CPSO released proposed changes to registration policies that seek to expand access and reduce existing barriers to practise independently in Ontario for U.S. board-certified physicians and U.S. physicians deemed eligible to sit a U.S. Specialty Board examination. The changes put forward in the newly titled draft, Alternative Pathways to Registration for Physicians Trained in the the United States, are the result of CPSO’s efforts to review its registration policies, and determine whether additional registration pathways can be found to improve access for IEPs seeking license to practise independently in Ontario. The changes would remove existing supervision and assessment requirements for physicians who are Board Certified in the U.S., enabling them to begin practising in Ontario to their full scope immediately. This removes a barrier and helps increase mobility from the U.S. Given the broad similarities in training programs between the U.S. and Canada, and the historical experience with current assessment processes, Council believed the current supervision and assessment requirements were unnecessarily burdensome. The draft policy also introduces a new pathway for U.S. physicians who completed their residency training and are eligible for their relevant board examinations. It considers enabling those physicians to come to Ontario and practise under supervision, while they complete their U.S. Exams. CPSO already has a similar route for College of Family Physicians of Canada (CFPC) or Royal College of Physicians and Surgeons of Canada (RCPSC) exam-eligible applicants, and the draft contemplates mirroring this process for U.S. trainees.

Proposed New Pathways to Registration

The proposed amendments aim to address the following groups of physicians:

1. U.S.-trained physicians certified by a U.S. Specialty Board (“board-certified”); and
2. U.S.-trained physicians eligible to sit a U.S. Specialty Board examination (“board-eligible”).

U.S. board-certified physicians Currently, U.S. board-certified physicians are captured under Pathway A of the Alternative Pathways to Registration policy, and can obtain licensure to practise independently in Ontario after completing a minimum of one-year supervised practice and an assessment. The draft policy modifies Pathway A to grant U.S. board-certified physicians a restricted certificate to practise independently in Ontario without the requirement of supervision or assessment. U.S. board-eligible physicians Currently, U.S. board-eligible physicians are not captured under an alternative pathway to registration. The draft policy sets out Pathway C to grant physicians deemed board-eligible a time-limited, restricted certificate of registration to complete the U.S. board exam. The proposed certificate would expire within three years, if the physician has not successfully written the board exam, mirroring CPSO’s existing Restricted Certificate of Registration for Exam Eligible Candidates policy. Upon successfully obtaining board certification, these physicians would be granted licensure under the draft Pathway A. Currently, physicians not certified by CFPC or RCPSC are not able to use the specialist title, unless CPSO grants them the ability to do so. Associated changes to the draft Specialist Recognition Criteria in Ontario policy were made to grant both groups of physicians specialist recognition in Ontario.

Acceptable Qualifying Examinations Policy Approved

CPSO formally approved removing additional barriers on our Acceptable Qualifying Examinations policy, which allows individuals a path to an independent certificate without completing the Licentiate of the Medical Council of Canada (LMCC) qualification. The original policy required applicants who completed examinations and obtained a qualification other than the LMCC to be subject to certain restrictions, which included requiring the physician to practise with a mentor and/or supervisor until they successfully completed an assessment. Before receiving formal approval, the draft policy — like all our proposed changes to registration policies — was circulated to the Ministry of Health, the coordinating minister under the Ontario Labour Mobility Act, 2009, and the Medical Regulatory Authorities in Canada. No feedback was received on the proposed changes.

Summary of Changes

Physician Category	Current Route and License	Proposed Route and License
U.S. board-certified physicians	Pathway A: Restricted certificate to practise independently after a minimum of one-year supervision and assessment, limited to scope of practice.	Pathway A: Restricted certificate to practise independently without supervision and assessment, limited to scope of practice.
U.S. board-eligible physicians	N/A	Pathway C: Time-restricted (three years) certificate to practise under supervision until completion of U.S. Specialty Board examination.