Medical professional by IMI PQ NET Romania

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THE EUROPEAN SOCIAL FUND Sectoral Operational Program Human Resources Development 2007– 2013 Priority Axis 3 „INCREASING WORKERS AND ENTERPRISE ADAPTABILITY” The Major Intervention Domain No 3.3„Development of Partnerships and Encouraging Initiatives for Social Partners and the Civil Society" Project Title:“The Network of Competent Authorities for Professional Qualifications in Romania(IMI PQ NETRomania)” Beneficiary: THE MINISTRY OF NATIONAL EDUCATION Contractno: POSDRU/93/3.3/S/53132

L30.2_Ghid1_Szuhanek_Camelia

Guide for Certification and Recognition of the Medical Professionals

Author: Memoirs Chief Dr.Camelia SZUHANEK Methodological ExpertANC, Healthcare Domain

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Contents Introduction

I. The situation of the regulation of the medical profession in Romania and Member States of the European Union 1.1. The medical profession in Europe

4 4

1.2.

The European Regulatory Provision through which the medical profession is regulated

II. The validation/certification Procedures of the competences applied by the CA from the countries where the profession/s is/are regulated

2.1. Certification for medical practice in Italy

2.2. Certification for medical practice in Spain

2.3. Certification for medical practice in Czech Republic

2.4. Certification for medical practice in Austria

2.5. Certification for medical practice in Great Britain

2.6. Certification for medical practice in Denmark

2.7. Certification for medical practice in Holland

2.8. Certification for medical practice in Germany

3.2.

Recognition of the Medical Qualification in Italy

3.3.

Recognition of the Medical Qualification in Spain

3.4.

Recognition of the Medical Qualification in Czech

3.5.

Recognition of the Medical Qualification in Austria

3.6.

Recognition of the Medical Qualification in Great Britain

3.7.

Recognition of the Medical Qualification in Denmark

3.8.

Recognition of the Medical Qualification in Holland

3.9.

Recognition of the Medical Qualification in Germany

IV. Practicing the Medical Profession in the European Union

V. Conclusions

Bibliography

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Introduction The present guide is one of the results of the project called „The Network of Competent Authorities for Professional Qualifications in Romania (IMI PQ NET Romania)” implemented by the Ministry of National Education in partnership with the National Qualifications Authority and the Institute for Social Policies(IPS), co-financed by the European Social Fund through the Sectoral Operational Program Human Resources Development 2007– 2013(POSDRU). The General Objective of the project called „The Network of Competent Authorities for Professional Qualifications in Romania(IMI PQ NET Romania)”consists in creating and consolidating the IMI Network (Internal Market Information) for the professional qualifications in Romania (IMI PQ NET), with the purpose of sustaining the CE initiative regarding the development of the System for Informing the Internal Market, the development of a common initiative in this respect, at a national level, targeting the consolidation of the social partners’ capability (agencies and governmental organizations, professional associations) to promote durable development through the creation of proper instruments and communication channels and mutual consultancy with the purpose of gaining efficient communication with the similar organizations within the European Union and the European Economic Area (EEA), through the IMI platform. The purpose of this guide is to consolidate the capacity of the Romanian Physicians’ College (RPC) as a social partner of the project and competent authority for the medical profession to get involved in the information exchange intermediated by the IMI Platform. Also, this guide was created in order to support the Ministry of Health (MS) and the Romanian Physicians’ College (RPC) in the ongoing efforts to standardize the processes of certification, attestation and recognition of the medical profession, by providing information regarding the common practices from other member states of the European Union. This guide also has the purpose of informing the Romanian citizens about the process of certification of the competencies, the requirements and particularities of the process of recognition for the professional qualification of being a doctor in the following member states of the European Union: Italy, Spain, Germany, Austria, Czech Republic, Holland, Denmark and Great Britain. For creating guides of recognition and certification for the regulated professions, the methodological external experts of the National Qualifications Authority have examined the national information sources (of the analyzed countries and Romania) and at a Community level (comparative studies conducted at the European Union level) and have participated to a study visit in Holland, thus having the chance to complete their work of documentation through the experience exchange with representatives of the Competent Authorities. 3

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The Situation of the Regulation of the Medical Profession in Romania and Member States of the European Union 1.1.The Medical Profession in Europe According to the 19th article from Directive no 2005/36/EC of the European Parliament and the

Council for free movement regarding the recognition of the professional qualifications; the professional status of a doctor should be based on the fundamental principle of automatic recognition of the evidence of formal qualifications on the basis of coordinated minimum conditions for training. In addition, access in the Member States to the medicine professions should be made conditional upon the possession of a given qualification ensuring that the person concerned has undergone training which meets the minimum conditions established. The medical profession the second most mobile profession in the EU according to the website: http://ec.europa.eu/internal_market/qualifications [26, 27]. The structure of the labor market and services in the medical field falls within the general phenomenon of labor migration in the healthcare industry, representing an existential interest. The differences in wages and working conditions are causes of this phenomenon. The differences between the structures of the systems have substantial repercussions on the offering and qualification structures. Over 70 percent of the Romanian Health System employees intend to leave the country and work abroad, but 36,8 % of them have different impediments related to their families. These are the results of the study called “The Migration Tendency of the sanitary system personnel” ran by the “Sanitary Solidarity” Romanian Federation in 2012. Simultaneously, the fact that the percentage of the undecided is around 40 % of the total employees shows a dependency of the amplitude of this phenomenon, especially of the conditions that the country offers, because these conditions are the same. This concludes the fact that the pull factors are constantly active [3, 5, 6, 26, and 27]. 1.2. TheEuropean Regulatory Provision through which the Medical Profession is regulated The European Regulatory Provision through which the medical profession is regulated is established by the Directive regarding the recognition of professional qualifications 2005/36/EC of the European Parliament and the Council [5, 24]. Freedom of movement and the mutual recognition of the evidence of formal qualifications of doctors are based on the fundamental principle of automatic recognition of the evidence of formal qualifications on the basis of coordinated minimum conditions for training. The minimum conditions for training for the medical practice are established at a European level and are part of the category of the so-called sectoral professions. In most of the member states, the medical activities are applied de jure or de facto by persons who either only have the official title of qualification as a doctor, or have this title along with another appellative, without these persons benefitting from a monopoly over practicing those activities, with the exception of the cases where there are contradictory legal dispositions. 4

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Recognition on the basis of coordinated minimum conditions for training The principle of automatic recognition. All member states of the EU recognize the medical qualification for all nationals who fulfill the minimum training condition. The “Doctor” titles which fulfill these criteria benefit from the same effect regarding the access to professional activities and pursuing these, on the territory of the host member state, the same as in the home member state. Directive no 2005/36/EC of the European Parliament and the Council relating to the recognition of the professional qualifications comprises in annex V article 5.7.1 the titles of medical qualifications which are covered by automatic recognition. [5, 6] Minimum conditions for medical training. Directive no 2005/36/EC of the European Parliament and the Council relating to the recognition of the professional qualifications describes in detail at article 46 the minimum conditions for training for which automatic recognition of the “Doctor” qualification title is given on the territory of the EU member states. [6]. The medical profession shall be based on the training referred to Article 34 from the Directive no 2005/36/EC of the European Parliament and the Council relating to the recognition of the professional qualifications and it is a specific and distinct profession. At point 5.3.2 from Annex V it is specified that pursuing the medical professional activity shall be contingent upon possession of a recognized qualification certificate. The International Labor Organization (OIM) has revised the International Standard Classification of

Occupations,

ENG FRA

Grand

thus

the

corresponding

Major

group

groupe

professions

ISCO88

(COM) 2:

intellectuelles

professionals et

scientifiques

GER - Berufshauptgruppe 2: wissenschaftler. Description: The Doctors study, diagnose, treat and prevent disease, infections, injury and other physical and mental impairments on human by applying the principles and procedures of modern medicine. They plan, supervise and evaluate the implementation of the healthcare and treatment plans provided by other health services providers, coordinate the medical education and research activities. In Romania the activity is regulated through the Act no 95/2006 with regards to the reformation in the healthcare domain, with further completions and addings (in progress). The medical profession is regulated by and comprised in COR 2013 (the Classification of Occupations in Romania), Base Group 222 corresponding to Major Group 2 – Specialists in different activity domains. Level of training: 4 (higher education): The specialists who have intellectual and scientific occupations develop the existing stock of knowledge, systematically teach and apply theories and scientific or artistic concepts or get involved in any combination of these activities. The professional levels differ: 222102 resident doctor, 222103 specialist doctor, 222108 primary doctor. The medical profession is based on assuring public and individual health by respecting the Professional Code of the Doctor. The specific character of the practiced activities based on the official medical qualification 5

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titles referred to by the law, individualizes, distinguishes and separates the medical profession from any other professions within the medical domain. At European level, the basic medical training requires a total of at least six years of study or 5500

hours of theoretical and practical training provided by, or under the supervision of, a university. Basic medical training shall provide an assurance that the person in question has acquired the following knowledge and skills: (a) adequate knowledge of the sciences on which medicine is based and a good understanding of the scientific methods including the principles of measuring biological functions, the evaluation of scientifically established facts and the analysis of data; (b) sufficient understanding of the structure, functions and behavior of healthy and sick persons, as well as relations between the state of health and physical and social surroundings of the human being; (c) adequate knowledge of clinical disciplines and practices, providing him with a coherent picture of mental and physical diseases, of medicine from the points of view of prophylaxis, diagnosis and therapy and of human reproduction; (d) suitable clinical experience in hospitals under appropriate supervision.

In Figure 1 there are equivalent names of the medical profession (according to Directive 36/2005/CE of the European Parliament and the Council with regards to the recognition of the professional qualifications)

Figure 1.equivalent names of the medical profession from the EU member states and Switzerland [6]. Country Qualification Title Professional Title Created Date België/ Belgique/ Belgien

Ministerieelerkenningsbesluit van huisarts /Arreté ministériel d'agrément de médecin généraliste

Huisarts/Médecin généraliste

Ceskarepub lika

Diplom o specializaci "vseobecnélékařstvi"

Vseobecnýlékař

Danmark

Tilladelse til at anvende betegnelsen alment praktiserende lge/Speciallgel i almen medicin

Almen praktiserende lge/ Speciallge i almen medicin

31 XII 1994

Deutschland

Zeugnis über die spezifische Ausbil-dung in der Allgemeinmedizin

Facharzt/Fachärztin für Allgemeinmedizin

31 XII 1994

Eesti

Diplom peremeditsiini erialal

Perearst

31 XII 1994

1 V 2004

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31 XII 1994 Espana

Titulo de especialista en medicina familiar y comunitaria

Especialista en medicina familiar y comunitaria

31 XII 1994

France

Diplôme d'Etat de docteur en médecine (avec document annexé attestant la formation spécifique en médecine générale)

Médecin qualifié en médecine générale

31 XII 1994

Ireland

Certificate of specific qualifications in general medical practice

General medical practitioner

31 XII 1994

Italia

Attestato di formazione specifica in medicina generale

Medico di medicina generale

31 XII 1994 1 V 2004

Latvija

Gimenes rsta sertifikts

Gimenes (visprejs prakses) rsts

1 V 2004

Lietuva

Seimos gydytojo rezidentros pa˛ymjimas

Seimos medicinos gydytojas

1 V 2004

Luxembourg

Diplôme de formation spécifique en medicine générale

Médecin généraliste

Magyarorszag

Haziorvostan szakorvosa bizonyitvany

Haziorvostan szakorvosa

1 V 2004

Malta

natal-familja

Mediina tal-familja

1 V 2004

Nederland

Certificaat van inschrijving in het register van erkende huisartsen van de Koninklijke Nederlandsche Maatschap pij tot bevordering der geneeskunst

Huisarts

31 XII 1994

Österreich

Arzt für Allgemeinmedizin

31 XII 1994

Polska

Diplôme: Dyplom uzyskania tytułu specjalisty w dziedzinie medycyny rodzinnej

Specjalista w dziedzinie medycyny rodzinnej

1 V 2004

Portugal

Diploma do internato complementar de clinica geral

Assistente de clinica geral

31 XII 1994

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Slovenija

Potrdilo o opravljeni specializaciji iz družinske medicine

Specialist družinske medicine/Specialistka družinske medicine

1 V 2004

Slovensko

Diplom o specializacii v odbore "vseobecné lekarstvo"

Vseobecný lekar

1 V 2004

Suomi/Finl and

Todistus lääkärin perusterveydenhuol-lon lisäkoulutuksesta/Bevis om tilläggsutbildning av läkare i primärvrd

Yleislääkäri/Allmänläkare

31 XII 1994

Sverige

Bevis om kompetens som allmänprak-tiserande läkare (Europaläkare) utfärdat av Socialstyrelsen

Allmänpraktiserande läkare (Europaläkare)

31 XII 1994

United Kingdom

Certificate of prescribed/equivalent experience

General medical practitioner

31 XII 1994

The didactic curriculum for the minimum 6 years of training needs to be comprised of at least the nominated disciplines or equivalents, graduated with the corresponding activity levels and given credits. A. Basic Subjects, B. Medico-biological subjects and general medical subjects, C. Specific Subjects: Anatomy – Embryology, -Biochemistry, -Biophysics and Medical Physics, -Medical Informatics and Biostatistics, -Cellular and Mollecular Biology, -Histology, -Physiology, -Microbiology, Virology, Parasitology, -Medical Genetics, -Physiopathology, -Immunology, -Morphopathology, -Pharmacology and Clinical Pharmacology, -Primary assistance of the general health state, -Internal Medicine, -Medical Semiology, -General Surgery, -Surgical Semiology, -Internal Medicine, -Pneumology, -Labor Medicine and Professional Disease, -Balneophysiotherapy, -Neurology, -Psychiatry, -Pediatrics, -Infant Care, -Endocrinology, -Oncology, -Family Care, -Infectious Disease, -Dermatology, -Radiology, -General Surgery, -Plastic and Aesthetic Surgery and Reconstructive Microsurgery, -Orthopedics, Traumatology, Pediatric Surgery and Orthopedics, Urology – ATI + Emergency Care, -ENT, -Ophtalmology, -Cranio-Maxillo-Facial Surgery, -Obstetrics, -Gynecology, Clinical Biochemistry, -Hygiene, -Environmental Health, -Scientific Research Methodology, -Epidemiology, Forensic Medicine, -Public Healthcare and Sanitary Management, -Behavior Science, -Medical Psychology, Medical Sociology, -Medical Conduct, -Bioethics, -Annual Practice for gaining medical skills and competencies, Foreign Language, Sports. The study of certain disciplines may take place incorporated in or in conjuction with others. A host member state may require the specialized doctors, whose specialized training in medicine based on an integral programme was regulated by Acts with the title of Laws and administrative acts issued on June 20th 1975 and who began their specialization before the 31st of December 1983, that their qualification titles be accompanied by an official document that attests that fact that they dedicated themselves effectively and legally 8

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to the activities in question for a timeframe of at least three consecutive years during the last five years prior to the issuing of that document. In Figure 2 the titles associated to the medical profession in the studied EU countries are being presented, according to the Directive 2005/36/EC of the European Parliament and the Council with regards to the recognition of professional qualifications.

