While politicians tout the benefits of reducing interprovincial trade barriers to unlock prosperity amid escalating trade tensions, our most precious health-care resources — fully qualified doctors — remain shackled. Physicians face a maze of regulations when attempting to practise beyond their home province. We must break these chains.
By 2026, 4.4 million Ontarians — one in four residents — will lack access to family doctors. The crisis extends nationwide, with projections showing 9.6 million Canadians could be without a family physician by 2034. And our existing doctors are stretched thin, with the average family physician seeing 18 per cent fewer patients annually compared to a decade ago.
It’s mystifying why Canada still struggles with the question of whether a doctor licensed in one province should be automatically qualified to practice in others. In October 2023, federal, provincial and territorial health ministers committed to “advancing labour mobility” for health-care professionals.
The Atlantic provinces launched a multi-jurisdictional licensing system in May 2023, allowing doctors to practice in all four Atlantic provinces for an additional annual fee. However, this licence is not accepted outside of Atlantic Canada, and no other provinces have such agreements: current legislation requires separate licensing in each province.
This uncertainty persists despite the critical shortage of physician services, especially for emergency department coverage and unexpected practice vacancies.
Inter-provincial restrictions undermine the efforts of overworked physicians to arrange coverage for temporary leaves. Such breaks could significantly enhance doctors’ personal well-being and extend their longevity in practice, ultimately benefiting holistic patient care while boosting Canadians’ access to physicians.
Is there a legitimate rationale, grounded in differences in training or competence, for inter-provincial barriers?
Medical training in Canada
Canada has 17 excellent medical schools with campuses in nine provinces (soon expanding to 20 covering all provinces). Although curricula and learning schemes vary according to individual philosophies and available resources, all are united by a shared vision. These institutions strive to equip students with a core set of physician competencies, ensuring graduates excel based on common educational objectives.
Canadian medical schools are inter-connected and collaborative. They share their approaches, discuss educational innovations, and engage common challenges. Medical student societies participate in collaborative activities to support knowledge sharing in clinical education.
Graduates of Canadian medical schools face the same qualifying examinations, established by the Medical Council of Canada. Success in these exams is required for entry to practice in all provinces and territories. Graduates apply to the same postgraduate residency programs, which are pan-Canadian. A graduate of an Ontario school interested in a career in family medicine, for example, is free to apply to training programs in any province without prejudice.
Those training programs operate under the guidance of national colleges that set pan-Canadian standards for training. All programs are expected to deliver the same training and meet the same standards, regardless of location. All medical schools and training programs are accredited by the same, pan-Canadian processes based on common, and extensive, criteria.
All this national commonality exists because (with some regional variability in prevalence) people are afflicted with similar medical problems wherever they reside. And so, the practice of medicine should be guided by consistent, high standards. Canadians, regardless of where they live in our country, deserve to be assured that their doctors are exceptionally well trained and qualified.
Provincial barriers
Why, then, are doctors with identical training and qualifications confined to practising in just one province or territory? The answer lies not in medical competence, but in bureaucracy. Despite national standards for training and qualification, the power to grant a licence rests with 13 separate provincial and territorial regulatory colleges. This fragmented system creates artificial barriers, limiting the mobility of our highly skilled physicians across Canada.
This is not to dismiss the important work of these provincial and territorial colleges. They are responsible for ensuring that the doctors working within their jurisdictions have completed appropriate training, achieved qualifications and maintained competence. Importantly, they are also responsible for investigating and assessing any potential breaches of competence or professionalism.
In calling for common pan-Canadian credentialing, the physician community is not suggesting the important role of provincial and territorial colleges be set aside or in any way diminished. Rather, those critical processes should be either centralized or shared reciprocally. Public protection from doctors who are disciplined or sanctioned can be accelerated through pan-Canadian licensure: the public could search physician sanctions through one online portal, not 13.
Regulation must be assessed against its purpose. If the purpose is public protection and advancing a high quality and equitable health-care system, then a doctor in good standing who lives and practises in Ontario should be able to take up emergency room shifts or cover a colleague’s practice in Manitoba without having to restart and reinvest in another lengthy, time-consuming and expensive registration process.
Pan-Canadian licensure can improve health-care access in underserved areas and increase flexibility for physicians. Canadian-trained doctors should be allowed to practice where they are qualified and needed, and that’s in Canada — all of it.