Tom Mulcair: Why Pierre Poilievre's plan to work with provinces to reduce barriers is a good idea

As part of its efforts to deal with the serious shortage of nurses and doctors in the province, the Ontario government has directed the colleges of nurses and physicians to streamline entrance requirements for foreign-trained professionals.

That’s the right call.

The professional licensing bodies are creatures of the provincial legislatures. Self-regulation by the professions is the backbone of our system, but the public interest commands that the ultimate authority reside with democratically-elected officials.

Never waste a crisis, the saying goes, and as we slowly exit the seventh wave of the pandemic, serious shortages of medical personnel have turned a spotlight on an overdue reform.

Many of the rules governing credentialing and equivalences between Canadian and foreign graduates are archaic, based on preconceived notions and in serious need of an objective overhaul.

Prior to the French language leadership debate, professional licensing bodies were high on the list of gatekeepers that Pierre Polievre was planning to reel in.

Of course, professional regulation is first and foremost provincial jurisdiction. If Poilievre didn’t know that prior to the Quebec debate his own handlers (dare I say: gatekeepers?) clearly did and he backed away from his more strident posture.

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Now, he said, he was going to work with the provinces to help reduce barriers. That, too, is a good idea.

Poilievre was right to make that concession to constitutional reality, but the validity of his core point was made obvious when the government of Ontario issued its recent directives.

THIS IS ABOUT PUBLIC PROTECTION

There’s nothing new in this debate. There’s a joke in Quebec (where over one million people don’t have a family doctor) that the best way to see a physician is to take a taxi. There’s a good chance the driver is a foreign-trained medical doctor.

I was president of the regulatory agency that oversees all of the professions in Quebec. The same debates took place then and, in the meantime, a lot of solid effort has gone into developing objective ways to evaluate training and determine equivalence of diplomas.

The bottom line is that this is about public protection so no shortcuts that could compromise safety should be allowed, even when there’s a shortage.

At the same time, training standards are more and more harmonized and while safety is the top concern, there’s still a lot of institutional bias in assessing foreign-trained medical professionals.

DON’T PENALIZE FOREIGN GRADUATES

We tend to forget that professional regulation isn’t only about entering a profession. It’s also about inspecting and supervising professionals once admitted. An entire disciplinary process caps the system to ensure respect of patients, standards of practice and rules of ethics.

Yes, we should supervise all professionals. No, we shouldn’t penalize foreign grads by suggesting that letting them in exposes the public to greater harm. They’ll be subject to the same rigorous supervision as all other members of the profession.

I recall a heated discussion between one of the officers of our regulatory agency and a senior player from the college of physicians. It turned on the quality of foreign grads and their training.

My colleague asked a simple question: if you’re travelling in Europe and have a heart attack will you refuse treatment in a local hospital? The answer, of course, was no. Why then all the barriers to integrating those same doctors who choose to move here?

There are arguments that have to do with credentialing: could letting in foreign practitioners dilute the overall evaluation of Canadian graduates and hurt their chances to get licensed in the United States, for example?

These issues are easily dealt with and shouldn’t be used as a shield to prevent foreign graduates from helping to provide the health care Canadians need and deserve.

Similar to Canada, in the U.S., professional regulation is considered a jurisdiction of the individual states: a subset of their policing and lincensing powers. They continue to have many barriers to interstate credentialing and the recognition of professionals.

Here in Canada, we’ve done a decent job of facilitating interprovincial recognition of professionals, though some needless hurdles remain here as well.

I was the first Canadian elected to the Board of the Council on Licensure, Enforcement and Regulation in the U.S.

It was soon after the signing of the original NAFTA. That treaty had the effect of reducing barriers to professional mobility between Canada and the U.S. The only restrictions allowed from now on would have to be competency based. Clearly and transparently.

WHAT WE NEED IN CANADA

Many states still had rules that required you to have taken your licensing exam in the state where you wanted to practise. For example, back then, a New York pharmacist had to be physically seated in Florida when they wrote the licensing exam, if they hoped to practise there. That had everything to do with protecting Florida’s pharmacists from competition and nothing to do with public protection.

Many of those unjustifiable interstate rules were swept away by an international agreement that required an objective look at the motive for restrictions. If a requirement wasn’t about competency and public protection, how could it be maintained?

It’s that type of objective analysis of restrictions and prerequisites that we need here in Canada now.

A second set of professional barriers should be under that objective microscope right now: the scope of practice rules between various health professions. The border line between what one professional can do and what requires membership in a different profession is often fraught and can compromise the ability to do the only thing that matters -- helping the patient.

My brother and I spent a good part of the weekend with our mother in a small regional hospital emergency ward. The care was top-notch but at one point the physician said he’d have to wait another hour before being able to stitch up the leg my mom had injured in her nursing home.

The LPN who was assisting explained that she was allowed to install one type of line and inject this substance but not that medication. That required an RN and none was available. The clock was ticking because stitches had to go in within a certain time after the accident.

All went well in the final result but the question that came to me was: is this barrier between professions really, objectively necessary? Or is it a relic from past arbitrations between professional bodies?

We should take advantage of the current context to insist that governments and professional bodies undertake a concerted effort to:

• Reduce barriers to recognition of foreign professionals;
• Develop objective ways to evaluate diplomas and experience.
• Review restrictions between professions, to improve care.

Tom Mulcair was the leader of the federal New Democratic Party of Canada between 2012 and 2017