g EU Acquis Procedures and Challenges Dr Jonas

g EU Acquis, Procedures and Challenges Dr. Jonas Bartlingas Head of Health Care Resources Management Division Ministry of Health, LITHUANIA Mutual Recognition of Qualifications for Medical Professions Five months of crossing Internal Market borders by health care professionals Polish-Dutch Twinning Project 22 nd September 2004, WARSAW

Implementation of EU Acquis into Lithuanian law • Republic of Lithuania implemented all obligations and transferred requirements of sector-based directives to Lithuania laws and legal acts: ü There were added/changed acts ü There were admitted acts on recognition EU diploma

Implementation of EU Acquis into Lithuanian law • Give great support: – European Commission and their experts – EU-Institution Building Twinning Programme (Project number: LT 2002. 0601/Ref. Number: LT 02/IB-SO-01 Employment and Social Policy, Free Movement of Workers) – Health ministry of Netherlands – Health ministry of Germany – Competent authorities of North Rhine–Westphalia (Germany), Sweden, Ireland, Norway, Netherlands

Implementation of EU Acquis into Lithuanian law • Improvement of programs on doctors, dentists, nurses, midwives, pharmacists professions training: • Most alteration was in training of doctors specialists

HARMONIZATION OF COORDINATION DIRECIVES: RESTRUCTURING OF DOCTORS’ TRAINING Tertiary residency: 1 -2 years / Sub-specialized clinical training in Gastroenterology, Gastroenterological surgery etc. Secondary residency: 2 -4 years / Family (general practice) medicine or specialized clinical training in Internal medicine, General surgery, Pediatrics etc. Primary residency: 1 year / General clinical training Basic medical education 6 years (education from 1952) University level Residency 3 -5 years / Specialized clinical training in different specialties Specific training in Family medicine 3 years Internship: 1 year / General clinical training Will be included Basic medical education 6 years University level

HARMONIZATION OF COORDINATION DIRECIVES: RESTRUCTURING OF DOCTORS’ TRAINING Surgery Internal medicine • Abdominal surgery • Allergology and clinical immunology • Vascular surgery; • Occupational medicine; • Neurosurgery; • Dermatovenerology; • Thoracic surgery; • Endocrinology; • Cardio-surgery; • Gastroenterology; • Urology; • Geriatrics; • Vascular surgery; • Hematology; • Plastic surgery • Infectious diseases; • Oro-maxillofacial surgery; • Cardiology; • Clinical toxicology; • Nephrology; • Onco-radiotherapy; • Pulmonology; • Rheumatology

Implementation of EU Acquis into Lithuanian law • Training programs of dentists, pharmacists, nurses, midwives were revised according to experts recommendations on requirements of directives: – Dentist’s professional title “stomatologas” to “odontologas” – Theoretical course in college study program of nurse is separated from practical training – Restart training of midwives after secondary education, also have 18 months training after graduated nurse

Recognition of EEA qualifications • The Ministry of Health is the competent authority in the Republic of Lithuania in relation to Community directives concerning health care specialists: doctors, dentists, nurses, midwives • The Pharmacy Department under the Ministry of Health is the competent authority in the Republic of Lithuania in relation to Community directives concerning pharmacists

Recognition of EEA qualifications In Lithuania the registration and licensing is one procedure which is done by one institution (under supervision of the Government): Ø Doctors and they specialization – the State Health Care Accreditation Agency under the Ministry of Health Ø Dentists and they specialization – Chamber of Odontology Ø Nurses, midwives – Ministry of Health Ø Pharmacists – Ministry of Health

Recognition of EEA qualifications Applicant Documents: Licensing institution License Competent authority ü ü ü Approximately 2 weeks Maximum 3 months ü An application Proof of identity Proof of qualification Proof of Physical and mental health Certificate of good standing Proof of previous diploma or certificate, which gives the right to exercise the profession State fee

Recognition of EEA qualifications (including third country qualifications recognized in other EEA countries) Language requirement No specific level of language skills is required to obtain license. It is the responsibility of the employer to assess that the specialists meet the requirements of the national acts that every specialist must practice in his field carefully and conscientiously. To comply with this provision, specialists are required to be capable of responsible communication with patients, relatives, other staff, licensing institution, etc.

After Accession: Certification of nationally acquired professional qualifications Dates of conformity Medicine Till 1950 study in medicine – 5 year, diploma, 1952 - 1992 – 6 year study From 1991 study program “comply” with directive 93/16/EEC, only one diploma From 1993 diploma with certificate accompanying qualification - “profesinės kvalifikacijos pažymėjimas” of “medicinos gydytojas” (1994) 1993 General practice (family medicine) Dates of conformity in specialized medicine differ according the specialization: 1994 Anesthesiology and reanimation, Ophthalmology, Otorhinolaryngology 1995 Gynecology-obstetrics 2005 Orthopaedics and traumatology, Physical medicine and rehabilitation, Clinical laboratory, Pathology 2006 Psychiatry, Radiology, Child and adolescent psychiatry

After Accession: Certification of nationally acquired professional qualifications Dates of conformity Internal medicine from 2007: 2006 Allergology and clinical immunology, Occupational medicine, Dermatovenerology, Endocrinology, Gastroenterology, Geriatrics, Hematology, Infectious diseases, Cardiology, Nephrology, Neurology, Pulmonology, Onco-radiotherapy, Rheumatology Or all diplomas in above mentioned specializations after qualified in internal medicine (program 2 years) General surgery from 2005 Neurosurgery, Urology, Abdominal surgery, Vascular surgery, Thoracic surgery, Children surgery, Plastic surgery from 2005 Or all diplomas in above mentioned specializations after qualified in general surgery (program 2 years)

After Accession: Certification of nationally acquired professional qualifications Dates of conformity Nurses – University diploma – College diploma from 2003 Midwives – College diploma from 2007 without nurse diploma – College diploma from 2005 with college nurse diploma

After Accession: Certification of nationally acquired professional qualifications Dates of conformity Dentists – University diploma, 5 year study – Comply with directive from 1991 – From 1993 diploma with certificate accompanying qualification - “profesinės kvalifikacijos pažymėjimas” of “bendrosios praktikos gydytojas stomatologas” (1994) Specialization in dentistry - from 2004 year are comply with directive

After Accession: Certification of nationally acquired professional qualifications Acquired rights: the certificates issued ü Certificate of good standing – about issued licence and its validity ü Certificate in accordance with Community Directive: ü Compliance to training standards laid down in Directive ü Acquire rights if not comply with training standards ü Acquire rights if study began before 1990 -03 -11

After Accession: Certification of nationally acquired professional qualifications Upsurge in migration In period May 1 st – 31 st August were issued certificates for 179 doctors, dentists, nurses, pharmacists: ü 123 doctors ü 28 dentists ü 20 nurses ü 8 pharmacists ü 70 of them left Lithuania before 1 st May