The associate physician licence in British Columbia

The associate physician class is a restricted licensure that permits a physician, with medical training acceptable to the College of Physicians and Surgeons of British Columbia (CPSBC) and who is not eligible for any other class of licensure, to practise under supervision in accredited structured team-based care. There is a single associate physician licence; eligibility and training requirements vary with the setting in which the associate physician will practise: acute care, community primary care, or surgical assisting.

Acute care category

• Setting: This category is designed for hospital-based settings, where health care is provided to patients with severe or urgent conditions.

• Scope of practice: Associate physicians in acute care typically work in emergency departments, intensive care units, or other hospital wards where they provide hands-on care to patients in critical condition. Their work is highly focused on managing acute, life-threatening conditions.

• Supervision: Since the work involves high-stakes medical situations, acute care associate physicians must operate under close supervision by a fully licensed physician, especially because they often deal with complex cases requiring immediate and precise medical intervention.

Community primary care category

• Setting: This category applies to outpatient settings, where care is delivered in community clinics, family practices, or other non-hospital environments.

• Scope of practice: Associate physicians in primary care focus on managing general health concerns, chronic diseases, preventive care, and routine check-ups. They typically see a broad range of patients, from children to the elderly, addressing various non-emergency medical issues.

• Supervision: Supervision in primary care is also required, but the nature of the work, which is less acute and more focused on ongoing management of patient health, means that it can be somewhat less intensive than acute care. Nevertheless, the associate physician is still required to consult with a supervising physician, especially for more complex cases. 

Surgical assisting category

• Setting: This category applies to surgical settings, where the associate physician assists during procedures in the operating room.

• Scope of practice: Associate physicians practising as surgical assistants support the operating surgeon during surgical procedures. Their duties are limited to those set out in the approved job description of their accredited program.

• Supervision: As in the other categories, surgical assistants work under the direction and supervision of an attending physician.

Key differences

• Type of care: Acute care deals with urgent, life-threatening conditions in a hospital, primary care is about long-term, general health management in a community setting, and surgical assisting is limited to supporting surgical procedures in the operating room.

• Level of supervision: Associate physicians in all three categories require supervision. The initial evaluation period set by CPSBC is 12 weeks for associate physicians in acute care settings or practising as surgical assistants, and six weeks for associate physicians in community primary care settings.

Associate physician registration may be granted to physicians who are not otherwise eligible for registration in the provisional or full class as determined by the registration committee, and who are practising under the direction and supervision of an attending physician. An associate physician may only practise in an associate physician program and may not be the most responsible physician.

Under section 6-39 of the CPSBC Bylaws, made under the Health Professions and Occupations Act (British Columbia), to be granted an associate physician licence, an applicant must:

• Have a medical degree from a school listed in the World Directory of Medical Schools

• Submit with the application a sponsorship letter from a health authority, satisfactory to the Licence Committee, that:

• Identifies the applicant’s sponsor

• Describes how the applicant will engage in the practice of medicine

• Notes that the applicant will be working under the direction and supervision of an attending physician

• Have completed, before applying for licensure, a minimum of one year of accredited training:

• As a medical or surgical specialist, if practising in an acute care setting

• As a general practitioner, if practising in a community primary care setting

• As a medical or surgical specialist or a general practitioner, including four weeks of surgical training (excluding obstetrics and gynecology), if practising as a surgical assistant

• Be current in clinical practice, defined as a minimum of 960 hours (24 weeks full-time) within the preceding three years, at the time of licensure. Applicants who have secured employment with a health authority may be eligible to complete a period of retraining to regain currency. Work in associate physician or clinical assistant roles does not count towards currency for independent practice.

• Have Canadian citizenship, be a permanent resident, or be legally able to live and work in British Columbia

Associate physicians must limit their practice to the provision of services in connection with fulfilling the terms set out in their sponsorship letter. An associate physician licence is cancelled if the licensee ceases to engage in the practice of medicine in accordance with the terms of the program accreditation; if sponsorship is withdrawn because of competency concerns; if sponsorship is withdrawn for other reasons and an alternative sponsor is not identified within seven days; or if the program loses its accreditation or there is a substantive change to the associate physician's job description.

Prescreening assessment

1. In your email to Health Match BC:

   1. Outline your interest in employment opportunities

   2. Include a recent curriculum vitae (CV)

2. Health Match BC will work with eligible candidates to:

   1. Apply for open positions as they are made available

   2. Assist successful applicants with submission of a registration package to CPSBC

3. Request for preliminary assessment by CPSBC:
   Health Match BC will forward the application documentation to CPSBC for preliminary assessment. The application documentation must include a job description of an accredited associate physician program.

4. Eligibility review by CPSBC:
   CPSBC reviews the preliminary assessment documentation to determine the applicant's initial eligibility for the associate physician licence.

5. Applicants will receive a letter two weeks after CPSBC receives the preliminary assessment documentation from Health Match BC. The letter outlines the pre-licensure requirements that the applicant must meet.The preliminary assessment of eligibility is valid for one year from the date it is granted, unless otherwise directed by CPSBC.

6. Meeting the pre-licensure requirements:
   The applicant must fulfil pre-registration requirements (mentioned above) outlined in the letter, including providing either a sponsorship letter or a contract of supervision that confirms employment and program accreditation.

7. Processing the application:
   If no additional follow-up is required, the file manager will submit the candidate file for a final review and approval.

8. Application package:
   The file manager will email an application package to the applicant. The applicant submits to CPSBC a completed application along with required documentation. This step will take a minimum of six to eight weeks. The file manager will review the completed application to ensure that no additional follow-up is required.

Registration and licensure

A licence is issued once the file is approved and the annual licence fees are paid. Licensure in the associate physician class is contingent on the following:

1. Submission of a complete application for licensure package

2. Submission of written documentation confirming that the employment position offered to the associate physician applicant is in a health authority associate physician program that has been accredited by CPSBC

3. Sponsorship letter from the health authority that confirms employment for the applicant in the accredited associate physician program

4. Compliance with the requirements for licensure under the Health Professions and Occupations Act and related CPSBC Bylaws.

5. The health authority obtains and maintains program accreditation