My Dominant Hemisphere

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Calling For A Common Worldwide Medical Licensure Pathway

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Medicine – Realm Of The Unknown

For ages, the medical sphere has been shrouded in mystery – for people outside of medicine that is. And this hasn’t been too good for the medical profession because many policy makers on matters of healthcare/medicine aren’t sufficiently acquainted with its many nuances to yield considered judgements. Sometimes you just can’t help get the feeling that doctors have a language of their own, with a community so tightly knit that it borders some sort of illuminati like cult.

Earlier, most of this mystery was limited to the knowledge base of medicine. Doctors were treated like gods walking on earth and people had no qualms whatsoever in having blind faith in them. With the rapid rise of web technologies however, doctors find themselves facing tough and pointed questions by their patients and policy makers about the decisions they make.

Some aspects, for the large part, still remain hidden away however. Stuff that affects policy decisions and how medical communities across the world interact with each other. Issues concerning licensure and taxonomy immediately come to mind.

An aspect of medicine that to this day, remains an enigma for many ‘outsiders’ is the entire academic hierarchy that applies to medical systems across the globe. Many ‘insiders’ end up at their wits ends too. The taxonomy is definitely confusing. What the heck is a Senior Registrar? Or for that matter, what in god’s name is the difference between house surgeons/officers, resident medical officers, civil surgeons, residents, interns, attendings, senior house officers and all that jargon? The world could definitely use a universal taxonomic architecture for medical systems akin to the WHO’s International Classification of Diseases (ICD) to streamline stuff and make interactions between communities easier.

Licensure – One Too Many Exams For A Globalised Age

When medical students step into the medical world, being relatively new ‘insiders’ at this stage, very few are cognizant of the fact that their careers depend on having to satisfy licensure requirements before even thinking about pursuing higher education. Getting through medical school is one step. After that, students are required to go through long winded licensure pathways before even beginning to gain higher training. Licensure serves as a quality control measure to ensure the safety of patients and is arguably, a necessary evil.

Modern society depends on the exchange of ideas and talent between countries. The same applies to medicine as well. Unfortunately, due to the myriads of medical licensure exams across different countries, this kind of exchange and collaboration can become extremely tedious and at times impractical. Getting into higher training for the international trainee becomes a daunting task. Take the following hypothetical scenario:-

Dr. Underdog went to medical school in a country bordering Angola and got his local medical license after graduating and passing local licensure exams. He now intends to gain higher training in colorectal surgery (… of all things 🙂 ) in the US. Before getting into a higher training program he needs an American license. He proceeds to sit for the United States Medical Licensure Exam (USMLE) and passes all 4 component exams in this process with flying colors. Good for him, Dr. Underdog’s thirst for knowledge is relentless. After gaining qualifications as a colorectal surgeon, he is now interested in learning a highly advanced and experimental procedure involving cosmic radiation and bizarre tumor polyps 😛 , only available in Australia. He is now required to pass the Australian Medical Council licensure exams before he begins. He goes ahead with that and gains the skills he’s always dreamed about 🙂 . By now, Dr. Underdog has been through at least a dozen different licensure exams. The exams he gave in the US and Australia weren’t directly related to the subjects he studied at those places. Seeing great potential in this emerging pioneer, a group of people from a country near Chile invite Dr. Underdog over. They’d like him to impart some of the training he received to a couple of their fortunate students. Unfortunately, he needs to clear their local licensure exams before he can begin. He candidly goes through that as well. In this new land, Dr. Underdog meets a fellow international doc who’s been through twice the number of licensure exams as he has, to get to a position as senior faculty member while also dealing with some mind blowing research – literally involving blowing stuff 😛 , partly as an outlet for his bottled up frustrations over licensure systems. … See how tedious it can get?

If I’m interested in gaining specialized skills and/or knowledge available in only certain parts of the world, I need to get straight down to business without having to worry about sitting for multiple licensure exams. Sitting for multiple licensure exams is not only wasteful of time and money, it is also redundant. Most of these exams test the same content anyway. Most importantly, as an aspiring international trainee, my focus has to be on the exams directly related to the training I intend to pursue rather than random licensure tests.

Solution? A universal licensure pathway ratified by an international body such as the WHO that should be acceptable to all countries.

At the moment, a few agencies such the Medical Council of Canada and the Australian Medical Council are conducting joint licensure tests. Their efforts in this direction are laudable and should be wholeheartedly welcomed. Hopefully other countries will follow suit and some day a universal licensure pathway will become a reality. Until then, international trainees can only follow in Dr. Underdog’s tortuous footsteps!

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10 Responses

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  1. Yes, I’ve heard it all, the plight of foreign trained doctors and nurses.

    Professional licensing is great for public safety but it has as indeed screwed us up in many other ways.


    May 4, 2008 at 2:01 am

  2. Jaffer – Yep. One of the glaring contrasts between professions like Medicine that involve complex licensure hurdles and professions like Engineering that aren’t plagued by this, is the volume of international exchange of students and scientists.

    Firas MR

    May 4, 2008 at 7:22 am

  3. Engineering is also plagued by licensing issues especially after the introduction of a Professional Engineering License that allows an engineer to practise engineering in Canada, which means to approve projects where safety of the consumer the general public will directly be affected.

    To get licensed in Ontario, one must obtain an accredited 4 year degree after which work for 5 years under a professional engineer. The final step is to pass an ethics examination.

    This makes it impossible for foreign trained engineers to climb the ladder and they are instead limited to taking orders and doing work of a technologist.


    May 4, 2008 at 8:07 am

  4. Jaffer – Darn! Another profession gets hit! You know, the whole licensing thing is fine by me. Public safety is definitely paramount. I just can’t take the redundancy issues when having to give multiple licensure exams. The subjects being tested are often the same. It just doesn’t make sense to me.

    Firas MR

    May 4, 2008 at 9:20 am

  5. I couldn’t agree more about the frustrations of licensing exams! Someone should tell medical students before starting that they better study in the same country they intend to pursue residency training, because otherwise things are just too difficult and frustrating. I think if countries absolutely insist on having different licensing exams, it should be a 20min affar that tests your knowledge of the laws and ethical guidelines and some of the more unique diseases you might encounter thier. Otherwise the basics are all the same…why should an opthalmologist study thier GYN, ENT, pediatrics and psychiatry all over again just to get liscensed, its unnecessary, mind numbing and hindering. Thanks for the opportunity to rant!


    October 8, 2008 at 6:35 pm

  6. @Sora

    Thanks for dropping by! And I’m sure there are many more who do think like you and me!

    PS: You’re welcome!

    Firas MR

    October 9, 2008 at 12:22 am

  7. Impressive blog! Well done!


    December 19, 2008 at 4:24 am

  8. this is very importanr issues for us as an overseas students , different licensure exam disperes our efforts , waste our time and realy exhausting .

    dr;Taghreed Basri

    February 20, 2009 at 10:05 pm

  9. I was trying to find information on this joint licensure tests that you talk about for Canada and Australia, where can I find information about this?


    August 2, 2011 at 1:09 am

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