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Category Archives: Medical Licensing

Discusses Canadian federal and provincial medical licensing issues that affect Canadian and foreign – IMG physicians.

Time to champion regionalization of Licensure

This April 15, 2016 Medical Post article by Dr. Sarah Giles once again addresses the high cost of credentialing and licensing for physicians seeking to do locum work in neighbouring health boards and provinces. CanAm has been out spoken on this issue. What the general public and government officials don’t realize is that we are talking about thousands for dollars not a few hundred. The redundancy is unreal and in no other profession is it tolerated. Why is it that the only government championing this issue is the smallest province of Canada? Prince Edward Island’s health minister appears to be the only brave government official to champion regionalization of Licensing Colleges.

See full article below:

‘Alphabet soup’ isn’t always easy to swallow

April 15, 2016 by Dr. Sarah Giles

Yet again, I’ve traveled to another province and paid a rather large sum of money to re-certify one of my alphabet courses. The “alphabet courses” is my name for those “mandatory” courses hospital administrators insist locums have up to date but look the other way when none of the physicians in their own ER department have done them in six years. I have quite a collection of these courses: BLS, ACLS, NRP, ALARM, PALS and ATLS, to name the big ones.

I think there is benefit in continuing education, reviewing changes in practice, and going through mock scenarios. I do, however, have some reservations about these courses:

1. Some of the courses are cash cows. They cost a lot of money to attend and for those of us who live outside major urban centres, they are difficult and expensive to get to. I do not believe the vast majority of courses need to be recertified in person or every two years. I think it is likely possible to read the text, write a test, and Skype into a few mock scenarios to prove one’s abilities in a given area.

2. There is an inherent bias in these American-made courses against rural and remote care provision. Basically, in these texts, if you don’t have a CT scanner, thoracic surgeon, interventional radiologist or high-level NICU within your facility, you need to drop everything and call in a plane. Now, that’s often the right thing to do but in rural and remote Canada, there are some opportunities to watch stable patients and to use clinical judgment that these U.S.-based practitioners, who face far more lawsuits than Canadian practitioners, are unwilling to consider.

3. The course faculty are almost exclusively Ivory Tower practitioners because the courses rarely come to the places I work and it’s cheaper to get to a big city than it is to travel to another small town where the courses may have local doctors running them. We need big-city specialists to help our patients but I become enraged when every story coming from the course faculty is about screw-ups in the periphery. I’ve never heard a story about a remarkable save from a resource-limited environment and I think the instructors are often disrespectful of the work remote and rural practitioners do. Of course, I’m not exactly part of the solution but in my defense, becoming a course instructor would require me to spend a lot of time in major urban centres and I would likely have to spend even more time there in order to teach the minimum number of courses needed to stay current.

4. I realize that we need to break the material down somehow, but it seems unrealistic to look at trauma and resuscitation without looking at cardiac rhythms. We need courses that allow us to bring these skills together. Courses such as the Comprehensive Approach to Rural Emergencies (CARE) are dreamy answers to this need but it doesn’t meet those alphabet soup needs, and it requires a hospital administration that is supportive and has money.

In the end, it’s probably best for me to try to recertify these courses at rural conferences, when the room is full of like-minded people. Unfortunately, it turns out that rural doctors who toil away in their small communities really need locums so they can leave to attend the big rural conferences, so I’m usually working during those events. I could try to help create a rural/remote supplement for these courses but I’m not sure I could win a conversation with the ivory tower academics when they often have big studies to back them up and I only have anecdotes.

Dr. Sarah Giles is locum family physician.

PEI physician opposes regional licensing for doctors

CanAm perspective: 

Having four licensing colleges in Atlantic Canada with less than two million people makes absolutely no sense. You only have to look south of the border and around the world to see we really only need one licencing college for all of Canada.

If anything, it is a major road block for recruitment. It takes a minimum of 2-4 months for a fully-licensed Canadian-trained physician to apply and get licensed. At least an Atlantic Canadian licence would allow physicians the freedom to move and pick up extra work in neighbouring provinces. 

CanAm has many clients and physicians who are extremely frustrated with the lack of mobility. Physicians can’t afford to hold multiple licences. The real issue is that no college wants to give up their power. Recruitment has absolutely nothing to do with it.

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There haven’t been formal talks about regulating physicians through an Atlantic body, but Dr. Cyril Moyse — registrar with the PEI College of Physicians and Surgeons — says a joint college would be “really difficult,” particularly for PEI doctors.

