MED-NET Conferences 1998, Lille & 1999, Maastricht
Anthology of presentations 4.3.

Mobility and free establishment of doctors: what is the present practice in Europe? What should happen in medical education to facilitate?

H. Hermans (Rotterdam, The Netherlands)

Freedom of mobility of doctors in Europe

Tensions between the formal right to move and reside freely within the territory of member states and the practical, administrative and legal obstacles. Mutual recognition of medical qualifications and minimum standards of training is required. Mandatory and automatic recognition of specialist diplomas only applies if it is a speciality that is common to all member states and listed in the Directive 93/16

There is no provision for the recognition of training received in countries outside the EU Such recognition may be granted by Member States but is binding only on the member state that grants it and does not extend beyond the territory of that Member State.

Doctors are entitled to full registration in any EEA Member State and have completed their primary training and hold a recognised qualification Doctors who are citizens of the EEA but obtained their primary qualification elsewhere do not currently have this right.

Formal requirements needed to practise as a doctor

In general applicants wishing to practise in a foreign Member State must produce the following documents: Recognition of diploma; Attested photocopy of the original diploma and the document that accredits the nationality; The original certificate issued by the competent authorities; Be registered at the professional organisation in the country of establishment; Personal application. Language competence could form a problem in those cases where doctors have insufficient language abilities.

Actual mobility of doctors

Actual mobility of doctors is low because of language and cultural barriers. A large number of medical immigration occurred in the UK because of less language problems and attractive employment prospects.

Mutual recognition

The most general question is how to prove that foreign qualifications are equivalent to national qualifications if no rules of the Community law exist as to their mutual recognition. The basic principles to solve this question are generally flowing as an obligation for the Member States from the treaty itself as the court ruled in the important Vlassopoulou Case (C-340/89, 1991 ECR, !-2357).

Telemedicine

Telemedicine is the delivery of medicine (or more in general: Health care) to a location distant from the medical provider. Areas of genuine success include tele-radiology and distance medical education through video-conferencing. The licensure issue is simple: if a physician in the Netherlands conducts an examination of a patient in Belgium using video-conferencing, is that physician practising medicine in Belgium, and consequently bound by the laws of the Belgian state regarding the delivery of medical care? In particular, does that physician need a Belgian State License? Moreover, how can that physician account for differences in state law regarding patient confidentiality and disclosure of clinical information?

Possible changes to facilitate

Harmonisation is necessary only to a certain degree to remove unnecessary barriers. The lack of information is in most cases the main reason for the current restricted state mobility of doctors. To improve this regional cross border information centres should be established, starting in the so-called EU-regions. Further training of medical specialists is necessary as some specialised areas do not exist in other countries, and finally telemedicine could be a new solution for many actual problems but in itself this creates new questions in particular relating to the legislation that should be applied.

ISBN Number 90.805758.1.X

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