Medical registration in Canada: a brief overview

Fleur-Ange Lefebvre

 

 

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Although physician leaders may be familiar with provincial and territorial medical regulation when recruiting Canadian-trained physicians, registration and licensure may seem more complicated for physicians who cross provincial or territorial boundaries or for physicians trained outside Canada. This paper provides information for physician leaders to better understand the basics of medical regulation, its standards, and the regulatory authorities in Canada.

 

KEY WORDS: medical regulation, registration, licensure, standards, regulatory authorities, complaints, Canada

 

Medical regulation

 

Professional regulation aims to provide public assurance and protection. Several professions are regulated in Canada, including medicine, usually by a process that relies heavily on the involvement of peers. Originally self-regulation, medical regulation now involves more and more public representation on various councils or boards across the country.

 

The three main mandates of medical regulation are:

 

  • Registration and licensure — the processes by which a physician applies for, and may be granted, a license to practise in a chosen jurisdiction.
  • Complaints and resolution — the processes by which public complaints and concerns about a physician’s practice or conduct are managed and adjudicated, including disciplinary action where necessary.
  • Quality assurance of practice — the processes through which a physician is expected to demonstrate ongoing competence in the scope of their medical practice.

 

In addition, several (but not all) medical regulatory authorities in Canada are also involved in reviewing and accrediting out-of-hospital diagnostic and surgical facilities.

 

Medical regulatory authorities

 

Professional regulation occurs at the provincial or territorial level in Canada. There are 13 medical regulatory authorities, one in each province and territory. In the ten provinces, the “colleges” exercise the authority delegated to them through legislation. In the three territories, government departments carry out the licensing functions of a regulatory authority.

 

Jurisdictional regulation means that there is no pan-Canadian license to practise medicine. If a physician wishes to practise in more than one province or territory, he or she must apply for and be granted a license in each jurisdiction. The exception to this is in the provision of telemedicine services, which may not require jurisdictional licensure in the province or territory in which the patient receives care. However, some jurisdictions do require licensure for telemedicine services.

 

Federation of Medical Regulatory Authorities of Canada

 

The Federation of Provincial Medical Licensing Authorities of Canada was created in 1968 to provide a forum for information exchange among the provincial colleges, called “licensing authorities” at that time. It later expanded to include the territories, and, in 2004, its current name was adopted to reflect the fact that professional regulation is broader than licensure.

 

Today, FMRAC’s mission is to advance medical regulation on behalf of the public through collaboration, common standards, and best practices. Its four objects are to:

 

  • Provide an effective forum for the exchange of information and collaborate with its members and others on issues that involve medical regulation
  • Develop and maintain programs, services, and benefits for its members
  • Develop and promote pan-Canadian policies, standards, statements, and perspectives on aspects of medical regulation
  • Interact with and inform key stakeholders (including the federal government, the public, and media) on medical regulatory matters of national or international importance

 

Evolution of registration classes and the Agreement on Internal Trade

 

The Federal–Provincial–Territorial Agreement on Internal Trade (AIT)1 was first implemented in 1995, and significant changes in labour mobility came into effect on 1 April 2009. Summarized, the changes dictate that full licensure in one jurisdiction should result in full licensure in another jurisdiction in Canada, without any further requirements.

 

There is one exclusion: language proficiency in English or French. In addition, this recognition does not preclude the need for a certificate of professional conduct. In addition to recognition of full licensure, provisional licenses are also included in the labour mobility part of the agreement, provided the receiving jurisdiction can meet the same restrictions and supervision requirements.

 

In 2008, the pending changes on labour mobility mobilized FMRAC and the medical regulatory authorities to streamline the categories of medical registration and licensure, agree on common language, and foster common standards and approaches. The intent was to facilitate the mobility of physicians across the country. As many aspects of regulation rely on legislation, it took several years for some of the changes to come into effect in each province or territory; indeed, some of them remain aspirational today.

 

The Canadian Standard sets out the academic qualifications that automatically make an applicant eligible for full licensure in every Canadian province and territory.

 

Physicians applying for the first time to become licensed to practise medicine in a Canadian jurisdiction may achieve full licensure only if they:

 

  1. have a medical degree [from a medical school that, at the time the candidate completed the program, was listed in the World Directory of Medical Schools (WDMS)], or a Doctor of Osteopathic Medicine degree from a school in the United States accredited by the American Osteopathic Association Commission on Osteopathic College Accreditation; and
  2. are a Licentiate of the Medical Council of Canada; and
  3. have satisfactorily completed a discipline-appropriate postgraduate training program in allopathic medicine and an evaluation by a recognized authority; and
  4. have achieved certification from the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada or the Collège des médecins du Québec.

 

Model Standards for Medical Registration in Canada

 

In addition to the Canadian Standard above, FMRAC’s Model Standards for Medical Registration in Canada2 set out the requirements for provisional licensure (including pre-screening requirements) for family physicians and general practitioners, as well as other medical and surgical specialties. They include a standard for the route from provisional to full licensure.

