This column is an opinion by Dr. James Maskalyk and Dr. Kirsten Johnson. Maskalyk is an emergency physician, associate professor at the University of Toronto, and member of Médecins Sans Frontières. Johnson is an emergency physician, associate professor at McGill University, president of the Canadian Association of Emergency Physicians, and advisor for health in emergencies at the Canadian Red Cross. For more information about CBC’s Opinion section, please see the FAQ.
We have worked as emergency doctors in epidemics and war zones around the planet, tending the sick and wounded. As cases of COVID-19 climb in a third wave that is overwhelming Canadian hospitals and whose crest is unknown, we worry it is easier to get a licence to treat patients in the Democratic Republic of Congo than in another province should they call for help.
When the need arises, a licence allowing a Canadian doctor or nurse to work in the DRC could be acquired in days, perhaps even hours. One allowing them to work in a different province in their own country, no matter their qualifications, can take months. As we scramble to redeploy medical staff wherever they are needed, we need freedom to be able to quickly send them anywhere throughout our nation. Now, and for the foreseeable future.
There are currently 13 provincial and territorial medical regulatory authorities that separately license physicians. Though doctors and nurses are all similarly trained, practicing in a province or territory takes reams of paperwork, reference letters, professional documents, money and time — and though the requirements are nearly all the same, the approval is not portable.
This separate regional oversight made sense when it took a horse months to get a person’s medical qualifications, or questions of their competence, from coast to coast. Now that good news and bad travels at the speed of light, and COVID-19 at the speed of air travel, clinging to old ways costs lives.
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Australia, our most similar Commonwealth country with dense cities and miles of wilderness, made the transition to a national licence in 2010. The United Kingdom licenses its physicians to work across four countries.
In Canada, research shows mortality rates rise each step you are away from places that have adequate resources, and into the gaps lives fall. Though the Canada Health Act includes universality and accessibility as core principles, many small populations, rural and indigenous ones in particular, never had the same opportunity for care as other Canadians.
Cases of COVID-19 are weakening an already stretched system, and urgency is upon us. Ontario, for example, has asked other provinces to share 620 health professionals to meet a rising number of cases, and while some have agreed, without changing the process of licensure it can’t be done quickly.
External assistance from other countries or international organizations would face a similar challenge.
Even prior to the pandemic, an overwhelming majority of physicians were in favour of a national licence and reported they would be more likely to work in under-served and rural areas if there were no inter-provincial restrictions. Human bodies are the same all over the country, so too the interest in offering them safety. The belief that everyone deserves the best possible care, no matter where they are in Canada, unites patients and health care workers alike.
Creating a pathway to national licensure, by establishing a “disaster licence” now as prelude to an abiding one, would enable doctors and nurses to better meet patients where they are, both in-person and virtually. Doctors and nurses without borders, in our own country. The idea is not to have them work in any urban centre they wish; it is to identify hospitals, clinics, and populations in need of help, and reduce barriers to providing it.
The less that stands between us as Canadians, the better.
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The premiers of each province and territory should strike an urgent meeting with provincial colleges to harmonize and waive, at least temporarily, their separate requirements. It would be an instant, exponential leap in accessibility, and with it, equity.
There are matters of payment and patient health records, but these can be solved.
Those with no intention of leaving their provincial boundary can maintain their current arrangement with their region. Physicians and nurses who seek a national licence could pay an additional fee on top of their provincial ones to mitigate the administrative costs, would be in good standing in their home province or territory, and like the Health Act does for patients who travel in Canada, be covered for up to three months of practice.
They could also take a standardized training program orienting them to settings with limited resources and First Nations, Inuit and Métis communities. Until the provinces are able to respond, organizations like the Canadian Association of Emergency Physicians and National Emergency Nurses Association could help with this preparation.
Canada is wild, beautiful, and the wealthiest place on the planet, but not for its green spaces. It is rich because it is filled with people who know what it is to care for each other. COVID-19 makes no distinction about what province or territory a person is from, nor should the fight against it.