Designated Medical Practitioner Handbook

Chapter 4: The Professional Life Cycle of DMPs

4.1 Categories of Appointment

Depending upon location and situation, DMP appointments may be of the following types:

Categories and Subcategories	Description	Example
Standard DMP: These are DMPs who have been selected and appointed to perform Canadian IMEs for full five-year terms. They are individually listed in CIC’s DMP roster and their contact information is noted on the Department’s website.
Individual	These are individual medical practitioners.	DMPs individually registered in CIC’s DMP roster.
Institutional	In certain situations involving the examination of large numbers of applicants, medical institutions, organizations or agencies may be designated as the primary DMP, and a senior medical professional from the organization is designated as the responsible individual for contact liaison. That individual is also the administrative point of contact for CIC. The institution may request approval to use appropriately trained and supervised staff to perform IMEs subject to departmental approval.	The International Organization for Migration (IOM), hospital or medical corporations, or large medical clinics
Short-Term/Temporary Appointment: These appointments are made when IME services are required either in an area not previously serviced, or where the number of applicants exceeds the current capacity to provide services in a timely fashion, or in situations involving the use of other individuals currently working regularly within the DMPs’ practice for a short period. They are also made when DMPs are absent from their practice or unable to provide service for other reasons for a short period. Appointments are for a six-month period. They may be renewed once for another six months.
Emergency DMPs	Acute situations in which DMPs are required quickly for a specific purpose.	Complex humanitarian emergency or acute refugee situations where large numbers of individuals require expedited processing and resettlement
Locum tenens	Medical practitioners replacing DMPs in their duties while they are on vacation or taking training.	DMP’s partner in a medical clinic
Other types of appointments: There may be situations when, for operational reasons, some DMPs require the assistance of other practitioners to complete immigration medical examinations. These situations exist for a specified period no longer than the maximum five-year term unless it is renewed.
Assistants	Usually involve the use of other individuals currently working regularly within the DMP’s practice.	In the case of an institutional DMP, all medical practitioners approved by CIC are classified as “assistants’’ and the practitioner who is the lead contact with CIC is the designated institutional DMP.
Alternates	Qualified individuals needed for exceptional situations to fulfil CIC’s obligations or improve service to clients.	When the distance between available DMPs and the client is more than 242 km (150 miles), the client can request to see another medical practitioner. See the CIC website for more information.

4.2 Phases of the DMP Professional Life Cycle

Selection

While many qualified physicians may apply and meet selection requirements, the number, distribution and location of DMPs depend on the current and anticipated demand for Canadian IMEs as well as departmental and government requirements (for example, obligations to deliver services in both official languages). Determining the requirement and location of DMPs is based on consultations between Canadian immigration officials and CIC medical officers. Therefore, DMP appointments are not permanent and may be revoked. Also, for those not appointed, applications will be retained for a period of two years, after which a new application is required for reconsideration.

Minimum DMP Qualifications

All types of DMPs need approval by the regional medical office to perform IMEs, and approval is only for the period specified. Practitioners who conduct medical examinations for CIC must:

• have graduated from an appropriate school or college recognized by the appropriate government agency in the country where the educational facility is located;
• have active and valid registration with the national medical registration or certification body at the location of practice;
• be in possession of an active license or permit to practice at the level necessary to complete IMEs and arrange for required diagnostic investigations and interventions (radiographic examinations, clinical laboratory investigations, referral to consultant physicians or facilities for specialized assessment or investigation); and
• have regular and practical access to and be able to use electronic communications technologies, such as the Internet and short message service, according to the local availability of those services. At a minimum, fax communication must be available.

Application to Become a Standard or Emergency DMP

In order to be considered for standard DMP appointment, a medical practitioner is required to submit:

• a DMP appointment application form (a copy can be found as Appendix XIII) and a specimen signature;
• a legible photocopy or notarized copy of the candidate’s medical degree;
• a legible photocopy or notarized copy of an official letter or certificate from local or national registration authorities, confirming that the applicant holds current and valid certification allowing the individual to practice at the level necessary to perform IMEs and related functions, including the ordering or requisition of clinical investigations and referrals;
• when available, a certificate of good standing issued by the DMP’s medical regulatory body. It must confirm that the DMP is entitled to practice medicine in the appropriate country and state or province, and note that the individual is not disqualified, suspended or prohibited from practising medicine. The certificate must be dated within three months prior to the DMP application.
• evidence of professional liability protection commensurate with local recommendations and standards of practice; and
• a curriculum vitae including
  • description of undergraduate and postgraduate qualifications
  • certification or specialization in relevant medical specialties
  • a list of languages in which the individual is proficient to provide services. One of these languages of proficiency must be either English or French.

