The College of Physicians and Surgeons of British Columbia, in partnership with its sister medical regulatory authorities (MRAs) across Canada, has been discussing the future of registration and licensure in Canada. Currently, the delivery of health care is a constitutional responsibility of each province and territory, and physicians must obtain licensure in the jurisdiction (or jurisdictions) in which they wish to practise. With the increased provision of medical services through digital health options, physicians may seek to work in more than a single provincial/territorial jurisdiction.
The provision of telemedicine services is not standardized across Canada:
- Some jurisdictions require physicians to have registration in the province in which the patient is located, regardless of location and licence status.
- Some jurisdictions require out-of-province physicians to obtain a specific telemedicine licence.
- Some jurisdictions simply require the physician to hold an acceptable licence in the Canadian jurisdiction in which they reside (the “home” jurisdiction) in order to be able to provide telemedicine services in that jurisdiction.
In some Canadian jurisdictions, the provision of telemedicine services may not be an insured service and physicians may be billing the patient directly. In others, the provincial or territorial health plan may consider this to be an insured service. Some jurisdictions are reconsidering requirements for telemedicine services, given the proliferation of entrepreneurial, stand-alone companies for the provision of episodic care.
In an effort to reduce fragmentation of care, some jurisdictions want to ensure that providers of telemedicine services have a clear and verifiable connection with the patient’s jurisdiction of residence and, through that, an ongoing connection with the patient.
In response, the Federation of Medical Regulatory Authorities of Canada (FMRAC) is embarking upon a review of the licensure of physicians.
There are three projects:
- Telemedicine: FMRAC is exploring the possibility of creating a single licence to support telemedicine across all jurisdictions in Canada. If possible and approved by the provincial/ territorial ministries of health, the MRA in the host jurisdiction in which the physician is licensed would assume responsibility for the investigation and adjudication of concerns regarding competence or conduct by the physician in any other Canadian jurisdiction where the physician is providing services through telemedicine.
- Fast-track licences: FMRAC is examining the opportunity to expedite the issuance of licensure for physicians who hold full registration in another province/territory through the traditional route (MD, LMCC, certification with either the CFPC or RCPSC) and have a “clean” certificate of professional conduct.
- Licence for portability: Finally, FMRAC is considering a licence portability agreement to enable physicians to work for a short time (locum tenens) in another jurisdiction based solely on licensure in the “home” jurisdiction. Interestingly, this aligns with a similar process for members of the legal profession across Canada used by the Federation of Law Societies of Canada.
As medical regulators are bound by statute, the first key stakeholder consultation will occur with all of the ministries of health. I hope to have more information on our consultations in a future edition of the College Connector.
Heidi M. Oetter, MD
Registrar and CEO
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