Quiet provincial progress gives more sense of what 'national medical licensure' might look like

As Ottawa pushes to remove interprovincial barriers, years of quieter work by provinces, regulators and the Canadian Medical Association may already have laid the groundwork for a new approach to physician mobility. Only time will tell what type of national licensure model the federal government will adopt.But Prime Minister Mark Carney’s drive to reduce interprovincial trade barriers puts this issue firmly on the national agenda.At the First Ministers’ Meeting in Charlottetown this summer, Canada’s premiers agreed to continue work on “mutual recognition and labour mobility” through the Committee on Internal Trade as part of a broader effort to reduce barriers to the movement of workers, goods and services across the country. Ottawa is pressing them to move quickly.In June, federal Internal Trade Minister Dominic LeBlanc said governments must “move faster” and meet established timelines, including a commitment to expand mutual recognition to the services sector by the end of 2026 .More than pushing a buttonMandating a pan-Canadian medical licence is constitutionally more complicated than simply calling for one. While the Canada Health Act establishes national principles for publicly funded healthcare, responsibility for regulating physicians and delivering healthcare rests primarily with the provinces and territories.The federal initiative renews attention on the Canadian Medical Association’s long-standing goal of making it easier for physicians to practise across provincial borders. The CMA has consistently argued that physicians in good standing should not have to repeat extensive administrative processes every time they wish to work in another province.The association first referred to the concept as a “pan-Canadian” licence. But its language on the issue has recently evolved.In a recent interview, CMA president Dr. Bolu Ogunyemi told the Medical Post that the focus is now on “multi-jurisdictional licensure”—a model he said could involve the vast majority of provinces and territories without necessarily requiring every jurisdiction to participate.Under multi-jurisdictional licensure, physicians would continue to hold a licence in their home province while applying through a common administrative body (not yet defined) for expedited approval to practise in participating jurisdictions, Dr. Ogunyemi said.When asked whether that model might resemble the solution developed at a provincial level in the 2023 creation of an Atlantic Registry, Dr. Ogunyemi said yes.“That would be reasonable,” he said. “In fact, I think that’s actually preferable than calling it federal.”Has Canada already started building the infrastructure?If Ottawa appears to be moving quickly, it is because Canada has already started quietly building the infrastructure for greater physician mobility.Provinces, medical regulators and national organizations have been introducing incremental changes that, taken together, could make multi-jurisdictional licensure more achievable than it once appeared.The aforementioned Atlantic Registry allows eligible physicians whose primary practice is in Nova Scotia, New Brunswick, Prince Edward Island or Newfoundland and Labrador to choose to practise in all four provinces. The individual provincial colleges have become more harmonized but are otherwise unchanged.It costs an additional $500 a year, on top of the physician’s regular annual licence fee in their home province. That payment replaces the separate temporary or locum licence fees that would otherwise be charged.Retired College of Physicians and Surgeons of British Columbia registrar Dr. Heidi Oetter, who was very vocal on physician mobility issues when she was active, said the Atlantic Registry, created at the request of the four Atlantic premiers, “led to a lot of standardization across those four provinces.”Dr. Ogunyemi’s comparison suggests a national model could perhaps build on a regional approach rather than replace provincial authority with a federally administered infrastructure. (Time will tell).Beyond the Atlantic RegistryThere are other examples of provinces working to reduce some of the administrative hassles facing physicians who are already fully licensed and in good standing in another Canadian jurisdiction.British Columbia provides a route under the Canadian Free Trade Agreement for physicians holding a full, unrestricted licence elsewhere in Canada. They may be reciprocally eligible for a full B.C. licence without much delay—whatever that means. The College of Physicians and Surgeons of British Columbia still reviews fitness to practise, currency of practice, criminal-record information and any complaints or disciplinary history. (There exists a potential to centralize that type of data through the emerging National Physician Registry so this work does not have to be conscientiously duplicated by every licensing body, but, again, time will