http://www.mauinews.com/news/story/0...w02Not0329.asp
Monday, March 29, 2004 — Time: 5:20:35 PM EST
Not all doctors back adding Canada to licensing
By EDWIN TANJI, City Editor
WAILUKU - A proposal moving through the state Legislature that would ease licensing requirements for a doctor who completes medical training in Canada is opposed by a group of Maui physicians.
They say the measure would pose a threat to the quality of health care in Hawaii.
"With two years of residency in Canada, a doctor can totally bypass any U.S. oversight through the Board of Medical Examiners to practice in Hawaii," said Dr. Thomas Spallino.
Spallino and other doctors with two independent physicians' organizations say the bills coming up for final reviews in both the House and Senate amount to changing standards to accommodate a doctor who might not otherwise qualify for a Hawaii license.
State Sen. Roz Baker, chairwoman of the Senate Health Committee, disputes the claims, saying that the pending bills are in line with standards in 30 other states that allow a physician trained in a Canadian hospital to qualify for a license in the United States.
"They're screaming we're dumbing down the professional standards, but basically we are putting our statutes in line with what about 30 other states are doing," she said. "We're working with the attorney general, so we can't have some guys from Zimbabwe who don't meet the standards to get through."
She said the assistant dean of the University of Hawaii School of Medicine advised her committee that the "the standards are basically the same" for boards that accredit Canadian medical schools and Canadian hospital residency programs.
Baker said the bills that were introduced in both houses of the Legislature as well as one introduced by the Lingle administration dealt with an issue that was raised on Maui in which a physician who was a graduate of a foreign medical school and completed training in Canada was hired to work on Maui.
"He was an anesthesiologist, but he didn't meet the standards of licensure in Hawaii. The Board of Medical Examiners found he hadn't met the letter of the law," she said.
But in barring the anesthesiologist from practicing on Maui, Baker said, the Board of Medical Examiners raised a concern that "there were other doctors who didn't meet the letter of the law" who had not been identified.
The two bills, House and Senate bill 2092, would amend the state licensing standards to allow a license for a physician from a foreign medical school who has completed two years of residency training either in accredited U.S. hospitals or in Canadian hospitals.
With the Canadian hospitals, the residency training programs must be approved by the Royal College of Physicians and Surgeons of Canada or the Royal College of Family Physicians.
In the United States, a physician must have been a graduate of a medical school accredited by the Liaison Committee on Medical Education, and served a minimum of one year in residency in a program accredited by the Accreditation Council for Graduate Medical Education.
For the physicians objecting to the changes proposed in the Legislature, a key difference is the requirement for a doctor who is a graduate of a foreign - non-U.S. and non-Canadian - medical school. The standard now is the the physician must complete two years of residency in a program accredited by the Accreditation Council for Graduate Medical Education - which has authority only in U.S. hospitals.
The legislative bills would allow a physician seeking a medical license in Hawaii to qualify by serving a residency in a program accredited by the Royal College of Physicians and Surgeons of Canada. The proposals also would permit a physician to be licensed in Hawaii even if training occurred outside of Canada and the United States by proving to the Board of Medical Examiners that the training met standards "substantially equivalent to those required for accreditation" by either the American or Canadian accrediting boards.
Drs. Kevin Kern and Peter Galpin said the issue is the state giving up oversight on the qualifications of a physician coming from Canada, not a question of quality of training in Canada.
"Are Canadian doctors just as good as American doctors? I wouldn't deny that they are, in general terms. In general, the medical training in Canada is just as good as in the U.S.," Galpin said. "But this is a question of the Legislature giving up the oversight of licensing to a Canadian board. We don't know how that board is formed and whether their standards might change over the years."
Just simply requiring the doctor to have completed two years of residency in Canada doesn't provide any measure on the quality of the training, Kern said. The biggest concern, he said, is the potential loophole created in providing for foreign medical school graduates to complete residency in Canada and then move into Hawaii.
If the applicant for a license has met the Canadian standards and passed a Canadian medical qualifying examination, the Hawaii Board of Examiners would issue a license without further examination, although the board may ask for letters or interviews with physicians who have worked with the applicant.
In a letter to the Hawaii Medical Association - which supported the bills - Dr. John Wright disputed the claim that most states have similar provisions.
"It would allow foreign medical school graduates, whose medical school education is not subject to any U.S. credentialing requirements whatsoever, to be licensed in Hawaii by doing only two years of residency training in either the USA or in Canada," Wright wrote.
"Most (27) states require foreign medical school graduates to have three years of post-graduate residency training and . . . most (35) states require foreign medical school graduates to have graduated from state-approved foreign medical schools," he said. "Neither existing Hawaii law, nor the proposed revisions require either of the above."
He said the Hawaii Medical Association support for the bills appeared to presume that hospital credentialing committees would prevent unqualified physicians from practicing.
But he said there is nothing to prevent a doctor from being licensed without having any review by a hospital credentials committee. On Maui, the physicians said, there are at least two properly licensed medical doctors who have not been "credentialed" and have no right to admit patients to Maui Memorial Medical Center.
Galpin said state medical licensing laws only establish a bottom-line standard for a physician to qualify for a license. For a physician to be qualified in a particular field in the United States, that physician must be certified by professional organizations in their specialties, often requiring years of specialty training as well as regular retesting. But there is no prohibition against a physician claiming to have a specialty, even if that physician is not "board certified," he said.
"He just can't admit a patient to a hospital," Galpin said.
Baker said she believed the bills dealt with all of the issues raised by the doctors who oppose the changes.
"They're trying to scare people off. When you look at it objectively, it just doesn't wash what they're saying," she said. "We've got it very tight. Someone sneaking in from one of the former colonial countries, if that is the concern, is not going to get through without a thorough review.
"We're making sure the consumer is protected and that the safety of patients will not be compromised," she said.