Labour Mobility and Physician Resources

1. Labour Mobility and Physician Resources Presentation to the Canadian Association of Staff Physician Recruiters (CASPR) 15 April 2009

2. FMRAC • Federation of Medical Regulatory Authorities of Canada • incorporated in 1968 • provides a national structure for the 13 provincial and territorial medical regulatory authorities • the voice of the 13 Members on the national and international scenes

3. Setting the stage • We believe in mobility for fully qualified physicians. • The recent amendments to Chapter 7 (Labour Mobility) of the federal/provincial/ territorial Agreement on Internal Trade (AIT) highlighted several areas for improvement and we are committed to addressing those areas.

4. Setting the stage (cont.) • Our concerns are not about mobility, but about patient safety. • The number of problematic physicians is small but significant.

5. Work schedule • Contribution Agreement with Human Resources and Social Development Canada (HRSDC) to review and update the 2001 Mutual Recognition Agreement • First meeting on 28 February 2008 in Ottawa led to changes in the 2001 document • Other factors influencing this work included the BC – AB and the QC – ON agreements

6. Work to date (cont.) • By the end of summer 2008, it was clear that mutual recognition agreements would be of little use • We began to hear that some governments were not interested in any legitimate objectives.

7. Concerns with the AIT • Extent of consultations • Extent of consultations between Labour and Health • Patient safety, patient safety, patient safety • Physician’s prior history • Fitness to practise • Discretionary authority of regulatory bodies

8. Concerns (cont.) • refusal only on the basis of complaints, discipline and criminal proceedings • quality assurance is now the norm and this would be excluded • scope of practice limitations • need to be able to impose retraining or additional training where deemed necessary to protect patients

9. Standard of qualifications • The “gold standard” will no longer be the norm. • Canada’s reputation as a world leader in medical education will be compromised. • Erosion of standards is a risky business.

10. Gold Standard • Medical degree from a recognized institution • Licenciate of the Medical Council of Canada • Recognized postgraduate training in family medicine, a medical specialty of a surgical specialty • Certification in family medicine or a specialty • Compliance with accountability for performance expectations

11. Underserviced areas • Limitations on licensure are a common tool to ensure the presence of physicians in some parts of Canada • medical regulatory authorities have a history or working hand in hand with their respective governments to address this issue • not their true mandate

12. Underserviced areas (cont.) • Once they achieve full licensure, these physicians leave for the more popular urban areas • the AIT could mean lower standards everywhere if these physicians are now eligible for mobility • The AIT eliminates the possibility of imposing geographic restrictions, even intra-provincially

13. Underserviced areas (cont.) • With mobility and consistent standards applied to all physicians, some of the “have not” jurisdictions will have even greater problems with physician resources.

14. Fairness? For whom? • Do we really want provinces bidding against each other for scarce physician resources? • Medical regulatory authorities exist to serve in the best interests of the public and patients • Preferable to refuse mobility to physicians rather than risk the safety / life of a single patient. • To do otherwise is unconscionable.

15. Lobbying • On 2 December 2008, letter sent to Forum of Labour Market Ministers (copied to First Ministers and to Conference of Ministers of Health) • On 4 December 2008, presentation to P/T Deputy Ministers of Health

16. And then… • On 5 December 2008, the Forum of Labour Market Ministers approved the amendments to the Agreement on Internal Trade • On 16 January 2009, the amendments were endorsed by the First Ministers

17. Where now? FMRAC and its 13 Members are working together to achieve consensus on: • Principles for labour mobility for entry-to-practice licenses, effective 1 April 2009 • Principles for labour mobility for physicians who are currently licensed • National standards and criteria for • Assessment • Licensure • Procedures

18. Should we… • affirm that the protection of the public is the prime responsibility of the medical regulatory authorities? • support that mobility of physicians across Canadian jurisdictions is an important objective?

19. Should we… (cont.) • in the spirit of the AIT, ensure the greatest possible degree of mobility for qualified physicians across Canadian jurisdictions? • work together to ensure consistent and sufficiently rigorous registration and licensure processes for physicians across all Canadian jurisdictions?

20. Practising physicians Should FMRAC and its 13 Members set standards to ensure that physicians who currently hold a full, unrestricted, unconditional license for independent practice have complete mobility across Canadian jurisdictions to work within their defined scope of practice?

21. Practising physicians (cont.) Should FMRAC and its 13 Members set standards to address the specific mobility issues and requirements for those physicians who do not hold a full, unrestricted, unconditional license for independent medical practice?

22. Assessment We will assess the following criteria (the 5 E’s) prior to issuing a license to practise medicine: • Education (a medical degree) • Evaluation of knowledge, skills and professionalism: • Medical Council of Canada Qualifying Exam Part I – usually at the end of medical school • MCCQE Part II – after a minimum of 12 months of postgraduate medical education • Equivalent – e.g., USMLE

23. Assessment (cont.) • Experience (postgraduate medical training) Includes FITERs (formal in-training evaluation reports) or their equivalent • Evaluation of knowledge, skills and professionalism: • Certification exam of the College of Family Physicians of Canada or • Certification exam of the Royal College of Physicians and Surgeons of Canada • Equivalent assessment • Evidence of currency of practice.

24. Standards for licensure For new licenses, what about: • a nationalstandard for the issuance of a full, unrestricted, unconditional license for independent medical practice? • an alternative route to this national standard? • a national standard for the issuance of an entry-to-practice “provisional” license?

25. Procedures Should FMRAC and its 13 Members work together to develop common procedures for licensure and registration for all Canadian jurisdictions?

26. Procedures (cont.) • Registration? • Licensure? • Supervision? • Certificates of professional conduct? • Currency of practice issues? • Revalidation? • Quality assurance of a physician’s practice?

27. Patients first • The AIT highlighted several areas where we could do better • Be careful about compromising patient safety

28. Where next? • Theme of FMRAC AGM in June 2009 in this beautiful city is: National Registration – Setting the Bar • International physician mobility • International Association of Medical Regulatory Authorities • Physician information exchange

29. Thank you Questions and comments, please! Fleur-Ange Lefebvre Executive Director & CEO 613 738-0372 falefebvre@fmrac.ca