Table 2. Titles of training courses in specialized medicine in the studied countries (according to the Directive 2005/36/ CE of the European Parliament and of the Council on the recognition of professional qualifications Country

Ceska republika Danmark Deutschland Italia Österreich Portugal United Kingdom Country

Anaesthetics Minimum period of training: 3 years Title Anesteziologie a resuscitace Anstesiologi Anästhesiologie Anestesia e rianimazione Anästhesiologie und Intensivmedizin Anestesiologia Anaesthetics

General surgery Minimum period of training: 5 years Title Chirurgie Kirurgi elsler kirurgiske sygdomme (Allgemeine) Chirurgie Chirurgia generale Chirurgie Cirurgia geral General surgery

Ceska republika Danmark

Neurological surgery Minimum period of training: 5 years Title Neurochirurgie Neurokirurgi eller kirurgiske nervesygdomme

Obstetrics and Gynaecology Minimum period of training: 4 years Title Gynekologie a porodnictvi Gynkologi og obstetrik eller kvindesygdomme og fødselshjælp

Deutschland Espana France Italia Nederland Österreich Portugal United Kingdom

Neurochirurgie NeurocirugiaObstetricia Neurochirurgie Neurochirurgia Neurochirurgie Neurochirurgie Neurocirurgia Neurosurgery

Frauenheilkunde und Geburtshilfe Obstetricia y ginecologia Gynécologie - obstétrique Ginecologia e ostetricia Verloskunde en gynaecologie Frauenheilkunde und Geburtshilfe Ginecologia e obstetricia Obstetrics and gynaecology

Country

General (internal) medicine Minimum period of training: 5 years Title

Ophthalmology Minimum period of training: 3 years Title 9

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Ceska republika Danmark Deutschland Espana France Italia Nederland Österreich Portugal United Kingdom

Vnitřni lékařstviOftalmologie Intern medicin Innere Medizin Medicina interna Médecine interne Medicina interna Interne geneeskunde Innere Medizin Medicina interna General (internal) medicine

Oftalmologie Oftalmologi eller jensygdomme Augenheilkunde Oftalmologia Ophtalmologie Oftalmologia Oogheelkunde Augenheilkunde und Optometrie Oftalmologia Ophthalmology

Country

Otorhinolaryngology Minimum period of training: 3 years Title Otorinolaryngologie Oto-rhino-laryngologi eller re-nsehalssygdomme Hals-Nasen-Ohrenheilkunde OtorrinolaringologiaPedia Oto-rhino-laryngologie Otorinolaringoiatria Otorinolaringoloija Keel-, neus- en oorheelkunde Hals-, Nasen- und Ohrenkrankheiten Otolaryngology

Paediatrics Minimum period of training: 4 years Title Dětské lékařstvi Pdiatri eller sygdomme hos brn

Ceska republika Danmark

Respiratory medicine Minimum period of training: 4 years Title Tuberkuloza a respiračni nemoci Medicinske lungesygdomme

Deutschland Espana France Italia Nederland Österreich

Pneumologie NeumologiaUrologia Pneumologie Malattie dell'apparato respiratorio Longziekten en tuberculose Lungenkrankheiten

Urology Minimum period of training: 5 years Title Urologie Urologi eller urinvejenes kirurgiske sygdomme Urologie Urologia Urologie Urologia Urologie Urologie

Ceska republika Danmark Deutschland Espana France Italia Malta Nederland Österreich United Kingdom

Country

Kinder- und Jugendmedizin Pediatria y sus areas especificas Pédiatrie Pédiatria Pedjatrija Kindergeneeskunde Kinder- und Jugendheilkunde Paediatrics

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Portugal United Kingdom

Pneumologia Respiratory medicine

Country

Orthopaedics Minimum period of training: 5 years Title Ortopedie Ortopdisk kirurgi

Ceska republika Danmark Deutschland Espana Italia Nederland Österreich Portugal United Kingdom

Country

Orthopädie (und Unfallchirurgie) Cirugia ortopédica y traumatologiaAnatomiapatologica Ortopedia e traumatologia Orthopedie Orthopädie und Orthopädische Chirurgie Ortopedia Trauma and orthopaedic surgery

Urologia Urology

Pathological anatomy Minimum period of training: 4 years Title Patologicka anatomie Patologisk anatomi eller vvs- og celleundersgelser Pathologie Anatomia patologica Anatomia patologica Pathologie Pathologie Anatomia patologica Histopathology

Ceska republika Danmark

Cardiology Minimum period of training: 4 years Title Kardiologie Kardiologi

Deutschland

Innere Medizin und Schwerpunkt Kardiologie

Espana Italia Nederland Österreich Portugal United Kingdom

Cardiologia Cardiologia Cardiologie

Gastroenterology Minimum period of training: 4 years Title Gastroenterologie Medicinsk gastroenterologi eller medicinske mavetarmsyg domme Innere Medizin und Schwerpunkt Gastroenterologie Aparato digestivo Gastroenterologia Leer van maag-darm-leverziekten

Cardiologia Cardiology

Gastrenterologia Gastro-enterology

Country

Rheumatology Minimum period of training: 4 years Title Revmatologie Reumatologi

General Haematology Minimum period of training: 3 years Title Hematologie a transfúzni lékařstvi Hmatologi eller blodsygdomme 11

Ceska republika Danmark

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Country

Ceska republika Danmark Deutschland Espana Italia Nederland Österreich Portugal United Kingdom

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Innere Medizin und Schwerpunkt Rheumatologie Hematologiayhemoterapia Reumatologia Reumatologie

Innere Medizin und Schwerpunkt Hämatologie und Onkologie Hematologia y hemoterapia Ematologia

Reumatologia Rheumatology

Imuno-hemoterapia Haematology

Endocrinology Minimum period of training: 3 years Title Endokrinologie Medicinsk endokrinologi eller medicinske hormonsyg-domme Innere Medizin und Schwerpunkt Endokrinologie und Diabetologie Endocrinologia y nutricion Endocrinologia e malattie del ricambio

Physiotherapy Minimum period of training: 3 years Title Rehabilitačni a fyzikalni medicina

Endocrinologia Endocrinology and diabetes mellitus

Neuropsychiatry Minimum period of training: 5 years Title

Ceska republika Danmark Deutschland

Nervenheilkunde (Neurologie und Psychiatrie)

Espana France Italia Nederland Österreich Portugal

Neuropsychiatrie (**) Neuropsichiatria (***) Zenuw- en zielsziekten (*****) Neurologie und Psychiatrie

Physikalische und Rehabilitative Medizin Medicina fisica y rehabilitacion Medicina fisica e riabilitazione Revalidatiegeneeskunde Physikalische Medizin Fisiatria ou Medicina fisica e de reabilitaço

Dermato-venereology Minimum period of training: 3 years Title Dermatovenerologie Dermato-venerologi eller hud- og knssygdomme Haut- und Geschlechtskrankheiten Dermatologia médico-quirúrgica y venereologia Dermatologie et vénéréologie Dermatologia e venerologia Dermatologie en venerologie Haut- und Geschlechtskrankheiten Dermatovenereologia 12

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Ceska republika Danmark Deutschland

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Radiology Minimum period of training: 4 years Title

Radiologie

Espana France Italia Nederland Österreich Portugal United Kingdom

Electrorradiologia Electro-radiologie (*) Radiologia Radiologie (****) Radiologie Radiologia

Country

Geriatrics Minimum period of training: 4 years Title Geriatrie Geriatri eller alderdommens sygdomme

Ceska republika Danmark Deutschland Espana France Italia Nederland Österreich Portugal United Kingdom

Geriatria Geriatria Klinische geriatrie

Child psychiatry Minimum period of training: 4 years Title Dětska a dorostova psychiatrie Brne- og ungdomspsykiatri Kinder- und Jugendpsychiatrie und psychotherapie Pédo-psychiatrie Neuropsichiatria infantile

Pedopsiquiatria Child and adolescent psychiatry

Renal diseases Minimum period of training: 4 years Title Nefrologie Nefrologi eller medicinske nyresygdomme Innere Medizin und Schwerpunkt Nephrologie Nefrologia Néphrologie Nefrologia

Geriatrics

Nefrologia Renal medicine

Theoretical training ensures acquiring the knowledge, understanding and professional competencies needed to organize, give and evaluate global medical assistance. Clinical training ensures learning within a team and in direct contact with a healthy or sick individual and/or collectivity, organizing, giving and evaluating the necessary global medical assistance based on the gained knowledge and competencies. The professional training must be certified by a Bachelor degree or equivalent. In Romania, the doctors that want to practice medicine must be members of RPC, having rights and duties according to the act 95/2006 - title XIII. It is therein specified: 13

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- the medical practice can be pursued on either an employed or/and self-employed basis; - the medical practice is pursued, according to the law, only by persons possessing an official qualification title if: a. they are citizens of Romania or of a Member State of EU, European Economic Area (EES) or the Swiss Confederation (CH); b. the spouse of a Romanian citizen as well as the direct descendants and ascendents which are dependent on them, irrespective of their nationality; c. family members of a citizen of one of the states provided at point b), as they are defined in art. 2 paragraph (1) point 3 of the Government Emergency Ordinance 102/2005 regarding the free movement of EU, European Economic Area (EES) or Swiss Confederation (CH) citizens in Romania, approved with amendments by the Law no. 260/2005, published in the Official Gazette no. 900 of October 7th 2005 for the approval of the Government Emergency Ordinance 102/2005 regarding the free movement of EU, European Economic Area (EES) or Swiss Confederation (CH) citizens in Romania [12]. The official title of professional qualification as a medical doctor means possessing: a. a medical degree, issued by a higher education institution in medical sciences, accredited in Romania; b. the certificate of specialist, issued by the Ministry of Health; c. a diploma, certificate or other title in medicine, issued according to EU regulations by member states of the EU, European Economic Area (EES) or Swiss Confederation (CH) or acquired in a third state and recognized by one of the member states initially listed or validated by Romania. It is important to note that the official titles of professional qualification in medicine acquired outside Romania, the member states of EU, the European Economic Area (EES) or Switzerland (CH) are to be validated according to the law. As an exception from the previous provisions, the titles of professional qualifications that have been already recognized by one of these states are exempt of further validation [1, 3, 10, 24]. Due to the nature of the activity undertaken, the medical profession is part of the health sector with a high risk of bio-contamination, benefitting of all facilities granted by the law. While practicing the profession, the doctor must show availability, honesty, devotion and respect towards the patient. The professional independence grants the right of initiative and decision in the practice of medicine and implies the full responsibility of the physician. By the humanitarian and liberal nature of the profession, the doctor cannot be considered a civil servant. In order to practice medical activities, the doctors that are citizens of a member state of EU, the European Economic Area (EES) or Switzerland (CH), residents of one

the

above-mentioned

states

are

exempted

the

obligation

the

Romanian Physiciansâ&#x20AC;&#x2122; College (RPC) in case of temporary or occasional medical service delivery. The RPC membership certificate is issued on the basis of the following documents: professional qualification certificate; 14

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health certificate; statutory declaration of compliance with the conditions provided in articles 481 and 482 from the act 95/2006[11]; criminal record. The membership certificate becomes valid after taking out civil liability insurance. Some of the provisions of the Hippocratic oath are applied to Romanian physicians settled abroad, the physicians that are citizens of a member state of the European Union, the European Economic Area (EES) or Switzerland (CH) settled in Romania or in one of these state or to physicians that comply with the provisions of the article 469, letters c) and e) of the act 95/2006 that request to practice in Romania. The medical profession can be carried out in Romania by the persons compliant with the article 469 from the act 95/2006 which: - are citizens of a third-party state but have a permannet or long-term residence permit in Romania; - have an official professional qualification title and are members of the RPC; - are not in one of the incompatibility situations provided by the law; - are medically capable of carrying out the medical profession; - in case of temporary or occasional medical service delivery, the physicians must notify the Ministry of Health regarding their activity, but they must be mebers of the Romanian Physicians’ College (RPC) during this time; - the physicians that are citizens of a member state of the European Union, the European Economic Area (EES) or Switzerland (CH) settled in Romania have the same rights and obligations as the romanian physicians that are memebers of the Romanian Physicians’ College (RPC) The control and monitoring of the medical profession is done by the Ministry of Health an the Romanian Physicians’ College (RPC) acknowledged as competent authorities in Romania. If a physician interrupts his professional activity or is in an incompatibility situation for more than 5 years, the Ministry of Health should certify again his professional competency. The procedure regarding the conditions for the professional examination and certification are determined by the National Board of the Romanian Physicians’ College (RPC), according to the Code of ethics and the Regulations of the Romanian Physicians’ College (RPC) [9, 10, 25]. These provisions are also valid for the physicians that are citizens of a member state of the European Union, the European Economic Area (EES) or Switzerland (CH) settled in Romania. The pursuit of the medical profession by a person that does not comply with the legal requirements is a criminal offense and it is punishable according to the Criminal Code. The Romanian Physicians’ College (RPC) is entitled to institute civil actions and apprise the competent authorities for the prosecution of the persons that are in the above-mentioned situation. The body of state authority in the medical field is the Ministry of Health and it has the following responsibilities: it provides the legislative and methodological framework for the practice of the profession; protects, promotes and supports the initiative and the professional quality of the activity; participates in the 15

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organization of the specific professional and vocational training as well as in the research, development and innovation in the medical field. Adress: Intr. Cristian Popişteanu, nr. 1-3, sector 1, cod 010024, E-mail: office@ms.ro, Bucureşti. Tel.+4 021 3072 500, +4 021 3072 600. The competenet authority for the recognition of official medical qualification titles is the Romanian Physicians’ College (RPC) which has the following responsibilities: issues and approves the physician certificate; prepares the continuous professional development programs; is the competent authority for the recognition of the official professional qualification titles for the citizens of the member states of the European Union, the European Economic Area (EES) or Switzerland (CH); issues the documents needed by the Romanian citizens that wish to practice the profession of medicine in the member states of the European Union, the European Economic Area (EES) or Switzerland (CH) as well as in third-party states. It also publishes in the Official Romanian Gazette, Part I, The National List of Physicians and the professional Code of ethics. Adress: Romanian College of Physicians Adress: Bulevardul Timişoara nr. 15, cod poştal 061303, Sector 6, Bucureşti, România. E-mail: office@RPC.ro. Tel.: +4021.413.88.00 Fax: +4021.413.77.50 Upon analysis of the procedures of validation and certification for the profession of doctor in Romania, it can be stated that the standard reference terms are met for the procedures of competencies validation and certification:  it is compulsory to present a personal file at the professional organization;  the file must have a simple and clear structure;  the content of the file can be accessed via the site of the mentioned professional organization;  an Attestation Comission having a clear structure is set by the decision of the Pesident of the Professional organization;  a procedure is in place that allows to verify the file’s content and the applicant’s compliance to the conditions;  the applicant is informed if additional information is to be provided;  exceptions and derogations are provided for the justified cases;  the verification of documents issued in other countries, needed for the file, is done using the IMI system;  an exam is organized and an examination/certification committee is established  there is a clear and transparent procedure for the evaluation of the exam and the results reporting  there is the possibility to make an appeal and there is a procedure for evaluating appeals  an independent appeal commission is set, a part from the certification committee  there is a clear and transparent procedure for the re-evaluation following the appeal submitted and for the results reporting 16

