How do medical doctors in the European Union demonstrate that they continue to meet criteria for registration and licencing?

Abstract

This paper reviews procedures for ensuring that physicians in the European Union (EU) continue to meet criteria for registration and the implications of these procedures for cross-border movement of health professionals following implementation of the 2005/36/EC Directive on professional qualifi cations. A questionnaire was completed by key informants in 10 EU member states, supplemented by a review of peer-reviewed and grey literature and a review conducted by key experts in each country. The questionnaire covered three aspects: actors involved in processes for ensuring continued adherence to standards for registration and/or licencing (such as revalidation), including their roles and functions; the processes involved, including continuing professional development (CPD) and/or continuing medical education (CME); and contextual factors, particularly those impacting professional mobility. All countries included in the study view CPD/CME as one mechanism to demonstrate that doctors continue to meet key standards. Although regulatory bodies in a few countries have established explicit systems of ensuring continued competence, at least for some doctors (in Belgium, Germany, Hungary, the Netherlands, Slovenia and the UK), self-regulation is considered suffi cient to ensure that physicians are up to date and fi t to practice in others (Austria, Finland, Estonia and Spain). Formal systems vary greatly in their rationale, structure, and coverage. Whereas in Germany, Hungary and Slovenia, systems are exclusively focused on CPD/ CME, the Netherlands also includes peer review and minimum activity thresholds. Belgium and the UK have developed more complex mechanisms, comprising a review of complaints or compliments on performance and (in the UK) colleague and patient questionnaires. Systems for ensuring that doctors continue to meet criteria for registration and licencing across the EU are complex and inconsistent. Participation in CPD/CME is only one aspect of maintaining professional competence but it is the only one common to all countries. Thus, there is a need to bring clarity to this confused landscape.

Prevalence of GMC performance assessments in the United Kingdom: a retrospective cohort analysis by country of medical qualification

“…One study found that in certain countries (Spain, Austria, Finland and Estonia) there was an implicit expectation that doctors maintain competence without needing to comply with formal standards. Whereas in others (Belgium, Germany, Hungary, the Netherlands, Slovenia and the UK), an explicit demonstration of continued competence is mandatory [34]. Further, when representatives from 14 EU countries were surveyed, authors concluded that the systems of licensing and registration vary so much that it creates confusion and problems in the context of the free movement of doctors.…”

Deciding when physicians are unfit to practise: an analysis of responsibilities, policy and practice in 11 European Union member states

“…Finally, it is interesting to consider possible pathways towards ensuring more affirmative approaches to physicians' competence to practise, with the intention of improving patient safety and quality of care in the future. Previous work 8 has shown that no uniform approach to actively maintaining competence could be identified among participating member states. However, CPD and CME are generally recognised as key requirements for maintaining professional standards.…”

“…This paper is part of a series exploring professional standards across Europe and builds on earlier papers on licensing and registration processes 7 and mechanisms to maintain professional competence. 8…”

Patient and public involvement in medical performance processes: A systematic review

“…Additionally, despite countries adopting recertification or re‐licensure of doctors, the PPI element in these processes is seldom reported in the academic literature. For example, in Belgium, evidence for continuing medical education (CME) involves a review of complaints or compliments . The College of Physicians and Surgeons of Alberta, Canada, the statutory medical registration body for the province, has adopted a multi‐source feedback (MSF) system for all physicians/surgeons in its jurisdiction .…”