Former health minister Doug Currie proposed the idea of a joint college and said it made sense in terms of licensing consistency.

But Moyse thinks a regional college would be less flexible — with less political access. It could also make it harder for PEI patients to file complaints since the office would most likely not be located on the island.

Current health minister Robert Henderson says he thinks a regional regulating body makes sense but the decision is up to the colleges.

H/T The Guardian

Delving into practice-ready assessment (PRA)

Practice-ready assessment (PRA) is one of several routes available to internationally-trained physicians interested in joining Canada’s medical profession. Although the structure and requirements of PRA programs vary from one province to the next, through the National Assessment Collaboration (NAC), the Medical Council of Canada (MCC) continues to collaborate with its partners to encourage consistency and adoption of pan-Canadian standards.

Through PRA, candidates participate in a work-place assessment whereby practising physician assessors observe them for up to three months. Typically, before engaging in practice-ready assessment, the internationally-trained physicians would have received an orientation to the Canadian medical system that differed in length and content from one province to the next. Over time, NAC and MCC are introducing orientation tools in support of pan-Canadian standards for PRA …

Read the full story from the Medical Council of Canada

NSHA leadership ‘disorganized,’ ‘frustrating’

The Nova Scotia Health Authority caused panic among medical residents when it announced they were requiring new family doctors to have their positions approved, and then physicians would need to undergo a long privileging process.

CanAm Physician Recruiting CEO John Philpott says he questions why anyone would create any kind of delay for a fully-licenced Canadian graduate in a province that is “underserved” by family physicians.

“Apparently new start-ups are being delayed by a minimum of three months,” says Philpott. “This will obviously force Dalhousie grads to look elsewhere.”

Dr. Lynne Harrigan, Vice-President of Medicine and Integrated Health Services with the Nova Scotia Health Authority (NSHA), admitted there was a communication breakdown and the process would most likely take under a month “for most people.”

The Health Authority is also cracking down on walk-in clinics.

Dr. Mark Fletcher owns seven walk-in clinics across Halifax as well as the Medicine in Motion Medical Centre. He says the NSHA’s vision of having every citizen belong to a collaborative practice — which would include family physicians, nurses, dieticians, social and workers — that provided all after-hours care would completely eliminate walk-in clinics like his own.

When he first heard what the new Nova Scotia Health Authority was planning, he felt it was “pretty extreme.”

“For a new physician starting up their practice to be forbidden from working at a walk-in would lead to all sorts of staffing problem and closures — which seemed to be their end game,” says Dr. Fletcher.

He says what the Health Authority doesn’t realize is that walk-in clinics exist because the demand is there.

“These facilities aren’t ever going to replace primary care providers, because people with diabetes or heart troubles or anything complex need a primary care physician,” says Dr. Fletcher. “But for a young healthy person with a bladder infection or a sore throat, they can be very effectively managed in a setting where they don’t need a nurse or a social worker or a dietician.”

Dr. Fletcher says it’s encouraging that the NSHA seems to have “softened” their stance slightly due to the negative feedback from physicians and patients. He predicts the end result will be a blend of the status quo — which didn’t cost the province anything — and what the NSHA is seeking, which is a costly system of collaborative healthcare.

“Now they’re saying they don’t want physicians ‘exclusively’ working in walk-in clinics — they need to provide primary care as well,” says Dr. Fletcher. “They don’t want a walk-in practice that’s only open from 9 a.m. to 3 p.m. on weekdays because that wouldn’t be supporting a primary care physician, but clinics that are offering after-hours care seem to be OK in their eyes.”

Philpott doesn’t think collaborative health practices will work well in Nova Scotia because — unlike Ontario or Alberta — the province restricts billing for tests conducted or equipment used outside of a hospital. He says Dr. Harrigan and the board need to find a way to reward physicians who want to work in the style of practice “she believes is correct,” not restrict them.

Although Dr. Fletcher no longer runs a primary care practice, he’s also concerned that the NSHA is taking a hard stance on physician recruitment by regulating the number of physicians in a given area.

“If a town loses two doctors but the Department of Health doesn’t think they need to be replaced, they might not get approval to replace them,” says Dr. Fletcher. “It’s all going to be based on their metrics — not the patients’ best interest.”

The Nova Scotia Health Authority’s website indicates the province is short 50 specialists and family practitioners, and the wait list for care in most areas exceeds the national accepted standard.