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 there is a register and a procedure for recording in the register;  there are procedures for monitoring the practice of the profession;  there are penalties set for the possible irregularities;  continuous professional development plans are set and periodically updated. We believe that the procedures for the validation and certification of competencies for the medical profession in Romania, as well as those of recognition of the professional qualification acquired in other member states are flexible and adapted to the requirements from the Directive 2005/36/EC on the recognition of professional qualifications. The comparative analysis of the physician profession in Romania and in member states of the European Union is presented in Table 3. Table 3. The comparative analysis of the physician profession in Romania and in member states of the European Union included in the study. Romania There are regulated professions in the medical field (Yes/No) Regulated professions in medical field Autoritatea competentă pentru profesiile reglementate din domeniul medic Activities (exclusive or shared) of professions in medical field Competencies

Working conditions

Germany

Austria

yes

Physician

Romanian College of Physicians

Bureau Bundesministerium Medicenregister für Wirtschaft, Familie und Jugend

No shared activities

Great Britain

Holland

Spain

Italy

yes

Physician

Medics Stichting Bureau Registration Medicen-register Board No shared activities

No shared activities

Denmak

yes

Czech Republic yes

Physician

Ministerul Sănătăţii

Ministry of Educațion, Univesities and Research No shared activities

Czech Chamber of Medics

Medics Association

No shared activities

yes

No shared activities

The universitary training for the medical services must maintain a balance between the theoretical and practical aspects of professional training and must ensure the acquirement of the following knowledge and competencies: (a) knowledge on the factors that may influence the quality of the medical assistance; (b) the capacity to understand the relationship between humans and medical service creation, the interaction with the social environment, the ability to understand the need to harmonize the medical creations according to the human needs and scale; (c) the ability to understand the physician profession and its role in society, especially considering the social factors; (d) the ability which allows him to fulfill the requirements of the medical practice while respecting the financial constraints and the regulations; (e) adequate knowledge of the organizations, regulations and procedures which interfere in the process of medical assistance and of integration in the general planning of the medicalpractice; (f) design, coordination and execution of activities in research programs. Employee in Employee in state Employee in state Employee in Employee in Employee in Employee in Employee in Employee in state or private or private medical or private medical state or private state or private state or private state or private state or private state or medical assistance units. assistance units. medical medical medical medical medical private assistance assistance units. assistance units. assistance assistance assistance medical units. units. units. units. assistance units.

Recognition type according to Automatic recognition Directive 2005/36/EC Level of qualification according to Directive 2005/36/EC

The basic medical training requires a total of at least six years of study on a basis of an integrated program, in a university or equivalent academic institution. This training must be proved by passing a university exam.

II. Validation/qualification procedures for the competencies applied by the 17

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competenet authorities in the countries where the profession/s are regulated 2.1. Certification for medical practice in Italy Italy implemented the Directive 2005/36/EC through the Decree law nr. 206 of 6 november 2007, Attuazione della direttiva 2005/36/EC relativa al riconoscimento delle qualifiche professionali, nonche' della direttiva 2006/100/CE che adegua determinate direttive sulla libera circolazione delle persone a seguito dell'adesione di Bulgaria e Romania. DL 206/2007 lays down rules according to which the citizens of the member states of the European Union can practice on Italian territory the profession for which they are qualified in their home state[3]. In Italy, the competent authority for certification of the competencies required to practice the doctor profession is the Ministry of Health, www.ministerosalute.it. The practice of medical professions is permitted to those that possess a diploma acquired in a foreign country, previously recognized by the Ministry of Health, and who enrolled in the Professional Register. In Italy, the applicants for a medical activity must file a request to the Ministry of Health for issueing a compliance certificate for the studies carried out abroad, consolidated with the features provisioned by the professional directives. For

the

physicians,

the

professional

college

FNOMCeO

having

the

address

http://portale.fnomceo.it/fnomceo/home.2puntOT. The affiliation is mandatory. For the recognition of the medical diploma, the following documents are needed: model A1 application; copy of a valid ID with the signature of the applicant; exemplification copy or office copy of the professional qualification title; certificate of compliance regarding the name of the specialization and the minimum training conditions, issued by the competent authority from the country where the diploma has been acquired; a good standing certificate, issued by the competent authority from the country where the diploma has been acquired, to prove that the applicant is the right owner of the diploma and that there are no limitations regarding the practice of profession in the state of origin; declaration of value issued by the Italian diplomatic authority; a certificate attesting the activities carried out in the state of origin after obtaining the diploma for which the recognition is being asked (including the internships); the list of all provided documents, signed by the applicant. In order to obtain a labor contract for the medical qualification, the applicant must go through the following steps: - validation and legalization of original documents (according to Haga Convention of October 5th 1961), translation in Italian and over-legalization; - file the necessary documents to obtain the â&#x20AC;&#x153;Declaration of Valueâ&#x20AC;? at the Chancellery of the Italian Embassy in Bucharest for the recognition of the professional qualification; - submit the file with the necessary documents to the Ministry of Healt in Italy that will issue a recognition decision of the professional diploma; 18

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- the employer takes over the applicant’s signed contract and will go through the required formalities to obtain the work and residence permits, the official stamp from the local authority, the over-legalization of the work contract; - procurement of the work visa on Italian territory, delivered by the embassy; - passing the Italian language exam, the ethics and professional standards exam at the professional organization IPASVI. Note: All documents written in Romanian must be translated in Italian by a certified translator of the Ministry of Justice, legalized by a notary public and over-legalized by the Court of Appeal/Tribunal with Apostille according to the Hague Convention of October 5th 1961. The file must be submitted to the Italian Ministry of Health (Ministero della Salute, Direzione Generale delle Risorse Umane e delle Professioni Sanitarie, Piazzale dell Industria 20, 00144 Roma). NB: Some regions (Calabria, Lazio, Umbria, Campania, Liguria, Veneto, Emilia Romagna, Lombardia, Valle

d'Aosta)

and

the

autonomous

regions

Trento

and

Bolzano

process

independently

the

validation/certification documentation of diplomas for physicians and radiological technicians. Hence, the applicants in these regions must file their requests using the type H application and the documents featuring in Annex

at:

http://www.ministerosalute.it/professioni/Documenti/Modello%20H%20enti.pdf

;

http://www.ministerosalute.it/professioni/Documenti/Allegato%20H.pdf. They have to go through the following process: a. Step by step documentation. Before the validation of the documents, the applicant must obtain from the issuing universities an authenticity certificate for each diploma (baccalaureate degree, bachelor degree). The necessary papers are: the diploma, academic records and the education plan from the graduated Medical School, the pre-contract signed with a healthcare facility in Italy (hospital, clinic etc.), obtain the visa for the diploma at the National Center for Equivalence and Recognition of Diplomas (C.N.R.E.D.) from the Ministry of Education and Research in Bucharest: authenticity certificate (this certificate is often appended to the syllabus), the Bachelor Degree, academic records, syllabus, pre-contract. Centrul Naţional de Recunoaştere şi Echivalare a Diplomelor (CNRED). Adress: Str. Spiru Haret, nr. 12, Sector 1, 010176 Bucureşti. Pagină web: www.cnred.edu.ro Important! The medical license (irrespective of the specialization) will bear the visa of the Ministry of Health. d. The documents legalized by the notary public must be over-legalized: the true copies and translations. Elaboration method of the file for the Chancellery and the order of documents within the file: 1. Filled in standard form (at the bottom of the page, from the 3 boxes, only the number 1 should be ticked for professional recognition or number 2 for academic recognition), 19

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2. Original power of attorney for the person delegated to submit/remove files; 3. Civil-status documents (for the persons that changed their names – marriage certificate or divorce order, original and copies) and the birth certificate 4. A copy (preferably legalized) of the document attesting that the holder of the documents has the official residence in a foreign country („Permesso di Soggiorno” for Italy). The training programme to become a physician, respectively to continue studies – once the diploma granting the right of practice is obtained – runs according to the decree M.I.U.R. no. 509 from 3rd of November 1999. According to the italian law, the Romanian applicants that acquired work contracts as dentists have the same rights and obligations as the italian citizens (Italian Act 286 of 25th of July 1998).

2.2. Certification for medical practice in Spain The competent authority for certification of the competencies required to practice the doctor profession is the spanish Ministry of Health (Ministerio de Salud), correlated to REAL DECRETO 1837/2008, de 8 de noviembre, por el que se incorporan al ordenamiento jurídico español la Directiva 2005/36/EC, del Parlamento Europeo y del Consejo, de 7 de septiembre de 2005, y la Directiva 2006/100/CE, del Consejo, de 20 de noviembre de 2006, relativas al reconocimiento de cualificaciones profesionales, así como a determinados aspectos del ejercicio de la profesión de abogado. BOE núm. 280, 46185-46320. The academic recognition (certification) allows the continuation of studies to a higher educational level and is in the competency of the spanish Ministry of Health. The Royal Decree 1837/2008 provides in Annex VIII (Annex L11a_2) the alphabetical list of professions and activities grouped according to the training level in Spain to acquire the right of practice, correlated to the levels described in article 19 (article 11 from the Directive 2005/36/EC on the recognition of professional qualifications [13, 15, 16]. Nomination associated to the profession of physician in Spain: Especialista en medicina familiar y comunitaria. Qualification title for physicians in Spain: doctor. In order to practice the medical professions in Spain, one has to hold a diploma delivered by a university in Spain or a EU member state, recognized by the Ministry of Education and Culture (Ministerio de Educacion y Cultura). The professional college for physicians is Consejo General de Colegios Medicos de España, active in 19 regional councils. Contact address: CONSEJO GENERAL DE COLEGIOS MÉDICOS, Playade las Cortes, 11-tel.: 91 431 77 80-fax: 91 576 43 88 (Presidencia) 91 431 9620 (Secretaria)-28014 Madrid. There is a register for doctors at the General Council in Madrid whiwh is reviewed daily. The fees collected vary depending on the regional council where the physician will practice the profession. For physicians from EU member states, the language exam is not required. 20

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In 2012, there were 37 000 physicians that worked legally in Spain, members of the professional organization. The distribution of doctors to the number of inhabitants was of 4/1000. Obtaining professional recognition allows the pursuit of professional acctivities on spanish territory, whereas the academic recognition allows the continuation of studies at a higher education level in Spain. Every Member State shall recognise the qualification of specialised doctors awarded in Spain to doctors who completed their specialist training before 1 January 1995, even if that training does not satisfy the minimum training requirements provided for in Article 25, in so far as that qualification is accompanied by a certificate issued by the competent Spanish authorities and attesting that the person concerned has passed the examination in specific professional competence held in the context of exceptional measures concerning recognition laid down in Royal Decree 1497/99, with a view to ascertaining that the person concerned possesses a level of knowledge and skill comparable to that of doctors who possess a qualification as a specialised doctor defined for Spain in Annex V, points 5.1.2 and 5.1.3. For details regarding the difference between professional recognition and certification, visit: http://www.eracareers.es/fecyt/guia/guia_cap07.pdf. The list of necessary documents can be found on the Site of Ministry of Health, "documentación necesaria", at the address http://www. ministeriodesaludps.es/ profesionales/formacion/recoTitulosEuro.htm . For further information, you can contact the Ministry of Health on the phone +34901400100 or write an e-mail oiac@ministeriodesaludps.es. Necessary documents: - application, according to the model provided on the Ministry of Health’s website - copy of the national identity document, passport or equivalent (ID card) that proves the applicant is a EU or EES citizen - copy of the academic qualification; - official and personal certificate of studies that show: - the duration of studies, in academic years,knowledge and competencies; - description of courses taken, providing the number of hours for theory and practice for each course. If there are substantial differences to the formal qualifications required in the host Member State, according to the art. 14 from the Directive on the recognition of professional qualifications 2005/36/EC of the European Parliament and of the Council, the applicant might have to provide information [5]. - a certificate issued by the competent authority from the country of origin proving that the applicant is a professional and that there are no limitations regarding the pursuit of the profession (Certificate of good standing) and that he fulfills the conditions set by the above-mentioned Directive for the pursuit of the regulated profession. This certificate is valid 3 months from the date of issue; - a certificate issued by the competent authority from the country of origin proving that the title awarded allows the pursuit of the profession in the country of origin and complies to the conditions set by the 21

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Directive on the recognition of professional qualifications 2005/36/EC of the European Parliament and of the Council - a certificate referring to the competence in pursuing the profession, issued by the competent authority, proving the pursuit of the profession on a full-time basis for two years during the previous 10 years in the Member State that released the title only if the mentioned state does not regulate that profession (this document is not required for the qualifications acquired in Romania where the profession is regulated). If the professional qualification does not fully complies with the requirements in Chapter III, Title III of the Directive 2005/36/EC of the European Parliament and of the Council, a certificate must be issued by the competent authority which attest that its holder pursued the professional activities, effectively and legal, at least 3 consecutive years in the 5 years following the issue of the certificate. All documents must be provided with the official translation in Spanish, must have copies legalized by notary public or other competent civil servants, after presenting the originals. The application for professional recognition in Spain, along with the necessary documents, shall be submitted to the central or regional institutions of the Spanish Ministry of Health, empowered according to art. 38.4 of the law 30 from 26th of November 1992, on Legal Arrangements of Public Administration and the Common Administrative Procedure.

2.3. Certification for medical practice in Czech Republic The pursuit of medical practice in the Czech Republic is regulated by the article 34 from the Directive on the recognition of professional qualifications 2005/36/EC of the European Parliament and of the Council, respectively the Law no. 189/2008 on the amendment of the law regarding the recognition of vocational qualifications in the Czech Republic [1, 2, 17]. The evidence of qualification acquired in the former Czechoslovakia has the same recognition as the evidence of formal qualifications issued by the Czech Republic and Slovakia and upon the same conditions as stated in the mentioned Directive. Name of the profession of physician in Czech Republic: Vseobecný lékař. Competent institutions in the certification of the professional qualification: 1. The Ministry of Education, Youth and Sports Karmelitská 7, 118 12 Praha 1, ČESKÁ REPUBLIKA Tel: + 420 257 193 376 / +420 257 193 579, Fax: + 420 257 193 39. E-mail: qualifications＠msmt.cz. Website: www.msmt.cz 2. The Ministry of Health (Ministerstvo zdravotnictví), Palackého nám. 4, 128 01 Praha. Tel.: +420 224 971 111, Fax: +420 224 972 111. Email: mzcr@mzcr.cz 22

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Conditions for the EU citizens that wish to pursue the profession in the Czech Republic: the recognition of the professional qualification by the Ministry of Health of the Czech Republic, the knowledge of the Czech language (language examination), residence permit, enrollment in the Czech College of Physicians (CSK). Application method for certification in the Czech Republic: 1. Submission of a written application by either a citizen of the Czech Republic or a citizen of a European Union, European Economic Area member state or Switzerland 2. The competent authority admits the applicant for the professional qualification exam within 6 months from the application submission date, if he fulfills the professional qualification and citizenship criteria 3. Professional training requirements: a) University studies or equivalent in the medical field provided by or under the supervision of a recognized university, section 3, paragraph a); the studies mùust comply with the requirements set by the points 1.2 and 1.3 from the Annex of certification in the regulated profession, section 4, sub. 2, paragraph a). b) University studies or graduated in a comparable institution in one of the fields of study listed in Section 5, subsection 3 or in a similar study field in the licence curriculum. 4. Required professional experience of at least three years if the applicant graduated a bachelor or masters degree and at least five years if the applicant graduated another study programme. 5. The professional qualification exam for the assessment of knowledge and competencies required in the pursuit of the profession, especially: a) attesting the professional knowledge if this is not part of the official recognised qualification of the applicant b) attesting the knowledge related to the legal aspects when pursuing the medical practice. 6. Payment of the certification fee. After passing the certification exam, the physician takes the oath. The enrollment in the professional organization is mandatory.

