canada (FMRAC) represented the medical regulatory bodies in expressing concern to the Government of Canada about the regulations. The Council of the College strongly supported FMRAC s position, expressed in a joint statement by FMRAC and the Canadian Medical Association issued in FMRAC and the member Colleges began work in November on guidelines for physicians to take effect on April 1, By that date, all Colleges had adopted guidelines or regulations on prescribing and/or dispensing marihuana to patients. CPSNL issued its advisory and interim guideline on 31 March 2014 and posted it to the College s website.: The College s view is summarized in the advisory and interim guideline: This College, and the other Colleges of Physicians and Surgeons across Canada, have expressed to Health Canada their concerns about the federal Regulations. In the view of the College, those concerns have not been addressed. The College believes that physicians should not be expected to facilitate patient access to a substance, for medical purposes, for which there is no body of evidence of clinical efficacy or safety. As well, medical standards and guidelines for prescribing of marihuana, addressing issues such as standardized dosage or quality control, are lacking. The amount of active ingredients in marihuana varies significantly, depending on the origin and method of production of the substance. Also, many uncertainties remain about the effects, whether considered beneficial or harmful, of marihuana use. In light of these concerns, the College believes physicians will be at increased risk of allegations of negligence and malpractice if they facilitate an individual s access to ma- 15

16 rihuana for medical purposes, as compared to the prescribing of drugs and treatments for which there is a recognized scientific body of evidence of clinical efficacy or safety. The College is monitoring the approaches being developed by medical regulators across Canada regarding this issue. The College believes it is premature at this time to publish standards of practice regarding the facilitation by physicians of access to marihuana for medical purposes, as this could be interpreted as the College supporting or legitimizing this practice. Despite these concerns, however, the College has an obligation to advise physicians regarding the College s expectations, if they are considering undertaking this gate keeper role. 16

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18 Council Election The Council of the College The College advised members by mail on September 4, 2013 of an election for four seats on Council to be held on December 9. Nominations closed on October 10, 2013.with only the names of the incumbents nominated. Dr. John Collingwood and Dr. Arthur Rideout were re-elected by acclamation to the Council of the College representing the region of the City of Mount Pearl and the City of St. John s. Dr. John Campbell and Dr. Gurmit Minhas were re-elected by acclamation to the Council of the College representing the remainder of the province. A Change at the Top In October 2013, Dr. Young advised the Council of the College that he would be retiring in the New Year. Council struck a committee and engaged Knightsbridge Robertson Surrette to help identify and screen prospective candidates. Due to the confidential nature of this process, it is not known how many applications were received and how many candidates were interviewed. Once the process was completed, the College announced on May 28, 2014 that Dr. Linda Inkpen will succeed Dr. Robert Young as Registrar effective September 15, Dr. Inkpen is respected within the College and throughout the medical profession for her knowledge of the profession, her business experience, and her strong leadership skills. Dr. Robert Young will retire as Registrar effective September 12, Dr. Young s career with the College spans 38 years, including 24 years as Registrar. As part of the transition process, Dr. Inkpen will consult with Dr. Young over the coming months. In a memo to physicians across the province, Dr. Gurmit Minhas, chair of the Council of the College said: "We are very proud of what we have achieved at the College under Dr. Young s leadership. The College takes this opportunity to thank Dr. Young for his exemplary leadership and tremendous contributions over the past three decades. Dr. Young will leave the College with a strong foundation; well-positioned for its work in the years ahead." 18

19 Licensing and Registration Figure 1: Total Annual Licenses, Since 2006, the total number of annual licenses issued by the College has increased steadily, including two larger-than-usual increases in 2011 and again in Annual licenses include the number of licenses issued during the year to new applicants as well as renewals for physicians who already held a license in the province. 19

20 Total Annual License New and Renewals Full Provisional Total New Registration/Licenses Full Provisional New Specialist Registration New Non-Canadian Certified Specialists Assessment of Applications Full Licensure Provisional Licensure Professional Medical Corporations Table 1: Annual Registration and Licensure Statistics ( ) Note that the College calculates the figures from fees paid during the calendar year. The slight variation between the statistical information presented in this section and the appendices results from the differing method of counting used in each section. For more information, please see the explanatory note accompanying the appendices. 20

