'National' licensure in medicine: What legal future can we create?: Discussion and technical papers

The purpose of this paper is to stimulate discussion on the current physician regulatory licensure system as a growing impediment to the sustainability and excellence of Canada’s health care system. The COVID-19 pandemic has highlighted the fundamental role that the healthcare system and physicians play in safeguarding the health of Canadians and the economy. The pandemic has also demonstrated that the health of Canadians should know no borders: a robust and responsive system is needed to meet the needs of patients, wherever they live. The Government of Canada has committed itself to ensuring that everyone can have access to a family doctor or a primary care team. It has also committed to expanding virtual health care. With a growing concern for physician health and wellness, an increasingly aging population and limited resources, governments across the country must work together to find bold and creative solutions to the gaps that exist in the system. A national survey of physicians suggests that the current approach to regulatory licensure has erected barriers that prevent them from providing continuing care to Canadians. This paper offers a solution to these barriers. This paper describes existing national regulatory systems in the Canadian securities industry and in Australia to regulate health professionals. They are illustrative of potential national frameworks to professional regulation and have relevant components to consider in the development of a pan-Canadian approach for medical licensure in Canada. With this background, the paper then proposes a national model for the Canadian medical profession. Environmental factors led to the adoption of the national approach to regulation in the Canadian securities industry and the Australian health profession scheme. In Canada it was the pressure of global trade and keeping current with other OECD countries. In Australia it was an agreement between all levels of government followed by a report from the Commonwealth government that mutual recognition legislation did not enable workforce mobility of health professionals, as well as a couple of highly publicized physician discipline cases. Provincial and territorial Canadian governments can show leadership by passing legislation to support regulatory efficiencies and cost savings. Currently, there are national medical and specialty exams that are accepted across the country as indication of competence, and the question arises as to why there cannot be a national approach for registration and regulation. The costs of maintaining thirteen regulators, for registration and regulation is inefficient and ineffective. The Passport System in the Canadian securities industry provides for a multi-jurisdictional license controlled by the provincial securities’ regulators. This System does not require involvement by the federal government in the regulation of securities dealers and advisers. It is a System built on complete cooperation of the provinces and territories. Another system is the Cooperative Capital Markets Regulatory system where the provincial and territorial governments delegate their authority to a central/national agency and this agency carries out all regulatory activities on behalf of the provinces. The Australian scheme is also a form of delegated authority from the individual Australian states and territories and covers 15 health professions with a national agency alongside national boards for each health profession.

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