2.4. Certification for medical practice in Austria The pursuit of the medical practice is regulated in Austria. The competent authority is : Bundesministerium für Wirtschaft, Familie und Jugend – The Federal Ministry of Economy, Family and Youth. Contact: Stubenring 1, Abteilung I/, 31010 Wien, Phone: +43-1 71100, Fax: +43-17142718, Email: service@bmwa.gv.at, URL: www.bmwa.gv.at. The competent professional organization is Österreichische Ärztekammer, Weihburggasse 10-12, 1010 Wien, Telefon: +43 1 51406-3000. Fax: +43 1 51406-3042. E-Mail: post@aerztekammer.at., where can be found additional information on the recognition and certification process. The name of the professional qualification in Austria is: Arzt für Allgemeinmedizin. 23

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The search for employment is mainly done by the Public Employment Service - Arbeitsmarktservice Österreich – Bundesgeschäftsstelle (V-card), Treustr 35-43, 1200 Wien. Tel. +431331780, fax. +43133178121, e-mail : ams.oesterreich @ams.at, or www.ams.at. Address of the Romanian Embassy in Austria: Prinz Eugen Strasse 60, 1040 Viena; tel: +4315053227, +4315038940, +4315038941, +4315051628; fax: +4315041462; e-mail: ambromviena@ambrom.at; site: http://viena.mae.ro. For the pursuit of the medical practice, the following conditions must be fulfilled: graduation of specific university studies, work experience of at least three years after graduation, passing the specialty examination. It is an oral examination and can be repeated twice. It includes themes from the following fields: Austrian laws of administration and medical/social care, specific legal and professional rules, professional ethics. For the residence in Austria, one must register with the competent authority from the Federal Police Department – Bundespolizeidirektion in the cities with the Federal Police Administration; in Wien, at the registration service – Meldeservice from the appropriate office of the municipal district Magistratisches Bezirksamt; in smaller communities, at the offices of the local council – Gemeindeamt. To benefit the right of residence in Austria for a period exceeding six months, it is mandatory to hold a health insurance and to attest that the Romanian citizen has the necessary means to support himself and, possibly, his family or to attest that he has a job, is self-employed or participates in a training course. The responsible authority will issue a document attesting the residence right - Anmeldebescheinigung. Concurrently, Romanian citizens may apply for an official ID with a photo - Lichtbildausweis für EWR-Bürger, as proof of identity. Special regulations are applied to the citizens of third-party countries that are not citizens of EU/EES/Switzerland, but are dependent to a Romanian citizen. Before 1998, in Austria only the professional qualification obtained in Austrian universities were recognized (Graz, Innsbruck, Wien). After 1998, the diplomas issued in other EU member states began being recognized. Until 2004, the physician that wanted to pursue the profession in Austria had to attest the Austrian (or another EU member state) citizenship, to certify the formal qualification with the Austrian title of Arzt für Allgemeinmedizin, Dr.med.univ, and to provide the current professional status certificate.

2.5. Certification for medical practice in Great Britain The public health system in Great Britain is the NHS (National Health System) and has 1,4 million employees. The Ministry of Health is the national authority in the field. The competent authority for the pursuit of the medical practice in Great Britain is the General Medical Council (GMC). Adresa: Regent’s Place 350 Euston Road London, NW1 3JN UNITED KINGDOM, http://www.gmc-uk.org/ 24

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The practice of the profession in Great Britain is regulated by the article 34 from the Directive on the

recognition of professional qualifications 2005/36/EC of the European Parliament and of the Council. The list of regulated professions in Great Britain, the competent authorities for the recognition of professional qualifications as well as the contact details are on the website of the British Department for

Innovation,

Universities

and

Skills

–

DIUS:

http://www.dfes.gov.uk/europeopen/eutouk/eutouk_search_form.shtml [20, 21]. There is the possibility of recognition as a general physician or a specialist. There is a specific registry for each of the two categories and the enrollment is mandatory. The professionals that graduated a training program accredited by the GMC can directly demand the enrollment in the Registry. Before finishing their studies, they will be notified regarding the imminence of obtaining a “Certificate of Completion of Training”. This certificate will later allow them to register. Additional information can be found by consulting the free electronic guide “Working and training in the National Health Service – a guide for international medical graduates thinking about working or training in the UK “.http://www.nhsemployers.org. The attestation and certification for the pursuit of medical practice is conditioned by the fulfillment of the following: filling in a form; submission of an ID attesting the citizenship (passport, ID card or birth certificate); the professional qualification title attesting the minimum required training to pursue the regulated profession, the proof of an internship or the registration to a similar body in the country of origin; evidence of professional experience; medical certificate; a certificate attesting the professional integrity issued by the competent authority from the country of origin. The physicians that wish to pursue the medical practice in Great Britain must register to the General Medical Council (GMC). It is the competent authority and maintains the registry of dental practitioners/ specialist dental practitioners. A registration fee has to be paid. The necessary documents for registration to the GDC for the graduates of EU member states are: professional qualification title, attestation of the right to practice the profession issued by the competent authority from the country of origin, medical certificate, conformity certificate (issued by the Ministry of Health for the Romanian professionals) and the certificate of current professional status (delivered by the Romanian College of Physicians). The physicians from the European Union member states must not attest the knowledge of English language. However, the physicians from non-EU countries must pass the IELTS examination and the professional specific tests organized by GDC (GDC’s Overseas Registration Examination - ORE). The contact address for GDC is www.gdc-uk.org. The services provided by the United Kingdom Chamber of Physicians(UK NARIC) are: delivery of Letters of Compatibility and the translation of the qualification title from the country of origin in English (Letter 25

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of Comparability with Translation Waiver), respectively elaborating a Career Path Report which provides an advice on the comparative UK education level and also recommendations for future study and/or professional development. For further information regarding the services, procedures, terms and fees of UK NARIC, visit www.naric.org.uk or contact the authority by e-mail (info@naric.org.uk) or phone (+44 (0)871 330 7033 or + 44 1242 258621). The applicant for the pursuit of the medical practice must submit an examination request to the competent authority, accompanied by the following documents: Curriculum Vitae, declaration of eligibility, the professional qualification titles in original or certified copy, academic records in original or certified copy, a copy of the ID (passport), comparative matrix part 1 (university studies with bachelor degree), comparative matrix part 2 (university studies inmedicine), annex to the comparative matrix attesting the number of hours for the subjects and applications (dated and signed), teaching plan / syllabus / structure of courses, examination fee, a photo, a copy of the marriage certificate in the case of a name change, IELTS certificate. After passing the exam, the physician must file a registration request to the UK NARIC. The application can be made online or by mail. The application to be sent by mail can be downloaded at http://www.arb.org.uk/Upload/40127-ARB-Form-E-UK-PR.pdf. The application must be accompanied by a copy of the ID, the official address of the office where the profession is pursued, the attestation of necessary qualifications and the proof of payment of the application and registration fees.

2.6. Certification for medical practice in Denmark The pursuit of the medical practice in Denmark is regulated by the article 34 from the Directive on the recognition of professional qualifications 2005/36/EC of the European Parliament and of the Council. The competent authoritiy for the attestation and certification of professional qualifications is Sundhedsstyrelsen (National Board of Health) â&#x20AC;&#x201C; the Danish equivalent of the Ministry of Health. Address: Axel Heides Gade 1 | 2300 Copenhagen S, Denmark | Phone +45 72 22 74 00 | sst@sst.dk, Danish Agency for Universities and Internationalisation, (+45) 33 95 12 00, or write to kontaktpunkt@ui.dk. The name of the profession is: Almen praktiserende lge/Speciallge i almen medicin. Information regarding the procedure of attestation and certification of professional qualifications in Denmark

can

found

accessing

the

following

website

http://www.sst.dk/English/Education_and_authorization/Nurse.aspx. For the physicians that obtained their professional qualification in a non-EU country, the Danish test is mandatory as well as specific tests of professional knowledge, as the case may be.

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For the pursuit of a temporary activity for a regulated profession, it is usually required only to fill in a statement, submitted to the competent regulation authority. More information http://fivu.dk/en/education-andinstitutions/recognition-and-transparency/regulated-professions Physicians must be registered in Tandlægeforeningen, (Danish Medical Association).

2.7. Certification for medical practice in Holland The pursuit of the medical practice in Holland is regulated by the article 34 from the Directive on the recognition of professional qualifications 2005/36/EC of the European Parliament and of the Council [5, 21]. The name of the profession is “Huisarts”. The competent authority is BIG Register, Postbus 3052, 6460 HB Kerkrade, Wijnhaven 16, 2511 GA Den Haag, tel. 0900 – 8998225, +31 70 3406600. E-mail: info@ bigregister.nl. The BIG Registry has particularly severe internal regulations. This is a data base of all professionals in the healthcare. Eight specific professions of medical practice have a central official registry: dental practitioners, physicians, psychologists, midwives, medical assistants, pharmacists, physiotherapists and psychotherapists. The patient is being protected against the inadequate treatment provided by the medical assistance supplier. The registry contains data for over 400 000 people, from which aprox. 70 000 are physicians. In order to pursue the medical practice, registering to BIG is mandatory. Penalties may be applied if the registration is missing. The registration in BIG is subject to specific conditions, depending on the country where the professional title or other qualifications were attained[24]. Conditions for the holders of university degrees: - have a valid qualification title; - be able to pursue the medical practice with no restrictions - pay the registration fee - not have suffered of psychological disorders In addition to the qualification titles, in order to attest and certify the right to pursue the medical practice, the general and professional knowledge are being evaluated. Additional examinations must be passed for: knowledge of Dutch, knowledge of read English, IT literacy, basic knowledge, the Dutch health care system, basic medical practice and clinical knowledge. The evaluation tests define results as “accepted” or “rejected”. The combined result of all examinations gives a general impression on the level of knowledge and abilities. After passing the exam, the applicant is submitted to a professional test, with a fee. In most cases, the evaluation procedure goes on with the “counseling interview”, held with members of the Commission for external health qualifications (CBGV). Additional information is gathered and discussions over surveillance or training take place. The exact form depends on the results of the evaluation, as well as the 27

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CBGV conclusions, which notes its recommendations and communicates the decision. Depending on the outcome of the evaluation, three situations may arise: 1. access to the pursuit of medical practice; 2. request to take additional training, as the case may be; 3. completing the entire study program for the mentioned medical specialty; The BIG law lists the “reserved procedures”, meaning the medical interventions that may present an unacceptable risk for the patient’s safety when performed by a non-authorized person. In this list are included injections, lumbar puncture (spinal tap), catheterization and administering a general anesthetic. According t the BIG law, a small number of service providers are authorized to perform this type of intervention autonomously. There is a Dutch brochure available (Onder Voorbehoud) that explains the restrictions imposed by the BIG law and the method by which the expertise is being assessed. The physicians are part of the medical assistance suppliers that are entitled to perform the reserved procedures. Processing time of the professional documentation: BIG Registry applies strict regulations regarding the maximum time spent for the processing of a request. In most cases, a decision is being taken in a few weeks delay. Despite all that, the request can suffer delays in treatment if all the required information is not offered from the beginning. Regulation regarding professional experience, effective starting 31st of December 2014 Any student graduating after the 31st of December 2014 and wanting to pursue the medical practice in Holland must finalize a period of professional practice during which the applicants are trained for the adequate provision of their profession. After this three years period of professional practice under the responsibility of a qualified member of that profession (mentor), the applicants can register to the BIG. The BIG office has the legal duty to lay down detailed rules to determine the structure, level of training, knowledge and the abilities one must acquire after completing the three years professional practice. The rules shall also provide clear answers regarding the structure of this practice, the mandatory mentors' supervision and the method to finalize the professional practice period. An important base for the content regulation is the recommendation published by WAT group project in March 2011 by Order of BIG Office. The Medicenregister Office includes all establishments of higher education involved in the training and regulation of the professional practice. The professional organizations are also an important dialogue partner when laying down the rules for the necessary content and complementary training. 2.8. Certification for medical practice in Germany The pursuit of the medical practice profession (Facharzt/Fachärztin für Allgemeinmedizin) in Germany is regulated by the article 34 from the Directive on the recognition of professional qualifications 2005/36/EC of 28

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the European Parliament and of the Council. The certification for medical practice in Germany is regulated by the Länder laws, with two exceptions: in the states Hesse and North Rhine-Westphalia, the physician title is protectedm but the profession is not regulated [7, 21, 22]. The national competent authority is: Bundesministerium für Wirtschaft, Familie und Jugend – Federal Ministry of Economy, Family and Youth. Address: Glinkastraße 24, 10117 Berlin, Postadresse 11018 Berlin. E-Mail info(at)bmfsfjservice.bund.de, Amtsanschluss (030) 20655 – 0, IVBB (03018) 555 – 0, Telefax (03018) 555 – 4400. The competent professional organization is: Bundesärztekammer, Arbeitsgemeinschaft der deutschen Ärztekammern, Herbert-Lewin-Platz 1, 10623 Berlin, Postfach 120 864, 10598 Berlin. Tel. 030.400456388. EMail: info@baek.de. The competency of certification for the medical practice falls on the authority of the land, it regulates the profession in the jurisdiction where the applicant lives. The organization that grants the right to practice is Kassenärztliche Vereinigungen (KÄV). Acquiring athe right to practice the professional activities is conditioned by the completion of a residential course of three years. This condition is not applicable to the physicians coming from another EU member state. The application form for

KÄV must be accompanied by the qualification title, a conformity certificate and a current

professional status certificate delivered by the competent professional organization from the country of training. In order to acquire the right to practice as specialised doctor, the applicant must obtain from the land's College the recognition in virtue of the evidence of specialist medical training. Specialist medical training can be followed at a university or a medical care establishment approved for that purpose. The evidence of specialist medical training is awarded after the registration to the physicians' Register, managed by the Land's Physician College. To enroll in the professional register the following documents must be submitted: application form, professional qualification title, examination certificate or any other relevant proof according to articles 46, 47 and 49 of the Directive 2005/36/EC of the European Parliament and of the Council, on the recognition of professional qualifications and relevant professional practice of two years. The submission for professional certification is under the incidence of the relevant professional chambers in Land. The applicant may also contact the local structures of the Federal Employment Agency which provides information regarding the possibility to work in Germany and the obligation to obtain a work permit. Address: Regensburgerstr.104, 90478 Nurnberg. Telephone: +49-0911.179.0, Fax: +49-0911.179.21.23. E-mail: zentrale@arbeitsagentur.de. In 2005, the Bologna process was implemented in Germany and currently efforts are being made to set up a national qualification framework. Further information can be found on the website of Deutscher Qualifikationsrahmen (DQR), dem Gemeinsamen Internetportal des Bundesministeriums für Bildung und Forschung und der Kultusministerkonferenz www.deutscherqualifikationsrahmen.de/. 29

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Although Germany does not have an official classification, starting 2002 the Center for Higher Education Development (CHE), in cooperation with Stern Weekly Magazine publishes an annual classification comprising a great number of institutions. The main task of the independent agency Akkreditierungsrat is the accreditation of specific agencies who carry out the accreditation of study programmes. Among the members of Akkreditierungsrat can be found representants of the federal states, higher education institutions, students’ Community, employers, employees and foreign partners. Only in exceptional cases can Akkreditierungsrat accredit study programmes.