 

Physician practice improvement

 

FMRAC also developed the physician practice improvement system3 with the following vision: that Canadians are assured of the competence of physicians and that physicians are supported in their continuous commitment to improve.

 

This multi-year endeavour involved seven other stakeholder organizations: the Association of Faculties of Medicine of Canada, the Canadian Medical Association, the Canadian Medical Protective Association, the College of Family Physicians of Canada, HealthCareCAN, the Medical Council of Canada, and the Royal College of Physicians and Surgeons of Canada.

 

The system aims to be transparent, relevant, inclusive, transferable, formative, efficient, and integrated. It comprises a five-step cycle (Figure 1).

 

By moving through these five steps, physicians will be able to demonstrate how their continuing education choices align with their learning needs and measure whether what they learn leads to improved care. This cyclical process is ongoing during the entire career of physicians, to ensure their practice is meeting the needs of the patients and the requirements of the CanMEDS 2015 and CanMEDS‐FM 2015 frameworks.

 

Pan-Canadian consistency and rigour

 

FMRAC and its 13 members agree:

 

  • That protection of the public is the primary statutory responsibility of the medical regulatory authorities
  • To the Model Standards for Medical Registration in Canada2
  • On consistent and sufficiently rigorous registration and licensure processes for physicians across all Canadian jurisdictions
  • To support the mobility of qualified physicians across Canadian jurisdictions
  • To notify other each other of changes to registration standards in advance of implementation

 

The websites referred to in this article offer additional and detailed information that may be of interest for physician leaders.

 

References

1.Chapter seven — labour mobility. In Agreement on internal trade. Ottawa: Industry Canada; 1994. Available: https://tinyurl.com/zsp4zk6 (accessed Jan. 2017).

2.Model standards for medical registration in Canada. Ottawa: Federation of Medical Regulatory Authorities of Canada; 2016. Available: https://tinyurl.com/jxesozg (accessed Jan. 2017).

3.Physician practice improvement. Ottawa: Federation of Medical Regulatory Authorities of Canada; 2016. Available: https://tinyurl.com/jfntm47 (accessed Jan. 2017).

 

Author

Fleur-Ange Lefebvre is executive director and CEO of the Federation of Medical Regulatory Authorities of Canada.

 

Correspondence to: falefebvre@fmrac.ca

 

This article has been peer reviewed.

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Although physician leaders may be familiar with provincial and territorial medical regulation when recruiting Canadian-trained physicians, registration and licensure may seem more complicated for physicians who cross provincial or territorial boundaries or for physicians trained outside Canada. This paper provides information for physician leaders to better understand the basics of medical regulation, its standards, and the regulatory authorities in Canada.

 

KEY WORDS: medical regulation, registration, licensure, standards, regulatory authorities, complaints, Canada

 

Medical regulation

 

Professional regulation aims to provide public assurance and protection. Several professions are regulated in Canada, including medicine, usually by a process that relies heavily on the involvement of peers. Originally self-regulation, medical regulation now involves more and more public representation on various councils or boards across the country.

 

The three main mandates of medical regulation are:

 

  • Registration and licensure — the processes by which a physician applies for, and may be granted, a license to practise in a chosen jurisdiction.
  • Complaints and resolution — the processes by which public complaints and concerns about a physician’s practice or conduct are managed and adjudicated, including disciplinary action where necessary.
  • Quality assurance of practice — the processes through which a physician is expected to demonstrate ongoing competence in the scope of their medical practice.

 

In addition, several (but not all) medical regulatory authorities in Canada are also involved in reviewing and accrediting out-of-hospital diagnostic and surgical facilities.

 

Medical regulatory authorities

 

Professional regulation occurs at the provincial or territorial level in Canada. There are 13 medical regulatory authorities, one in each province and territory. In the ten provinces, the “colleges” exercise the authority delegated to them through legislation. In the three territories, government departments carry out the licensing functions of a regulatory authority.

 

Jurisdictional regulation means that there is no pan-Canadian license to practise medicine. If a physician wishes to practise in more than one province or territory, he or she must apply for and be granted a license in each jurisdiction. The exception to this is in the provision of telemedicine services, which may not require jurisdictional licensure in the province or territory in which the patient receives care. However, some jurisdictions do require licensure for telemedicine services.

 

Federation of Medical Regulatory Authorities of Canada

 

The Federation of Provincial Medical Licensing Authorities of Canada was created in 1968 to provide a forum for information exchange among the provincial colleges, called “licensing authorities” at that time. It later expanded to include the territories, and, in 2004, its current name was adopted to reflect the fact that professional regulation is broader than licensure.

