ALBERTA, CANADA
CPSA MEETS WITH HEALTH MINISTER TO CLARIFY IMPACT OF “THIRD WAY” PROPOSAL
In a meeting with Health Minister Iris Evans, the College of Physicians and Surgeons of Alberta (CPSA) said they are cautiously optimistic about the proposed Health Policy Framework, but noted that some elements of the plan need further clarification.
“We understand this document is a work in progress,” notes CPSA Registrar Dr. Trevor Theman. “While we applaud the Health Ministry’s efforts to be innovative in proposing ideas for change, we need more information on how this framework will affect physicians and the public before we can provide constructive feedback.”
Some Health Policy Directions received conditional support from the College. For example, Policy Direction #2 outlines plans to promote flexibility in scope of practice amongst health professionals. “This approach could help address the physician shortage,” Dr. Theman says, “and we have supported expansion of the scope of practice of other professions when they have demonstrated the necessary knowledge, skills, clinical training and assessment.” Theman went on to explain that the CPSA does not support primary prescribing for pharmacists because “we have not been provided evidence that pharmacists are properly trained to diagnose conditions safely, a necessary precursor to safe prescribing.”
According to Theman, other elements of the Health Policy Framework will require significant consultation and collaboration to be successful. “We look forward to working with the Ministry to ensure these recommendations improve quality, safety, and access — regardless of ability to pay.” In particular, the College will focus their efforts on the following:
Helping to develop a knowledge infrastructure that includes quality indicators, measurement tools and improved monitoring of health care facilities
Assisting in addressing the shortage of physicians with-out compromising quality patient care
Helping to create the necessary guidelines for physicians should they be allowed to work in both the public and private system
Reprinted from the College of Physicians and Surgeons of Alberta website.
WELLINGTON, NEW ZEALAND
RECENT IMG DEVELOPMENTS
New Zealand is critically dependent on international medical graduates (IMGs) with 41.5 percent of doctors currently registered in New Zealand having graduated overseas. The 2003 workforce survey reveals that 36 percent of specialists in New Zealand are IMGs.
Under the Medical Council of New Zealand’s (Council) current policy there are two pathways to registration within a vocational scope for IMGs:
The IMG is required to satisfactorily complete 12 months of supervised practice, ensuring the doctor has adjusted to New Zealand conditions; or
The IMG needs to complete further assessments which may include a requirement to sit and pass a vocational branch advisory body (BAB) or College examination or other forms of assessment, in addition to a minimum of 12 months of satisfactory supervised practice.
Difficulties facing the Council and BABs
There are a number of difficulties in assessing IMGs applying to the Council for registration within a vocational scope of practice. These difficulties include:
Some overseas training programs use very different assessment processes and training programs. This makes it difficult to determine whether the IMG is practicing at the standard which would be expected of a New Zealand trained doctor registered in a vocational scope of practice.
Applicants may not have completed a clinical or external assessment similar to those used in New Zealand.
Several overseas postgraduate training providers are not accredited by external agencies. College or BAB examinations, although suitable for those involved in or completing training programs, may not be suitable for IMGs who have been in specialist practice for a number of years.
In December 2005, the Council circulated a consultation paper, Pathway to registration within a vocational scope for international medical graduates, suggesting changes to the current pathway to registration within a vocational scope for IMGs. We sought comment from various external stakeholders, including BABs, the chief medical advisors of district health boards and the NZMA. There was a very encouraging response to the document with 40 submissions received.
The consultation process was useful in identifying:
Support from BABs for the Council to develop a wider range of assessment tools for those IMGs that the Council considers need more assessment than simply the year of supervision, but for whom further College examinations are not suitable.
A consensus that the length of time a doctor has practiced as a specialist in a comparable health system would not necessarily exempt him or her from completing further assessment.
Inconsistencies in the interview process and in the advice provided to Council by BABs. The objective of the interview with an IMG is for the BAB to give advice to Council on whether the doctor is of a comparable standard to a New Zealand doctor registered within the same vocational scope of practice.
A range of views about whether it would be appropriate for Council to assess and restrict IMGs to small specialty areas. There were concerns about increasing the number of doctors registered in sub-specialties. This may create problems in providing on-call services particularly in smaller hospitals.
Third pathway to registration within a vocational scope
As a result of the consultation process Council is exploring three pathways that may lead to registration within a vocational scope for IMGs:
01 A year of supervision only, where the IMGs’ training and assessment programs are well known and similar to those in New Zealand and Australia.
02 An external clinical examination and 12–18 months of supervised practice where there are differences between the IMGs’ training program and assessment compared with a New Zealand trained specialist.
03 Twelve to 18 months of supervised practice with an external performance assessment. The performance assessment would use a variety of assessment tools.
Assessment tools
The Council’s professional standards team currently uses performance assessment to ensure a New Zealand doctor is practicing at the required standard of competence in accordance with his or her scope of practice. These tools, based on international research, are valid and reliable. They would require modification for each vocational scope.
Most BABs supported the Council’s move to adapt its current tools so that they can be used to assess selected IMGs applying for registration within a vocational scope of practice. It is proposed that Council staff will work with BABs to modify the tools to ensure they are appropriate for assessment of IMGs within the different vocational scopes.
Council continues to work closely with the BABs in moving forwards on the pathways to registration within a vocational scope. Council considers that it will offer a more appropriate and valid form of assessment for a number of well established specialists coming to New Zealand.
Reprinted from Issue 42 of Medical Council News, published by the Medical Council of New Zealand.
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