Medical Education in the European Communities: Moving toward 1993 and beyond

In 1985, at the request of the Council of Ministers, the EC Commission published its White Paper on the creation of the Single Market, setting forth proposals for 325 directives judged necessary to achieve the free movement of goods, persons and services by 31 December 1992, the date adopted by the Single European Act which came into force in 1987. Of these 325 directives, more than half of which have now been adopted or submitted, it is estimated that about 75 are concerned with health and social matters, although these are not matters which could be considered of central organisational concern for the health care systems of the Member States. About another 75 of the directives are of some interest for the public health sector e.g. tax on medicines and medical appliances, sanitary affairs in the veterinary and agricultural sectors and some educational matters although again these are hardly matters of direct central concern for the field of medical education. Nevertheless, other activities being undertaken within the Community, and the very fact that some of the directives proposed in the White Paper do have relevance for health and social affairs, seem to indicate that the original view that health care did not fall within the terms of reference of the Rome Treaty and that such matters were left exclusively to the individual Member States was too narrow a view. In any event, the White Paper does not contain guidelines of direct relevance for patient care or health care personnel except, of course, with regard to the directives already adopted prior to 1985. One thing is clear: we see today an enormous amount of discussion being generated as to what relevance the Single Market might have for the field of health care and for contingent matters such as education in the medical and health professions. We see major conferences such as that initiated by Erasmus University in Rotterdam in October 1989 [1] which, although it does not include the topic of medical education on its programme, does include numerous other matters that may have repercussions for medical education. In many of the European medical groupings, we see actions to set up working parties to study the possible effects of the Single Market on the medical profession and medical education. Perhaps even more interesting, we hear an increasing amount of legal discussion which would conceivably have far-reaching effects upon the delivery of health care and the structure of the health care services. And if such effects are felt, it would be highly unlikely that they did not have an impact on medical education as well.