Close to 30 per cent of walk-in patients in Halifax don’t have a family physician, and the 70 per cent who do have their own doctor often struggle to get an appointment in a timely manner. A walk-in clinic allows them to get same-day treatment quickly and easily.

Philpott says the CanAm team believes the Nova Scotia Health Authority is heading down a dangerous path that’s only going to worsen the province’s healthcare system.

“Restricting physicians and creating delays for practice start-up is a recipe for disaster in a province where physicians are among the lowest-paid and one of the highest taxed in Canada,” says Philpott. “If we’ve learned anything from past mistakes, it’s that physicians have options on where to practice.”

“Bulling them will certainly backfire.”

New licensing law expected to boost rural care, cut costs

CanAm perspective: CanAm applauds the Governor of Wisconsin for taking such a common-sense approach. We wish the Canadian system would follow suit, and Doug Currie (PEI’s Minister of Health and Wellness) gives us hope … 

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A new law in Wisconsin promises to save time and money as physicians go through the process of becoming licensed in multiple states.

The Physician Licensure Compact eliminates much of the red tape and costs associated with the process, and experts say the new law will expand healthcare in rural areas as well as curb rising costs.

The compact is often called “license portability,” and physicians in states who have not joined the compact must endure a time-consuming process of submitting full applications and paying substantial fees in each state.

Thanks to the new arrangement, a physician can become licensed in what they determine is their “home state,” and use that paperwork to gain credentials in other U.S. states.

H/T Lacrosse Tribune

English Language Policy

CanAm’s perspective:

All provinces with the exception of Ontario now strictly adhere to ELP (English Language Policy) set out by FMRAC (Federation of Medical Regulatory Authorities of Canada).

Prior to August 5, 2015, colleges of CPSNS and CPSNL were allowing exceptions to the rule by applying some common sense to the guidelines. Unlike the College of PEI, where guidelines were judged as strict rules, both CPSNL and CPSNS would exempt physicians whose post-graduate training and scope of practice were primarily completed in English countries — such was the case for Dr. Victoria Dawson.

However, on August 5, 2015, both CPSNL and CPSNS decided to adhere to FMRAC’s policy strictly. The reason given was to maintain a unified position on this matter across the country. CPSNS and CPSNL’s “flexibility” had put some of their MRA partners across the country in some jeopardy. An example in point was CPSPEI. So the common sense approach is no more.

Interestingly enough, CPSO — which is the largest jurisdiction in Canada — has NOT introduced an ELP. So while the smaller provinces strictly adhere to FMRAC’s policies, Big Brother ignores and reaps the benefit of having less complex licencing requirements.

So all of those Canadian citizens who are training abroad and desire to return to Canada, such as Dr. Victoria Dawson, can take comfort in CPSO common sense policy!

Hanging in licensure limbo

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.”

Navigating the confusing ELP standards

There’s often a bit of confusion over ELP (English Language Proficiency) when it comes to licensure, so CanAm Physician Recruiting has been looking into rumours of recent changes. Here’s what we’ve learned:

The issue of ELP was discussed at a recent meeting of the Federation of Medical Regulatory Authorities of Canada (FMRAC), held in Fredericton.

Every province has a different set of standards. British Columbia and Alberta adhere to the pan-Canadian standard and apply that to even francophone medical schools here in Canada, and Saskatchewan does the same — except they will exempt a Canadian Studying Abroad (CSA) if they have a passing mark in Grade 12 English 1030 or 1040.

Prince Edward Island famously made headlines for denying licensure to a Canadian-born doctor simply because her medical school was not listed on the English Proficiency Policy adopted by the FMRAC and the College of Physicians and Surgeons of PEI.

In Nova Scotia, however, there appears to be room for exemptions. Saba University of Medicine was added as an exempted school/country in 2013, and individual applications are sometimes exempted based on the discretion of the College of Physicians and Surgeons of Nova Scotia.

We are told the CPSNS may look at referring to passing grades in high school English when it comes to licensing a Canadian studying abroad, providing these courses are somewhat standardized across the country. However, in some provinces a recent immigrant is only required to pass “English as a second language” in order to graduate from high school, so it remains to be seen if this solution would work.