21 Pre-Application Assessments Applications New Licenses Issued Table 2: Pre-Application Assessment ( ) Note that the College calculates the figures from fees paid during the calendar year. The slight variation between the statistical information presented in this section and the appendices results from the differing method of counting used in each section. For more information, please see the explanatory note accompanying the appendices. 21

22 Figure 2: Current full-time physicians by year of birth. The vertical axis shows number of physicians born in a particular decade shown on the horizontal axis. Thus, two physicians currently practicing were born between 1920 and

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29 Complaints Resolution The Complaints Authorization Committee continues to be busy and productive. Since the last annual report the Committee has had separate meetings and has reviewed 135 files. Following a review of the allegation records and discussion 46 allegations were dismissed and 24 were dismissed with advice. There were two allegations referred back to the Registrar instructing him to refer them to the Disciplinary Panel, and eight allegations resulted in a caution and counsel being given to the physician. The Committee directed the investigators to conduct further investigation on 55 separate files and on seven occasions directed the respondent physician to appear before the Committee or the investigator. During the 12 month period, 77 allegations were concluded and the complainants and the respondent physicians were notified in writing of the Committee s decision. The average time that it has taken to complete the allegations has remained stable over the last 12 months and this is approximately 19 months from the time the complaint is received to when the decision has been provided. Of the 77 allegations completed, two were received in 2010 and 10 were received in 2011 with the remaining 65 being received by the College in either 2012 or The investigators continue to try and resolve the issues in a very timely fashion, however, we still have two files that predate It was interesting to note that the shortest time to complete an allegation was seven and one-half (7½) months and the longest was just over 42 months. As noted in previous reports to the annual general meeting by Dr. John Collingwood, the chairman of the Complaints Authorization Committee, the nature of the allegations has become more complex. Dr. Collingwood has noticed an increase in the number of physicians that are filing allegations against their colleagues, and also that there are more complaints by a single complainant against several physicians that was previously the case. Legal counsel for the College is preparing a handbook for the CAC to assist CAC and staff in addressing complaints. The Committee looks forward to this document being available for assistance as they deliberate. 29

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31 Quality Assurance Ensuring quality of practice, ensuring quality of care The College is committed to ensuring that physicians in the province maintain the highest standards of practice and patient care. The College supports physicians in providing quality care through the Quality Assurance program. Quality Assurance implements policies aimed at defining, monitoring, and improving overall practice quality. Physician Practice Enhancement The Atlantic Provinces Medical Peer Review program contributes to quality patient care through the assessment and education of physicians and the promotion of excellence in medical practices and procedures. The medical regulatory colleges and the medical associations in Prince Edward Island, New Brunswick, and Newfoundland and Labrador fund APMPR and each of the six bodies appoints one member to the programs board of directors. The College s representative on the AMPMR board is Dr. William Moulton, a family physician in Marystown and a former chair of the College s Council. Through AMPMR, experienced, trained physicians review office facilities and operations, medical records management, paramedical personnel working with the physician, and overall patient care. In 2013, APMPR physicians assed 57 physicians in Newfoundland and Labrador, split evenly between onsite visits and reviews of medical records conducted offsite. More than half of these reviews were of family physicians (32). Over the past three years, APMPR has completed assessments on 155 physicians in the province. In 2011, peer reviewers conducted more off-site assessments than on- sites 31

32 visiti but the program increased the number of onsite visits the following year to compensate. Quality Assurance Review The College has the responsibility and authority under the Medical Act 2011 to address a physician s competency and/or fitness to practice when a situation has the potential to impact patient care and safety. Through the Quality Assurance Committee (QAC), practice reviews are conducted that may result in restrictions on, or withdrawal from, practice. Under these circumstances, College imposed terms and conditions remain in force until the College is satisfied that the condition related to the health and fitness issue has been managed and/or patient safety is not impacted. The Committee s scope covers the practice of all licensed physicians as well as medical and post-graduate students. It operates under a strict policy of confidentiality; separate from all other operational processes of the College Methadone Maintenance Program The goal of the College s Methadone Maintenance Treat-ment (MMT) program is to improve the quality of methadone treatment for patients with addictions in Newfoundland and Labrador Through the development and support of Methadone Maintenance Treatment Standards and Guidelines, the College provides physicians with the generally recognized principles of patient care, as well as recommendations of best practice. Physicians in NL with a Health Canada exemption to prescribe methadone 15 Opioid Dependence (long-term) 19 Analgesic agent (full exemption) 8 Analgesic agent (single patient) Methadone Practice Assessments 4 Practice Assessments conducted In 2013, a peer review tool and process specific to MMT providers was implemented. 32

