New Rules may Strip Rural, Remote Areas of their Physicians, Colleges Warn

February 5, 2009
By Patrick Sullivan

Canada’s political leaders say an agreement that will allow workers with occupational certification in one province to transfer it to all others will be a boon for the country, but there is growing concern about the agreement’s impact on medicine.The concern stems from a Jan. 16 amendment to the Agreement on Internal Trade (AIT), which “will provide that any worker certified for an occupation by a regulatory authority of one province or territory is to be certified for that occupation by others.”

Prime Minister Stephen Harper says this will help “ensure that all Canadian workers have the freedom to be able to work in their fields anywhere in Canada.”

However, the provincial colleges that regulate the medical profession say the amendment may strip some rural and remote areas of their physicians.

“I think the drafters of this agreement have failed to assess the potential unintended consequences in the health sector,” warns Dr. Dennis Kendel, registrar of the College of Physicians and Surgeons of Saskatchewan.

A CMA discussion paper says the new “mutual recognition” rules raise several questions. For instance, will they apply to international medical graduates (IMGs) who are working under some form of restricted or conditional licence?

The paper points out that a doctor seeking a provisional licence in Saskatchewan “must make a three-year commitment to practise in a named community” in order to obtain the licence. Will the rule change now allow them to leave immediately?

CMA President Robert Ouellet said concern over the mobility amendment is not limited to regulatory bodies. “The CMA has always supported physician mobility among jurisdictions but we also value the need for a national standard and we do not want to see it weakened,” he said.

Kendel said there is “considerable concern that a completely open marketplace will put some provinces at a competitive disadvantage and will make it even more difficult to retain physicians in rural and remote communities.

“The reality in Saskatchewan is that our rural communities have sustained the physician supply by relying on IMG family physicians who previously were not eligible for registration until they acquired certain Canadian credentials. Once they acquire these credentials they tend to leave the rural communities, but at least the communities could benefit from their services for two or three years. Under the revised AIT, it may be possible for these IMGs to leave immediately, or very soon after being registered in another province or territory.”

The Federation of Medical Regulatory Authorities of Canada (FMRAC) is also “very concerned” about the issue, and it explained why in a December letter to federal and provincial labour ministers.

– It is worried that there will be little incentive for physicians to begin practising in areas of need, since it will become easier for them to practise in more attractive locations.

– It is worried that changes to AIT’s labour mobility rules will handcuff regulatory authorities. “Most physicians are not employees and the responsibility for ensuring that they meet and maintain appropriate standards falls to the regulatory authorities,” said FMRAC President Douglas Anderson. “You do not want to deprive the colleges of some of the tools they need to do their job.”

Anderson said the federation shares Kendel’s concern about the impact on rural Canada. He said the rule change may encourage doctors to leave before completing return-of-service commitments and this could “deprive Canadians in rural and remote communities of the care they currently receive.”

FMRAC had requested an urgent meeting with labour ministers and asked them to postpone the mobility amendment until its concerns have been considered. The new rules are supposed to take effect Apr. 1.

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