The Society of Rural Physicians of Canada (SRPC) welcomes the Federal Medical Regulatory Authorities of Canada’s (FMRAC) evaluation of the Atlantic Registry pilot and recognizes the efforts made by provincial regulators to trial a model of regional licensure. As long-standing advocates for national licensure, we see this as a significant and positive step.
However, in our roles as rural advocates, we suggest some important clarifications particularly concerning the evaluation framework as it applies to rural areas. Rural communities are uniquely affected by licensure barriers, face greater recruitment and retention challenges, have a higher dependency on locum providers, and often have fewer options when coverage gaps arise. While healthcare staffing issues are a nationwide challenge, rural areas are where these issues rise to crisis levels.
1. Better Understand Impact of Low-Volume Service Coverage and Burnout Prevention
While we agree with many of the findings in the report, we are uncertain about the conclusion of limited impact at a systems level. As the report’s evaluation methodology relies heavily on billing data to evaluate physician movement and participation, this approach may miss a critical dimension of value – prevention of disruptions in service.
For example, one of our members provided cross-border virtual coverage for a colleague who is the sole pediatric palliative care physician in Saskatchewan. No calls came in during the coverage period, and thus, no billing data was generated. However, the real impact was significant: the regular provider was able to take time away with peace of mind, knowing her patients had backup. These types of arrangements, often informal, low-volume, or preventative, are vital in rural and highly specialized care settings but can be easily overlooked in billing-based assessments.
We suggest that future evaluations include measures of clinical continuity, system flexibility, and avoided service gaps (e.g., emergency department closures, obstetrical service closures, service diversions, etc.) in addition to billing data to better assess impact.
2. Rural-Specific Analyses
As health system needs and provider mobility are generally different between rural and urban settings, future evaluations should examine potential differences in rural and urban practice patterns. Rural communities are uniquely affected by licensure barriers, face greater recruitment and retention challenges, have a higher dependency on locum providers, and often have fewer options when coverage gaps arise.
Without rural-specific data, it remains unclear whether the registry is achieving its potential of improving rural healthcare access. Future evaluations should engage directly with rural partners and include rural-urban disaggregation in both data collection and analyses.
3. Better Evaluation of Impact with Longer Duration Data
As changes in practice patterns, particularly interprovincial coverage and rural locum uptake may take a period of time to develop, future evaluations should examine longer timeframes to better assess utility.
Evaluation of long-term system benefits would benefit from a broader lens, spanning multiple recruitment cycles, seasonal fluctuations, and sudden or unexpected emergent community needs.
The measures used to assess impact likely underestimate the benefit of the Atlantic Registry. For example, one of the authors of this letter had previously practiced in an Atlantic jurisdiction but had given up their license due to the administrative burdens and complexity of maintaining licensure. After the Atlantic Registry was implemented they have since returned to working in this jurisdiction and have made several locum visits.
4. Broader Collaboration Nationally
The Atlantic Registry pilot, while promising, underscores the need for a truly national approach to physician licensure. Fragmented, regional solutions may ease mobility in a limited manner, but they would not address the full scope of challenges facing our country’s health human resources.
SRPC, alongside the Canadian Medical Association and other national organizations, continue to advocate for a pan-Canadian licensure model, one that prioritizes equity of access for Canadians, and flexibility across all provinces and territories.
Canada’s rural communities depend on a flexible, responsive physician workforce. National licensure can and must be a part of the solution. To realize its full potential, the workforce needs thoughtful, inclusive, and evidence-informed implementation guided by the experiences of those on the ground.
We look forward to continued dialogue and collaboration with FMRAC and other health system leaders to build a licensure model that truly serves all Canadians, no matter where they live.
Our full body of national licensure advocacy work is available online.