 

Today, FMRAC’s mission is to advance medical regulation on behalf of the public through collaboration, common standards, and best practices. Its four objects are to:

 

  • Provide an effective forum for the exchange of information and collaborate with its members and others on issues that involve medical regulation
  • Develop and maintain programs, services, and benefits for its members
  • Develop and promote pan-Canadian policies, standards, statements, and perspectives on aspects of medical regulation
  • Interact with and inform key stakeholders (including the federal government, the public, and media) on medical regulatory matters of national or international importance

 

Evolution of registration classes and the Agreement on Internal Trade

 

The Federal–Provincial–Territorial Agreement on Internal Trade (AIT)1 was first implemented in 1995, and significant changes in labour mobility came into effect on 1 April 2009. Summarized, the changes dictate that full licensure in one jurisdiction should result in full licensure in another jurisdiction in Canada, without any further requirements.

 

There is one exclusion: language proficiency in English or French. In addition, this recognition does not preclude the need for a certificate of professional conduct. In addition to recognition of full licensure, provisional licenses are also included in the labour mobility part of the agreement, provided the receiving jurisdiction can meet the same restrictions and supervision requirements.

 

In 2008, the pending changes on labour mobility mobilized FMRAC and the medical regulatory authorities to streamline the categories of medical registration and licensure, agree on common language, and foster common standards and approaches. The intent was to facilitate the mobility of physicians across the country. As many aspects of regulation rely on legislation, it took several years for some of the changes to come into effect in each province or territory; indeed, some of them remain aspirational today.

 

The Canadian Standard sets out the academic qualifications that automatically make an applicant eligible for full licensure in every Canadian province and territory.

 

Physicians applying for the first time to become licensed to practise medicine in a Canadian jurisdiction may achieve full licensure only if they:

 

  1. have a medical degree [from a medical school that, at the time the candidate completed the program, was listed in the World Directory of Medical Schools (WDMS)], or a Doctor of Osteopathic Medicine degree from a school in the United States accredited by the American Osteopathic Association Commission on Osteopathic College Accreditation; and
  2. are a Licentiate of the Medical Council of Canada; and
  3. have satisfactorily completed a discipline-appropriate postgraduate training program in allopathic medicine and an evaluation by a recognized authority; and
  4. have achieved certification from the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada or the Collège des médecins du Québec.

 

Model Standards for Medical Registration in Canada

 

In addition to the Canadian Standard above, FMRAC’s Model Standards for Medical Registration in Canada2 set out the requirements for provisional licensure (including pre-screening requirements) for family physicians and general practitioners, as well as other medical and surgical specialties. They include a standard for the route from provisional to full licensure.

 

Physician practice improvement

 

FMRAC also developed the physician practice improvement system3 with the following vision: that Canadians are assured of the competence of physicians and that physicians are supported in their continuous commitment to improve.

 

This multi-year endeavour involved seven other stakeholder organizations: the Association of Faculties of Medicine of Canada, the Canadian Medical Association, the Canadian Medical Protective Association, the College of Family Physicians of Canada, HealthCareCAN, the Medical Council of Canada, and the Royal College of Physicians and Surgeons of Canada.

 

The system aims to be transparent, relevant, inclusive, transferable, formative, efficient, and integrated. It comprises a five-step cycle (Figure 1).

 

By moving through these five steps, physicians will be able to demonstrate how their continuing education choices align with their learning needs and measure whether what they learn leads to improved care. This cyclical process is ongoing during the entire career of physicians, to ensure their practice is meeting the needs of the patients and the requirements of the CanMEDS 2015 and CanMEDS‐FM 2015 frameworks.

 

Pan-Canadian consistency and rigour

 

FMRAC and its 13 members agree:

 

  • That protection of the public is the primary statutory responsibility of the medical regulatory authorities
  • To the Model Standards for Medical Registration in Canada2
  • On consistent and sufficiently rigorous registration and licensure processes for physicians across all Canadian jurisdictions
  • To support the mobility of qualified physicians across Canadian jurisdictions
  • To notify other each other of changes to registration standards in advance of implementation

 

The websites referred to in this article offer additional and detailed information that may be of interest for physician leaders.

 

References

1.Chapter seven — labour mobility. In Agreement on internal trade. Ottawa: Industry Canada; 1994. Available: https://tinyurl.com/zsp4zk6 (accessed Jan. 2017).

2.Model standards for medical registration in Canada. Ottawa: Federation of Medical Regulatory Authorities of Canada; 2016. Available: https://tinyurl.com/jxesozg (accessed Jan. 2017).

3.Physician practice improvement. Ottawa: Federation of Medical Regulatory Authorities of Canada; 2016. Available: https://tinyurl.com/jfntm47 (accessed Jan. 2017).

 

Author

Fleur-Ange Lefebvre is executive director and CEO of the Federation of Medical Regulatory Authorities of Canada.

 

Correspondence to: falefebvre@fmrac.ca

 

This article has been peer reviewed.

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