III. The processes of recognition of the qualifications attained in other member states of the European Union 3.1. General framework of the recognition process for regulated qualifications/professions in the European Union In the European Union there are specific instruments that promote the transfer of qualifications and skills for academic or professional purposes. The aim of implementing these instruments is to facilitate the right to free movement of citizens, especially ensuring the right of individuals to pursue a professional activity or training in a Member State. The National Center for Equivalence and Recognition of Diplomas (CNRED Str. Spiru Haret 12, Sector 1, 010176 Bucuresti, Ilfov, e-mail: www.cnred.edu.ro) is appointed as national point of contact for professional recognition by the article 37, index 1 of the Romanian Government Emergency Ordinance no. 109/2007. The Romanian competent authorities mentioned in the Law no. 200/2004, amended and completed (Legea 222/2010) [5], are responsible for the professional recognition of qualifications acquired in EU Member States, European Economic Area and the Swiss Confederation by the citizens of those states wishing to pursue a regulated profession in Romania. CNRED is also the competent authority for professional recognition of qualifications obtained abroad, in order to obtain the work permit issued by the Ministry of Labor, Family and Social

Protection,

accordance

with

the

General

Inspectorate

for

Immigration. CNRED issues, in accordance with Law no. 200/2004, amended and completed, a certificate of conformity of studies for non/unregulated professions in Romania, in accordance with the provisions of Directives 2005/36/EC and 2006/100/EC. There are two types of such instruments: a) the system of recognition of qualifications for regulated professions and b) instruments designed to ensure skills’ and competencies’ visibility at European level: Europass and national contact points for professional qualifications. In each Member State there are two information points, namely the National Reference Point for professional qualifications and ENIC-NARIC network. 30

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A person who has studied in an EU member state may ask for recognition in another EU country in order to continue their studies or to practice the profession. Qualification recognition is the responsibility of professional recognition organizations existing in each country. There are two types of “international” recognition:  Academic recognition, which allows the applicant to pursue or continue studies or grants the right to use a national title or a professional degree in the host country based on the title or degree acquired in the country of origin;  Professional recognition, referring to the evaluation methodology and procedures in order to exercise a profession Academic and professional recognition have different objectives and in most EU Member States they are addressed differently, using different instruments. Each EU country has its own system of regulated professions. Thus, a profession may be regulated in a member state, but not in another. In the country where the profession is regulated, the applicant must follow the academic recognition procedures to pursue the profession, while in the country where the profession is not regulated the requirements of professional recognition must be met. There are other situations, for example in the United Kingdom, where professional qualification (for certain professions) is acquired after completion of an additional professional training of post-graduate level provided by authorized suppliers of vocational training. In such situations, the professional requirements are established by national law or by professional organizations (e.g. Länder in Germany). For the profession of physician, minimum training conditions are harmonized at European level by the Directive 2005/36/EC on the recognition of professional qualifications, of the European Parliament and of the Council, the profession being included in the so-called sectoral professions. The Directive 2005/36/EC on the recognition of professional qualifications identifies two situations: persons that wish to pursue the profession permanently and the ones that wish to practice the profession temporarily in another EU member state. Moreover, the rules set by the Directive 2005/36/EC on the recognition of professional qualifications are applied as follows: 1. If the applicant wishes to work or study in another EU member state - the rules laid down in Directive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications apply only to those who completed the professional training that want to pursue their profession in another EU member state, and not to those who wish to continue their studies in another EU member state. The latter should contact the Academic Recognition Information Centres (NARIC) for information on the academic recognition of diplomas - http://www.enic-naric.net/. 2. Citizen’s nationality - the rules set by the Directive 2005/36/EC on the recognition of professional qualifications apply only to the citizens of 30 countries: the 27 member states of the European Union and Iceland, Norway and Lichtenstein. To benefit prom the provisions of the Directive 2005/36/EC on the 31

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recognition of professional qualifications, the physician must be the citizen of one of these states when the applying for recognition. The provisions also apply to those with dual citizenship. Example: a brazilian citizen physician which has also portuguese citizenship. The Directive also applies to citizens of other countries (besides the 30) who are family members of a EU citizen. Example: A Brazilian physician who holds a professional title obtained in Portugal, married to a Portuguese citizen. If the family decides to live in France, the citizen can benefit from the recognition of the medical practice profession in France under Directive 2005/36/EC on recognition of professional qualifications. 3. The country where the title was obtained - the provisions of theDirective 2005/36/EC on the recognition of professional qualifications apply only if the physician obtained the professional qualification in one of the 30 states of the Directive. It is considered that the medicine professional qualification was obtained in a member state if the applicant has obtained a certificate of completion of a degree program in medicine, with a minimum duration provided for in the Directive, in an EU member state. It does not apply to EU citizens who have obtained professional qualifications in another state. Example: A French citizen who qualified as a physician in Canada and wants to pursue the profession in France - the first recognition of his qualification in an EU member state is subject to national legislation of France. a) Temporary provision of services in the medical practice The physician legally residing in a Member State wishing to provide temporary physician services in another EU member state will act under the provisions of Directive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications, regarding the temporary service provision. Rules for temporary provision of services are more flexible than those for establishment. The conditions a physician must meet for the temporary provision of professional services in another EU member state are: - Be legally established in one of the 27 member states or in one of the countries: Norway, Iceland, Lichtenstein. In this case, the physician benefits from automatic recognition of qualification, if he holds the qualification specified by that Member State in Annex 5 of the Directive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications. This qualification must certify the completion of minimum training conditions set by the Directive. - Be present on the territory of the EU member state where he wishes to provide temporary professional services. According to the definition in the Directive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications, a person is legally established if he fulfills all conditions for of pursuing the activities concerned in a member state and if he is not prohibited from practicing, even temporarily. The citizen may be legally established in a EU member state as employee or self-employed and not necessarily actively practice the profession at the time of the application. 32

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Example: A French physician enrolled in the professional register in France is legally established even if not actively practicing the profession at that time in France. He can request the right to temporarily provide services in Germany. On the other hand, if the physician is not enrolled in the professional register, he is not considered legally established. For the first provision of temporary services in an EU member state, it may be necessary to submit a statement by which the applicant notifies the competent authority of that state on his intention. The Directive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications does not force the EU states to demand such a statement, it is an option that each state may apply within the limits set by the Directive. If a member state chooses to request such a declaration, it is valid for one year. After that, if the applicant wishes to continue providing services on a temporary basis, he must submit a new declaration, valid also one year. The declaration must be drawn up in writing, but may be sent via mail, fax, e-mail etc. It can be sent at any time prior to providing the professional service for the first time. In some EU member states, it should be taken into consideration that is required for up to five months to examine it. To find the competent authority of the member state to address the declaration for temporary provision of

professional

services,

the

physician

may

consult

the

National

Contact

Points:

http://ec.europa.eu/internal_market/qualifications/docs/contact-points/infopoints_en.pdf. The statement shall include the following information: full name, contact details (address, phone number, e-mail address, etc.), nationality, the profession for which the applicant is qualified in the EU member state where he is legally established and the profession he wishes to pursue in the host member state. Also, the applicant must provide information about professional liability insurance: insurance company name and

contact number. It should be equally mentioned if the applicant wishes to provide temporary professional services on the territory of the member state for the first time or if he applies for a permit renewal. The host member state may not under any circumstance ask the citizen to specify in the statement the location and/or time and/or length of the service provided on its territory or to provide an address on its territory where they will work. Documents that may be required with the declaration: proof of nationality, a document certifying that the applicant is legally established in a member state and that he is not forbidden to practice the profession, not even temporarily â&#x20AC;&#x201C; a certificate from the competent authority in the member state of establishment and a copy of the certificate of professional practice, evidence of professional qualifications, proof that he was never convicted for any serious offences if he wishes to work in high security areas and the EU member state requests the same for its citizens. 33

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The competent authority of the host member state may not require original documents, but can require certified copies of the more important documents, such as: professional qualifications and documents proving the professional experience. If the applicant cannot provide legalized copies, the competent authority has the obligation to verify the authenticity of these documents by consulting with the EU member state where the citizen is legally established. For the general doctor profession, it is not necessary to request certified translations of documents, since the qualifications are listed with their original names in Annex V to the Directive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications, and can be easily checked by the competent authority. If the professional title held by the physician is not mentioned in Annex V to the Directive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications, the applicant does not benefit of the automatic recognition and his qualification will be examined by the competent authority of the host member state. In this case, the competent authority may require the following types of information about the applicant’s professional training: the total duration of the studies, subjects and number of hours, the ratio between the activities of theoretical courses and practical applications, experience, continuous training - courses and seminars followed to complete the studies. The decision of the competent authority may be:

1. The competent authority may decide not to check the applicant’s professional qualification and to grant the right to provide temporary services;

2. The competent authority may decide to check the applicant’s professional qualification and: a) authorize him to provide service; b) prohibit him from providing the service; c) demand him to adopt additional measures - in this case, only after these measures are met the applicant will be informed on the decision of the competent authority. Compensation measures. The competent authority can require the applicant to adopt additional measures if there are substantial differences between the professional training received by the migrant and the one in the host country. These measures shall be adopted only if the citizen's professional experience and / or professional training courses completed are unlikely to cover the differences in initial training. The compensation measures may be either an aptitude test or a professional practice period. The time period in which the competent authority of the host member state decides on the temporary provision of professional services is between one month of receipt of applications and supporting documents (if there are no file processing problems) and four months of receiving the applications and supporting documents (if there are problems processing the file). If the competent authority decides the implementation of compensatory measures, the decision will be taken only after completion by the applicant of that requirement. In this case, the applicant must adopt compensatory measures in the next month following the decision. 34

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If the applicant meets all the conditions relating to freedom to provide services stipulated by the host member state's national law, transposing Directive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications, and the competent authority does not respond within the prescribed period, once this period has ended he can provide the service in the host member state. The request is considered tacitly accepted.

During the temporary provision of services in an EU member state, the applicant must comply with all the rules of professional conduct related to his profession, in force in that State. In return, he is exempted from the obligation to register with the relevant professional organization or forum in that state and to have professional liability insurance. b) Pursuing medical practice permanently in another EU member state When a physician wants to settle in another EU member state to pursue the profession, his qualifications will be checked more thoroughly and the formalities to comply with are more complex. To find out the competent authority in the member state to which he must submit the file for recognition of professional qualifications,

the

physician

may

refer

the

national

points

contact:

http://ec.europa.eu/internal_market/qualifications/docs/contact-points/infopoints_en.pdf. The documents which must accompany the application are:  the proof of nationality;  evidence of professional skills certification or qualification which grants the applicant access to practice the profession;  evidence of professional experience if the qualification is obtained in a third non-EU member state and is already recognized in another EU member state. In this case, the competent authority of the state in which the applicant wishes to establish may request a certificate, issued by the competent authority of the EU member state where his qualification is already recognized, attesting that he pursued the profession for at least three years in the respective member state;  attestation of professional integrity, moral reputation – a statement affirming that he was he was never prohibited from practising due to grave professional misconduct or criminal offence;  medical certificate attesting the health condition allows the applicant to correctly pursue the profession;  proof of financial situation and health insurance;  compliance certificate - issued by the member state of origin and attesting the correspondence between the applicant's qualification and the one listed in Annex V to Direct ive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications.

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If the professional title held by the physician is not mentioned in Annex V or VI or in other specific situations described by Directive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications – an attestation must be issued by the member state of origin regarding the effective and lawful professional practice for at least three consecutive years during the last five years. In some cases, the document must also stipulate that the applicant is authorized to use the title of doctor in the member state of origin before the date provided for the respective member state in Directive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications. For further information: http://ec.europa.eu/internal_market/qualifications/docs/contact-points/infopoints_en.pdf. For the general doctor profession, it is not necessary to request certified translations of documents, since the qualifications are listed with their original names in Annex V to the Directive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications, and can be easily checked by the competent authority. Processing time of the application. First, the competent authority must inform the applicant within one month of the receipt of the application and whether documents are missing. The competent authority shall take a decision within a maximum period of three months from the receipt of the complete file, for cases falling within the rules of automatic recognition, and within five months for cases falling under the general rules of recognition. Recognition gives the applicant the right to practice their profession in that EU member state like any other citizen of the state, which has the same right. In other words, he must obey the same laws, regulations, administrative provisions and code of practice obeyed by the citizens of the host EU member state. Automatic recognition of medical qualification To benefit from automatic recognition, the physician must meet the following conditions: - to hold a qualification specified by that member state under Directive 2005/36/EC on recognition of professional qualifications, Annex V; - the qualification must certify a training period that meets the minimum requirements laid down in Directive 2005/36/EC on recognition of professional qualifications. Usually, this applies if the candidate's academic training began after the reference year included in Annex V for the concerned qualifications and EU member states, but not before it. Example: A Spanish physician who holds the formal qualification „titulo oficial de arquitecto” awarded by Universidad Europea de Madrid, which began the studies at the earliest in the academic year 1998/1999 (Annex V, point 5.1.7.) can benefit from automatic recognition. An Italian physician holding the formal qualifications and began his studies after the academic year 1999/2000, but did not obtain „diploma di abilitazione all ezercizio indiependente della professione”,