33 Noteworthy Items Quality Assurance Regulations The College continues to work closely with the provincial government on drafting new regulations specific to Quality Assurance. It is anticipated that the additional regulations will be finalized in Blood Borne Pathogens policy - In 2013, the College implemented a new policy specific to Blood Borne Pathogens (BBP). Under this policy, physicians with a blood borne communicable disease who perform or assist in performing exposure prone procedures, must inform the College of their condition and satisfy a review and the recommendations of the College s BBP Committee prior to practice continuation. Multi-Source Feedback Assessment A representative of the College chaired a working group of the Atlantic Provinces Medical Peer Review (APMPR) that explored Multi-Source Feedback as a means of improving physician performance enhancement. The committee was established to consider ways of incorporating patient and colleague input into our current peer review process. 33

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35 Appendices Note: The information contained in this section represents a snapshot of the number of licensed physicians on a given day in of each year. The numbers come from information contained in the College s database of currently licensed physicians. While there may be some minor variation at different times of the year, the numbers generally reflect the number of licensed physicians on any one day during the year. 35

36 Appendix 1: Licensed physicians practicing in Newfoundland and Labrador Full License Provisional License Restricted Provisional License Telemedicine Restricted Provisional License Residents Prescribing License (R) Restricted Provisional License Residents Locums (L) Restricted Provisional License Family Practice II (M) Restricted Provisional License Family Practice III (M) Total The number of physicians holding a full license increased by 14.5%, between 2009 and The number of physicians with a provisional license has decreased over the same period. Restricted provisional licenses for telemedicine are issued to physicians licensed and practicing elsewhere in Canada who hold a locum license in this province solely for telemedicine consultation. L. M, and R licenses are all variations of restricted provisional licensure issued to residents in postgraduate training whose names are included on the Education Register. L licenses enable residents to provide locums commonly referred to as moonlighting. M licenses apply to second and third year residents in family practice training. R licenses enables residents to write prescriptions which can be dispensed in community pharmacies for patients seen during postgraduate rotations. These prescriptions do not require a counter-signature. 36

37 Appendix 2: Full License General Practitioners Certified Specialists Non-Cdn Certified Specialists In Province Residents (F) Out of Province Residents Restricted Practice FP II or FP III (F) Anaesthesia (GP Guidelines) Public Health Clinical Associate Administration Palliative Care Emergency Medicine Total

38 Appendix 3: Provisional License General Practitioners Certified Specialists Non-Canadian Certified Specialists Anaesthesia (GP Guidelines) Restricted Practice Resident (MUN) Telemedicine Clinical Associate Palliative Care Emergency Medicine Public Health Total

39 Appendix 4: Specialists Certified (Full Licence) Certified (Provisional) Sub-total Non-Cdn Certified (Full ) Non-Cdn Certified (Provisional) Sub-Total Total Certified specialists are physicians who hold certification from the Royal College of Physicians and Surgeons of Canada. They may hold full licenses or provisional licenses based on other licensing criteria. CPSNL also recognizes specialists who hold certification from some other credentialing bodies or who have completed the necessary training but have not completed the Royal College examinations. The College considers these physicians to be non-canadian certified specialists. 39

40 Appendix 5: General Practitioners Full Licence Provisional Licence Total The number of general practitioners in the province continues to increase and currently stands at 633, compared to 582 in Appendix 6: Other Licensed Physicians Retired, Non-practicing Reside and Practice Outside Province Some retired physicians continue to hold a restricted license that enables them to prescribe medication. The license does not permit clinical practice. Other physicians who previously lived in the province maintain a license in Newfoundland and Labrador in order to return to the province and perform locums. The College refers to these physicians as Left/Renew. The number of Left/Renews is consistent with historical trends. 40

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