As part of its efforts to address the severe shortage of nurses and physicians in the province, the Ontario government has mandated nursing and medical colleges to streamline entry requirements for professionals trained abroad.
That is the correct call.
Professional licensing bodies are creatures of the provincial legislatures. The self-regulation of the professions is the backbone of our system, but the public interest demands that the highest authority rests with democratically elected officials.
Never let a crisis go to waste, the saying goes, and as we slowly emerge from the seventh wave of the pandemic, the dire shortage of medical personnel has highlighted overdue reform.
Many of the rules governing accreditation and equivalencies between Canadian and foreign graduates are archaic, based on preconceived notions, and are in serious need of objective review.
Before the French-language leadership debate, professional licensing bodies were high on the list of gatekeepers that Pierre Polievre planned to bring on.
Of course, professional regulation is above all provincial jurisdiction. If Poilievre didn’t know that before the Quebec debate, his own controllers (dare I say: gatekeepers?) clearly knew and he backed away from his most strident posturing.
Now, he said, he was going to work with the provinces to help reduce barriers. That is also a good idea.
Poilievre was right to make that concession to constitutional reality, but the validity of his central point became clear when the Ontario government issued its recent directives.
IT IS ABOUT PUBLIC PROTECTION
There is nothing new in this debate. There’s a joke in Quebec (where more than a million people don’t have a family doctor) that the best way to see a doctor is to take a taxi. The driver is most likely a foreign-trained doctor.
I was president of the regulatory agency that oversees all professions in Quebec. The same debates took place then, and in the meantime a lot of solid effort has been put into developing objective ways of evaluating training and determining the equivalence of diplomas.
The bottom line is that this is public protection, so no shortcuts should be allowed that could compromise safety, even when there is a shortage.
At the same time, training standards are becoming more harmonized, and while safety is the primary concern, there is still a large institutional bias in evaluating foreign-trained medical professionals.
DO NOT PENALIZE FOREIGN GRADUATES
We tend to forget that professional regulation is not just about accessing a profession. It is also about inspecting and supervising professionals once admitted. An entire disciplinary process covers the system to ensure respect for patients, standards of practice and rules of ethics.
Yes, we must supervise all professionals. No, we should not penalize foreign graduates by suggesting that letting them in exposes the public to greater harm. They will be subject to the same rigorous supervision as all other members of the profession.
I remember a heated discussion between one of the officials from our regulatory agency and a senior player from the medical college. It focused on the quality of foreign graduates and their training.
My colleague asked a simple question: If you were traveling in Europe and had a heart attack, would you refuse treatment at a local hospital? The answer, of course, was no. Why then all the barriers to integrating those same doctors who choose to move here?
There are arguments to do with accreditation: could allowing in foreign professionals dilute the overall evaluation of Canadian graduates and harm their chances of being licensed in the United States, for example?
These problems are easy to treat and should not be used as a shield to prevent foreign graduates from helping provide the health care Canadians need and deserve.
As in Canada, in the US, professional regulation is considered a jurisdiction of the individual states: a subset of their licensing and policing powers. They continue to have many barriers to interstate accreditation and professional recognition.
Here in Canada, we have done a decent job of facilitating inter-provincial recognition of professionals, although some unnecessary obstacles remain here as well.
I was the first Canadian elected to the Board of the Council on Licensing, Compliance and Regulation in the US.
It was shortly after the signing of the original NAFTA. That treaty had the effect of lowering the barriers to professional mobility between Canada and the US. The only restrictions allowed from now on would have to be based on competition. In a clear and transparent way.
WHAT WE NEED IN CANADA
Many states still had rules that required you to have taken your licensing exam in the state where you wanted to practice. For example, back then, a New York pharmacist had to be physically seated in Florida when he wrote the licensing exam, if he expected to practice there. That had everything to do with protecting Florida’s pharmacists from competition and nothing to do with protecting the public.
Many of those unjustifiable interstate rules were swept away by an international agreement that required an objective look at the reason for the restrictions. If a requirement was not of public competence and protection, how could it be maintained?
It is that kind of objective analysis of constraints and prerequisites that we need here in Canada now.
A second set of professional barriers should be under that objective microscope right now: the scope of rules of practice between various health professions. The line between what a professional can do and what a different profession requires is often tense and can compromise the ability to do the only thing that matters: help the patient.
My brother and I spent much of the weekend with our mother in the emergency room of a small regional hospital. The care was top notch, but at one point the doctor said he would have to wait another hour before he could sew up the leg that my mother had injured in her nursing home.
The LPN who was attending explained that she was allowed to install one type of line and inject this substance but not that medication. That required an RN and none were available. Time was running out because the stitches had to come in within a certain time after the accident.
Everything turned out fine in the final result, but the question that arose for me was: is this barrier between professions really necessary? Or is it a relic of past arbitrations between professional bodies?
We should take advantage of the current context to insist that governments and professional bodies make a concerted effort to:
- Reduce barriers to the recognition of foreign professionals;
- Develop objective ways to assess diplomas and experience.
- Review restrictions between professions, to improve care.
Tom Mulcair was the leader of the New Democratic Party of Canada from 2012 to 2017.