Application for Short-Term or Other Types of DMPs

Short-term or other types of DMPs usually seek approval through a standard DMP, with the objective of working together or within an institution. Persons seeking appointment should take the following steps:

• Contact the RMO and seek medical officer concurrence;
• Submit the proposed substitute physician’s current curriculum vitae, a copy of the medical registration, a letter of good standing from the individual’s licensing body, and a specimen signature; and
• Submit a statement from the proposed practitioner indicating that the individual has read the DMP Handbook and agrees with the standards and requirements defined therein.

Once approval has been given, DMPs may engage the temporary service of assistants, alternates or locum tenens during the period approved by the RMO. Assistants, even if they have been authorized to provide services during a DMP absence, may not be used by the DMP as a surrogate to expedite the performance of IMEs without prior approval. DMPs must also ensure that the replacement physician is adequately informed of the requirements of the Canadian IME and reporting procedures, and any updates.

Approval Process

Approval of all DMP categories and subcategories are person- and location-specific and are also subject to program and performance standards. These categories and subcategories are not transferable without the written permission of a medical officer or HMB headquarters. In addition, relocation of the DMP’s practice must be brought to the attention of the RMO. Depending on the local situation, DMP status may or may not be continued after the relocation. Approval will include an interview by telephone or in person.

Prospective DMPs who have completed all of the requirements for their category should not begin to examine applicants until the following steps have been taken: they have been officially advised by the RMO that they are approved as DMPs; they have been issued a DMP stamp and/or a DMP ID number by CIC; and they have completed the orientation phase.

All DMPs, including those who are temporary or short term, will not be approved until the responsible RMO has received the following:

• confirmation that the prospective DMP has read the handbook and agrees with the terms and conditions contained therein by signing the following forms: Appendix XII, Consent to Share Information with Australian/U.S. Immigration Health Authorities; Appendix XIV, DMP Acceptance of Appointment Form; and Appendix XVIII, DMP’s Acknowledgment of Having Read the Handbook;
• a sample signature form;
• accreditation certificates and information from all of the laboratory centres and radiology centres that the DMPs intend to use; and
• all forms and specimens described above.

Orientation: Various activities are involved in the orientation phase, including reading and understanding this handbook, and participating in a discussion with CIC medical personnel. DMPs are not allowed to perform IMEs during the orientation phase. Approval will not be confirmed until orientation has been completed to the satisfaction of the responsible regional medical officer.

Handbook: This handbook has been designed to be the standard reference for DMP orientation and training. All DMPs must ensure that they remain familiar with it and with departmental instructions, including interim changes and updates provided by CIC.

Instruction: Newly approved DMPs will receive a period of instruction and direction provided by CIC medical personnel as part of their orientation to the immigration medical examination. This instruction may be individual or through group activities involving several DMPs in locations where DMPs operate in geographic proximity.

Initial Probationary Appointment: After successfully completing orientation, some categories of DMP will be granted a probation period. The duration depends on various factors such as the number of IMEs performed and their quality, the types of applicants, the presence of prior appointments, the presence or absence of complaints, the length of time between each IME performed, etc. Depending on the outcome of a performance review, a DMP may be granted a standard DMP appointment.

Appointment: Those DMPs who successfully complete their probation will be appointed. These are the standard DMPs and assistants. Appointments are for a period of five years and may be renewed, as required, on the recommendation of the responsible regional medical office.

During situations involving complaint or dispute resolution (See Chapter 9), the status of the DMP may be affected. Depending on the situation, the DMP may be suspended or terminated, or remedial measures may be recommended or required.

Reappointment of DMPs: Reappointment is subject to satisfactory performance as well as the continued need for the DMP’s services in the location.

Suspension of Appointment: DMP appointments may be suspended for a variety of reasons. For example, an anticipated period of extended absence may result in the DMP requesting to interrupt the provision of IME services temporarily. Alternatively, a DMP appointment may be suspended for cause, as defined in Chapter 9.

When DMP appointments are suspended for any reason, Canadian IME activities by the DMP cease until the DMP is notified otherwise by Citizenship and Immigration Canada.

Termination and Retirement

The operational need for DMP services will be influenced by the dynamics of the Canadian immigration program, which evolves in response to a variety of influences. CIC retains complete authority regarding the number of DMPs and their location. DMP positions will be increased or reduced in response to the local demand for IMEs or for cause, as described in Chapter 9. DMPs so affected will be notified in writing by the regional medical officer at least 60 days prior to the end of the need for services.

DMPs may retire or request removal from the DMP roster at any time. DMPs should send written notification to the regional medical officer, including the anticipated date on which activity will cease.

Training: The nature and duration of the training provided by CIC will vary. For example, in situations of institutional DMP appointment, the institution already appointed by CIC may provide some aspects of training and orientation.

On-site training may be provided to individual DMPs. Alternatively, and depending on location and DMP numbers, training sessions involving multiple DMPs may be arranged by the responsible regional medical officers.

 

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