POLICY - Licensure of Physicians to Work in Limited Roles

This policy applies to alternative forms of licensure to physicians who do not meet the normal criteria for independent registration. Such physicians will be restricted to working in tertiary hospitals under supervision.

1. Guiding principles

a) Insofar as possible and practical, physician who seek to be licensed to work in limited roles in tertiary care centers should be required to follow the same processes for registration as physicians who seek to be licensed to engage in independent practice;

b) Programs to provide licensure for physicians to work in limited roles should ensure that the care provided by physicians working in such programs should be equivalent to the care provided by fully licensed physicians.

2. Requirements of the Saskatchewan Health Authority who seek to have such physicians licensed

If the SHA who seeks to establish a program to hire physicians who do not meet the normal criteria for independent registration to work in tertiary hospitals under supervision will be responsible to prepare information about the proposed program for consideration by the College. The information should include, at a minimum, the need for such a program, a general description of the training and experience that the SHA anticipates will be required of candidates, the certifications or qualifications that will be required of candidates, the roles and responsibilities of the physicians who will work in the program, the skill set that the physicians will be required to have in order to work in the position, the methods that will be used to assess the skills and knowledge of the physicians who will be hired to work in the program, and the reports that it will provide to the College.

The description of the skill set can form the basis for the assessment to determine if the physician who has been accepted by the SHA has the necessary skills to perform in that role.

The description of the role and responsibilities should be detailed and should address the following matters, among others:

a) Can the physician give independent orders, or only implement and modify the orders of other physicians?

b) Whether the physician will independently work up patients by examination, communicating with the patient, ordering tests, etc.;

c) Details of the supervision and the responsibility of the supervisor(s);

d) A detailed description of the working relationship with the other  physicians working within the facility.


3. Proposals from the SHA to license physicians in restricted roles

Proposals will be reviewed by the Registrar who will have the authority to accept or reject such proposals.

4. Minimum requirements for physicians to be eligible to be considered for licensure in a restricted role

Physicians seeking licensure for such positions shall have:

a) A medical degree from a university listed in either the WHO or FAIMER directory

b) Current ACLS or an equivalent program in resuscitation appropriate for the physician's domain of practice

c) MCCEE (MCCQE1 after June 30, 2019)

d) Proof of English proficiency

e) If the physician has not attended a course in history taking and a course in physical examination skills, the SHA will be required to include training and assessment in history taking and physical examination skills as part of the orientation to the position and  provide a report of their assessment of the physician’s skills and knowledge

All such physicians should be required to attend the history taking course and the physical examination course offered by Continuing Professional Learning, Saskatchewan at the first opportunity after licensure.

5. Assessments of physicians working in limited roles.

Types of licensure

Initially, the SHA will be required to provide information to the College to demonstrate that the physician has the necessary skills and knowledge to perform the role defined in the information from the RHA.

Based upon that information the College can:

a) issue an educational licence to permit the physician to engage in an assessment program prior to making a decision to grant or refuse a licence to practise in the restricted role defined in the program information from the RHA;

b) grant a provisional time-limited licence to practise in the restricted role defined in the program information from the SHA; or

c) refuse a licence.

The physician, after having been granted a provisional time-limited licence to practise in the restricted role defined in the program information from the SHA will be required to undergo a thorough assessment. This assessment should involve more than the physician(s) who has direct supervisory responsibility. The assessment should include part of the assessment being done in another centre.

The initial period of provisional time-limited licensure should be for a defined period, with a new licence only being granted at the end of the period if the College is satisfied that a new licence should be granted, based upon the information provided by the Regional Health Authority.

After a period of two years of successful practice the SHA will conduct a final, more  thorough, 360 assessment that will input from all physicians who work with the physician assessed {not only the supervising physician(s)}, and also from nurses and others, and a chart review to assess the quality of care provided by the physician. The SHA must provide this report to the College who will review the report to determine if an indefinite licence should be granted.

Provided the physician is successful in this final assessment, the physician should be licensed on an indefinite licence.

The indefinite licence that will be granted will restrict the physician to working within the roles and responsibilities set out in the information provided by the SHA, and described in paragraph 2 above. A physician or SHA who seeks to expand or change the roles and responsibilities of a particular physician, or of the physicians working within the program, must apply to the College for an amendment of the terms and conditions of the physician’s licence.  If the SHA seeks to change the roles and responsibilities of physicians working within the program from that described in the information provided under paragraph 2 above, the College may require the SHA to seek an amendment to the approval granted for the program.

6. Decisions to grant, extend and refuse licensure

The responsibility to make these decisions will lie with the Registrar’s office, consistent with the current legislation, bylaws and policies relating to licensure of physicians. 


. Title to be used for such physicians

The College will refer to physicians who are licensed to work in restricted roles as described above as “clinical assistants”.

Approved by Council, November 2007
Amended by Council, September 2010
Reviewed and confirmed November 2013
Reviewed November 2018
To be reviewed November 2023