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Overseas doctors no longer welcomed in Canada with open arms
THE LANCET
POLICY AND PEOPLE
Overseas doctors no longer welcomed in Canada with open arms he Royal College of Physicians and Surgeons of Canada will discontinue certification of specialists from the UK and several other Commonwealth countries under regulatory changes scheduled to take effect in June, 1997. Arguing that an assessment of postgraduate residency programmes in countries other than Canada or the USA is “extremely complicated and expensive”, the college’s executive committee has revised regulations for accreditation of specialists from the UK, South Africa, Australia, New Zealand, and Ireland. In the past, the college assessed the training of overseas specialists who were seeking entry to Canada, and who were prepared to take the college’s certification exams, on a case-by-case basis. Hereafter, the college will only certify specialists whose residency training programme is approved by the Royal College in Canada, or by the Accreditation Council on Graduate Medical Education in the USA. Executive Director, Hugh Scott, said in an interview last week
T
(Dec 17) that the change was necessary because the college felt it was “simply unable to assess” training in countries other than the USA. The college also felt “ill at ease, from a human-rights point of view”, because in the past they had assessed the training of specialists from some Commonwealth countries, but refused outright to assess specialists from non-Commonwealth countries. The regulatory change has angered specialists from several provinces, such as Saskatchewan and Newfoundland, who argue that they will find it increasingly difficulty to attract foreign specialists to Canada to supply underserviced areas. Several foreign specialists in Canada have suggested that the move is aimed at artificially creating a shortage of specialists, so as to bolster the incomes and bargaining power of Canadian-trained physicians. These specialists also claim that the new regimen will effectively create “two classes” of specialists, because in most jurisdictions provincial fee schedules for doctors are pegged to
Ontario outlines compromise on fee dispute ealth-care services will be delisted under Ontario’s Medicare plan to help cover the projected annual Can$150 million cost of a tentative agreement settling the fractious fee dispute between the province and its doctors, says Health Minister Dave Johnson. The deal, which awaits ratification, will see the province reduce its 10% clawback (see Lancet 1995; 346: 1550) on doctors’ billings to 2·9%, retroactive to Nov 1. The province will also partly restore malpractice-insurance premiums and give doctors a break on penalties imposed for earnings beyond a specified threshold (see Lancet 1996; 347: 1255). Family doctors will be able to earn up to $300 000 (rather than $250 000), and specialists can earn up to $380 000, before a 33% clawback takes effect. Both thresholds are above current median incomes of family doctors and specialists. In exchange for these concessions, the OMA agreed to support a regime to penalise new doctors who have just received billing licenses and set up shop in overserviced areas of the
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province. New doctors who set up in cities such as Toronto, Ottawa, Hamilton, and Kingston will be paid only 70% of the full fee for their services in the first year of practice, to a cap of $140 000. In the second year, they will be paid 75% of fees, to a cap of $165 000. In the third and final year of constraints, they can earn 80% of fees, to a cap of $205 000. The agreement is projected to add $150 million per year to Ontario’s $17·4 billion health-care budget, and will be paid for by delisting Medicare services. Johnson said, “We will sit down with the doctors and look at tightening of the fee schedule modernisation”. An independent commission will report within a year on recommendations for services that should be delisted under Medicare. Although a date has not been set for ratification of the deal by the province’s doctors, the OMA is encouraging members to support the package. But Ontario’s interns and students are once again accusing older colleagues of “selling off your young to make a few extra bucks”. Wayne Kondro
Royal College certification. But Scott counters that nothing in the regulatory changes precludes a province from accepting an overseastrained specialist into its provincial health-care regime, or from modifying its fee schedule in whatever manner it chooses to account for the training differences. Under Canada’s fractured health-care system, provinces “are free to license whomever they wish”. He also notes that it is intrinsically “good public policy” for Canada to seek to be self-sufficient in the supply of specialists, rather than having to rely on overseas-trained specialists. The college does not maintain data on the nationality of specialists seeking certification. But on the basis of 1995 figures, which indicate 148 of 1924 specialists who wrote certification exams last autumn had some graduate training outside of North America, Scott projected “somewhere between 5–10%” of specialists now seeking certification were trained abroad. Wayne Kondro
Australian government softens blow to young doctors
A
fter rallies by young doctors across the country, the Federal Health Minister has offered a compromise in relation to the Government’s August Budget announcement of restrictions on Medicare “provider numbers”to prevent graduates from setting up as family doctors immediately after their internships (see Lancet 1996; 348: 1026). The olive branch now offered by the Government is an extra 250 training places in rural areas during the next 3 years for medical graduates unable to find other training places. The trainees will be obliged to stay in their country jobs for 6 years. The Royal College of General Practitioners welcomed the change which has passed through the Parliament. But, the Australian Medical Association criticised the offer for not addressing the core concerns of young doctors about provider number restrictions. Stephen Cordner, Kathy Ettershank
