Doctors in favour of greater mobility

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Post-graduate medical qualifications should be recognised across the European Union in order to remove barriers to the mobility of doctors, Lisette Tiddens, secretary-general of the Standing Committee of European Doctors (CPME), told EURACTIV in an interview.

Lisette Tiddens is secretary-general of the Standing Committee of European Doctors (CPME). 


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What is CPME’s view of the Cross-border Healthcare Directive and how will this affect doctors? 

We are very much in favour of the directive. It’s better to decide at political level what patients can do rather than leaving it to the courts. From the beginning, we’ve always said we’re in favour of free movement of physicians and free movement of patients, so we think Europe should make it possible for patients to move between countries to get the treatment they need. 

But that’s not the same as saying that we think a whole lot of patients are going to move. It’s not as if a whole lot of patients in Amsterdam are going to want their treatment in Berlin. The actual movement will probably be limited to border areas and for rare diseases, where patients will go to highly specialised centres. 

Could it encourage migration of specialists in Europe? 

In itself, there has always been a tendency for physicians to go abroad, because it’s an international profession and diseases don’t stop at borders. Physicians have to learn from others and there has always been a tendency to go abroad anyhow. This directive does not have a direct influence on physicians moving directly between member states. There is a directive – the professional recognition directive – which sets out the minimum level of training for physicians – that makes it possible to go abroad. That’s already in place and the last revision was in 2007. 

Telemedicine is growing in popularity: what are the major advantages as you see them? 

Electronic patient records help to organise the easy transfer of data when a patient moves from one physician to another. In addition, if you talk about exchanging information on diseases or reporting side effects of diseases, you are talking about telemedicine or e-health. Also, helping a physician who is somewhere at the North Pole to treat a person needing help from an expert in Berlin. It’s very complex. So far, industry has been determining what has been developed, and that’s our worry. We think physicians have to be far more involved in the development of e-health. 

And are there potential pitfalls, such as the danger of exacerbating health inequalities? 

If we are focusing only on the electronic part, then there are still large parts of the world – even in the EU – that are not connected to the Internet. We have to be careful that these patients don’t fall out of the system. And when we talk about providing information to patients we shouldn’t just talk about doing so over the Internet, because a whole group of patients would miss out. Another pitfall is ordering medicines over the Internet and having delivery of counterfeit medicines. That’s a real problem. 

Does the Committee have a position on the growth of privatisation in healthcare? 

We don’t have a position on healthcare systems for the simple reason that our members have to work within a variety of systems. 

What is your view of the Green Paper on the EU Health Workforce? How can Europe balance the need for highly trained doctors with the ethical issues arising from attracting staff from the developing world?

Brain drain is one of the major issues which we say should be prevented. It should be that every member state takes care that it has enough trained physicians and we should certainly not take doctors from countries that have too few already. 

Would the CPME like to see greater mobility of doctors within Europe, and what are the barriers to greater mobility? 

Mobility of doctors in itself is a good thing as far as the exchange of knowledge is concerned. Nowadays you have the advantage of the Internet as well, so it may not be as necessary as in the past. But we do say that doctors should be allowed to go from one country to the next. 

Are you satisfied that postgraduate qualifications are recognised when doctors move across 27 states? 

Well, that’s why we have the professional recognition directive for the minimum level, and we are currently working to ensure that the continuous professional development and continuing medical education are being guaranteed at a level that is acceptable to all member states. That is not a very easy thing to do, but it is a point of our attention. 

At present, if doctors have postgraduate qualifications in, for example, radiology, is it possible simply to move from Germany to France? 

There is a list of 15 specialities for all member states and more than 30 specialties which are recognised by agreement between states. 

Is general practice widely seen as a speciality? 

There are countries where a general practitioner is called a specialist in family medicine, and others are still seen as generalists. I know that GPs are themselves working hard to have the specialisation recognised as such. They want to become part of the Specialists Recognition Directive, but at the moment they have their own chapter. The minimum level is not the same everywhere, and the definition is not the same everywhere. 

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