According to Wendy Glauser in her recent article for the Medical Post, the average yearly fees paid by US physicians is $240 (Cdn), while their Canadian colleagues, on average, pay in excess of $1500 (Cdn) per year.
In addition a review of cross-border medical licensing authorities reveals that their respective organizational missions are essentially the same, – physician licensing, competency, discipline and the development and approval of policies to ensure public safety.
Research by Glauser also revealed that some US physicians involved in cross-border medical practices, who would normally maintain multiple US licenses, would not be able to do the same in Canada simply because the cost to maintain their Canadian credentials, at up to 400% more than their US fees, was too financially onerous.
A review of possible differences, include the provision of ‘glossy’ publications, an apparent enhanced emphasis on Continued Medical Education, and an emphasis on quality assurance programs by some Canadian colleges. In particular, the Ontario college focused on their QA programs and peer review assessment program. Unfortunately, when approached, other Canadian colleges refused to discuss potential program enhancements that could explain the significant cross-border fee differences.
However, from the perspective of American physicians working in Canada, who would not normally be involved in these ‘enhanced’ benefits, they really don’t see any substantial difference in the services being provided by the Canadian medical licensing authorities.
Economies of scale seem to play a role, particularly from the American perspective. Over the past several years some Canadian colleges have made some inroads in this area, however, there is still a long way to go to obtain cross-Canada consensus on the standardization of licensing and service delivery.
Phil Jost, vice-president of operations at CanAm Physician Recruiting, said the high initial and renewal licensing fees in Canada are a source of frustration for the U.S.-trained physicians that his company recruits to work here. He thinks a national or zone-based licensing authority would make sense. “It would be helpful if whatever categories you have—full licence, provisional licence, etcetera—were all called the same thing and recognized as being equivalent by all colleges, so it would be possible to transfer them from one province to the other”.
In the meantime, there are strategies that could be taken that could reduce the bureaucracy for physicians and colleges, said John Philpott, executive director of CanAm. He pointed out that when his physician wife was applying to work in Prince Edward Island, she had to obtain letters of good standing from two previous jurisdictions, Newfoundland and Ohio, even though the Ohio letter had previously been reviewed by the college in Newfoundland. He thinks letters of good standing from a previous jurisdiction should suffice. “Why do you have to go back your whole life?” he asked.
Funding of the American medical boards is provided directly by the respective state legislatures, and thus can be a bureaucratic and political nightmare to even try to obtain an increase in annual funding. Some states, are so financially strained, some feel that patient safety could be jeopardized. As a consequence, the US the state medical boards are highly motivated to seek internal operating efficiencies, before asking the politicians for more funding.
In Canada, the main funding is from physicians’ annual fees, augmented by subsidies from the respective provincial legislatures.
In summary, the research shows that although the respective medical authorities are somewhat different, essentially they are mandated to provide the same services, – the provision of safe medical services to the public.
Ms. Glauser provides a comparison of the Medical Board of North Carolina and the College of Physicians and Surgeons of BC. The mandates of the respective agencies are very similar, except that the BC college manages peer assessments, inspects physicians’ offices, inspects non-hospital medical facilities and oversees Rx review programs. Notable is the fact that:
- The NC Board, serving a population of 9.7 million – closed 2,730 medical complaints, with a staff of 69 people, a budget of $9.2 million, while charging physicians an annual fee of $191.
- The BC College, serving a population of 4.8 million – closed only 1,024 medical complaints, with a staff of 136 people, a budget of $23 million, while charging physicians an annual fee of $1,542.
CanAm believes that in view of the above information, that the time has come for Canada’s provincial governments to review their legislation governing the provincial medical colleges to determine if physicians and the public could be better served through economies of scale, such as:
– Integrating provincial colleges to create regional organizations
– Standardizing the types of medical licenses to improve inter-provincial physician mobility.
– Creating a national licensing system.
– Creating a single national medical licensing body.
We encourage your feedback to provide us with your views regarding your satisfaction and value of the services provided by Canada’s provincial colleges.
To learn more about this important issue, readers are encouraged to read Ms. Glauser’s article in the October 7, 2014 issue of the Medical Post magazine.
