Public consultation: amendment to: Practice Direction – Professional Practice and Inactivity
CPSM requests feedback from registrants, stakeholders, and the general public regarding a proposed amendment to remove section 7.3 of the Practice Direction - Professional Practice and Inactivity, which states:
7.3. Family practice physicians who have not completed acceptable postgraduate clinical training in obstetrics and who are not registered with entitlement to practise obstetrics must refer a patient to an appropriately qualified physician:
7.3.1. Before fourteen (14) weeks of pregnancy, or
7.3.2. if the diagnosis is established after fourteen (14) weeks, as soon as possible after diagnosis.
The issue
Concerns have been raised to CPSM that this section can be interpreted to preclude family physicians from providing prenatal care beyond 14 weeks of pregnancy. It is not intended for the Practice Direction to limit prenatal care in this manner. Concerns include:
- The reference to “acceptable postgraduate clinical training in obstetrics” is vague. Physicians may not be clear about whether they have this training.
- The reference to making a referral before 14 weeks of pregnancy, or as soon as possible after diagnosis (if diagnosis is made after 14 weeks) may cause physicians to assume that they cannot provide prenatal care to pregnant patients after 14 weeks of pregnancy and must refer patients to an appropriately qualified physician.
- Family medicine practitioners may read sections 7.3.1 and 7.3.2 and conclude that they do not have acceptable obstetrics training and cannot provide prenatal care to patients who are more than 14 weeks pregnant.
Other specialties do not have Practice Direction provisions such as section 7.3.
Proposed amendment
The proposed amendment would remove section 7.3 from the Practice Direction – Professional Practice and Inactivity to prevent confusion regarding the provision of prenatal care by family physicians and any implications that they can only provide prenatal care up to a specific gestation.
Additional Information
Removing section 7.3 will leave section 7.2 for guidance on this topic. Section 7.2 states:
Physicians registered to practice in the field of family medicine must not practice obstetrics unless the following conditions are met:
7.2.1. The family practice physician must have completed acceptable post-graduate clinical training in obstetrics and practiced obstetrics within the past three (3) years.
7.2.1.a. Family practice physicians who do not meet the foregoing requirement and wish to provide obstetrical care must do so in accordance with the Council Policy - Assessment Candidate (Re-entry to Practice) Class. This must include completing acceptable postgraduate clinical training in obstetrics, if not already completed.
7.2.2. Family practice physicians who are registered with entitlement to practice obstetrics, but who have not performed any deliveries for more than three (3) years may provide prenatal care to patients but may not do deliveries.
The stipulation in section 7.2 that anyone providing intrapartum care (and by extension holding privileges to admit to hospital to provide this care) would have been active in this type of care within a three-year period, otherwise would require retraining to resume intrapartum care, would remain.
The primary intention of sections 7.2 and 7.3 is to ensure that family physicians providing intrapartum care have current and relevant expertise in this specific skill set. That is already generally covered by the overall Practice Direction.
How to Submit Your Feedback
- Review the information provided above. View the Practice Direction – Professional Practice and Inactivity.
- Submit your comments regarding the proposed changes through the following:
· By email to: CPSMconsultation@cpsm.mb.ca
· By mail to:
The College of Physicians & Surgeons of Manitoba
1000-1661 Portage Avenue
Winnipeg, MB R3J 3T7
The deadline for feedback is February 18, 2025.