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needed in Italy to complement the academic qualification (Annex V, point 5.1 .7.) cannot benefit from automatic recognition. SOLVIT is a problem solving network in which EU member states work together to solve without legal proceedings problems caused by the misapplication of Internal Market law by public authorities. There is a SOLVIT centre in every European Union member state that provide free of charge services. SOLVIT deals with cross-border problems between a business or a citizen, on the one hand, and a national public authority on the other, where there is possible misapplication of EU law. The areas for which SOLVIT receives most complaints to be treated are: recognition of professional qualifications and diplomas; access to education; residence permits; voting rights; social security; employment rights; driving licenses; motor vehicle registration; border controls; market access for products; market access for services; establishment as self-employed; public procurement; taxation; free movement of capital and payments. There is a SOLVIT centre in every European Union member state that provide free of charge services. For solving any complaint by SOLVIT, there are four steps: Step 1 - accepting the case, check the legal basis, if the documents entered in the database by the home center are not enough, additional documents are required; Step 2 - obtaining the solution: the competent public authority is contacted regarding the case and SOLVIT cooperates with it in order to obtain a correct solution in accordance with European legislation; Step 3 - offering solution (implemented or not) - the solution must be real, practical and in accordance with European legislation; Step 4 - if the solution was not implemented at the time of the proposal, it will be monitored - a case is resolved only when the solution is implemented and solves the customer's problem. The member states should intensify their efforts in order to ensure that the citizens and the companies can use efficiently their legal rights regarding the unique market, guaranteeing an efficient application and implementation of the legislation regarding the unique market by the national authorities, by supplying quality information, e-government instruments and procedures, and also by investing in mechanisms that are designed for quick solving issues. SOLVIT potential is still insufficiently exploited as a problem solving key instrument at a national/European level, partially because of the insufficient staff from different SOLVIT centers and also because of the insufficient information received by the European citizens regarding the competencies of these centers. The SOLVIT centers from member states mentioned in this guide are: SOLVIT Italy: Presidenza Consiglio Ministri, Dipartimento Politiche Comunitarie, Piazza Nicosia 20, IT - 00186 Roma, Tel. +39 06 677 95 844, Fax. +39 06 677 95 044, solvit@palazzochigi.it SOLVIT Czech Republic: Odbor vnitřního trhu a služeb EU, Ministerstvo průmyslu a obchodu, Na Františku 32, CZ – 11015 Praha 1, Tel. +420 22 422 1701, Fax. +420 22 485 3079, solvit@mpo.cz 37

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SOLVIT Denmark: Danish Business Authority (Internal Market Centre), Langelinie Allé 17, DK – 2100 Copenhagen, Tel. +45 35 46 62 00 (the hotline), Tel. +45 35 46 66 16, Tel. +45 35 46 66 73, SOLVIT@erst.dk SOLVIT Germany: Bundesministerium für Wirtschaft und Technologie, Scharnhorststr. 34-37, DE -10115 Berlin, Fax. +49 3018 615 5379, solvit@bmwi.bund.de SOLVIT Spain: SOLVIT – España, Ministerio de Asuntos Exteriores y de Cooperación, Serrano Galvache 26, ES - 28033 Madrid, Tel. +34 91 379 9999, Fax. +34 91 394 8684, solvit@ue.maec.es SOLVIT Holland: Ministerie van Economische Zaken, Landbouw en Innovatie, Bezuidenhoutseweg 30, Postbus 20101, NL – 2500 EC, Den Haag, Tel. +31 70 379 7708, Fax. +31 70 379 7014, solvit@mineleni.nl SOLVIT Austria: Bundesministerium für Wirtschaft, Familie und Jugend, SOLVIT

Center,

Abteilung C1/2, Stubenring 1, AT - 1010 Wien, Tel. +43 1 71100-5119, Tel. +43 1 71100 – 5293, Tel. +43 1 71100-5187, Fax. +43 1 71100-2207, solvit@bmwfj.gv.at SOLVIT United Kingdom: Department for Business, Innovation and Skills, 1 Victoria Street, UK London SW1H 0ET, Tel. +44 20 7215 2833, Fax. +44 20 7215 2234, solvit@bis.gsi.gov.uk In Romania the SOLVIT center has as contacts details: the Romanian Government, the Department of European Affairs, Aviatorilor Avenue, number 50A, Sector 1, Bucharest 011854, Romania, tel.: +4021 308 53 60, Fax.: +4021 318 55 24, E-mail: solvit@dae.gov.ro.

3.2 Recognition of the medical qualification in Italy Italy implemented the Directive 2005/36/EC of the European Parliament and Council on the recognition of professional qualifications through the Legislation Decree number 206 from 6th of November of 2007: “Attuazione della direttiva 2005/36/EC relativa al riconoscimento delle qualifiche professionali, nonche' della direttiva 2006/100/EC che adegua determinate direttive sulla libera circolazione delle persone a seguito dell'adesione di Bulgaria e Romania”[3]. The profession of doctor is regulated in Italy and the competent authority is Ministero dell'istruzione, dell'università e della ricerca. Contact details: MIUR D.G.I.R. Ufficio III/Int. piano IV, stanza 92, P.le J.F. Kennedy 20, Roma 00144, Tel. +39-0697727639, Fax +39-0697727600, email office COST: cnc@miur.it, e-mail coordinator: maria.uccellatore@miur.it. Through this decree [3] are established the rules based on which the citizens of the EU member states can practice on Italy`s territory the regulated profession for which they are qualified in the home member state. The conversion text refers to so called “regulated” professions defined in article 4, paragraph1, letter a) from this decree. The decree applies to the citizens of the European Union member states that want to practice on Italy`s national territory as employees or self-employed – including freelancers, a regulated profession based on a professional qualification, obtained in a European Union member state and the conditions in which the 38

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practice of this profession is allowed. Also, the competencies certification is made based on some normative documents with general character. The profession that the applicant wants to practice on the Italian territory will be the one that he was qualified for in the home member state if the activities are comparable and can be practiced under the establishment or cross-border provision of services on a temporary and occasional basis. Based on the provisions of article 56, paragraph 4, and article 57 from the Directive 2005/36/EC of the European Parliament and Council on the recognition of professional qualifications, the Community policies coordination department of the Ministers Council Presidency is the national coordinator and national point of contact: Presidenza del Consiglio dei Ministri, Dipartimento Politiche Comunitarie, Ufficio Mercato Interno e Competitività,

Piazza

Nicosia

20,

0018

ROMA,

ITALIA,

e-mail:

puntonazionaledicontattoqualificheprofessionali@politicheeuropee.it, Website: www.politichecomunitarie.it. Contact persons: Dott.ssa Lucia Monaco e-mail: lu.monaco@palazzochigi.it,

Dott.ssa Maria

Giuseppina Castellano e-mail: g.castellano@palazzochigi.it, Tel.: 0039 06 677 92 548- Fax: 0039 06 6779 5064[19]. For the recognition of medical professional qualifications, the Directive 2005/36/EC of the European Parliament and Council on the recognition of professional qualifications provides a system based on the preventive harmonization during the training and that stipulates the automatic recognition. For the recognition in the general system, the recognition request is addressed to the Competent Authority from the host member state (Italy). This request must be accompanied by documents and certificates stipulated in Annex VII of the Directive 2005/36/EC of the European Parliament and Council on the recognition of professional qualifications. The required documents in Italy for EU citizens who wish to settle in this country are, according to Presidenza del Consiglio dei Ministri, DIPARTIMENTO PER L’INFORMAZIONE E L’EDITORIA - GUIDA ALL’UTENTE, Direttiva 2005/36/ECE relativa al riconoscimento delle qualifiche professionali[19]: 1. Copy of a valid identity document of the concerned person; 2. Authenticated copy of the specified profession qualification (also mentioning the passed exams that are necessary to determine the potential existence of some significant differences from the national training, stipulated in article 14 from the Directive 2005/36/EC of the European Parliament and Council on the recognition of professional qualifications); 3. Authenticated copy of the professional qualification, if it is stipulated by the country where the qualification was obtained; 4. Authenticated copy of registering in the Professional Register of the country where the title was obtained, only if there are provided in this country

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5. Certificate stating that there are no criminal or professional obstacles in practicing the profession, issued by the competent authority from the home country and/or provenance; 6. Certificate presenting in detail every work activity in the country of origin, as result of the graduation of the qualification for which the recognition is requested (including the performed practical training timeframes). In the case of professions regulated both in Romania and in Italy, the following documents are required: 1. Certificate or other accreditation issued by the competent authority from Romania from which results that that diploma gives access to the professional practice for the applicant, in the country of origin; 2. The detailed program of studies with the clear indication of the taken hours and the debated topics for each subject, and also the number of intership hours, issued by the unit that awarded the diploma; 3. Document to certify the carried activity in the country of origin or provenance, subsequent to the diploma the recognition is required for; 4. Documents attesting the performed interships, specialization courses or other acquired diplomas. All documents written in a foreign language must be accompanied by an italian translation, authenticated according to the original text, issued by the italian diplomatic or consular Authority from the country that issued the diploma, or by an authorized translator from an italian court. Photocopies are used by the EU citizens according to DPR 445/2000 Law which imposes that these must be accompanied by a statement in accordance with the original on the applicant`s own responsability. The authorities can verify through a survey the authenticity of these statements. The original documents cannot be subsequently withdrawn by the applicant or the empowered person, at the diploma recognition process closure. 3.3 Recognition of the medical qualification in Spain The Royal Decree 1837/2008: “REAL DECRETO 1837/2008, de 8 de noviembre, por el que se incorporan al ordenamiento jurídico español la Directiva 2005/36/EC, del Parlamento Europeo y del Consejo, de 7 de septiembre de 2005, y la Directiva 2006/100/CE, del Consejo, de 20 de noviembre de 2006, relativas areconocimiento de cualificaciones profesionales, así como a determinados aspectos del ejercicio de la profesión de abogado. BOE núm. 280, 46185-46320” [16], presents in Annex VIII (Annex L11a_2) the alphabetical list of grouped professions and activities according to the existent level of preparation from Spain to access the profession pursuit, correlated with the described levels from the article 19 (article 11 from Directive 2005/36/EC on the recognition of professional qualifications). The regulated profession in Spain is physician and the competent authority for the professional recognition is the Ministry of Health. The professional organization for physicians is Consejo General de Colegios Medicos de España, it operates in 19 regional councils. The contact details are: CONSEJO GENERAL 40

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DE COLEGIOS MÉDICOS, Playade las Cortes, 11-tel.:91 431 77 80 - fax: 91 576 43 88 (Presidencia) 91 431 9620 (Secretaria) - 28014 Madrid. The recognition for the profession of doctor in Spain is automatic, according to the stipulations of the Directive 2005/36/EC of the European Parliament and Council on the recognition of professional qualifications. However, if the applicant does not meet the minimum conditions of professional training stipulated in the directive, or if his diploma is not found in Annex V, the member states' compensation mechanisms are applied: aptitude test or a professional practice period, which are applicable before the title recognition. The file for the professional recognition must contain the following documents: the application for the recognition of the diploma obtained in an EU country addressed to Ministry of Education (official standard model), authenticated photocopy of the academic and professional title, authenticated copy of the citizenship proof, the authenticated Spanish translation of the academic and professional title. The evaluation result is: The professional recognition certificate. After obtaining it, the physician has the obligation to sign up for the professional college in the region he wishes to establish himself and has the right to practice the profession only in that region. The legislation regarding the professional recognition in Spain Spain implemented the Directive 2005/36/EC of the European Parliament and Council on the recognition of professional qualifications through the Royal Decree 1837/ 8.11.2008: REAL DECRETO 1837/2008, de 8 de noviembre, por el que se incorporan al ordenamiento jurídico español la

Directiva

2005/36/EC, del Parlamento Europeo y del Consejo, de 7 de septiembre de 2005, y la Directiva 2006/100/CE, del Consejo, de 20 de noviembre de 2006, relativas al reconocimiento de cualificaciones profesionales, así como a determinados aspectos del ejercicio de la profesión de abogado. BOE núm. 280, 46185-46320[16], that establishes the rules based on which the citizens of the EU member states can practice the regulated profession for which they are qualified within their own member state, on the Spanish territory. Regarding the recognition procedure in Spain, the following can be summarized: a. It consists of the qualifications recognition in Spain obtained by the citizens of any EU member state, countries that are part of European Economic Area (Island, Norway and Liechtenstein), Switzerland and – when necessary – citizens from third parties countries, that are also citizens of one of the above countries (dual citizenship), for the access to practice a regulated profession or activity in Spain, with same effects as if they would have obtained the corresponding Spanish qualification. The official recognition gives the applicant the right of becoming a member of the respective professional associations and practicing the profession in those activities that are exclusively assigned to the professional group. b. The application must be addressed directly by the applicant to the Secretariat of the professional association: Consejo General de Colegios Medicos de España, it operates in 19 regional councils. The contact 41

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details are: Consejo General de Colegios Medicos, Playade las Cortes, 11-tel.: 91 431 77 80 - fax: 91 576 43 88 (Presidencia) 91 431 9620 (Secretaria) - 28014 Madrid. The application has a standard form and must be accompanied by justifying documents (both academic and professional), certifications, accompanied by their authenticated translation in Spanish (by an authorized translator, any diplomatic representation or the Spanish Consulate or abroad, by the diplomatic or consular representation in Spain of the applicant`s country of origin). Recognition of the medical qualification in Spain The doctor profession is regulated in Spain. For the efficient development of their activity, the physicians are obliged to register in the territorial professional association, both those who want to establish in Spain and also those who want to practice the professional services. The professional practice will take place in free competition conditions and under the Competition Law and the Law against the unfair competition, regarding the provision of services and determining the remuneration. Other aspects of the professional practice are regulated by the professional association of the applicant. Supply of services with establishment Step 1. The recognition of the corresponding title â&#x20AC;&#x201C; are the same as the general requirements for regulated professions Step 2. Registering in the professional association from the region of service. Documents: The required documents are the same for all the independent communities. - Filled in application form; - The original or the authenticated copy of the physician title or the certificate issued by the university or the title recognized by the competent organization; - Identity document or any other document attesting that the applicant is a EU member state citizen; - Registering declaration in the taxpayers registry/registration certificate within the professional association; - Declaration regarding the civil responsability; - Standard photos; Additional documentation for the service provider from another member state: - Certificate issued by the state of origin, which certifies the qualification, accompanied by the authenticated translation; - The statutory declaration that he was not registered as a physician in no other country from the EU, otherwise: Certification from the member state of origin that he is not under disciplinary penalty regarding the profession practice. Result: Licensing, registering collegiate and license number, documentation standards for practicing. Regulations regarding the change of residency: stipulations regarding the professional title 42

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recognition for persons already residing in Spain that wish to practice the profession in other autonomous region of Spain. Documents: the required documentation is not consistent for the regional governments, but the most frequently asked documents are: filled in application form, certificate regarding the administration discharge from the territorial professional association, copy of the certificate issued by the college regarding the professional title (as a professional organism), data regarding the bank account proving the payment of the registration fee or the payment proof, the proof of contracting a professional responsability ensurance, copy of the identity card. Result: Registration number in the professional college and the documentation standards for practicing. Temporary supply of services in medical field Step 1. Communication between colleges for pursuing the profession The physician supplies a service for a limited period of time in a different area than the one in which he is authorized in. In this case, he needs to be registered in the professional college where he usually activates. The necessary documents are: Communication form between the professional colleges, filled in by the home organization and the one that the doctor will move to, that describes the service that is about to be supplied. The applicant, an EU member state citizen that is about to supply services in Spain needs to meet the following conditions in order to have access to activity: Step 1. The recognition of the corresponding title â&#x20AC;&#x201C; are the same as the general requirements for regulated professions Step 2. Registering in the professional college from that region, both for spanish citizens and citizens of a EU member state. The required documents are not the same for all the regions, but the common ones are: application â&#x20AC;&#x201C; college registration form; certificate issued by the state of origin attesting the professional title and its official translation; declaration of civil responsability (if the contracted civil liability insurance is not in spanish, the authenticated translation of the document and a validity certificate must be added); if there is no contracted civil liability, an insurance can be required as the respective college requires it. Result: Instructions and necessary informational documents for practicing the professional activity. 3.4 Recognition of the medical qualification in Czech Republic The professional qualifications recognition and the list of necessary documents are regulated in Czech Republic through Law 18 from 2004. In Czech Republic there is an information point for the professional qualifications recognition - The Professional Qualifications Recognition Center, with the corresponding legislation [1,2].

