A national license In Canada: Two medical professionals tell us why it matters

The national license debate is an issue that has concerned medical professionals for years. In this story, we hear from a couple who have practiced medicine in different provinces to gather their insight. Kylie Taggart, journalist from the Medical Post, also shares Australia's story of transitioning to a national license and whether this could be possible in Canada. Transcript Misia Lerska Hello, my name is Misia Lerska, and I'm a visual storyteller operating for the medical post. This video will be about both the effects and possible futures of the national license debate in Canada. This has been a topic that has fascinated and perplexed medical professionals for years. To this end, I'd like to introduce a fascinating couple, emergency Dr. Stephen Cashman and emergency nurse Marianne Leblond, who have both occupied over 10 combined licenses across the country. Dr. Stephen Cashman and Marianne LeBlond have valuable insight into what it means to relocate as a medical professional. Please join me in welcoming them to the medical post. Dr Cashman: My name is Steven Cashman. I'm about five years into practice. I'm a family physician, with many certificates. I mostly work in emergency medicine as well as some work up north as kind of a generalist. Ms. Leblond: Well, first of all, I'm a registered nurse, so I'm RN. I've been working for 14 years now. And I do emergency most of my practice so I do regional northern emergencies, but also I do some obstetric pediatrics and medicine. Dr. Cashman: I have or have had nine total licenses, I think, in different territories or provinces. Ms. Leblond: Seven licenses and one is like in northwest territories in Nunavut, which are like together. Question: Where have you practiced medicine? Dr. Cashman: In Nunavut, Northwest Territories, in a couple of spots in Nunavut, I worked at a few small communities in the Baffin Island region, a few communities in the Quebec region, which is in the middle and one or two, and that took me to the West. I've also worked in the Northwest Territories in Yellowknife, and a couple of other kinds of mid-sized or smaller communities. And I've worked in Manitoba, in Winnipeg and in northern Manitoba. Ms. Leblond: So I mostly work in Quebec as a French speaker. Also, I work in Ontario, I do some contracts in the north northwest territories. That's actually where I started to do locums. And that's where I learned English as well. So Northwest Territories, Nunavut, I have my license, but I didn't do any contract yet. And I do a lot of maritime, so p i, New Brunswick, I have a license and also Nova Scotia. Question: What were the reasons for your moves? Dr. Cashman: I mean, the biggest reason is just because I really like doing that. And I enjoy working in different places and seeing the country and I like working in different places where I'm both in demand and where I get to go to a different city and check it out and see a different hospital. Ms. LeBlond: So I just decided to do a short contract, so I have more control of my life. Also, I really like the adventure and I like to meet new people and seeing different practices is very enriching. Question: What was the biggest problem that you encountered while trying to transfer your license? Dr. Cashman You still have to submit this onerous paperwork repeating what you've done in the past, every single time and the licensing colleges don't talk to each other. And it's time consuming and expensive and frustrating. And you have to go out and get documents notarized and, you know, you can literally look them up on the internet and kind of find a lot of my prior credentials, but I still have to send this in notarize, it is just a huge headache. Ms. LeBlond: So I would say the more licenses that you have, and the more complicated it gets. So every time that I apply for a new license, now I have to provide them proof of my practice for all the other places. Every time every paper they send, it costs money, and it's a lot of time. So for applying to a new license, I have to, like, plan, like your six months or something like that. Very expensive. So every time it's more than 1000. And also, I have to provide so many papers, so I have to call my other employees, my old employers, they don't remember me, maybe i work like a week for them. Because I have so many different employers, I have to go to all of them. Very annoying. Also, for me, I have to do that jurisprudence exam. So it's like a two, three hours exam for most of all, not all of the provinces or territories, but a lot of them. Question: What do you wish were different about the process? Dr. Cashman: I think that the best possible solution would be just as a national license, where you apply for a Canadian license, and you can work anywhere in Canada, you know, you would still need to get privileges perhaps in certain, that's a whole different issue, which can be streamlined to but you know, you might still need to get privileges to work on a particular hospital. But I don't really see any advantage to siloing licensure in different provinces. I think it's bad for basically everybody. Ms. LeBlond: I think if all the licenses were available, they could talk to each other, that would be so much easier. Because I mean, it's all the same papers, it's all the same practice, I don't have to do a new course or anything, I'm a nurse, I'm doing exactly the same job. Also for population safety. So if I would be, let's say working in Nunavut and malpracticing, like I'm, I don't know, drugging my patient or killing my patient or whatever. But then when I renew my license in Quebec, I just have to check a box that I never had anything against my practice that I'm like, I'd never done anything wrong, or no complaint or anything, and they are not gonna do any investigation. So I don't think it's good for the population, either. Because if they would all talk to each other. So if somebody is not doing his job, right, then they