Overview of the CPSO Registration Process for Physicians

Overview of the CPSO Registration Process for Physicians

W

e are often approached by clients who wish to obtain a license to practice medicine in Ontario, and who are having registration issues or problems at the College of Physicians and Surgeons of Ontario (CPSO). Such clients often include recent medical graduates such as International Medical Graduates (IMGs), foreign-trained physicians, and physicians licensed in other provinces.  

In order to practice medicine in Ontario, a person must first obtain a certificate of registration from the College of Physicians and Surgeons of Ontario. Even fully licensed physicians in other jurisdictions must go through this process. 

To become registered with the CPSO, the applicant must submit an application package to the Registrar of the CPSO. The applications are quite lengthy, and include questions about education and other credentials such as qualifying tests. Physicians coming from other jurisdictions must also answer questions about their discipline history in that jurisdiction, including answering questions about prior complaints, investigations, and discipline proceedings against them. It is a CPSO policy to request a criminal background check from every applicant.  

Each applicant wishing to obtain a license to practice medicine in Ontario must meet “non-exemptible requirements” set out in O. Reg. 865/93: REGISTRATION, a regulation under the Medicine Act, 1991, S.O. 1991, c. 30. The non-exemptible requirements are as follows: 

2. (1) It is a non-exemptible standard and qualification for a certificate of registration that the applicant’s past and present conduct afford reasonable grounds for belief that the applicant,

(a) is mentally competent to practise medicine;

(b) will practise medicine with decency, integrity and honesty and in accordance with the law;

(c) has sufficient knowledge, skill and judgment to engage in the kind of medical practice authorized by the certificate; and

(d) can communicate effectively and will display an appropriately professional attitude.  O. Reg. 865/93, s. 2 (1).

 

The applicant must submit the application to the Registrar of the CPSO. Once the Registrar has received and reviewed the application, the Registrar has two options: to register the applicant and issue a certificate of registration, or to refer to the matter for consideration to the Registration Committee.

The Registrar of the CPSO can refer the matter to the Registration Committee if, among other possibilities, the Registrar has doubts that the applicant has met the registration requirements, including the non-exemptible requirements set out above.

The Registration Committee consists of a panel of both physicians and non-physicians.

The applicant is entitled to notice from the CPSO if the Registrar has referred their application to the Registration Committee. The applicant is also entitled to make written submissions to the Registration Committee – that is, to provide a written statement about why the applicant has met all relevant conditions of registration. Providing persuasive and clear written submissions to the Registration Committee is one of the most important parts of the registration process for any applicant.

After considering all the evidence and the written submissions, the CPSO Registration Committee will issue its decision. The Registration Committee can (1) direct the Registrar to issue a certificate of registration; (2)  direct the Registrar to issue a certificate of registration if the applicant successfully completes further training; (3) direct the Registrar to issue a certificate of registration with terms, conditions and limitations; or (4) direct the Registrar to refuse to issue a certificate of registration. 

The Registration Committee will issue reasons for its decision, which explain why it made its decision.  

An applicant has the right to appeal a decision of the Registration Committee. Such appeals lie to the Health Professions Appeal and Review Board (HPARB). The HPARB is a government-funded independent body constituted by members of the public who are not health care professionals. 

An applicant can require the HPARB to conduct either a review or a hearing. The applicant has 30 days from the date they receive a decision to commence an HPARB appeal or review. On HPARB review, the board re-considers the documents which were before the Registration Committee. In contrast, an HPARB appeal is a full hearing, involving live witnesses and oral argument by the applicant or by the applicant’s lawyer. The CPSO is a party to an HPARB appeal or review, and is typically represented by a lawyer who defends the Registration Committee’s decision. 

Following a review or appeal, the HPARB can require the Registrar to issue a certificate of registration, overriding the Registration Committee’s decision. However, HPARB can only do this if it finds that the Registration Committee “exercised its powers improperly”. If the Board finds that the Registration Committee erred without exercising its powers improperly, the Board will likely remit the matter back to the Registration Committee for re-consideration, taking into account the HPARB’s comments. The HPARB can also confirm the Registration Committee’s decision. 

It is important to seek legal advice on registration issues as early in the registration process as possible. It is especially important not to wait until the appeal stage to seek legal advice. Well-argued submissions to the Registration Committee can help avoid a proceeding before HPARB in the first place, potentially allowing the applicant to become licenced with the CPSO much sooner.  

Some special considerations apply to physicians who are licensed to practice medicine in Canada but outside Ontario (sometimes referred to as out-of-province applicants). This is due to the Agreement on Internal Trade, to which the Province of Ontario is signatory. The purpose of the agreement is to remove labour mobility restrictions between provinces. Applicants who may fall into this category should seek specific advice on how best to approach obtaining a certificate of registration with the CPSO.