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Ophthalmologists could lose their role in determining the future of medical training in Europe under a new European Union plan.
The plan, drafted by the European Commission as a proposed "Directive on the Recognition of Professional Qualifications," would scupper the prestigious Advisory Committee on Medical Training (ACMT). The ACMT is the group through which ophthalmologists and all other European doctors help shape, update and harmonise requirements for medical education and training throughout the EU.
The doctor-dominated ACMT has advised the European Commission on medical education and training requirements for general practitioners and specialists - including ophthalmologists - since its inception in 1975.

ACMT's days numbered?
Now it appears that the days of the Committee are numbered.
Under the proposed Directive, a new committee will replace the ACMT. That new committee will have only one representative from each country. That single representative, who probably won't be a physician, will not only advise the Commission on the training of doctors but also on the training of nurses, veterinarians, architects, dentists and pharmacists.
The plan to do away with the ACMT and replace it with the monolithic committee for all professions follows an EU initiative to streamline EU policy-making procedures to save money and to prepare for the enlargement of the EU. The Commission initiative is known as Simple Legislation Internal Market, or SLIM for short.
While admitting that the ACMT could be improved, doing away with the committee entirely makes little sense, according to Cillian Twomey MD, an Irish geriatrician who serves as President of the European Union of Medical Specialists.
Proposal would downgrade doctors' role
"I don't mind if they get rid of the ACMT if they replace it with something that is more efficient," Dr Twomey says. "But this proposal represents a significant downgrading of the involvement of doctors."
The UEMS, which is the officially recognised lobbying group for medical specialists in the European Union, has joined with its counterpart lobbying groups for general practitioners and residents to oppose the elimination of the ACMT.
Dr Twomey notes that the European Commission has effectively downgraded the work of the ACMT over the last three years. Over that period, the Commission has allocated only enough money to the committee to pay for one meeting - in February of 1999.
ACMT is lone "statutory" advisor
Under current law, the ACMT is the only advisory committee to the European

Commission on medical training matters.
Doctors are not alone in their opposition to the new proposal. Sidney Allman, a Brussels-based consultant with long-experience in advising doctors, nurses, and veterinarians on EU affairs, says the proposed directive would be a disaster for all professions.
"The new committee is based on the idea that there is an expert in veterinary medicine, architecture, dentistry, pharmacy, medicine, midwifery and nursing in every country - and that's a nonsense," he says. "These are all very complicated areas and to appoint one representative for all of these professions with a stroke of a pen is crazy."
In addition to the scrapping of the ACMT, there are also other parts of the proposal that worry Dr Twomey.

More certification for some specialists
Dr Twomey notes that under the terms of the proposal, doctors who practice a specialty that is not recognised in all 15 EU countries will be forced to apply for special recognition if they want to practice in a country that does not recognise that specialty.
Under current EU law, any doctor who practices a specialty recognised by at least two EU countries has a right to practice that specialty in any EU country - without having to apply for any special certification.
Because ophthalmology is recognised as a specialty by all EU countries, the new rules about recognition will not affect the specialty. However, the proposed directive will affect a number of specialties with an ophthalmology component - such as tropical medicine, geriatrics, and accident and emergency medicine - because they are not recognised in all 15 states.
Dr Twomey predicts that the new certification requirement would burden medical regulators in every country as they review applications from such specialists on a case-by-case basis.
The terms of the proposed directive are far from permanent. Under EU law-making procedure, the European Parliament and the Council of Ministers will be able to amend the proposed directive before voting to accept or reject it.
Physicians must complain quickly and loudly
Against such a political backdrop, Dr Twomey believes that doctors may still be able to retain some say in medical training - if they act quickly. He notes that national and specialist medical associations throughout Europe should lobby their national politicians; the commissioner directly responsible for the internal market, Frits Bolkestein; and also the commissioner responsible for health and consumer protection, David Byrne.
"If we look at this proposal in terms of health and consumer protection, quality medical training produces quality doctors," Dr Twomey asserts. "It's a part of the remit of the commissioner of health and consumer affairs that the Commission should guarantee the quality of medical care."
And a major part of guaranteeing that quality should rest with the medical profession through a legally recognised, doctor-led, advisory committee, Dr Twomey asserts. "And that committee needs to be there as a legal right rather than as a gift of the commission."

For a copy of the proposed Directive on the Recognition of Professional Qualifications in English see: www.europa.eu.int/cgi

European terminology at a glance

European Commission -
This European Union institution initiates and monitors compliance with EU legislation. The Commission, which is based in Brussels, is composed of 20 Commissioners. France, Germany, Britain, Spain and Italy each appoint two commissioners. The other 10 smaller EU countries appoint one Commissioner each. Once appointed, commissioners take responsibility for a particular portfolio. Commissioner Frits Bolkestein, who heads the internal market portfolio within the Commission, is in charge of the proposed Directive on the Recognition of Professional Qualifications, which would amalgamate into one law existing EU laws about the recognition of qualifications of doctors, nurses, midwives, pharmacists, dentists, architects and veterinarians. Because the Commission proposal is in the form of a directive, the European Parliament and Council of Ministers must also consider it before the proposal takes effect. The European Parliament will have a chance to amend and vote on the directive before it reaches the Council of Ministers, where government representatives of the 15 EU states have the final chance to amend the proposal before voting to adopt or reject it.

Directive -
This is a type of European law that is enacted by the European Union collectively; however a directive does not take effect immediately. Rather, individual countries enact their own laws to meet the objectives of the directive before a certain EU-imposed deadline. As a result, a directive can take effect in one country years before it takes effect in another country.

Advisory Committee on Medical Training -
This Committee was established by European Union law in 1975, just after the EU enacted two directives to guarantee freedom of movement within the EU for doctors by providing for the mutual recognition of medical education, training and qualifications among all EU countries. The committee was established to advise the European Commission about how best to insure that doctors could provide medical services unhindered throughout the EU area while at the same time ensuring the quality of general and specialist care. Some 45 persons, three from each of the 15 member EU states, comprise the ACMT. Among the three representatives: the first represents the interests of the country's practicing doctors; the second represents the interests of the country's medical schools and training programs; and the third represents the interests of the country's medical licensing and disciplinary body.

European Union of Medical Specialties -
This group, commonly known by its French acronym - UEMS - is the main European Union lobbying group for medical specialists. The UEMS has 36 sections, including one for ophthalmology. Based on the advice of its sections, the UEMS advises the umbrella lobbying group for European Union physicians, the Standing Committee of European Doctors. The Standing Committee in turn advises the Advisory Committee of Medical Training. By law, the ACMT then has the remit to advise the Commission about regulating medical education, training, specialty recognition and regulation. After receiving such advice, the Commission then initiates proposals for new European laws.

If you would like to read previous "Regulatory Matters" columns, check out the archive.

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