know. Question: What should healthcare professionals know about if they intend on moving their practices? Dr. Cashman: You know that it's annoying that it takes longer than you expect that it's frustrating and a headache. That said, I think that for a doctor who just wants to move, it's not that big a deal. Like if I'm if I've been working in Quebec, and I say I'm moving for good Ontario, then is it annoying to go through these hoops for Ontario? Absolutely. But I think where it really limits is in the kind of people who are looking to work in both provinces at the same time, or people who are looking to kind of fill in when there's an urgent demand or an urgent need in a particular area plan ahead. But it's, as I said, very enriching. I really like to do it. Ms. LeBlond: But you have to do it because you want to do the experience, not because you want to make more money, not because you want your practice to be easier, because it's not going to be like that. But I would advise them to try it. I think it's very good to see different practices. And I've learned so much from my colleagues from different places and also seeing different communities and different ways we like different hospitals. So I think it's very good and it makes me a better nurse. But it's not easier. Question: Do you envision any possible solutions over time? Dr. Cashman: Like I really hope so I know there's a lot of people working on it. There's a working group within a society of rural practitioners of Canada, and they have put together a letter advocating for national licensure or at least a move in that direction. Basically, everybody is in support, like every medical organization of any any note has signed on to the letter every Going from the CFTC the Canadian call failing the College of Family Physicians of Canada to the I forget exactly what the acronym means but the the association of indigenous physicians of Canada, various specialty societies are the resin doctors of Canada. The Canadian Federation medical students, like literally everybody, are kind of the Canadian Armed Forces. Basically everyone is united saying that the current system is not good and that we should change it. But it is still there's still very slow movement. Ms. LeBlond: I think that if they would have a national license that would be so great and a very good solution and I talked to so many nurses that they're actually interested in trying to work in different provinces or like going to the Maritimes. It's so nice there. But they just don't don't even want to try it. It's too much paper and too much money to actually help the government so they just don’t. Misia Lerska: After hearing from Dr. Stephenen Cashman, and emergency nurse Marianne LeBlond about what it means to move to so many different places, I reached out to the medical post journalist, Kylie's Taggard, who followed this topic while writing an article in 2019, about Australia's transition to a national license. Kylie Taggart: I’m Kylie Tagore, I'm a writer for the medical post. I've been following the national licenser issue a little bit and I did write an article about how Australia achieved national licensure. That article was published in 2019, I believe. Question: How did Australia transition to a national license? Well, Australia's journey for the national license really started in 2006. As far as I understand, they had a group called the productivity committee. And they investigated the situation and found that their license or system as it hindered physician mobility, hindered physician supply and, and efficiency, there was also a question of patient safety. So Australia is a federation, in that it has different states and the states at the time, regulate the registration of medical professionals. So they had 65 different pieces of legislation that looked after different health professionals, including doctors. So after this report was published, the movement was, you know, in retrospect, quite quick, it was 2010, when they introduced their, their sort of national licensure system. Question: How would a national license work in Canada? We have a very similar system of government, getting national licensure could go through that same route, go through sort of the implication of a model law that gets adopted by all our provinces and territories. There's precedent for this, we've seen this happen with other laws, privacy laws are very similar in a lot, all the provinces and territories, security laws, things like that. So it is feasible. It's just a lot of work. And it's important to always consider that registration of medical doctors also goes with regulation of doctors. Question: Who would be able to make this change and has there been any progress? The Federation of medical co- regulatory authorities of Canada, so their members include all the regulatory medical regulatory bodies in Canada, so all the colleges and the provinces and, and other groups. They've been working on this for a while. A lot of lobby groups have also been pushing for this. A lot of medical associations have been pushing it. There's a great appetite in Canada for national licensing. What the Federation of medical regulatory authorities of Canada's doing is sort of doing work without changing legislation in that they're trying to streamline the process of becoming registered in a Canadian province or territory as a physician. So they've got sort of a model standard for medical regulation, that they're hoping that provinces and territories their medical regulators might do So it's more of a streamlined process. And to have this sort of uniformity or consistency across provinces could be the starting steps to having sort of a national system. Misia Lerska: In conclusion, while we cannot know what the future holds for national licenses in Canada, we hope that this video article helps you better understand some of the nuances of the issue.

A national license In Canada: Two medical professionals tell us why it matters

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