A new agreement that makes it easier for workers, including doctors, to move within Canada could spell an exodus of physicians from rural areas this spring, leaving patients suddenly without care.
The warning comes from those who license, certify and regulate doctors. They are concerned the federal government's Agreement on Internal Trade could unwittingly come at the cost of patient care.
"It's really about patient safety and making sure that if somebody is under scrutiny or under a different regime in one province that they don't escape that by moving across the border," said Andrew Padmos, chief executive officer of the Royal College of Physicians and Surgeons of Canada.
Although the Agreement on Internal Trade came into effect 13 years ago, the changes made to it last week allow for workers - including doctors, teachers, engineers and architects - to take jobs between provinces and territories without the red tape of requalification, starting on April 1, 2009.
The agreement covers 100 professions and government-related trades and occupations, involving close to 400 regulatory bodies, with the aim of making things easier for the 200,000 Canadians who relocate to other provinces in a given year.
But groups that license and certify physicians say doctors will be able to flee unpopular rural areas, those with addictions may go unmonitored and physicians who have competence issues will be able to relocate with little if any oversight.
"It erodes the quality and it removes the discretionary power of the regulatory authorities to act in the best interests of the patient," said Fleur-Ange Lefebvre, executive director and chief executive officer of the Federation of Medical Regulatory Authorities of Canada. "That was a real biggie for us."
Currently, each province and territory licenses and regulates physicians. Most physicians - more than 70,000 of them - have full medical licences. About 4,000 more have restrictions on how or where they can practise medicine, according to 2007 figures from the federation.
International medical graduates, for example, often receive less than a full medical licence, agreeing to work in a doctor-starved area for several years. That helps patients in remote or rural communities obtain care while that physician works to obtain a full licence, at which point she or he can relocate.
There is also another group of physicians closely monitored by provincial regulatory bodies due to substance-abuse issues or blood-borne illnesses such as HIV or hepatitis. Because these cases are rarely the subject of public discipline and are handled discreetly, that history would not likely follow the physician to another province.
"There are a lot of physicians who are safe because they are very carefully controlled, in terms of what they can do," said Dennis Kendel, registrar of the College of Physicians and Surgeons of Saskatchewan. "If you lose that capacity to put those controls in place, it does certainly cause concern."
Saskatchewan is particularly vulnerable to the new deal, with international medical graduates constituting 54 per cent of its physicians. A review found only 18 per cent of doctors who practise in small communities under an alternative form of licence remained in rural areas of that province five years later.
Similarly, a Newfoundland study found half of its physicians left the province as soon as the necessary credentials were obtained.
That is why physician regulatory groups want to meet with the federal government, with the aim of working on guidelines to repair some of those problems. Otherwise, "in relatively short order, physician supply could be quite depleted," Dr. Kendel said.
Human Resources and Social Development Canada spokesman Jason Bouzanis said the ministry is aware of concerns over the movement of physicians away from rural and remote areas, but doctors are already allowed to do that.
"The amendments to Chapter 7 neither created this situation, nor does it attempt to limit the labour mobility of physicians," Mr. Bouzanis wrote in an e-mail. "HRSDC believes that all professions, including physicians, should enjoy the benefits of interprovincial labour mobility."
As part of an annual assessment, labour market ministers are to monitor and address any unintended consequences, he said.