canada's doctors can't practise anywhere in the country due to interprovincial barriers
the canadian medical association has long pushed for a 'pan-canadian approach' as part of the response to the health workforce crisis
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when dozens of hospital patients were evacuated by military flight out of yellowknife as the wildfires approached in the summer of 2023, the doctors who accompanied them couldn’t care for their patients once the aircraft landed, because they didn’t have licences to practise in british columbia or other jurisdictions.
instead, “they had to find local doctors to help out and care for those patients that had been under their care in yellowknife,” said canadian medical association president dr. joss reimer.
the scenario underscores the limits imposed by licensing barriers at provincial borders and the benefits of a more flexible system, reimer said. “what we want to see is an ability for doctors to work anywhere in the country.”
u.s. president donald trump’s tariffs and “51st state” turbulence have put new focus on interprovincial barriers within canada, including labour mobility hurdles.
the cma has long lobbied for a pan-canadian licensure program, which it defines as the ability of doctors with full licences and in good standing to practise in any jurisdiction “without having to acquire more than one licence or pay additional licensing fees.”
such a scheme “represents a path to a more unified and efficient health-care system,” the cma says.
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support among doctors is high: 95 per cent of 5,002 members who responded to a 2022 survey said they were very (87 per cent) or somewhat (eight per cent) in favour of the idea.
the “overall complexity of the process,” the time (often months long) and costs (thousands of dollars in fees) were cited as the biggest obstacles in applying for an additional licence.
respondents said a national licensure system would make it more likely for them to remain in canada, more likely to continue practising part-time in retirement, and more likely to “relieve/assist my colleagues.”
almost eight in 10 (78 per cent) said it would help bolster the rapid mobility of doctors in times of disaster or crises like covid.
canada’s charter has enshrined a right to mobility, reimer said. “most people in canada can live and work anywhere in the country and provide the service that they’re trained to do, anywhere in the country. we’d like to see the same for doctors.” a more flexible system could help fill gaps in the system, she added.
“let’s say there’s a rural emergency room that needs to close for a weekend. some doctors in toronto might be able to help out for a weekend. they’re not going to pay thousands of dollars and go through that application process to help for a weekend,” reimer said.
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“to set up these artificial barriers where a physician who is trained in toronto can’t work in halifax really doesn’t make sense when we do know that the training they received in toronto is going to be top tier.”
federal, provincial and territorial health ministers committed in october 2023 to “advancing labour mobility” for doctors, nurses and other health professionals “so they can practise across jurisdictions without significant delays or the need to meet additional requirements,” according to a communique issued after their meeting.
regulatory colleges across the country are focusing on labour mobility, though none of them has the ability to issue a pan-canadian licence, or to accept one, said stephanie price, executive director of the federation of medical regulatory authorities of canada.
“all of them have provincial legislation that contains some version of the phrase that says, ‘to call yourself a doctor or practise medicine in this province, you must have a licence from this college.’
“they don’t have the ability to pursue pan-canadian licensure and none of their ministers of health have asked them to,” price said.
what the colleges are pursuing “is making sure that people who do want to come to their province can do so quickly,” through a fast-track licensure process for people who are fully licensed in another province or territory, price said.
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“anyone who has a full licence and a clean record is immediately licensed in a new province, and that can be done in a matter of days, sometimes in matter of hours when there are emergency situations, like a hospital emergency room is about to close,” price said.
a new national registry of physicians, a database that provides information on all licensed mds in canada, is being used to reduce the red tape and paperwork involved in applying for another licence.
doctors still have to pay for the licence. “so physicians who want to practise in six provinces, they’re going to have to have six licences and pay for that six times,” price said.
“i think the dream of the pan-canadian licence is one single licence and that’s it, you’re done, you can practise everywhere,” she said. “the legislation doesn’t allow it in any province. it would have to come from the provincial governments to make that change.”
the atlantic provinces launched a multi-jurisdictional licensing system, the first of its kind in canada, in may 2023. doctors who opt in are immediately licensed in all four atlantic provinces for an annual fee of $500, in addition to any licensing fees charged by their home college.
twelve doctors have obtained additional licences and went on to practise in another province.
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