Pandemic showed need for national physician licence, doctors argue
Paperwork is hampering recruitment efforts to rural areas, some doctors say
Dr. Monika Dutt was just adjusting to her new role as the medical officer of health for the central and western parts of Newfoundland and Labrador when COVID-19 reached the province.
As the regions turned to her for guidance, she faced an added stress: applying for her licence to practise there.
Dutt, a family doctor and public health physician in Nova Scotia, was hired in February 2020 and issued a short-term licence that allowed her to work for three months in Newfoundland and Labrador. She was then told she would have to apply for a full licence in order to stay on.
"There was actually a point at which it was questionable whether the process would be finished before my short-term licence was done, and whether there would be no medical officer of health for half the province for that period of time," she said.
"Which in some ways to me, doesn't make sense. If I was qualified to work for the first three months, what is the difference now?"
While Dutt did get her licence in time, she said her experience is just one in a long list of reasons why Canada needs a national licence for doctors, instead of relying on separate regimes for each province and territory.
It's something that a chorus of physicians across the country have been wanting for years.
Some experts say national licenses could speed up redeployment of doctors and nurses to the areas where they're needed most. And there is a doctor shortage across Canada. In Newfoundland and Labrador, roughly 98,000 people are without a family doctor, according to the province's medical association. Some New Brunswickers have been told it's a three-to-four year wait to get a doctor.
But regulatory bodies say the issue is far more complicated than it seems at first glance, and would require legislative change to make it work.
Months of paperwork
Currently, physicians must apply to the regulatory body in each province or territory where they want to work, often spending months gathering paperwork and thousands of dollars on fees.
Regulatory bodies ask for everything from training certificates to criminal record checks. They also look for references from former instructors or colleagues, while others want to see immunization records.
Dutt thinks all of that information is important, but argues if a physician has been vetted in one province, they shouldn't have to do the full process again in another. She currently pays thousands of dollars to renew her licences in four jurisdictions every year, because she said it's easier than reapplying from scratch.
"We should have the same standards for any physician working anywhere in the country."
The issue is also being championed in Neils Harbour, a village in Cape Breton, N.S., that has spent years trying to recruit new doctors.
Dr. Genevieve Rochon–Terry, who is originally from the Toronto area, has been trying to convince her former classmates and colleagues from her residency to replace her while she's on maternity leave.
She said the area provides unique opportunities for family doctors who also want variety and shifts in the local hospital.
"Potentially we would have a lot more success finding a young person, a young doctor who is still looking for a community to commit to, if they could just pack up and come here even for a short period amount of time."
Rochon–Terry said national licences could eliminate a big barrier that is hampering rural recruitment efforts.
"It's a very intensive process with a lot of paperwork. And for people who might be interested in coming here, it's frankly a lot easier to just stay in your own province," she said.
Government involvement required
In Ontario, a spokesperson for the College of Physicians and Surgeons pointed out that creating a national licence isn't as simple as agreeing that all physicians could move freely across provincial and territorial borders.
Each jurisdiction has its own set of rules, and the disciplinary process can vary from province to province.
Meanwhile, the Federation of Medical Regulatory Authorities of Canada said the mandate would have to come from federal, provincial and territorial governments, and would likely require changes in legislation at all levels.
"There is no evidence to indicate that that is something that will happen in the near future," the federation said in a statement.
A few years ago, there was brief hope that the effort was taking shape.
Nova Scotia's former premier, Stephen McNeil, saw national licensing as a way to tackle the doctor shortage.
He pushed the idea at meetings with his counterparts, and negotiations began to create a regional model between Nova Scotia, Prince Edward Island and Newfoundland and Labrador.
But that all came to a halt when the pandemic began, said Dr. Gus Grant, the registrar of Nova Scotia's College of Physicians and Surgeons. Grant said the college fully supports the idea, but adds that a national licence is unlikely to have a big effect.
"Ninety-three per cent of physicians in Nova Scotia have a full licence," he said. "I think it's fair to assume that those physicians wish to practice here. It's very rare the physician that wishes to move around a lot."
Grant said colleges across the country have taken strides to be more flexible. He said some, including Nova Scotia's, have made it easier to get a locum licence, which allows doctors to fill in for short periods of time.
Some jurisdictions have also reduced the burden of paperwork if a physician has a licence elsewhere in Canada, he said, and these factors have reduced the urgency of introducing a national licence.
Nova Scotia's new health minister, Michelle Thompson, said she isn't ready to take a stance on the issue yet.
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"I think we're open to conversation," she said. "It would need a lot of detail and a lot of discussion, I think as evidenced that it hasn't happened yet already."
Both Dutt and Rochon–Terry said it's time to get the momentum going again, and finally turn years of discussion into action.
"It just doesn't make sense in our current context in the pandemic, or just in general when we're trying to fill urgent needs," said Dutt.
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With files from Rose Murphy