German Medical Association
Federation of the German Chambers of Physicians
The Role of Physicians’ Self-Governance
in Medical Education
13.04.2015
© Bundesärztekammer 2011
Dr. Ramin Parsa-Parsi, MPH
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
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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
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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 selfmonitoring
 The profession assures patients and society of professional competence
and integrity
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Physicians’ Self-Governance in Europe
Different Tasks and Responsibilities
 Tasks and responsibilities of medical chambers differ among ZEVA
countries
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Physician Chambers in Germany
Tasks and Responsibilities
 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)
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Medical Education
Postgraduate medical education
Basic
medical
training
Specialty
training
Continuing
medical
education
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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 (e-mail)
 Main findings from ZEVA countries: Albania, Austria, B&H Rep. Srpska,
B&H Zenica Canton, Croatia, Estonia, Hungary, Poland, Romania, Serbia,
Slovenia
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Basic Medical Training
Basic
medical
training
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Basic Medical Training
Germany
 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
Basic
medical
- Case-by-case
training
- 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
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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
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Specialty Training
Postgraduate medical education
Basic
medical
training
Specialty
training
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Specialty Training
Germany
 Responsibility of chambers of physicians
 Minimum of five years of training (including for GPs)
Basic
 EU
Professional Recognition Directive 2005/36/EC
medical
training
 Recognition of diplomas from non-EU countries (case-by-case)
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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)
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Continuing Medical Education
Postgraduate medical education
Basic
medical
training
Specialty
training
Continuing
medical
education
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Continuing Medical Education
Germany
 Responsibility of chambers of physicians
 250 credits in 5 years
 Accreditation
of CME/CPD events
Basic
medical of certificates from EU and non-EU countries
 Recognition
training
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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)
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Medical Education
European Integration
Further European integration or harmonization needed or wanted?
Basic
medical
training
Specialty
training
Continuing
medical
education
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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.“
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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 selfgoverning 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
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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
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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
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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
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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
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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
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One World
One Medical Profession
Thank You !
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