Career Focus

Certify a specialist

BMJ 1996; 313 doi: (Published 23 November 1996) Cite this as: BMJ 1996;313:S2-7068
  1. Stella Lowry
  1. BMA

    Legal challenges and European legislation have complicated specialist certification. Stella Lowry, head of the BMA's international department, guides you through the latest regulations

    Since January this year the way that medical specialist training is certified has changed to bring British systems into line with those elsewhere in Europe. The regulation which allows this mutual recognition of specialist qualifications from across the community is known as the European Specialist Medical Qualifications Order (1995). It established the Specialist Training Authority (STA) which will issue the certificates of completion of specialist training (CCSTs) that replace accreditation by the royal colleges.

    The duration of specialist training in most specialties in Britain has always been longer than the minimum duration required by the European directive/93/16/EEC. However, until January 1996 the General Medical Council issued a certificate of specialist training (CST) to doctors whose training met the minimum requirements of the directive. The CST was accepted by other European countries as evidence of specialist status, although it never conferred such rights on doctors in Britain. British doctors could obtain a CST and practise as specialists elsewhere in Europe at a stage in their training far short of that required for appointment as a consultant in the NHS. Many European doctors, particularly from countries with high medical unemployment, came to Britain to obtain training leading to the granting of a CST which then allowed them to return home and work as specialists.

    A guide to the jargon

    • CST: Now obsolete certificate of specialist training. Not the same thing as…

    • CCST: Certificate of completion of specialist training. British specialist qualification valid Europe wide, issued by…

    • STA: Specialist Training Authority. The great and the good of the profession: representing the royal colleges, postgraduate deans, the GMC, and lay members… oversees accreditation… but devolves standards for each specialty back to the colleges.

    • GMC: General Medical Council. Responsible for registration of doctors and their specialist status.

    Two tier system

    This meant that Britain was operating a two tier system, with a lower standard of training for those who wanted to work as specialists elsewhere than was required of those staying in Britain. The European Commission eventually threatened legal action which forced Britain to abandon these double standards. Since the introduction of the new regulations CSTs have not been issued and the only certificate issued is now the CCST

    The CCST will be the document required as evidence of specialist status when a doctor trained in Britain moves to another European country. It will also be the route by which most doctors can have their names entered on the specialist register in Britain. From 1 January 1997 a doctor's name must be on the specialist register before he or she is eligible for appointment as an NHS consultant. The transitional arrangements for existing specialists are summarised below. If you wish to check whether you are included on the specialist register ring the appropriate GMC division. Locum consultants will not necessarily be eligible unless they have also held a substantive post. Doctors who are EA nationals who have been accredited in another European country can write to the GMC enclosing their original certificates and their names will be included in the specialist register.

    Summary of specialist certification transitional arrangements

    View this table:

    Rapid transition

    The transition from CSTs to CCSTs was implemented rapidly and this has caused problems for some doctors. While the duration of training for most doctors wanting to work as specialists in Britain has effectively been reduced, those European doctors who came here to obtain a CST now face a longer than expected training before they can be granted a CCST. Many of them sought written advice about how to obtain a CST and planned their careers around the expectation that they could return home as specialists after a set date. Some currently hold job offers elsewhere in Europe which they will lose if they are required to extend their stay in Britain to complete CCST training. Many feel that this is inappropriate given that in many European countries the specialist certificate allows a doctor only to enter at the bottom of a specialist career structure working towards the most senior appointment which, they believe, is equivalent to that of an NHS consultant.

    For those who would be willing to remain in Britain to complete a prolonged training there can be further problems. Some doctors were advised that a CST could be granted without them passing college examinations. Such doctors may now find that membership of the appropriate royal college is a requirement for entry to the specialist registrar grade and that the years of specialist training they have done so far in Britain cannot count towards the requirements for a CCST.

    The BMA recently raised concerns about the effects of the rapid transition from CSTs to CCSTs. The STA has agreed to issue a letter confirming the training posts that a doctor has held and stating that these would previously have made the doctor eligible for a CST. This letter will be provided as a transitional arrangement only to doctors from other European countries who began training in Britain before the introduction of the new system. Registering authorities in other countries are not obliged to grant specialist status to doctors offering the STA letter, but the GMC and the STA will be urging them to treat applications sympathetically.

    European equivalents to the CCST

    Facharztdiploma (Austrian, competent authority)

    Titre D'agregation en qualite de medicin specialist/erkenningstitel van geneersheer specialist (Belgium minister for public health)

    Bevis for tilladelse til at betegne sig som speciallaege (Denmark, competent authority)

    Todistius erikoislaarkarin tutkinnosta/betyg over specialakareexamen (Finland, competent authority)

    Certificate d'etudes speciales de medecine (France, university)

    Facharzliche Anerkennung (Germany, Land chamber of physicians)

    Serfaedileyfi (Iceland, ministry of health)

    Diploma di medico specialiste (Luxembourg, minister for public health on advice of medical college)

    Getuigscrift van erkenning en enschrijving in het Specialistenregister (The Netherlands, commssion for the registration of specialists)

    Bevis for tillatelse til a benytte spesialisttelen (Norway, competent authorities)

    Grau de Asssistent, Titulo de Especialista (Portugal, Professional Association of Medical Practiitioners)

    Titulo de Especialista (Spain, Ministry of Education and Science)

    Bevis om specialiskompetens som lakare utfardat av Socialstyrelsen (Sweden, national Board of Health and Welfare)

    Individual assessment

    Doctors working abroad as specialists on the strength of a British CST cannot expect to be admitted to the specialist register if they decide to return to Britain. Time spent working independently as a specialist cannot be counted towards making up the shortfall between the training completed before the CST was granted and that required for the issue of a CCST. Some doctors will, however, have been working in junior specialist posts where there has been an element of supervised training. The STA will be willing to assess this on an individual basis, and such doctors should contact the STA for further information and advice.

    Doctors who completed their specialist training before the introduction of the CCST cannot be granted one retrospectively. If such doctors want to move to another European country they will have to ask the STA for a “certificate of equivalence” which will be accepted as evidence of specialist status throughout the community. NHS consultants are automatically entitled to entry to the United Kingdom specialist register, but those who have not been accredited by their royal college should not assume that they will be eligible for a certificate of equivalence if they want to move elsewhere. Each case will be assessed on its merits by the STA.

    Useful contacts

    MC Registration Division: 178 Great Portland Street, London W1N 6JE

    Registry inquiries 0171 915 3630 (to check whether a doctor is included on the Register) Helpline 0171 915 3638 Automated faxline 0171 915 3636

    Specialist Training Authority of the medical royal colleges: 1 Wimpole Street, London W1M 5AE.

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