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The Center provides information about professional qualifications recognition and applied regulations in Czech Republic based on the Directive 2005/36/EC of the European Parliament and the Council on the recognition of the professional qualifications. It coordinates the activities of the recognition authorities and represents Czech Republic at the European Commission. The contact details of the Center are: Ministry of Education, Youth and Sports, The Center for Professional Qualifications Recognition, the â&#x20AC;&#x153;Education for Adultsâ&#x20AC;? department. The center manages the databases that contain Czech regulated and unregulated professions. For each profession there are qualification requirements, specific recognition committees and legal regulations that govern the profession in Czech Republic. The database specific to the type of profession also contains information regarding the recognition procedure [1] and the application form for a professional qualification recognition. For the regulated professions, the proper point of contact can be the Ministry of Health, because it is relevant through the high number of regulated professions it manages. As in Romania, the regulated professions are recognized only by the relevant competent authorities by submitting an application accompanied by the necessary documents: application form in Czech, personal identification, a document that certifies the candidate`s citizenship, the proof of the formal qualifications and the receipt for the payment of the administrative fee. The recognition authority examines if the application and the attached documents contain all the required information to certify the qualifications and taking a decision. If necessary, the competent authority will ask the applicant for additional information. After the file receipt, the qualification recognition committee is required to take a decision in maximum 60 days, as per the stipulations from art. 24, paragraph 5 from Law number 18 of 2004. In complex cases, the authority can overcome this deadline but, it is however obliged to take a decision within 90 days [3]. As a result of the application examination submitted by the candidate, the competent authority must take a decision according to one of the below situations: - the professional qualification is recognized, or - it communicates to the applicant the compensation methods, either an adaptation period or an aptitude test that must be sustained by the candidate, or - the professional qualification recognition submission is rejected. Compensation measures are applied by the recognition committee only if there are important differences between the certified competencies of the applicant and the ones that are necessary for the profession practice in Czech Republic. During the adaptation period, the candidate provides regulated services under the surveillance of a competent professional person. The adaptation period cannot be longer than 3 years. The aptitude test consists normally in a written and an oral examination. Usually, it is sustained in czech, in the presence of a representative recognition committee for the given qualification, university or other institution, taking into consideration the citizen`s specialization. The examination consists of verifying if the 44

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candidate has the necessary knowledge and competencies for practicing the profession, which were not included in the previous training of the candidate. The decisions taken by the recognition authorities committees can be disputed within 15 days from the announcement date. The NARIC CZ Center (The Higher Education Center/ The Recognition of Documents on Education ENIC/NARIC, Udvou srpů 2024/2, 15000 Praha 5, Tel.: + 420257011335, Fax: + 420257531672, e-mail: naric@csvs.cz, web: www.naric.cz.), network member of EU ENIC from 1997, provides information regarding the higher education qualifications in Czech Republic and EU states, this way facilitating the professional qualifications for the czech citizens gone to work abroad. National Institute of Technical and Vocational Education (NUOV), Weilova 1271/6, 102 00 Praha 10, Tel.: + 420 274 8 62 251 – 6, Fax: +420 274 863 380, E-mail. nuov@nuov.cz, web: www.nuov.cz, is a consultancy center for elementary or higher education qualifications. If required by the competent authorities, NUOV provides an expertise regarding the educational level received by a citizen or the content and purpose of the education for the required qualification, in order to convince that the citizen has the necessary competencies for practicing the regulated profession in Czech Republic. NUOV cooperates with similar institutions from abroad. Practice of the profession of doctor on a permanent base in Czech Republic The

application

file

contains:

standard

application

form,

example

at:

http://www.cka.cc/cca/prilohy/form_resident_person, copies of the diplomas and professional qualifications, document attesting the professional experience – a description of the professional practical experience, document attesting the suitability – criminal record, document proving the existance of a malpraxis insurance, the proof of the registration fee payment. The file is sent to: Secretary of the Certification Committee, Josefská 34/6, Praha 1, 118 00, Czech Republic milena.ondrakova@cka.cc or katerina.folprechtova@cka.cc. As a result of the recognition, the physician obtains the license/certificate, will have to pay the annual cotization at the professional Association and will also have the same professional rights as any other czech physician. Temporary services provision in medical profession in Czech Republic The documents that are attached to the notification for temporary provision of services in the medical domain on Czech Republic’s territory are the same as the ones for permanent establishment. Also, the same fee is payed. The professional recognition for the temporary provision of services is valid for a year. The doctor has the same rights as a certified czech doctor, except the right to vote within the General Assembly of the professional association. Standard application form for the notification regarding the temporary services provision in the medical field on the Czech Republic`s territory is standardized and can be found at http://www.cka.cc/cca/prilohy/form_visiting_person. 45

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3.5 Recognition of the medical qualification in Austria The competent authority is: Bundesministerium für Wirtschaft, Familie und Jugend - the Federal Ministry of Economy, Family and Youth. Contact details: Stubenring 1, Abteilung I/, 31010 Wien, Phone: +43-171100, Fax: +43-17142718, Email: service@bmwa.gv.at, URL: www.bmwa.gv.at. The competent professional organization is Österreichische Ärztekammer, Weihburggasse 10-12, 1010 Wien, Phone: +43 1 51406-3000. Fax: +43 1 51406-3042. E-mail: post@aerztekammer.at. Medical profession recognition for EU, EEA and Switzerland citizens A doctor, citizen of amemeber state of EU, European Economic Area (EEA) or Switzerland, can apply for the practicing the profession in Austria. Requirements for application: the proof of their nationality, the attestation of the right to practice the specific profession in his state of origin, the proof of good behaviour, financial solvability and non-violation of the professional ethics code issued by the competent authority in his state of origin.

3.6 Recognition of the medical qualification in United Kingdom In United Kingdom, the access to regulated professions that benefit of automatic recognition of professional qualifications acquired in the other member states of the European Union is made according to the stipulations of Directive 2005/36/EC of the European Parliament and the Council on the recognition of the professional qualifications. For having the professional qualification for doctor recognized, the citizen of an European Union member state must submit a demand for registration to the Immigrants Registration Council. The

application

can

submitted

online

(https://applicants.arb.org.uk/Login.aspx?status=n&formtype=eu) or by mail at the address: UK Qualifications, 8 Weymouth Street, London, W1W 5BU, T: 020 7580 5861 F: 020 7436 5269 E: info@arb.org.uk W: www.arb.org.uk.

For

the

applications

sent

mail,

the

form

can

downloaded

from:

http://www.arb.org.uk/Upload/40127-ARB-Form-K-Euorpean-PR.pdf. Temporary services provision in a regulated domain For temporary services provision, it is required that the applicant normally practice their activity on another European Union member state`s territory, to have a qualification that allows him the practice of the regulated profession in the state of origin and not to have been forbidden the right of practice by the authorities of that state. The temporary provision of the services is possible after notifying the competent authorities from United Kingdom. In some situations, the presentation of some documents regarding the practice of the profession in the state of origin, an aptitude test or a short adjustment period could be necessary. 46

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During the services provision, the use of the existent professional title in the United Kingdom and the compliance with the professional regulations imposed by the competent professional authority are mandatory. The application needs to be accompanied by a copy of the identity card, official address of the office where he practices the profession, the proof of the qualifications – university diplomas, the declaration issued by the competent authority from the state of origin that certifies the qualification, the nationality proof, copy of the marriage certificate if the name was changed and the proof of registration and application fees payment.

3.7 Recognition of the medical qualification in Denmark The competent authority for the recognition of the doctor qualification is Sundhedsstyrelsen (National Board of Health) – the Danish equivalent for the Ministry of Health. Address: Axel Heides Gade 1 | 2300 Copenhagen S, Denmark | Phone +45 72 22 74 00 | sst@sst.dk, Danish Agency for Universities and Internationalisation, (+45) 33 95 12 00, or write to kontaktpunkt@ui.dk. Further information can be accessed via http://www.sst.dk/English/Education_ and_authorization /Nurse.aspx. An authorisation or similar recognition is needed from the danish competent authority. In case of temporary provision of service on danish teritorry, the EU, EEA citizens must submit only a declaration. Professional recognition for EU, Island, Norway, Lichtenstein and Switzerland citizens. If the applicant is a citizen of one of these states and completely graduated studies in one of these states and has the right of practicing the profession in the respective state, he has to apply for authorization or similar recognition at Physicians Association in Denmark. The physician provides the service under the professional title from his state of origin. The Danish title can be used only if the applicant’s professional qualification has been verified and recognized in Denmark. 3.8 Recognition of the medical qualification in Holland The Foundation for Cooperation on Vocational Education, Training and the Labor Market (S-BB) and Holland Organization for International Cooperation in Higher Education, in Hague (NUFFIC) are two Dutch recognition centers of qualifications acquired in other states, depending on the qualification type: NUFFIC (Hague), for the recognition of higher education diplomas and of general pre-university education, namely S-BB (in Zoetermeer), for the recognition of qualifications obtained in the EFP system. All the necessary information for the recognition of a qualification acquired outside Holland can be obtained from the website http://www.idw.nl/start.html. If the practice of a regulated profession in Holland is wanted, the first step is checking if the profession is framed as regulated or not on the website http://www.Professionalrecognition.nl; if the profession is regulated, the organization with the role of competent authority that manages the recognition process must be identified. From the perspective of access to practice, in Holland the professions can be classified in two big categories: regulated and unregulated professions. Regarding the unregulated professions, for the legal pursuit 47

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of the respective profession it is not necessary to obtain the recognition of the professional qualification from a competent authority from Holland in case the title was obtained in another member state. NUFFIC also has the NARIC role in Holland, therefore provides assistance both to the applicants for higher education qualifications recognition (workers, employers), and also to the competent authorities for the regulated professions, and also provides information concerning the stipulations of the Directive 2005/36/EC of the European Parliament and Council on the professional qualifications recognition. Qualification recognition is made in a separate department of S-BB, which is financed by the Ministry of Education. Usually, the recognition process can last up to 4 months.

3.9 Recognition of the medical qualification in Germany The qualification recognition for foreigners in Germany is made differently for access to education and profession pursuit. The national competent authority is Bundesministerium für Wirtschaft, Familie und Jugend – The Federal Ministry of Economy, Family and Youth. Address Glinkastraße 24, 10117 Berlin, Postadresse 11018 Berlin. E-Mail: info@bmfsfjservice.bund.de, Amtsanschluss (030) 20655 – 0, IVBB (03018) 555 – 0, Telefax (03018) 555 – 4400. The national coordination of professional recognition activities is governed by “The Law of recognition”. The recognition of the doctor profession in Germany is regulated by the land legislation, through the relevant professional chambers from the states (land). For the recognition of professional qualifications acquired abroad, only in 2012 was adopted in Germany “The Act of Recognition”, also known as the “Law for improving the evaluation/analysis and foreign professional qualifications recognition”; it regulates the foreign qualifications recognition for professions for which the federal government is responsible. “The Law of Recognition” combines a new federal act, “The Law of professional qualifications determination” – BQFG (BMBF’s responsibility), with modifications made on the existent legislation and the professional regulations (governmental departments that are responsible in the respective domains). The Law regarding the evaluation and recognition of professional qualifications (BQFG – Article 1 from the Law of Recognition) is a federal law from the new competency sphere of the Federal Ministry of Education and Research. It stipulates the procedures and evaluation criteria for the equivalence of the foreign professional qualifications with the ones of the German reference profession, through which the integration of qualified immigrants and foreign workers is supported on the German labor market. Starting with 1st of April of 2012, the possibility of having the foreign professional qualifications recognized in Germany was significantly improved. The act approved by the Federal Government on the recognition of diplomas inserts the legal right of having qualifications obtained abroad, evaluated in comparison with the equivalent from Germany, thus improving the opportunities for individuals that obtained professional qualifications abroad to practice the acquired professions in Germany. This act contains simplified and improved extensive procedures for the 48

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evaluation of the foreign vocational qualifications that are in Federal Government`s responsibility. This act does not, however, regulate those professions for which the regions are responsible.

IV. Practicing the Medical Profession in the European Union It must be emphasized that the “reserved” activities are only one aspect of market access barriers. Examples of signifiant restrictions on the market entry are: • rules on the duration of the applicant's practice - for example, a minimum number of years of experience; • restrictions on the total number of available education and training places; • requirements to obtain certificates or licenses, such as compulsory apprenticeship or a minimum period of work experience, • quantitative and limitative restrictions regarding the number of the new entrants to the labor market per year. In its conclusions from 10 March 2011, the EU Council recognized as unjustified the requirements which reserve the access to certain activities for service providers who hold special qualifications. All these may be the major obstacles to the efficient functioning of the single market and the Commission's intention to further evaluate this issue was welcomed. Related to these mentions, however, the competent authority of the member state in which the applicant wishes to pursue a professional activity can request:  a certificate of „conformity”: issued by the member state of origin, certifying the conformity with the qualifications set out in the Directive 2005/36/EC of the European Parliament and Council on the recognition of professional qualifications;  a certificate of name change, if the name of the qualification that meets the minimum training requirements does not match the name of the corresponding Annex in the Directive 2005/36/EC on the recognition of professional qualifications of the European Parliament and Council. The physicians which are not the citizens of a member state of EU, European Economic Area or Switzerland, established in one of these states but having the right to practice the profession in the resident country, can pursue the specific profession on the Romanian territory only occasionally, on the basis of the approval of the Ministry of Public Health and the validation issued by the Romanian Physicians’ College (RPC). The applicants from this category will pursue medical activities exclusively in a medical unit or in a medical education institution for teaching purposes and only during the approved timeframe.

