This April 15, 2016 Medical Post article by Dr. Sarah Giles once again addresses the high cost of credentialing and licensing for physicians seeking to do locum work in neighbouring health boards and provinces. CanAm has been out spoken on this issue. What the general public and government officials don’t realize is that we are talking about thousands for dollars not a few hundred. The redundancy is unreal and in no other profession is it tolerated. Why is it that the only government championing this issue is the smallest province of Canada? Prince Edward Island’s health minister appears to be the only brave government official to champion regionalization of Licensing Colleges.
See full article below:
‘Alphabet soup’ isn’t always easy to swallow
April 15, 2016 by Dr. Sarah Giles
Yet again, I’ve traveled to another province and paid a rather large sum of money to re-certify one of my alphabet courses. The “alphabet courses” is my name for those “mandatory” courses hospital administrators insist locums have up to date but look the other way when none of the physicians in their own ER department have done them in six years. I have quite a collection of these courses: BLS, ACLS, NRP, ALARM, PALS and ATLS, to name the big ones.
I think there is benefit in continuing education, reviewing changes in practice, and going through mock scenarios. I do, however, have some reservations about these courses:
1. Some of the courses are cash cows. They cost a lot of money to attend and for those of us who live outside major urban centres, they are difficult and expensive to get to. I do not believe the vast majority of courses need to be recertified in person or every two years. I think it is likely possible to read the text, write a test, and Skype into a few mock scenarios to prove one’s abilities in a given area.
2. There is an inherent bias in these American-made courses against rural and remote care provision. Basically, in these texts, if you don’t have a CT scanner, thoracic surgeon, interventional radiologist or high-level NICU within your facility, you need to drop everything and call in a plane. Now, that’s often the right thing to do but in rural and remote Canada, there are some opportunities to watch stable patients and to use clinical judgment that these U.S.-based practitioners, who face far more lawsuits than Canadian practitioners, are unwilling to consider.
3. The course faculty are almost exclusively Ivory Tower practitioners because the courses rarely come to the places I work and it’s cheaper to get to a big city than it is to travel to another small town where the courses may have local doctors running them. We need big-city specialists to help our patients but I become enraged when every story coming from the course faculty is about screw-ups in the periphery. I’ve never heard a story about a remarkable save from a resource-limited environment and I think the instructors are often disrespectful of the work remote and rural practitioners do. Of course, I’m not exactly part of the solution but in my defense, becoming a course instructor would require me to spend a lot of time in major urban centres and I would likely have to spend even more time there in order to teach the minimum number of courses needed to stay current.
4. I realize that we need to break the material down somehow, but it seems unrealistic to look at trauma and resuscitation without looking at cardiac rhythms. We need courses that allow us to bring these skills together. Courses such as the Comprehensive Approach to Rural Emergencies (CARE) are dreamy answers to this need but it doesn’t meet those alphabet soup needs, and it requires a hospital administration that is supportive and has money.
In the end, it’s probably best for me to try to recertify these courses at rural conferences, when the room is full of like-minded people. Unfortunately, it turns out that rural doctors who toil away in their small communities really need locums so they can leave to attend the big rural conferences, so I’m usually working during those events. I could try to help create a rural/remote supplement for these courses but I’m not sure I could win a conversation with the ivory tower academics when they often have big studies to back them up and I only have anecdotes.
Dr. Sarah Giles is locum family physician.
