It’s been two years since the Atlantic Registry launched in the Maritimes, allowing eligible physicians licensed in one of the four Atlantic provinces to opt-in and be licensed to practice in the other three.
The Registry was created with the intention of improving physician mobility, especially during workforce shortages. While it didn’t dramatically shift the number of practicing physicians or resolve systemic issues like staffing gaps or burnout, it did prove that collaboration among provincial regulators can pave the way for a smarter, faster regulatory system.
“The review was very positive in terms of showing how regulators can work together to reduce barriers and streamline a licensing process,” said Dr. George Carruthers, Registrar with the College of Physicians and Surgeons of PEI. “I think the Registry is a success, just not in the way people originally hoped.”
The Registry shows that even within existing legislation, four jurisdictions can create a unified licensing pathway – something long seen as difficult, if not impossible.
As of March 2025, 417 physicians were part of the Atlantic Registry. Of those, 35 physicians came to work in PEI through the Registry, and at least 20 of them were new to the province. Many worked as locums or visiting specialists, offering services both in-person and virtually.
For some physicians who regularly work in multiple provinces, the Registry is a game-changer. Dr. Jamie Johnstone, a Nova Scotia-based locum who frequently works in PEI, participants in the Registry and said the process is refreshingly smooth.
“I was a little skeptical at first. For so long, there have been many barriers to working in other jurisdictions and changes have been slow,” said Dr. Johnstone. “But the Atlantic Registry made it so much easier. The process is streamlined, eliminating the need for me to be run around for paperwork, constantly trying to obtain temporary licenses or worrying about when they expire.”
With a single $500 application, the Registry reduces both licensing costs and administrative burden, eliminating the need for repeat paperwork, multiple applications, and coordination with several licensing bodies, allowing physicians to focus more on patient care delivery and less on the bureaucracy.
“Before the Atlantic Registry, every time you wanted to be licensed in a new province, you had to request certificates of standing (professional conduct) from every jurisdiction you had worked in over the past five years,” Dr. Johnstone said. “Each of those documents could cost $100 to $150, and it was time-consuming – not just the cost, but coordinating everything. The Registry eliminated a lot of that.”
Despite these benefits, a recent independent review revealed the Registry’s limitations. It didn’t significantly improve access to care across the region, and the investment didn’t yield a strong return. Many physicians obtained licenses in provinces they never planned to practice in, creating unnecessary administrative work. In PEI alone, staff spent an estimated two hours processing each registration, totaling hundreds of hours that may not have led to actual patient care.
Physicians face hurdles beyond licensing, such as obtaining hospital privileges, billing numbers, and contracts – areas controlled by health authorities. Carruthers believes these bodies must modernize to streamline processes. Dr. Johnstone agrees, suggesting hospital privileges be granted for multiple locations through a single Registry application instead of working with each health authority separately.
“There are areas where improvements are needed. If I’m good enough to work in an Amherst, Nova Scotia hospital, for example, why do I need to prove my credentials and apply for privileges all over again in order to work in a PEI hospital?” he said. “I will say my experience with the Atlantic Registry makes me hopeful that it could be rolled out nationally, and even that the spirit of it could be applied to something like better interprovincial trade, which is a hot topic with all of the tariff changes lately.”
The Registry’s model is gaining international attention, and professionals outside medicine – engineers and other regulators – are studying how four provinces pulled it off.
While the current Atlantic Registry may not scale nationally, it’s laying the foundation for smarter, more flexible licensing systems in the future, like multi-jurisdictional licenses where physicians choose specific provinces to practice in.
For now, the Atlantic Registry serves as both a proof of concept and a lesson in expectations.
“Overall, we are pleased with what we discovered in working on the Atlantic Registry,” Carruthers said. “It didn’t solve the bigger healthcare issues or address the current crisis across the country, but it did show that collaboration, trust and change is possible. That’s a good first step.”
For more information on the Atlantic Registry, visit: https://www.cpspei.ca/atlantic-registry/