Back in February, the government
of British Columbia announced plans for wide-ranging
healthcare reforms, setting off something akin to panic
in the medical community.
Undaunted, Premier Gordon Campbell
and Health Minister George Abbott are at it again. Their
latest project, a set of legislative amendments known
as Bill 25, follows through and even expands on some
of the divisive ideas Premier Campbell mentioned in
his February throne speech and budget.
The two proposals within Bill 25
that are causing physicians the greatest concern are:
government interference in aspects of physician licensing
that had previously been left to doctors, and significantly
expanded scopes of practice for nurses and pharmacists.
LICENSING
REFORMS
The principle of physician self-governance is one of
those unassailable traditions safe from the caprices
of the government of the day. Or so you thought. Ontario
and Alberta have already passed similar laws that erode
physicians' right to self-govern.
Introducing Bill 25 in the provincial
legislature on April 10, Mr Abbott touted it as the
beginning of "a new standard of transparency and accountability
in college registration, inquiry and discipline processes."
After dispensing with the obligatory
political buzzwords of "transparency" and "accountability,"
Mr Abbott continued, explaining in broad terms that
Bill 25 will help get internationally trained healthcare
workers into practice in BC faster by granting them
restricted licences.
Bill 25 also proposes a new Health
Professions Review Board, which has really caused doctors'
hair to stand on end. The board would be a sort of appeals
court for people who disagree with a health regulatory
body, and it would have the authority to overrule that
body.
"The government said before they
would like to streamline and smooth the obstacles for
IMGs and we support that, but we're not happy with the
way it's being done," says British Columbia Medical
Association (BCMA) president Geoff Appleton. "[Licensing]
is a College issue. It looks now like a lay group could
license an IMG. Our concern is how could these people
make a decision on competency, if they don't go through
the College? And if they do find a foreign graduate
is competent and something goes off the rails, who is
going to cover it? Will the Canadian Medical Protective
Association cover them even if the College hasn't licensed?
There are some questions, and that's always a concern
when it's open-ended like this."
The debate about how to deal with
IMG licensure has been reignited with an ongoing case
against the College of Physicians and Surgeons of British
Columbia in front of the BC Human Rights Tribunal. Dr
Paola Nasute Fauerbach, an Argentine radiologist, alleges
the College's 2007 decision not to recognize her credentials
in diagnostic breast imaging amounted to discrimination.
In late March, just several weeks before Bill 25 arrived,
the Human Rights Tribunal dismissed the College's motion
to throw out Dr Fauerbach's complaint on a technicality.
"NO
HEADS-UP"
Over the past month, the BCMA and the BC College have
been left scrambling to discern the specifics of what
the government is trying to do. "We had no heads-up
about this at all, which is sort of an irritant," says
Dr Appleton. College registrar Dr Morris VanAndel was
unavailable to respond to questions from NRM
because he and Mr Abbott were still in negotiations
in Victoria about the details of Bill 25, including
restricted licensing.
But there's a twist: the College
isn't actually under the purview of the Health Professions
Act yet. Plans have been in the offing for some
time now to bring the College into that legislative
framework — it had been hoped that it might happen
this fall — but Bill 25 and its unanticipated changes
to that Act may throw a wrench in the works, says College
communications director Susan Prins.
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