The College of Physicians and Surgeons of British Columbia was founded in 1886. That was also the year, interestingly enough, that Canada’s new transcontinental railway first started carrying passengers. The first trip—Montreal to Vancouver—took six days.

I mention these bits of historical fact to point out that our system of provincial colleges of physicians and surgeons came out of a post-colonial time. A time, in a vast land such as Canada, when lengthy communication and travel times would have made any national medical regulatory system—almost anything national—all but unworkable.

Recently, this system of provincial regulation of doctors has been bumping up against some indications that the next two decades may see provincial colleges adopt national standards.

Clearly many of the physicians and surgeons working in our regulatory systems believe so: The theme of this month’s annual meeting in Halifax of the Federation of Medical Regulatory Authorities of Canada (FMRAC), the provincial colleges of physicians and surgeons’ national voice, is “National Registration—Setting the Bar.”

Here is the evidence:

Indication #1: The Agreement on Internal Trade

Click here to read our special report on Internal Trade: Ticket to ride

If you didn’t read the 2,000-word cover story “Ticket to ride” in our March 10 issue about just what Canada’s Agreement on Internal Trade (AIT) is doing to the colleges, you should. The impact is quite astonishing.

Basically, without much apparent consideration of FMRAC concerns, in January the First Ministers approved more sweeping labour mobility rights under AIT than was expected.

The mobility amendment requires that all kinds of professionals, not just doctors, certified by one province must also be certified by another Canadian province upon application for a licence. The amendment says there can be no requirement “for any material additional training, exercise, experience, examinations or assessments as part of that certification procedure.”

Effectively, the First Ministers have ordered the provincial regulatory authorities to “go national.”

Exactly what this means to the colleges, with their varying resource levels and varying types of provisional licences (sometimes perhaps used to keep international medical graduates in underserviced regions until they attain full licensure), is not clear. Suffice to say, the FMRAC’s annual meeting June 12 to 16 should be pretty spicy.

Indication #2: Telemedicine Where did the ‘treatment’ occur?

The provincial colleges are divided—as they have been for the last decade or so—into two camps:

• those who believe that during interprovincial telemedicine—the doctor in one province, the patient in another—the “treatment” occurs in the province the doctor is in; and

 • those who say the “treatment” occurs in the province where the patient is.

We can’t imagine it matters which way they choose; we just have to pick one!

If half the colleges don’t back down some day we’ll be in a pickle when something goes wrong during an interprovincial telesurgery. British Columbia will tell the patient, “You need to speak to New Brunswick where the doctor was,” while N.B. will say, “The surgery occurred, patient, where you are: B.C.”

What will happen next is predictable: A decade or so will pass involving numerous lawyers and various courtrooms, and eventually the Supreme Court will tell the provincial colleges (paraphrasing): “Are you kidding me?”

Indication #3: National licences: Doctors want them

Last summer at the “parliament of the profession”—as the Canadian Medical Association’s general council calls itself—93% of delegates voted in favour of encouraging provincial regulatory authorities to develop national licensing for physicians. Do the rest of dues-paying doctors—those with no position with the CMA—agree with CMA delegates? Hmm, worth finding out. Use our online poll on Medicalpost.com to vote on the licensure question.

If most physicians want something simpler—something that doesn’t require multiple licence fees if one, for instance, performs short locums in different provinces—it should be possible for the provincial colleges to develop some fee standardization and reciprocity that smoothes this out.

In a country of only 67,000 practising doctors without the communication problems we had when the provincial colleges were set up, it may just be time for the colleges to start developing more unified approaches.

By the way, the Medical Post did ask the FMRAC if we could send a reporter to its annual meeting. Dr. Fleur-Ange Lefebvre (PhD), executive director and CEO, said our request had “sparked a lot of interest” but no, not this year at least. She did, however, say the request to allow the public and press to attend future meetings would be discussed “at the executive committee level after our AGM.”

If the FMRAC is going to become some sort of “senate of the profession,” letting an independent press report—like we do from the CMA general council—is part of open and public debate of issues that affect all of Canada’s doctors.