title: How do medical doctors in the European Union demonstrate that they continue to meet criteria for registration and licencing?
abstract: This paper reviews procedures for ensuring that physicians in the European Union (EU) continue to meet criteria for registration and the implications of these procedures for cross-border movement of health professionals following implementation of the 2005/36/EC Directive on professional qualifications. A questionnaire was completed by key informants in 10 EU member states, supplemented by a review of peer-reviewed and grey literature and a review conducted by key experts in each country. The questionnaire covered three aspects: actors involved in processes for ensuring continued adherence to standards for registration and/or licencing (such as revalidation), including their roles and functions; the processes involved, including continuing professional development (CPD) and/or continuing medical education (CME); and contextual factors, particularly those impacting professional mobility. All countries included in the study view CPD/CME as one mechanism to demonstrate that doctors continue to meet key standards. Although regulatory bodies in a few countries have established explicit systems of ensuring continued competence, at least for some doctors (in Belgium, Germany, Hungary, the Netherlands, Slovenia and the UK), self-regulation is considered sufficient to ensure that physicians are up to date and fit to practice in others (Austria, Finland, Estonia and Spain). Formal systems vary greatly in their rationale, structure, and coverage. Whereas in Germany, Hungary and Slovenia, systems are exclusively focused on CPD/CME, the Netherlands also includes peer review and minimum activity thresholds. Belgium and the UK have developed more complex mechanisms, comprising a review of complaints or compliments on performance and (in the UK) colleague and patient questionnaires. Systems for ensuring that doctors continue to meet criteria for registration and licencing across the EU are complex and inconsistent. Participation in CPD/CME is only one aspect of maintaining professional competence but it is the only one common to all countries. Thus, there is a need to bring clarity to this confused landscape.
authors.affiliation: University of Barcelona, Barcelona, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Solé
authors.affiliation: Berlin University of Technology, Berlin, Germany.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Panteli
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Risso-Gill
authors.affiliation: Karolinska Institutet, Stockholm, Sweden, and Maastricht University, Maastricht, the Netherlands helena.legido-quigley@lshtm.ac.uk.
authors.forename: Nora
authors.initials: N
authors.lastname: Döring
authors.affiliation: Berlin University of Technology, Berlin, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Busse
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Helena
authors.initials: H
authors.lastname: Legido-Quigley
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003406:Credentialing / Q000592:standards*; D004502:Education, Medical, Continuing / Q000592:standards*; D005062:European Union; D006801:Humans; D010820:Physicians / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards; D011795:Surveys and Questionnaires
keywords: EU; Revalidation; licencing; maintaining competence; professional mobility; quality of care; registration