tell.)Nova Scotia offers a streamlined application for physicians holding a regular, general or full licence elsewhere in Canada, provided they have no restrictions, conditions, undertakings or disciplinary sanctions. Once all required documents have been received, the College of Physicians and Surgeons of Nova Scotia says approval usually takes one to three business days. Still the physician making the application must gather letters of good standing from every jurisdiction in which they have worked.Another significant development has been the creation of the aforementioned National Physician Registry, housed by the Medical Council of Canada. Still being rolled out, the registry is intended to provide participating jurisdictions with a common source of information about physician licensure and, eventually, broader workforce data for health-care planners.Dr. Oetter believes those developments represent meaningful progress.“Those have all been very, very good initiatives,” she told the Medical Post. “Anything you can do to actually make the bureaucracy behind the scenes work more efficiently . . . that’s a good thing.”Asked whether those developments have made broader physician mobility more achievable than when she first examined the issue several years ago, Dr. Oetter’s answer was succinct. “I think it’s certainly more doable.”She cautioned, however, that significant challenges remain. Provinces continue to operate under different legislative frameworks governing professional regulation. There’s hospital privileges, billing systems and other administrative requirements that would still need to be navigated one by one, even if physician licensing itself became easier.Why does it matter?For the CMA, the issue extends well beyond reducing paperwork. Dr. Ogunyemi says multi-jurisdictional licensure could make it easier to deploy locum physicians, support rural, remote and Indigenous communities, expand access to virtual care and respond more quickly to emergencies ranging from wildfires and pandemics to military deployments and Arctic sovereignty challenges requiring the rapid movement of healthcare personnel.Dr. Oetter adds the example of sub-specialists whose patient rosters include residents of more than one province. She recognizes the burden they face in maintaining multiple licences and thinks streamlining the process would benefit physicians and their patients. But she also offers an important caution: improving mobility does not address the underlying shortage of physicians.“To make doctors more mobile doesn’t make more of them,” she said.=One already-mobile physician’s perspectiveDr. Kyle Sue-Milne, an Alberta-based family physician and sub-specialist in pediatric palliative care and developmental pediatrics, holds multiple five full medical licences—in Alberta, British Columbia, the Northwest Territories, Nunavut and Yukon. He is exactly the type of mobile physician Dr. Oetter identified as needing some kind of restructuring of the system.His five licences enable him to provide in-person care in the Beaufort Delta region of the Northwest Territories and in several Carrier Sekani First Nations communities in British Columbia. He also provides virtual care to patients in Nunavut’s Kitikmeot region.But maintaining the licences means completing five separate renewal processes every year and paying the full annual fee in each jurisdiction. That is still the system right now.In an email exchange with the Medical Post, Dr. Sue-Milne described requirements that vary considerably among regulators. One licensing authority requires him to appear before a lawyer and formally declare that the information in his renewal application is true. Some require him to obtain and submit his own annual criminal-record check, involving one visit to a police station to apply and another to collect it.“The second most onerous is B.C.’s, which takes me about an hour,” he said. “Alberta’s takes me about half an hour.”A multi-jurisdictional system would not necessarily enable Dr. Sue-Milne to take on more patients or work in more regions—as Dr. Oetter predicted.“I’m at the limit of what I feel I can handle workload-wise,” he said.What it might do, depending on how the issue is resolved, is reduce the annual bureaucracy involved in continuing to serve the communities that already rely on him. Dr. Sue-Milne said it could also make it easier for other physicians to cross provincial borders temporarily when a service is at risk.Dr. Sue-Milne estimates that only about 40 physicians practise pediatric palliative care across Canada. While some centres are well staffed, others face significant shortages.“Having an easy process for someone to come help fill scheduling gaps in a pinch could help prevent service closures or gaps.”Ann Graham Walker is the Medical Post’s B.C.-based correspondent.

Quiet provincial progress gives more sense of what 'national medical licensure' might look like

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