Doctors want provincial barriers broken, call for national licensing system

Dr. Paul Mackey likes to say it's easier for him to practise medicine in Tasmania than it is in Nova Scotia.

The British Columbia-based general practitioner and anesthetist fills in for other doctors temporarily (known as locum work) throughout B.C. and occasionally in Manitoba. Each time he travels from his home province to another for work, it requires him to apply for a licence. Recently it took five months and $3,000 to get the paperwork he needed to go to Neepawa, Man., to cover for a colleague so she could take a break.

It's exasperating, he said. In his native Australia, his licence permits him to practice anywhere within the country, and Mackey thinks Canada needs a similar approach.

"Most of us locum in one province because it's a pain in the ass to get licensed in another province," he said.

The provincial barriers affect all Canadian doctors.

According to the Royal College of Physicians and Surgeons of Canada website: "All practising physicians must hold an educational or practice licence from the medical regulatory authority in the province or territory where they study or practise."

In a phone interview, Mackey said having to go through that amount of effort is causing him to seriously consider not leaving B.C. again for work purposes. 

'Out of sight, out of mind'

According to Mackey and other doctors involved with locum work, unnecessary bureaucratic borders and a lack of political will are standing in the way of doctors in rural communities getting the breaks they need, patients knowing services will be there when they need them and communities getting increased recruitment opportunities.

Mackey said rural communities, particularly those near provincial borders, are especially disadvantaged by the system that sees each province overseeing its own licensing requirements.

"I joke that if the capitals of Alberta and Saskatchewan were in Lloydminster [which straddles the borders of both provinces], this would have been solved yesterday," he said. 

"It's out of sight, out of mind."

Too much red tape

Dr. Stephen Hiscock is trying to confront the problem.

The general surgeon in Salmon Arm, B.C., said trying to get a licence to work in another province is a "huge bureaucratic quagmire." Hiscock and other members of the Canadian Association of General Surgeons believe they have a way to get general surgical care into areas that need it, but red tape is proving to be a hindrance.

There is currently a group of 30 general surgeons in Toronto and 10 in Vancouver, he said, who are willing to travel to work because they can't get operating room time in their respective cities.

The doctors are very interested in locum work, but they aren't interested in the bureaucracy that goes with leaving their home provinces, said Hiscock. That includes producing certificates of good standing each time to go from one province to another and paying licensing fees for each province in which they'd go to work.

An outdated approach

Hiscock, Mackey and other doctors say a national licensing body would solve these problems. When a doctor is in good standing in one province, they'd be able to travel freely to another to work because the system is able to follow them.

While it might have made sense at one point for each province to have its own oversight body, Hiscock said medical schools in Canada are all well regarded and everyone is aware of what a graduate has done to become a doctor and the national accreditation they require to work.

"Everybody jumps through the same hoops," he said.

"You can argue that if someone is safe enough to operate in Truro, they're certainly safe enough to operate in Salmon Arm."

Considering a streamlined system

"The possibility of or need for a national medical licensing registry has not been raised in recent federal-provincial-territorial health discussions," said Health Canada spokesperson Sindy Souffront. 

Nova Scotia Health Minister Randy Delorey said the idea of a national licensure system isn't something on his radar and he noted any kind of national deal tends to be complex, especially when it comes to health-care services because jurisdiction falls to the provinces.

"Each province is responsible for their health care, and regulation and licensing would be part of that responsibility."

Delorey said he's not sure if a move to national licensure would even require provincial action or if it could fall to the various provincial and territorial colleges of physicians and surgeons to handle.

"They are the body that actually defines the regulatory and licensing regime. I think the first step would be for those bodies to assess if that's the path they feel is appropriate."

Dr. Gus Grant, registrar of the College of Physicians and Surgeons of Nova Scotia, said during a recent interview there is discussion within the Federation of Medical Regulatory Authorities of Canada about how to create a more streamlined system to improve physician mobility, but those talks are in early stages.

A way to preserve doctor longevity

Regardless of who takes the lead, Hiscock said having timely access to a locum makes a major difference for patient care and for a doctor.

"Lots of us who work in small towns, we're lifers. I mean, I'm not working in Salmon Arm because I can't get a job in Vancouver. It takes me four minutes to go to work. My kids can play street hockey and go trick-or-treating quite safely.

"So this is where I'm going to stay, and [locums] can help preserve longevity."

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