German Medical Association Federation of the German Chambers of Physicians The Role of Physicians’ Self-Governance in Medical Education Dr. Ramin Parsa-Parsi, MPH© Bundesärztekammer 2011

2 Agenda  Physicians’ self-governance  Survey ZEVA countries - Basic medical training - Specialty training - Continuing medical education  Physician self-governance and European integration  Physician self-governance and European challenges

3 Physicians’ Self-Governance The Medical Profession - A Liberal Profession  The management and control of professional services is particularly important for the “liberal professions”  Complex expert knowledge and formal, unstructured services make control and detailed regulation by non-professionals or indirect quality assurance difficult  For physicians a high level of performance can be a matter of life or death  Medical profession needs self-governance and autonomy  Transferral of responsibility based on the recognition that self-control is the most effective means of governance

4 Physicians’ Self-Governance in Europe Common Vision and Mission At the basis of self-governance lies a contract between society and the profession  Society assures the profession of autonomy in practice and protection against unqualified competition  The profession promises to guarantee effective self-regulation and self- monitoring  The profession assures patients and society of professional competence and integrity

5 Physicians’ Self-Governance in Europe Different Tasks and Responsibilities  Tasks and responsibilities of medical chambers differ among ZEVA countries

6  Compulsory membership  The chambers of physicians are responsible for safeguarding the professional interests of the physician community  They exercise the sovereign task of registering and supervising physicians  They ensure the highest possible ethical and scientific standards in medicine Core responsibility:  To organize, regulate and promote postgraduate medical education (specialty training and continuing medical education) Physician Chambers in Germany Tasks and Responsibilities

7 Medical Education Basic medical training Specialty training Continuing medical education Postgraduate medical education

8 Basic Medical Education, Specialty Training and CPD/CME Survey by the German Medical Association  Participating countries -EEA member states -EU candidate and potential candidate countries  Motivation -Differentiated overview of medical training in Europe -Understand role of chambers of physicians  Survey period: August/ September 2011  Method of data collection -Semi structured interview (phone) -Written questionnaire ( )  Main findings from ZEVA countries: Albania, Austria, B&H Rep. Srpska, B&H Zenica Canton, Croatia, Estonia, Hungary, Poland, Romania, Serbia, Slovenia

9 Basic Medical Training Basic medical training

10 Basic Medical Training Germany Basic medical training  5500 hours and 6 years with final state exam (oral/ written)  Licensing by state ministry of health  EU Professional Recognition Directive 2005/36/EC - Revision in process (Legislative proposal by Dec 2011)  Recognition of diplomas from non-EU countries - Case-by-case - Professional Qualifications Recognition Act: The right to have application considered, maximum processing time, priority access for EU citizens will be dropped, permanent license for everyone - Adjustment period of up to one year and exam  Bologna process not supported

11 Basic Medical Education Main Findings of the Survey  Duration In general in accordance with minimum requirements stipulated in directive 2005/36/EC: 6 Years or 5500 hours Some countries allow completion of medical training in shorter time (Austria, Poland)  Form of final examination Written thesis, multiple choice exam, oral exam, no final examination  No involvement of chambers in regulating content or certification (advisory role only)  Bologna Process (Partly) implemented in some countries (Albania, B&H Rep. Srpska, B&H Zenica Canton, Croatia, Romania).  ECTS widely used

12 Specialty Training Basic medical training Specialty training Postgraduate medical education

13 Specialty Training Germany Basic medical training  Responsibility of chambers of physicians  Minimum of five years of training (including for GPs)  EU Professional Recognition Directive 2005/36/EC  Recognition of diplomas from non-EU countries (case-by-case)

14 Specialty Training Main Findings of the Survey  Regulation of content: Austria, Poland, Slovenia, Romania, Germany  Accreditation of specialist training institutions: Ministry of health is the proper authority for accreditation in all countries, some countries involve chambers in accreditation of training hospitals (Austria, Slovenia, Germany)  Issuing of certificates: Only few countries involve chambers (Austria, Slovenia, Germany)  Recognition of foreign diplomas: Chambers fully responsible in some countries (Austria, Germany), responsible for EU diplomas only (Poland, Slovenia) and in advisory role (Romania)

