Provincial licensing and regulatory procedures are dissuading family doctors from coming to B.C., according to a family doctor who directs a medical clinic in Vancouver.
Dr. Linda Jando says a family doctor wishing to move to B.C. from another province is not guaranteed approval by the B.C. College of Physicians and Surgeons to work in a family clinic. She points to an Alberta family doctor who was initially denied a licence to work at her clinic until a protracted appeal of the original decision, by herself and the doctor, led to a reversal.
The issue of licensing out-of-province doctors has not garnered as much of the public’s recent attention as accreditation for internationally trained doctors, said Jando; however, this should not be the case, she told Glacier Media.
“I’ve had good doctors, who are accredited nationally and licensed in another province, express an interest in working at my clinic and they just give up on the process,” said Jando.
All family doctors trained at one of Canada’s 17 medical schools must be accredited by the Canadian College of Family Physicians (CCFP), which ensures a competent level of professional care can be met. Following accreditation, a family doctor must be licensed by a provincial regulator.
Alberta family doctor initially denied family doctor licence
Last year, Jando, not unlike many clinic operators, was seeking new doctors. Then, a veteran family doctor from Alberta applied to Jando’s Yaletown clinic; Jando says the doctor had a clean professional record, was accredited by the CCFP and licensed by Alberta’s regulator as a family practitioner.
Jando said she thought she had a match but what ensued was a difficult process with this province’s regulator — the B.C. College of Physicians and Surgeons. At issue was the fact the Alberta doctor had been recently working in a medical centre akin to an urgent and primary care clinic in B.C.
Initially, said Jando, the college “told him, he's not allowed to be a family doctor in my clinic and practice longitudinal care. In other words, he's not allowed to become a family doctor and provide longitudinal care to family practice patients in B.C. Yet he's certified and competent in Canada,” said Jando, who described the process as “bizarre,” especially when the college proposed that the doctor work in an emergency room or urgent care setting.
Eventually, the college changed its tune, as Jando and the doctor argued the Alberta clinic was akin to offering longitudinal care, which in simple terms is seeing one patient for medical issues over an extended period of time.
With her experience, Jando now wonders what roadblocks doctors will face should they want to transfer from a B.C. urgent and primary care clinic to a family practice, if the college is requiring recent longitudinal care experience.
The college told Glacier Media that it licenses doctors on a case-by-case basis. It also says it does not track how many out-of-province applications it handles nor how many Canadian doctors are denied a licence in B.C.
The college also claims it supports a national licensure system.
Groundswell of support for national licensure
Such a system is required in order to reduce barriers to physician mobility and improve access to patient care, according to the Canadian Medical Association (CMA), which released a poll on Jan. 30 showing 95 per cent of physicians and medical students support pan-Canadian licensure.
“Canadian patients and health-care providers are struggling with the greatest health human resources crisis our country has ever seen,” said CMA president Dr. Alika Lafontaine following the poll results.
The association called the provincial licensing system one that can be “complicated, time-consuming, and costly.”
Lafontaine is urging the provincial and territorial governments, with the support of the federal government, to implement pan-Canadian licensure “as one of many solutions to Canada’s health-care crisis.”
Such steps are on their way by the Ontario government, which announced a plan on Jan. 19 to cut its regulators’ provincial licensing limitations by reciprocating out-of-province licences.
“With our new ‘As of Right’ rules, Ontario is the first province in Canada to allow health-care workers from across the country to immediately start providing care. That’s the kind of innovative solutions that will cut down unnecessary bureaucratic delays and help bring reinforcements to the frontlines of our health-care system,” stated Ontario Premier Doug Ford on Jan. 19.
Ford intends to legislate changes this month.
On Jan. 30, Atlantic provinces announced their intentions to “eliminate licensing barriers that impact the movement of physicians between the Atlantic provinces,” according to a statement by the Prince Edward Island government.
National licensure is also supported by Doctors of BC president Dr. Joshua Greggain, who is confident the vast majority of his members also agree.
“It would be very helpful, partly for movement and mobility of physicians, but also to reduce the administrative burden of people trying to get licences,” said Greggain.
However, Greggain also acknowledges national licensure must be done in a manner that doesn’t create more acute have and have-not jurisdictions, noting, “there's a principled conversation there around not wanting to take physicians or health-care workers or nurses from out of province and yet trying to look at the whole resources within our own community or within our own province.”
On Feb. 1, Glacier Media asked B.C. Health Minister Adrian Dix if B.C. would consider mirroring Ontario’s proposed legislation.
B.C. health minister not following Ontario's lead
“It’s not legislation you need. It’s actual significant reform together and breaking down barriers for people wherever they come from,” said Dix, noting reforms he’s made to improve accreditation processes for internationally trained doctors in B.C.
“I want there to be great public health care in Ontario. I don't think what we need as a country is competition between jurisdictions,” said Dix, who said he discussed this matter with his Ontario counterpart Sylvia Jones.
“We were talking about our joint responsibility to train people and their doctors,” said Dix.
“All of us have an obligation to increase those numbers, and for nurses and for health science professionals and for health-care workers. I think because of what B.C. is and the relationship we have with doctors, this is going to be an attractive place to be for a long time, but we don't need to do that at the expense of that.”
Jando disagrees with Dix’s reticence to reduce the regulatory burden, arguing B.C. is not an attractive place for family doctors.
“Tell me, how is it so attractive? There are not enough doctors who want to come here and many who can come here can't because of the red tape,” she said.
Jando points out over one million British Columbians report not having access to a family doctor, far outweighing the national per capita average.
An Angus Reid poll from September 2022 states British Columbia (59 per cent) and Atlantic Canada (60 per cent) are home to the highest number of adults who report difficult access to their current doctor or can’t find one at all. (Alberta and Ontario’s rate is 44 per cent each.)
If anything, it is B.C.’s health minister who should be cutting the red tape, said Jando.
Greggain, meanwhile, said similar conversations are being had over mobility between B.C.’s five health authorities.
“If you really drill it down, you have to have credentials to work at individual health authorities. And so there's been a conversation and movement to say, ‘Let's at least start to remove the credentialing across different communities and health authorities in the province, as well as look at pan Canadian licensure,’” he said.
Greggain agrees with Dix, however, in that money and resources need to be in place to support rural doctors and to attract more of them, regardless of mobility issues.
“We don't want to potentially have people move out to places that are already under serviced for the sake of larger places. …And, so, licensure, credentialing, and mobility are all three elements to that problem,” said Greggain.
