1974年,欧洲经济共同体建立了对其任何成员国获得的医疗资格的相互承认。随后,一系列指令详细阐述了最初的规定,最近的一次颁布于2013年。然而,越来越多的医生跨境流动和一些备受瞩目的丑闻引发了人们的疑问,即如何防止在一个国家受到制裁的医生简单地转移到另一个国家,而不破坏自由流动的原则。对11个欧盟(EU)成员国的主要线人进行的调查得到了同行评审和灰色文献的补充,结果由独立审稿人验证。它检查了过程,为评估出现担忧的医生而采取的裁判和纪律措施,和相关的制裁,以及专业标准和法规的其他方面。总的来说,参与国之间的反应差异很大,关于负责监管医疗专业的机构,调查过程到位,以及每个成员国使用的术语。虽然制裁的类型(从医疗专业人员登记册中删除和/或吊销执照,悬架,解雇,谴责,警告,罚款,以及额外的教育和培训)应用类似,涉及的个人的角色和公开披露信息的水平差异很大。然而,一些关键特征,例如专业同行参与纪律小组和法院参与刑事案件,在大多数研究的成员国中都是相似的。鉴于监管环境的变化,我们的发现说明了所涉及的个人和过程,对实践能力定义的共同理解,其损害及其对患者安全的潜在影响变得尤为重要。一些成员国已经公开披露纪律成果,但是应该考虑采取其他措施来保护医疗专业人员免受不当后果的影响。
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.