AIT (Agreement on Trade) was created with the idea of making things easier — if a physician was licensed in one Canadian province, the notion was that they should be licensed in all provinces.
CanAm CEO John Philpott says the CanAm Physician Recruiting team was very pleased when they heard about AIT, but it didn’t take long for them to realize it wasn’t going to work the way they’d hoped.
Philpott is married to a family physician from Newfoundland who was once trained and fully licensed to practice there. She’s worked in PEI and Nova Scotia since then, but would not be able to return to her home province to practice without a huge struggle.
“If she wanted to go back to Newfoundland to do a week-long locum, she’d have to fill out the same paperwork as a doctor coming from India,” Philpott says. “It’s insulting for a Canadian medical school graduate to have to fill out a form to see if they prequalify for licensure in another province.”
It’s also expensive and time-consuming. Philpott says once the pre-qualification comes through after 2-3 weeks of waiting, it’s then up to the physician to collect their paperwork, pull their diplomas off the wall, and spend a lot of put putting together their full application.
Phil Jost, CanAm’s Regional Manager and Vice President of Operations, says AIT is letting them down because it was “broken from the very beginning” when it comes to addressing international medical graduates (IMGs). Each Provincial College has their own approach and requirements for licencing IMGs, and therefore has different types of restricted/provisional/defined licences unique to that province.
Shortly after the AIT decision became public, Philpott penned an article in The Medical Post in 2009 about the Health Ministers’ first meeting concerning provincial licensing. He wrote that the Ministers were feeling frustrated regarding the paperwork required for licensing a physician from one province to another, and he believed there had to be a better solution.
But the Medical Council of Canada announced they needed more time to come up with a plan, and promised a decision in eight months. At that point, they asked for a year-long extension. But it’s been five years now, without any action, and Philpott says he’s frustrated with the wait.
“Canada has 10 different licensing authorities — one per province — plus three boards covering the territories, and we have a population of about 30 million. But California has a single licensing board for a population of 33 million,” says Philpott. “Why do we need so many licensing authorities in Canada?”
Philpott says there is “very limited portability” of doctors throughout the country, and it’s frustrating because it limits the amount of jobs a physician can accept — and makes it harder for provinces to secure the medical professionals they desperately need.
Just in the last two weeks, Philpott has fielded two calls from Newfoundland requesting an orthopedic surgeon and an obstetrician — both within very short notice. Although he has excellent candidates who would be happy to accept the positions, Philpott wouldn’t be able to get them licensed in Newfoundland in time.
“They are licensed in numerous other provinces, but it would take me 6-8 weeks to get them licensed in Newfoundland — and that’s if I really pushed — so they can’t go,” says Philpott. “Who is suffering in this situation? It’s the patients.”
Philpott says the colleges argue the rules are in place to protect patients and ensure top-quality healthcare, but he doesn’t believe it’s necessary to separate each province.
“If you’re Royal College certified with a full license somewhere in Canada, why can’t another province respect your province’s credentialing?” says Philpott. “You would think a doctor working in Amherst and seeing a patient from Moncton should be able to cross the border and see the same patient in Moncton, but that would be illegal. It’s ludicrous.”
He and Jost say many physicians are unhappy with the difficulty involved in practicing in different provinces, but many of them won’t speak up for fear of being reprimanded by their College.
“They’re afraid their College will single them out and make their lives difficult — just like an employee of the government won’t speak out against the government,” says Philpott.
Philpott hopes to sit down with the all of the Health Ministers in Atlantic Canada to discuss the possibility of merging the Colleges of Nova Scotia, New Brunswick, PEI, and Newfoundland. He’s already met with a few and they are all very interested in talking about it more.
Jost says there’s been talk of a national licensing system but he’s yet to see any action.
“The different Colleges all have their own territory, and they don’t want to give up their power,” says Jost. “There are also arguments that a national system would make the provinces compete with each other, and that physicians would all rush to the larger provinces — like Ontario.”
Services like PhysiciansApply.ca make it easier for international medical graduates (IMGs) to have their credentials source-verified, so Philpott believes it’s disheartening that Canadian physicians do not have the same kind of service.
“We should have them in a database, so if a physician wants to move to a different province, it’s just a matter of forwarding their file and sending a letter of good standing from their College — and perhaps a reference or two,” says Philpott. “All of that could be done in 24 hours. It would be so easy.”