A National Medical License May Ease Canada’s Doctor Shortages

It won’t end the pronounced shortage of physicians that’s plaguing many parts of Canada. But the Canadian Medical Association has an idea that it thinks might help.

Its proposal seems simple: a single medical license that allows doctors to practice without restrictions anywhere in the country. But like many ideas in the fractured world of Canadian federalism, introducing it is a daunting task.

I spoke with Dr. Alika Lafontaine, the president of the medical association, who practices anesthesia in Grande Prairie, Alberta. While he acknowledged that the idea of a single medical license had been promoted on and off over two decades with no success, he said he was confident that the widespread turmoil and staff shortages in the medical system that emerged during the pandemic might mean that its time has finally arrived.

“What’s really shifted is the ability for Canadians to wrap their head around how much of a simple solution this actually is,” said Dr. Lafontaine, the first Indigenous person to lead the physicians’ association. “The moment that we’re in right now is one where Canadians are realizing the existing system doesn’t really make a ton of sense for what patients actually do when they move throughout the health care system. It doesn’t make any sense for how providers move throughout the health care system.”

Like members of all licensed professions in Canada, physicians are licensed and supervised by provinces and territories. That, Dr. Lafontaine said, brings considerable inflexibility to the system. Doctors who are available to work are unable to cross provincial borders to help when there’s a staffing shortage in another province — a particularly acute need in remote communities — or to fill in during gaps like parental leaves. Nor can they serve patients in other provinces using telehealth, Dr. Lafontaine said. If doctors were more mobile, they could reduce the need to fly patients to large regional hospitals.

Becoming licensed in other provinces is a formidable task. While it varies by province, just registering involves extensive paperwork, takes months and costs about 2,000 Canadian dollars for a single province. On top of that, there’s an annual fee. In Alberta’s case, for example, that comes to 2,200 dollars.

“It costs a lot of money to hold two licenses or three licenses,” Dr. Lafontaine said.

There have been recent developments to support Dr. Lafontaine’s optimism. On May 1, the four medical licensing bodies in Atlantic Canada will open a registry for doctors who want to work in any of the four provinces.

Earlier this year, Doug Ford, the premier of Ontario, promised to introduce legislation that would allow the province to recognize the credentials of doctors and nurses licensed in other provinces.

Some critics of national licensing worry that if doctors can practice anywhere, some regions may suddenly be abandoned by their health care workers. Dr. Lafontaine dismissed that.

Jacob Shelley, a professor who teaches in the law and medical schools at Western University in London, Ontario, told me that he agreed that it was unlikely that significant numbers of doctors would pack up and move if they had a license to work anywhere in the country. He said that getting another license was more of a nuisance than a barrier for doctors intending to make a permanent move. The far bigger issue, he said, will be getting “political buy-in” from the provinces and territories to cede their powers to a single licensing body.

Two factors, he said, may help the medical association’s cause. The increasing privatization of health care services in several provinces may create political pressure for the creation of a more flexible system. And the Covid pandemic, he said, has opened debate about the need for changes to the health care system.

But he anticipates that partial measures may prevail. One outcome, Professor Shelley said, might be a system in which the 13 medical licensing and disciplinary bodies remain but the provinces agree, as they now do with drivers’ licenses, to recognize one another’s credentials — what Ontario is effectively proposing. Another alternative, he said, may be some sort of national passport as a supplement to provincial licenses for doctors and nurses looking for mobility.

“There are some significant challenges introducing this type of system, although the benefit of it is important,” he said. “A lot of the regulatory environment presently feels a little bit like they’re protecting their turf.”

A native of Windsor, Ontario, Ian Austen was educated in Toronto, lives in Ottawa and has reported about Canada for The New York Times for the past 16 years. Follow him on Twitter at @ianrausten.

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