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Canadian Journal of Rural Medicine
CJRM Summer 2001 / été 2001

Portable licensure: On the distant horizon?

Suzanne Kingsmill, BA, BSc, MSc
Shawville, Que.

CJRM 2001;6(3):215-6.


A panel of experts, convened by the SRPC, discussed the question of portability of licensure within Canada at the SRPC's 2001 Rural and Remote Area Conference in Hockley Valley in late April.

SRPC President Dr. Peter Hutten-Czapski echoed the frustration felt by countless rural docs with the existing rules and red tape put up by all provinces. Living in Ontario, he says he has trouble recruiting from anywhere else. "We need good locums who can cover our skills. To make a viable living as a locum we need licensure in a number of provinces. We want to recruit from across the country, both locum and full time, to make rural practice more sustainable."

Enter the Agreement on Internal Trade (AIT). According to Mr. Brendan Walsh, Human Resources Development Canada, the AIT is an agreement the government signed in 1994 to remove or decrease interprovincial barriers to goods, services and people. "Chapter 7 of the agreement," he says, "deals with labour mobility and its purpose is to enable a worker licensed in one jurisdiction to have access to other jurisdictions and have their qualifications recognized." Chapter 7 of the agreement sets out 3 main objectives: no residency requirements; licensing practices that are not prejudicial to those coming from other jurisdictions, and recognition of qualifications. It is this last requirement, says Walsh, that requires the regulatory bodies to meet and compare standards and answer the question: Is a physician a physician all across the country? "If standards are shown to be the same," he says, "then portability is assured, but if standards differ across the country then there could be some requirements made."

As is the case in Ontario, Dr. Rocco Gervace, College of Physicians and Surgeons of Ontario, says that Ontario's criteria are somewhat more stringent than other provinces, but he says they are in keeping with the AIT. "We recognize the shortage of doctors and we are looking at ways to facilitate registration." He noted that his Council will soon be announcing a mechanism by which they will facilitate registration across jurisdictions. However, a common registration process nationally has not yet been addressed.

Some form of national licence could be difficult to achieve. As Dr. Gary Johnson, Federation of Medical Licensing Authorities of Canada, says: "There is no such thing as a national license that would allow portability, because health care is a provincial jurisdiction. There is no such thing as a portable licence, but there are portable qualifications." Some of those qualifications include the 2-year CCFP residency. Johnson says there is an agreement that grandfathers those doctors who, prior to 1994, took rotating internships and therefore do not meet the 2-year residency criteria.

Unfortunately, according to Dr. Keith MacLellan of the SRPC, who commented from the audience, there are 56 000 doctors in Canada, and 19 000 are not registered with the CFPC or the Royal College of Physicians and Surgeons of Canada. "How many of them aren't grandfathered?" he asks. "How many of them have not kept up their dues?" He argues that the status quo in Ontario is transported elsewhere and even if you are grandfathered you may or may not be accepted. In response, Dr. Johnson said: "This is the standard we will accept, but to meet local requirements we can waive them, and this is a reasonable way to deal with the shortage [of rural doctors]." He went on to say that "the intent of the CCFP requirement is to show you have postgraduate training in family medicine."

Dr. Hugh Scully, past president of the CMA, said he supports "the principle of eligibility for portability across the country," but said he "has issues of values and skills — Are they the same across the country?"

The CFPC supports portable rural locum licenses, according to Dr. Peter Newbery, past president of the CFPC, but he sees 2 problems with portability: 1) "Although there are different standards from province to province, there is one standard LMCC. Some provincial licensing authorities have made the CCFP a licensing element. Why not return to the LMCC?" and 2) the bad apples. "Licensing authorities are concerned about bad apples and portable licensure." He suggests setting up a national database of those wanting locum portability to solve this problem. "It's not about training," he says, "or what program you've come from, or mobility. It's not about AIT. It's about the delivery of service in rural communities."

And it's also about the frustration that ensues when that service is thwarted. Dr. Conleth O'Maonaigh, who, as Dr. MacLellan, spoke from the audience, summed it all up by noting that doctors in the 12 European countries can go anywhere, yet "a doctor who works in Goose Bay is not qualified to work on Baffin Island, but the guy who graduated from downtown Toronto is?"


S. Kingsmill, Managing Editor,CJRM

Correspondence to: admin@srpc.ca

© 2001 Society of Rural Physicians of Canada