title: Deciding when physicians are unfit to practise: an analysis of responsibilities, policy and practice in 11 European Union member states.
abstract: In 1974, the European Economic Community established mutual recognition of medical qualifications obtained in any of its member states. Subsequently, a series of directives has elaborated on the initial provisions, with the most recent enacted in 2013. However, greater movement of physicians across borders and some high-profile scandals have raised questions about how to prevent a physician sanctioned in one country from simply moving to another, without undermining the principle of free movement. A survey of key informants in 11 European Union (EU) member states was supplemented by a review of peer-reviewed and grey literature, with the results validated by independent reviewers. It examined processes, adjudicative and disciplinary measures that are in place to evaluate physicians about whom concerns arise, and related sanctions, along with other aspects of professional standards and regulation. Overall, responses varied greatly between participating countries, with respect to the institutions responsible for the regulation of medical professions, the investigation processes in place, and the terminology used in each member state. While the types of sanction (removal from the register of medical professionals and/or licence revocation, suspension, dismissal, reprimand, warnings, fines, as well as additional education and training) applied are similar, both the roles of the individuals involved and the level of public disclosure of information vary considerably. However, some key features, such as the involvement of professional peers in disciplinary panels and the involvement of courts in criminal cases, are similar in most member states studied. Given the variation in the regulatory context, individuals and processes involved that is illustrated by our findings, a common understanding of definitions of what constitutes competence to practise, its impairment and its potential impact on patient safety becomes particularly important. Public disclosure of disciplinary outcomes is already applied by some member states, but additional measures should be considered to protect medical professionals from undue consequences.
authors.affiliation: Department of Health Care Management, Berlin University of Technology, Berlin, Germany verena.struckmann@tu-berlin.de.
authors.forename: Verena
authors.initials: V
authors.lastname: Struckmann
authors.affiliation: Department of Health Care Management, Berlin University of Technology, Berlin, Germany.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Panteli
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore, and London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Helena
authors.initials: H
authors.lastname: Legido-Quigley
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Risso-Gill
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.affiliation: Department of Health Care Management, Berlin University of Technology, Berlin, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Busse
mesh_terms: D002983:Clinical Competence; D004651:Employment / Q000458:organization & administration*; D005062:European Union; D006801:Humans; D010820:Physicians / Q000331:legislation & jurisprudence*; D057766:Policy; D013038:Specialization / Q000592:standards*
keywords: Directive on Professional Qualifications; EU; Physician competence to practise; disciplinary processes; litigation; professional mobility; sanctions