February 5, 1999

The directors of the American Board of Psychiatry and Neurology (ABPN) have voted to rescind temporarily their decision to prohibit Canadian psychiatry training graduates from sitting for ABPN certification examinations. The vote by the ABPN leaders, which was urged by APA and the Canadian Psychiatric Association (CPA), was taken last November and calls for a suspension of the ban until June 30, 2001.

The Chicago-based organization that certifies psychiatrists decided to limit its certification process to psychiatrists who had graduated from residency training programs that have been approved by the Accreditation Council for Graduate Medical Education (ACGME), all of which are in the United States.

ABPN officials had decided to take this action in part because they were concerned that Canadian provinces, which are responsible for establishing physician licensure requirements, had adopted different licensure standards. Also, none of the provinces was issuing medical graduates unlimited licenses to practice medicine, a requirement the ABPN insists on before candidates can sit for its certifying examinations. In the United States, all of the states grant physicians who meet licensing requirements unlimited licenses to practice.

ABPN directors also decided about five years ago that it was discriminatory to continue certifying Canadian psychiatrists after they had already stopped doing so for psychiatrists in other English-speaking countries.

"Despite good cross-border relationships with Canadian psychiatrists, we realized there was no good justification for continuing to give special treatment to psychiatrists from only one other country," said ABPN Executive Vice President Stephen Scheiber, M.D. "We were unable to devise a Solomonic solution, so the board voted to end the special treatment."

An additional reason the decision was made was that training sequences in Canadian residency programs have moved away from certain requirements set by the Residency Review Committee in Psychiatry. In several Canadian programs, for example, the Residency Review Committee's requirement that PGY-1 physicians go through a primary care rotation is absent.

The decision by the ABPN did not sit well with either Canadian or U.S. psychiatric organizations. "APA was distressed to learn that our Canadian members might no longer be eligible to sit for the ABPN exams," APA Deputy Medical Director James Thompson, M.D., told Psychiatric News. "Canadian psychiatrists have been an important segment of APA membership for many years."

The ABPN's planned certification restrictions "made Canadian members appear to be more different from U.S. psychiatrists than they really are. Canadian training programs are of excellent quality, and there has long been a close relationship between U.S. and Canadian programs," added Thompson, who heads APA's Office of Education.

CPA President Nady El-Guebaly, M.D., said that Canadian psychiatrists were "surprised and very concerned" when they learned of the ABPN prohibition, but characterized the temporary rescission as "a giant step in the right direction."

The ABPN is encouraging APA, the American Medical Association, American Neurological Association, and Royal College of Physicians and Surgeons of Canada to use the temorary rescission period to arrive at a consensus on a system through which the U.S. and Canadian accrediting organizations can jointly accredit Canadian psychiatry training programs.

In a December 21, 1998, letter to ABPN's Scheiber, APA Medical Director Steven Mirin, M.D., pledged that APA "will work closely with our Canadian colleagues to help achieve a method of joint accreditation" that will allow the ABPN to continue permitting Canadian psychiatrists to sit for its certification examinations.

El-Guebaly said that the CPA "is looking forward to being part of the discussions" about the development of a system that would keep the option of ABPN certification open to Canadian psychiatrists.

Thompson described ABPN's vote to review its certification decision as "another example of how the close relationship between APA and ABPN has contributed to an outcome we see as very positive."

Scheiber told Psychiatric News, however, that "it is very hard to predict" whether the groups representing different constituencies will succeed in agreeing on a certification plan acceptable to all parties.

APA has 1,339 Canadian members, including MITs, while 2,750 psychiatrists belong to the CPA. -K.H.