The CPSNS’s policy may be changed in the coming months, so stay tuned for more information as it’s available. In the meantime, here is our perspective …

CPSNL conforms with ELP standard set out by FMRAC but ads that if post-graduate training was completed in an English country, it will exempt the physicians. However, if the physician has taken an ELP exam and failed to meet the minimum standard which CPSNL requires, then they will demand the physician to retake the exam.

CanAm became aware of this policy when a Saudi IMG radiologist who had completed seven years of post-graduate training at McGill and passed the FRCPC, MCCEE and MCCQE but had answered “Yes” to the pre-application question “Have you ever taken an English Language test?”

This candidate, whose spoken English is better than most Canadians, has passed the TOEFL-Ibt /IELTS seven times but has failed to obtained the minimum standard set out by CPSNL in the verbal category. Although he has passed the minimum standard in each component of written and verbal English, just not on the same exam.So being 110% truthful on the pre-application has caused great frustration.

The cost of ELP is $300 U.S. so this physician who has interviewed and obtained an job offer to work in one of Canada’s most rural regions where the local dialect is so thick you would think they speak a foreign language. To make matters worse, he is a radiologist who would have very little to no interactions with patients — not to mention, living in a rural location where it would be doubtful that anyone would pass the ELP test.

CanAm would like to see a registrar from each College across Canada take the TOEFL-ibt or IELTS exam and publish the results. We are betting 50% would not meet the minimum standard set out by FMRAC. CanAm has witnessed numerous physicians taking the ELPs exams multiple times. Does it make sense that a physician can pass the MCC and even Royal College exams but not have a basic grasp of the English language? I guess common sense is not that common. What happen to picking up the phone and interviewing the candidate?

CSI Inc. helps physicians cut through red tape

A job in a new licensing board is within your grasp, and the only thing standing in your way is a few pieces of paper.

Trish Dehmel, Director of CSI Inc. in Halifax, says her job is to help physicians cut through the red tape — allowing them to obtain those documents quickly and easily.

“It can be hard for individuals to contact the right people in some countries — or even to know who to contact — and how to get them to take you seriously,” says Dehmel. “Providing criminal checks is not a priority in some foreign countries, and so they may not attach as much importance to providing the results as we do in North America.”

In some instances, records are centralized to the region in which they lived, searches cannot be conducted nationally, and data may only be obtainable for the past seven years.

A former federal police office, Dehmel knows the industry inside out and has been helping healthcare professionals navigate the system for the last decade.

CSI employees work with healthcare professionals, hospitals, private clinics, and licensing colleges in order to simplify the process of obtaining police clearance checks and certificates of conduct.

The requirements are different for each licensing board. In Nova Scotia, for example, a new physician needs a criminal records search to satisfy the requirements of the College of Physicians and surgeons. If they plan on working for Capital Health or the IWK Health Centre, they will also need a search of the pardoned sex offender database, which requires a set of fingerprints and takes about two weeks.

But it’s not always as easy as it sounds.

“We often work with physicians who are in Canada and apply for a job within a new board, and the board says ‘Well, you worked in Saudi Arabia, so you need to provide a criminal record check from Saudi Arabia,’ or ‘You worked in four different U.S. states. We need checks from all of them,’” explains Dehmel. “That’s where we can help.”

In many cases, a criminal record search can be ordered on CSI’s website using a system called e-Consent. You’ll be asked five “out of wallet” questions about things that only you would know, and answering correctly allows the system to verify your identity without a passport or fingerprints.

While many people still refer to the “vulnerable sector check” that was in place prior to 2009, Dehmel says it’s now a search of the pardoned sex offender database. It involves using fingerprints to ensure a person is not listed in the sexual assault database under any name, in any province. CSI has a portal service with the College of Physicians and Surgeons so the results are reported directly to them.

Dehmel says healthcare professionals are welcome to call CSI with questions about the process, and they have resources and contacts in most countries around the world.

“We provide fast, efficient service, and make the process easier for professionals who need these documents,” says Dehmel. “We’re here to help.”

Dearth of resident slots riles foreign-born doctors

Physician recruitment specialist John Philpott understands the frustration of foreign doctors who move to Canada in search of better lives, but end up having to take other jobs because they can’t find residency seats.

“This is a national problem that we’ve been dealing with for 20 years,” says Philpott, chief executive officer of Halifax-based CanAm Physician Recruiting.

“Shame on the government of Canada for granting landed immigrant status to doctors without providing them with a pathway for licensing.”

Read Mark Cardwell’s full story in The Medical Post by visiting CanadianHealthcareNetwork.ca