Licensing procedures and registration of medical doctors in the European Union

Abstract

The current proposals to update the European Union (EU) directive on professional qualifi cations will have potentially important implications for health professions. Yet those discussing it will struggle to fi nd basic information on key issues such as licensing and registration of physicians in different countries. A survey was conducted among national experts in 14 EU member states, supplemented by literature and independent expert review. The questionnaire covered fi ve components of licensing and registration: (1) defi nitions, (2) regulatory basis, (3) governance, (4) the process of registration and (5) fl ow and quantity of applications. We identify seven areas of concern: (1) the meaning of terminology, which is inconsistent; (2) the role of language assessments and the responsibility for them; (3) whether approval to practise should be lifelong or time limited, subject to periodic assessment; (4) the need for improved systems to identify those deemed no longer fi t to practise in one member state; (5) the complexity of processes for graduates from non-EU/European Economic Area (EAA) countries; (6) public access to registers; and (7) transparency of systems of governance. The systems of licensing and registration of doctors in Europe have developed within specifi c national contexts and vary widely. This creates inevitable problems in the context of free movement of professionals and increasing mobility. KEYWORDS: Registration, licensing, revalidation, directive on professional qualifi cations, professional mobility Introduction Doctors have long had the right to practise throughout the European Union (EU). EU legislation enacted in 1975 (Council directives 75/362/EEC and 75/363/EEC) and its subsequent revisions set out the core requirements for registration as a medical practitioner. 1-3 These underpin the assumption that anyone licensed as a medical practitioner in any EU member state is qualifi ed to practise anywhere else, something that derives from the fundamental freedoms of movement enshrined in European treaties. Yet, in some countries, there have been concerns that the system is not working. First, the core training requirements are defi ned in terms of hours of study, rather than the acquisition of defi ned competences, now seen in many countries as the mark of completion of training. Second, the concept of lifelong qualifi cation is being challenged in some countries by requirements to demonstrate continuing competence at points throughout one's working career. Third, there have been some high-profi le cases of failings by doctors working outside the country in which they obtained their qualifi cation.The most recent directive, which came into force in 2007, is being revised in response to these concerns. A draft text was proposed by the European Commission in July 2013 with proposals for a voluntary European 'professional card', an alert mechanism for malpractice or fraudulent diplomas, and the ability of competent authorities to assess language skills. On 9 October 2013 the text was accepte...

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

“…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. In particular, there were large differences in how fitness to practise is conceptualised and some countries showed weaknesses in their systems that should identify doctors who are unfit to practise [35]. As well as IMGs, European graduates are more likely to experience difficulty in adapting to a very different healthcare context than the one in which they trained [21].…”

The medical licensing examination debate

“…Opponents of licensing examinations also suggest that easily testable learning outcomes become the focus of such examinations and that the competences needed more for actual practice are often missing from the blueprint (Neilson 2008;Noble 2008;Harden 2009). Their answer is for more job assessment, appraisal, and professional development to provide more accurate, up-to-date, and ongoing evidence of practitioner competence (Calnon 2006;Waldman & Truhlar 2013;Kovacs et al 2014). Neilson (2008) develops this argument: The standardisation of final, licensing, and fitness to practice examinations may make educationalists weep with joy, but there is no clear evidence that it makes for better doctors.…”

“…A third distinct group of countries exclusively involve international medical graduates (IMGs) who undergo an additional examination alongside an accreditation process, where they are required to provide evidence of language competence and validated documentation of their primary qualifications in order to practice in the new country. These include Australasia, parts of Europe (Sonderen et al 2009), including Sweden (Musoke 2012), and the United Kingdom (UK) (Kovacs et al 2014).…”

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

“…In some countries, licensing and/or registration (again terms that have different meanings in different countries and both being used in different settings to explain the same processes) is indefi nite, whereas in others it is time limited and requires periodic relicensing and/or reregistration, 7 either by means of a simple reapplication or based on more formal requirements of demonstrating fi tness to practice. In both instances, professional misbehaviour and crimes can lead to a premature end of the license, although as we have shown elsewhere, the criteria for removal also vary markedly.…”

“…This is the second part in a series exploring professional standards across Europe and follows our work on licensing and registration processes. 7 …”