Notice to Profession Respecting Clinical and Physician Assistants

Due to changes in the legislation governing the regulation of Physician Assistants and Clinical Assistants in Manitoba, all Contracts of Supervision and Practice Descriptions (previously known as “Job Descriptions”) must be updated.  This will require all supervising physicians, Clinical Assistants and Physician Assistants to sign new Contracts of Supervision in substitution of the now outdated ones that would have been signed under The Medical Act.

New legislative requirements under The Regulated Health Professions Act (“RHPA”) are largely located in the College of Physicians and Surgeons of Manitoba General Regulation (“General Regulation”). Other requirements may be found in the Practice of Medicine Regulation and the Standards of Practice of Medicine.  For reference, Legislation, Acts & Regulations can be found on our website.

Significant modifications found in the new contracts include:

  • Additional description respecting the role and responsibilities of the Clinical/Physician Assistant, the Primary Supervisor, as well as any alternate or additional supervisors named in a Contract of Supervision.
  • Changes to on-site supervision requirements.
  • Reporting obligations to the College for Primary Supervisors.
  • Communication requirements between the Primary Supervisor and any alternate or additional supervisors named in a Contract of Supervision.
  • Additional description respecting practice and supervision requirements when working in a departmental or program setting.
  • New rules respecting the performance of reserved acts.

The College will be writing to all effected Primary Supervisors, Clinical Assistants and Physician Assistants in order to facilitate the transition. It is anticipated that all regulated associate members of the College will be transitioned on to the new contracts by the end of 2020.

It is noted that new Contracts of Supervision are now in use, and therefore this notice will not apply to any Contract of Supervision signed in April 2020 and thereafter.

Contract of Supervision

Approved form Contracts of the Supervision are available at the following links:

In most cases, parties to a Contract of Supervision (i.e. the Clinical/Physician Assistant, Primary Supervisor, etc.) will only need to insert practice locations, site descriptions, full-time equivalence, and signature lines for all those signing into the approved form Contract of Supervision.

  • The practice location is the physical location where the Clinical/Physician Assistant will be engaged in their professional practice, for example the name and address of the respective private clinic/health care facility (e.g. HSC/WRHA, Winnipeg, MB).
  • The site description is a brief descriptor of the practice setting (e.g. private family practice, urgent care, etc.).
  • For the purpose of Contracts of Supervision, full-time hours are forty (40) hours per week. Full-time equivalence will be the average fraction of full-time hours the Clinical/Physician is anticipated to work (i.e. 1.0 for a full-time employee, 0.5 for a half-time employee, etc.).
  • All supervisors must be approved in writing by the Registrar.
  • Any changes to the contract require approval in writing from the Registrar.
  • Primary supervisors may only act as the primary supervisor for a maximum of 3 Clinical/Physician Assistants, unless approval is received from the Registrar to permit more.

Practice Description

Under Part 8 of the General Regulation, Contracts of Supervision must be associated with a Practice Description describing the practice setting in which the regulated member will work and outlining the permitted professional practice of the Clinical Assistant or Physician Assistant. The preparation of the Practice Description is the responsibility of the employer but must meet certain College criteria and be approved by the Registrar.

In part, the purpose of the Practice Description is to allow the College to understand the scope of the Clinical/Physician Assistant’s professional practice and to ensure the signatories to the Contract of Supervision mutually understand the limits of that scope so as not to exceed its bounds.

Essential components of the Practice Description include:

  1. A description of the practice setting in which the Clinical/Physician Assistant will be engaged in their professional practice.
  2. A description of the Clinical/Physician Assistant’s anticipated scope of professional practice, including:

a. the type of work they will be doing, including all examinations and procedures;

b. the reserved acts the assistant will be expected to perform;

c. a list of medications or categories of medications the assistant may prescribe and/or administer;

d. expectations for the assistant respecting patient care, including but not limited to:

i. rounds (if applicable),

ii. history taking and physician examination,

iii. documentation,

iv. ordering and interpreting investigations; and

v. development of management plans;

e. a plan for training, education, performance evaluation and continuing professional development; and

f. a schedule for reporting to the College.

Respecting the practice setting, this component of the Practice Description should contain a detailed description that includes, but is not limited to, the following information:

  • whether the setting is institutional or non-institutional;
  • whether the setting is a hospital unit (e.g. cardiac inpatient unit), or a solo or group family practice clinic, etc.;
  • a reasonable approximation of the typical number of patients seen in the practice setting;
  • the categories of care delivered in the setting (e.g. family medicine, specialist or subspecialist care); and
  • information about other health care professionals present in the practice setting.

New College reporting obligations will be integrated into the Practice Description under the heading ‘College Reporting’. For the vast majority of Clinical/Physician Assistants, the Primary Supervisor will be required to send periodic reports to the Registrar of the College that are satisfactory to the Registrar regarding the Clinical/Physician Assistant’s performance. Absent exceptional circumstances, for example evidence that the Clinical/Physician Assistant has worked with the Primary Supervisor within the previous few months under a similar Practice Description, reporting will occur on the following schedule:

  1. once per month for the first three months;
  2. every three months for the following 9 months, and
  3. every 12 months thereafter.