Vol 349 • January 4, 1997
POLICY AND PEOPLE
Overseas doctors no longer welcomed in Canada with open arms he Royal College of Physicians and Surgeons of Canada will discontinue certification of specialists from the UK and several other Commonwealth countries under regulatory changes scheduled to take effect in June, 1997. Arguing that an assessment of postgraduate residency programmes in countries other than Canada or the USA is “extremely complicated and expensive”, the college’s executive committee has revised regulations for accreditation of specialists from the UK, South Africa, Australia, New Zealand, and Ireland. In the past, the college assessed the training of overseas specialists who were seeking entry to Canada, and who were prepared to take the college’s certification exams, on a case-by-case basis. Hereafter, the college will only certify specialists whose residency training programme is approved by the Royal College in Canada, or by the Accreditation Council on Graduate Medical Education in the USA. Executive Director, Hugh Scott, said in an interview last week
T
(Dec 17) that the change was necessary because the college felt it was “simply unable to assess” training in countries other than the USA. The college also felt “ill at ease, from a human-rights point of view”, because in the past they had assessed the training of specialists from some Commonwealth countries, but refused outright to assess specialists from non-Commonwealth countries. The regulatory change has angered specialists from several provinces, such as Saskatchewan and Newfoundland, who argue that they will find it increasingly difficulty to attract foreign specialists to Canada to supply underserviced areas. Several foreign specialists in Canada have suggested that the move is aimed at artificially creating a shortage of specialists, so as to bolster the incomes and bargaining power of Canadian-trained physicians. These specialists also claim that the new regimen will effectively create “two classes” of specialists, because in most jurisdictions provincial fee schedules for doctors are pegged to
Ontario outlines compromise on fee dispute ealth-care services will be delisted under Ontario’s Medicare plan to help cover the projected annual Can$150 million cost of a tentative agreement settling the fractious fee dispute between the province and its doctors, says Health Minister Dave Johnson. The deal, which awaits ratification, will see the province reduce its 10% clawback (see Lancet 1995; 346: 1550) on doctors’ billings to 2·9%, retroactive to Nov 1. The province will also partly restore malpractice-insurance premiums and give doctors a break on penalties imposed for earnings beyond a specified threshold (see Lancet 1996; 347: 1255). Family doctors will be able to earn up to $300 000 (rather than $250 000), and specialists can earn up to $380 000, before a 33% clawback takes effect. Both thresholds are above current median incomes of family doctors and specialists. In exchange for these concessions, the OMA agreed to support a regime to penalise new doctors who have just received billing licenses and set up shop in overserviced areas of the
H
38
province. New doctors who set up in cities such as Toronto, Ottawa, Hamilton, and Kingston will be paid only 70% of the full fee for their services in the first year of practice, to a cap of $140 000. In the second year, they will be paid 75% of fees, to a cap of $165 000. In the third and final year of constraints, they can earn 80% of fees, to a cap of $205 000. The agreement is projected to add $150 million per year to Ontario’s $17·4 billion health-care budget, and will be paid for by delisting Medicare services. Johnson said, “We will sit down with the doctors and look at tightening of the fee schedule modernisation”. An independent commission will report within a year on recommendations for services that should be delisted under Medicare. Although a date has not been set for ratification of the deal by the province’s doctors, the OMA is encouraging members to support the package. But Ontario’s interns and students are once again accusing older colleagues of “selling off your young to make a few extra bucks”. Wayne Kondro
Royal College certification. But Scott counters that nothing in the regulatory changes precludes a province from accepting an overseastrained specialist into its provincial health-care regime, or from modifying its fee schedule in whatever manner it chooses to account for the training differences. Under Canada’s fractured health-care system, provinces “are free to license whomever they wish”. He also notes that it is intrinsically “good public policy” for Canada to seek to be self-sufficient in the supply of specialists, rather than having to rely on overseas-trained specialists. The college does not maintain data on the nationality of specialists seeking certification. But on the basis of 1995 figures, which indicate 148 of 1924 specialists who wrote certification exams last autumn had some graduate training outside of North America, Scott projected “somewhere between 5–10%” of specialists now seeking certification were trained abroad. Wayne Kondro
Australian government softens blow to young doctors
A
fter rallies by young doctors across the country, the Federal Health Minister has offered a compromise in relation to the Government’s August Budget announcement of restrictions on Medicare “provider numbers”to prevent graduates from setting up as family doctors immediately after their internships (see Lancet 1996; 348: 1026). The olive branch now offered by the Government is an extra 250 training places in rural areas during the next 3 years for medical graduates unable to find other training places. The trainees will be obliged to stay in their country jobs for 6 years. The Royal College of General Practitioners welcomed the change which has passed through the Parliament. But, the Australian Medical Association criticised the offer for not addressing the core concerns of young doctors about provider number restrictions. Stephen Cordner, Kathy Ettershank
Vol 349 • January 4, 1997