Abstract
BackgroundTraditional top-down national regulation of internationally mobile doctors and nurses is fast being rendered obsolete by the speed of globalisation and digitisation. Here we propose a bottom-up system in which responsibility for hiring and accrediting overseas staff begins to be shared by medical employers, managers, and insurers.DiscussionIn this model, professional Boards would retain authority for disciplinary proceedings in response to local complaints, but would lose their present power of veto over foreign practitioners recruited by employers who have independently evaluated and approved such candidates' ability. Evaluations of this kind could be facilitated by globally accessible National Registers of professional work and conduct. A decentralised system of this kind could also dispense with time-consuming national oversight of continuing professional education and license revalidation, which tasks could be replaced over time by tighter institutional audit supported by stronger powers to terminate underperforming employees.SummaryMarket forces based on the reputation (and, hence, financial and political viability) of employers and institutions could continue to ensure patient safety in the future, while at the same time improving both national system efficiency and international professional mobility.
Highlights
Traditional top-down national regulation of internationally mobile doctors and nurses is fast being rendered obsolete by the speed of globalisation and digitisation
A national Register for this purpose could be accessed by potential foreign employers on being granted permission by the job candidate in question; in support of this proposal’s credibility, it has been noted that a significant proportion of malpractising health practitioners are repeat offenders [46]
If a practitioner in country A has an unresolved complaint against his/her name, an employer in country B would have options either (i) to delay, or decide against, granting a contract, (ii) to offer a contract in which continuation was conditional upon dismissal of the complaint, or (iii) having been given the details of the complaint, to consider the relevance in country B of the complaint lodged in country A
Summary
To expedite the safe yet efficient migration of foreign (-resident or -qualified) healthcare workers, an internationally accessible database of current work-related complaints and past (upheld) offences is one quality control measure which could be created. The perennial issues surrounding CPD - who should regulate it, and how much should be carried out over what period, how it should be assessed, whether it should be linked to license renewal, and (above all) whether it achieves its stated justification of substantively improving patient safety - could be simplified by an employer-led model of contracts and liability Such a system would fit the common purpose of employer and employee to maintain competence and safety; the benchmarks by which employers and employees monitor practice could be mutually agreed, strengthening audit via emphasis on meaningful clinical indicators rather than on educational marking schemes of presumed but unproven value, to the best of our knowledge, the value of post-licensing education has never been proven in any context; for example, postlicence driver education has been reported to be ineffective in reducing car accidents [47]. Authors’ information The views of the authors represent their own personal opinions, and not the view of any organisation with which they are associated
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