Reports must be satisfactory to the Registrar. An approved reporting form can be found at the following links:

Primary Supervisors may develop their own reporting form, but it would have to be pre-approved by the Registrar and at least be composed of the same information fields as appear in the above noted approved reporting form. The ITER form used within Shared Health, for example, has been determined to be satisfactory.  

Reporting obligations rest with the Primary supervisor and cannot be delegated.   

Legal requirements

The new requirements under the RHPA and the General Regulation have been in effect since January 1, 2019 and must be complied with by members regardless of whether they are still practicing under an outdated Contract of Supervision.

Applicable laws and regulations are posted on the College website.

In particular, we draw your attention to the following authorities:

  1. Part 8 of the General Regulation concerning requirements for supervising physician assistant and clinical assistants;
  2. Part 6 of the General Regulation concerning title restrictions.
  3. The College’s Standards of Practice, particularly including Schedule I – Volume of Service;
  4. Sections 4, 5 and 6 of The Regulated Health Professions Act respecting the performance of reserved acts and the delegation of the performance of reserved acts;
  5. Section 6 of the Practice of Medicine Regulation respecting the performance of reserved acts and the delegation of the performance of reserved acts; and
  6. Part 5 of the General Regulation respecting the performance of reserved acts and the delegation of the performance of reserved acts, particularly:

a. subsections 5.8(3) and subsection 5.12 which relate to prescribing,

b. subsection 5.16(1), which prohibits Clinical/Physician Assistants from delegating reserved acts, and

c. subsection 5.20(1), which restricts Clinical/Physician Assistants to performing only those reserved acts they are authorized to perform by their practice supervisor where the practice supervisor is legally permitted and competent to perform the reserved act.

 Liability coverage

The Clinical or Physician Assistant must provide evidence of satisfactory professional liability to the College.

Signatories

The Clinical/Physician Assistant and all members who will act in a supervisory capacity must sign the Contract of Supervision. This includes the Primary Supervisor as well as any alternate supervisors and additional supervisors.

In signing, parties to the contract acknowledge having read and understood both the Contract of Supervision and Practice Description.

The Contract of Supervision contains the following termination provisions, which will be explained in more detail below:

This contract may be terminated by either Primary Supervisor or Physician/Clinical Assistant by giving thirty (30) days’ notice of the fact in writing to the other and to the College. It can be otherwise cancelled in accordance with subsection 8.16(1) of the General Regulation. Upon termination of the contract, Primary Supervisor and [Clinical/Physician] Assistant must advise the College of the circumstances which led to termination.  

Those named in this Contract of Supervision as alternate or additional supervisors may have their name removed from this contract by giving thirty (30) days’ notice of the fact in writing to both Primary Supervisor and to the College.

Breach of Contract of Supervision

A breach of this Contract of Supervision may result in the following:

a. The imposition of conditions of Physician/Clinical Assistant’s Certificate of Practice by the Registrar;

b. Removal of an alternate or additional supervisor from the Contract of Supervision; or

c. Cancellation of the Contract of Supervision.

Under the termination provisions, a Primary Supervisor may have their name removed from a contract by giving 30 days’ notice to the College and the Physician/Clinical Assistant. The Physician/Clinical Assistant may exit the contract by giving the College and Primary Supervisor 30 days’ notice. Any alternate or additional supervisor may have their name deleted from a contract by giving 30 days’ notice to the Primary Supervisor and the College.

Under subsection 8.16(1) of the General Regulation, a Contract of Supervision is automatically cancelled if the Primary Supervisor is unable to fulfil their responsibilities under the contract and none of the designated alternate supervisors can fulfil their responsibilities under the contract. As a Primary Supervisor is a requirement, if the Primary Supervisor is permanently unable to fulfil their responsibilities, then it flows the alternate supervisor is unable to fulfil their responsibilities and the Contract of Supervision is cancelled. The Registrar further has discretion to cancel the Contract of Supervision if one or more of its terms are breached.

In the event a Clinical/Physician Assistant can no longer work at the practice location(s) listed in a Contract of Supervision, for example due to loss of employment, the Primary Supervisor or alternate supervisor would consequently no longer be able to fulfil their supervisory role for that Clinical/Physician Assistant at the listed practice location(s) and therefore the contract would be cancelled. Thus, employment issues can have implications respecting the ability of the parties to fulfil the terms of a Contract of Supervision.

Primary and alternate supervisors are required to promptly notify the College if they are permanently unable to fulfil their supervisory role under the terms of a Contract of Supervision, for example in the event of loss of employment. 

Clinical/Physician Assistants are required to promptly notify the College if they cease to practice at a listed practice location, for example due to loss or employment.

Any addition of an alternate or additional supervisor to a Contact of Supervision must be approved by the College. This can be done by the execution of a new contract or by way of an addendum in the approved form to the original contract.