15 Basic medical training Specialty training Continuing medical education Postgraduate medical education Continuing Medical Education

16 Continuing Medical Education Germany Basic medical training  Responsibility of chambers of physicians  250 credits in 5 years  Accreditation of CME/CPD events  Recognition of certificates from EU and non-EU countries

17 Continuing Medical Education Main Findings of the Survey  CPD/CME compulsory in all surveyed states, however models differ (points/year)  No standard penalty in case of non-compliance, withdrawal of license possible in some states (Albania, B&H Rep. Srpska, Slovenia)  Some states have a system of recertification (Albania, B&H Rep. Srpska, Croatia, Hungary, Romania, Slovenia)  Chambers of physicians (partly) responsible for regulations and accreditation of training events in most surveyed states (B&H Rep. Srpska, Croatia, Romania, Slovenia, Germany, Austria (delegated to Academy of Physicians), Poland (only accreditation)

18 Medical Education European Integration Basic medical training Specialty training Continuing medical education Further European integration or harmonization needed or wanted?

19 Physician‘s Self-Governance and European Integration The Principle of Subsidiarity  EU Treaty (Article 168 TFEU (ex Article 152 TEC)): Union action shall complement national policies, European level shall foster coordination between national policies in certain areas  Principle of Subsidiarity: “Union action shall respect the responsibilities of the Member States for the definition of their health policy and for the organization and delivery of health services and medical care.“

20 Physician‘s Self-Governance and European Integration Increasing Influences  European integration increasingly affects health sector Professional Qualifications Directive (2005/36/EC) Cross-Border Healthcare Directive  As long as the medical profession benefits from integration efforts chambers support the processes  However, if the quality of medical education is jeopardized or the self- governing rights of chambers of physicians are challenged, the medical profession needs to be ready to intervene in the interest of quality and patient safety  Several ongoing projects that may affect medical training or the professional code

21 Physician‘s Self-Governance and European Challenges Accreditation of CME/CPD  System for recognition of CPD/CME already in place (European Accreditation Council for Continuing Medical Education, EACCME)  Accreditation of CPD/CME training events by (European) organizations other than national competent authorities may facilitate migration and free movement, but recognition must remain the prerogative of national level

22 Physician‘s Self-Governance and European Challenges Accreditation of Specialty Training  Efforts by organizations other than national competent authorities to perform accreditation of specialty training including content definition: European Council for the Accreditation for Medical Specialist Qualifications (ECAMSQ)  Specialty training is different to CPD/CME - No automatic recognition should be possible - Harmonized European curriculum may not be desirable  Further integration may circumvent and jeopardize competencies of chambers of physicians with regards to medical training

23 Physician‘s Self-Governance and European Challenges Medical Standardization by CEN  Comitée Européen de Normalisation (CEN): Project Committee Aesthetic Surgery Services CEN/TC 403  Proposal by Austrian Standards Institute (January 2010): Aim was to safeguard patient safety by defining European standards for aesthetic surgery services against the background of growing patient mobility  Necessity to harmonize certain standards (clinic facilities) uncontested  However: These standardisation efforts also affect medical procedures, specialty training requirements and scope of practice  Competencies of national authorities are affected

24 Physician‘s Self-Governance and European Challenges Medical Standardization by CEN  Standards also entail provisions regarding -Procedure of patient information -Patient-physician communication -Documentation -Advertising  Professional code affected  European standards created by CEN are voluntary, but have potential to create an additional tier of European professional law  Standardisation must not circumvent competencies of national authorities

25 Physician‘s Self-Governance and Medical Education Summary  Physician chambers have more expertise regarding medical education and professional codes than European institutions or organizations  Rights of chambers of physicians at national level may be affected by certain EU regulations or individual European projects  Many integration efforts are beneficial and can be supported  If new developments circumvent medical chambers or jeopardize medical education and patient safety, the medical profession must intervene  Developments on European level have to be monitored  Close cooperation between chambers is necessary to voice concerns and protect self-governing rights

26 One World One Medical Profession Thank You !