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Throughout the profession pursuit, the physician is committed to respect the Ethics code of the profession

doctor

detailed

http://www.oar.org.ro/upload/2012/

Codul_deontologic_al_profesiei_de_medic.doc [25]. The doctor profession is practiced in one of the member states of the European Union only by the members of the corresponding professional organizations in Romania, example: IPASVI in Italy, NMC in United Kingdom, SAK in Norway. The Romanian Government, at the initiative of the Ministry of Education and Research, approved the Law number 260/2005, for the approval of the Government Emergency Ordinance number 102/2005 regarding the free movement on Romania`s territory for the citizens of the member states of European Union and European Economic Area, published in Official Monitor number 900 from 7th of October 2005 [13]. The occupations corresponding to the physician qualification are regulated and stipulated in the OCR 2013 (Occupations Code from Romania), basic group 222, associated to Major group 2 – Professionals. Skill level: 4 (higher education). Professionals increase the existing stock of knowledge, apply scientific or artistic concepts and theories, teach about the foregoing in a systematic manner, or engage in any combination of these activities. The professional levels differentiate: 222102 resident physician, 222103 specialist, 222108 primary care physician. The activity of the physician is regulated through Law number 306/2004 regarding the pursuit of the medical practice and the appointment, organization and operation of the Romanian College of Physicians, with the subsequent modificationsand additions [9]. In Italy, the certified applicant must enroll in the professional association in the province in which he wants to pursue the profession and obey to the specific rules and code of ethics. In Italy there is the National Federation of Italian Professional Physicians Colleges (FNOMCeO). Address: Via Agostino Depretis 70, 00184 Rome, Tel: 0039.0646200101, Fax: 0039.0646200131, Web: www.ipasvi.it In Spain, the accreditation and the certification for the access to the profession of physician is issued by the Spanish Ministry of Health (MoH) correlated with REAL DECRETO 1837/2008, de 8 de noviembre, por el que se incorporan al ordenamiento jurídico español la Directiva 2005/36/EC, del Parlamento Europeo y del Consejo, de 7 de septiembre de 2005, y la Directiva 2006/100/CE, del Consejo, de 20 de noviembre de 2006, relativas al reconocimiento de cualificaciones profesionales, así como a determinados aspectos del ejercicio de la profesión de abogado. BOE núm. 280, 46185-46320. The academic recognition, allows the continuation of studies, on a different educational level and is the competence of the Spanish Ministry of Health. The Royal Decree 1837/2008 presents in Annex VIII (Appendix L11a_2) the alphabetical list of the professions and the activities grouped, according to the existing training in Spain to access the profession, in correlation with the levels described in Article 19 (Article 11 of Directive 2005 / 36/EC on the recognition of professional qualifications). 50

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The Spanish General Secretariat of the Ministry of Labor and Immigration has issued new clarifying guidance regarding the SGIE/1/2012 Norm, referring to the enforcement regime of the Romanian workers and the members of their families, following the complaints of the Romanian authorities in the working group between the Romanian Ministry of work and the Spanish one, relating to the uncertainties of the measure of labor market restrictions for the Romanian citizens in Spain, a measure that was imposed on 22 July 2011. The modifications of these instructions improve the situation for a wide range of Romanian workers meaning that: - there is no longer the need of a commitment for the Romanians to return to the country of origin at the end of a fixed term employment contract; - It clearly states the status of family members (husband / wife / children under 21 or dependent) of the Romanian workers, both for those who already have the right to work and for those who must obtain in advance by the employer a work permit; - family members, whatever their nationality is (husband, wife and children up to 21 years or dependents), are treated under the EU legislation applicable to EU citizens, and not as Romanians undertaken to the restrictions required from the 22nd of July 2011. With these new instructions, it is being derogated from both the DGI/SGRJ/5/2011 instructions, as from the Addendum from September 16, 2011. The professional practice takes placed under the conditions of free competition and is the subject of the Law on Protection of Competition and Unfair Competition Law, concerning the delivery of service and the determination of its remuneration. Other aspects of professional practice are regulated by the College of Physicians to which the applicant is registered. In the Czech Republic, after graduating the certification exam, the physician takes an oath. After the recognition, the physician obtains the license / certificate and will have to pay an annual fee to the territorial professional association. He will enjoy the same labor rights as any Czech physician. In Denmark, the competent authority in certifying the doctor profession is Sundhedsstyrelsen (National Board of Health) â&#x20AC;&#x201C; the Danish equivalent for the Ministry of Health. The professional practice takes place under the conditions of free competition and it is the subject to the Law on Protection of Competition and Unfair Competition Law, regarding the provision of services and determination of their remuneration. In Holland, the doctor profession is regulated. The BIG registry works, with particularly severe internal rules and regulations regarding the access and the practice of the medical profession. The BIG registry is a database with information about all the health care staff. Eight specific healthcare professions have a central official registry. It creates psychological effect among the patients and protects patients against improper treatment by healthcare provider. BIG registration is mandatory, in order to practice any medical profession. The inclusion in the BIG registry is the subject of certain conditions, depending on the country in which the 51

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diploma or other qualifications were obtained. The refusal to subscribe into the BIG registry is being severely sanctioned. In Germany, the citizens of the EU member states may apply for a job and be employed only if they have EU work permit issued by Bundesagentur fur Arbeit (Federal Employment Agency). EU citizens have the unconditional right of residence, under the Community law. The conditions under which a work permit can be issued, according to the provisions of Section 284 and following from the 3rd volume of Sozialgesetzbuch (Code of Social Law), and additional provisions: Anwebestoppausnahmeverordung (Regulation on exemptions from the prohibition of recruitment), which can be found in Circular 7, on the employment of foreign workers in Germany,

and

information

can

found

at:

www.

Arbeitagentur.de/

ServicevonAbisZ/Auslanderbeschaftigung. When a contender for the job identified an employer, he must submit to the Agentur für Arbeit (employment agency) of the local employer to require a work permit. More information regarding the procedure on obtaining a work permit can be found at www. Arbeitagentur.de/Service A-Z /Vermitttlung/ Auslanderbeschaftigung Zentralstelle fur Arbeitvermittlung (Placement office) (ZAV) in Bonn, Villemombler Strasse, 75, tel. + 49228713-0. The EURES advisers are connected to EURES network, for information. ZAV can also be accessed at www.arbeitagentur.de/Ihre Agentur fur Arbeit/Besondere Dienststellen /Zentralstelle fur Arbeitsvermittlung (www.arbeitagentur.de). In the countries mentioned above, a largely self-regulatory approach is applied to regulate the profession of medical practitioner, with an emphasis on promoting high professional standards, through the involvement of professional organizations (which provide training and can develop codes of practice). In addition, detailed rules also helps to regulate the market, such as the rules and regulations associated with health standards, health and safety laws and regulations relating to the training and professional evaluation. An important role in the accurate and consistent exercise of any profession is the motivation for choosing the profession. It is noted that much of the medical practitioners keep the traditional motivation in choosing this profession: altruism, the desire to help their peers: 53% of the respondents said that they chose this profession because of the desire to help people in distress, 28% because they like this domain and 19% to follow their vocation. The economic and social conditions, the lack of incentives for choosing a medical career and the prolonged crisis of the health system determined the orientation of young people to this profession because of pragmatic reasons: the advice of the family members, the hope of a safe workplace or the possibility of an independent professional activity. The relatively high percentage of non-responses – 18%, as well as respondents who cited other reasons – 10% show indecision in choosing a profession, the lack of information when choosing a profession, the exploitation of opportunities for obtaining qualifications, manipulation in career choice.

V. Conclusions 52

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The guide covers aspects of validation / certification of skills, recognition and pursuit of the medical profession comparing EU countries, namely Austria, Czech Republic, Denmark, Germany, Italy, United Kingdom, Holland, Spain. Freedom of movement and the mutual recognition of professional title of physician are based on the fundamental principle of automatic recognition of qualifications, on the basis of coordination of minimum training conditions. Minimum training conditions for the medical profession are harmonized at European level, making part of the sectoral professions. Toate EU member states recognize the qualification of doctor for all citizens who meet the minimum training conditions. Creating a guide for the certification and recognition of medical qualifications primarily aims to be a useful tool to inform people who may be in one of the following situations: -

aims to follow a professional training program in one of the analyzed countries at the end of

which it will practice a profession; -

has appropriate qualifications and wishes to have them recognized and pursue in the analyzed

countries similar or compatible professions permanently, temporarily; -

after the recognition in one of the surveyed countries, the applicant wishes to know more on the

regulations regarding the practice of profession and continuing training obligations, conduct and professional ethics in the field, membership in certain professional organizations, etc. The guide also aims to support the competent authorities in Romania in their efforts to standardize the certification and recognition processes for the regulated professions they manage by informing them about the practices of other EU member states. There are significant differences between EU member states on job tasks that can be performed by a doctor on a regulated domestic market, being the reservation of activities, reservation of professional title or an open mechanism. If the applicant has obtained medical qualifications prior to the reference date in Annex V to Directive on the recognition of professional qualifications 2005/36/EC, of the European Parliament and of the Council, and the qualification does not meet the minimum required training conditions or in other specific situations from the Directive, a certificate may be requested from the home member state on the actual and lawful pursuit of the profession, applying appropriate compensatory measures. Member States may require applicants attending a preparatory and / or a period of work experience, with periodic evaluations. It highlights any codes of ethics and professional conduct, career development terms, the organization of continue training, etc. The creation, at European level, of professional cards by professional associations or organizations could facilitate the mobility of professionals, in particular by speeding up the exchange of information between the host member state and the member state of origin. 53

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Bibliography 1.Act no. 18/2004 Coll., On the Recognition of Professional Qualification and Other Eligibility of Citizens of Member States of the European Union and Some Citizens of Other States and on the Amendment of Certain Acts (Act on Recognition of Professional Qualifications), which was amended by Act No.189/2008 Coll, Czech Republic. 2.Act no. 224/2003 Coll., Trade licensing act, 2 oct. 1991. Federal Assembly of the Czech and Slovak Federative Republic 3. Legislative Decree no. 206 of November 6, 2007 – “Attuazione della direttiva 2005/36/EC relativa al riconoscimento delle qualifiche

professionali,

nonche'

della

direttiva

2006/100/CE

che

adegua

determinate direttive sulla libera circolazione delle persone a seguito dell'adesione di Bulgaria e Romania”, Italia. 4. Presidential Decree. 107 of 10 June 2002, transposed into Law 173 of August 1, 2002, concerning the "Urgent provisions on access to regulated professions." 5. Law 222/2010 – for modification of annex no. 2 şi 3 to the Law no. 200/2004 on the recognition of diplomas and professional qualifications for the regulated professions in Romania 22nd of November 2010 Official Gazette 775/2010 6. Directive

2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the

recognition of professional qualifications, published in the Official Journal of the European Union series L, nr. 255 of 30th September 2005. 7. Gesetz

über

die

Feststellung

Berufs-qualifikationsfeststellungsgesetz-BQFG)

der

Gleichwertigkeit von Berufsqualifikationen; http://www.gesetze-im-

internet.de/bundesrecht/

bqfg/gesamt.pdf. 8. HG number 932 from 1st of September 2010 for Methodological Norms of application of Law number 184/2001 regarding the organization and medical practitioner pursuit 9. Law nr. 306/2004 regarding the pursuit of the medical practice and the appointment, organization and operation of the Romanian College of Physicians, with subsequent amendments and additions, published in Official Gazette. nr. 578/30th June 2004. 10. HG nr. 1282 of 17th October 2007 approving the rules on the recognition of diplomas, certificates and titles of doctor, physician, pharmacist, nurse and midwife, issued by a member state of the European Union, the European Economic Area state or Switzerland. Published in the Official Gazette, Part I no. 733 of 30th October 2007. 54

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11. Regulation of organization and functioning of the Romanian College of Physicians. Adopted by the General Assembly of the Romanian College of Physicians in the meeting of 21.07.2000 and amended at the meeting on 11.05.2001. 12. Law no. 260/2005 for the approval of Government Emergency Ordinance no. 102/2005 on the free movement of citizens of member states of the European Union and European Economic Area, published in Official Gazette no. 900 of 7 October 2005 13. Navarro-Astor E.and Caven V. (2012) Medics in Spain: A profession under risk In: Smith, S.D (Ed) Procs 28th Annual ARCOM Conference, 3-5 September 2012, Edinburgh, UK, Association of Researchers in Construction Management, 577-587. 14. Presidenza del Consiglio dei Ministri, Dipartimento per l’Informazione e l’Editoria - Guida All’Utente, Direttiva 2005/36/EC relativa al riconoscimento delle qualifiche professionali 15. Real Decreto 1837/2008, de 8 de noviembre, por el que se incorporan al ordenamiento jurídico español la Directiva 2005/36/EC, del Parlamento Europeo y del Consejo, de 7 de septiembre de 2005, y la Directiva 2006/100/CE, del Consejo, de 20 de noviembre de 2006, relativas al reconocimiento de cualificaciones profesionales, así como a determinados aspectos del ejercicio de la profesión de abogado. BOE núm. 280,46185-46320. 16. Real Decreto regulador de las facultades profesionales de los Decoradores. «BOE» núm. 105, de 3 de Vo de 1977, páginas 9527 a 9527 (1 pág.) 17. Law no. 189/2008 on amending the law on recognition of vocational qualifications in the Czech Republic. 18.Presidenza del Consiglio dei Ministri, DIPARTIMENTO PER L’INFORMAZIONE E L’EDITORIA GUIDA ALL’UTENTE, Direttiva 2005/36/ECE relativa al riconoscimento delle qualifiche professionali, 19, 19.Romulus BENA, Presentation of SOLVIT at the conference to promote IMI PQ NET Romania, 20 September, Neptune, 2012. 20.Study to provide an Inventory of Reserves of Activities linked to professional qualifications requirements in 13 EU Member States & assessing their economic impact, Final Report 2012, Centre for Strategy & Evaluation Services, for the European Commission’s DG Internal Market and Services (DG MARKT), 2012. 21. The Medicural Profession in Europe - A Sector Study Commissioned by the Medics’ Council of Europe, 18 XII 2008 22.The Medicural Profession in Europe 2012 - A Sector Study Commissioned by the Medics’ Council of Europe, XII 2012, http://oar-iasi.ro/wp-content/uploads/ 2013/03/Sector_Study_2012_Final_EN140213.pdf. The new Recognition Act, Germany 23.Țigănaș Ș. , On the edge of the third study Sectoral Council of European Dentists, Zeppelin magazine, nr. 111, feb. 2012, http://www.e-zeppelin.ro/revista.php?id=239.

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24.User guide Directive 2005/36/EC, Everything you need to know about the recognition of professional qualifications, 66 Questions, 66 Answers. 25. Code of Medical Deontology, 30 March 2012 Romanian College of Physicians. Published in the Official Gazette, Part I no. 298 of May 7, 2012. 26. Communication from the Commission — Notification of evidence of formal qualifications — Directive 2005/36/EC on recognition of professional qualifications (Annex V). (Text with EEA relevance). (2013/C 183/02). Official Journal of the European Union, 28 iuny, 2013. 27. Proc. of Joint EFTA/Eurostat/UNECE Seminar on „Global Assessment of National Statistical Systems. 2527 june, Alushta, Crimea.