provider – not least a local doctor treating the insured – wants to deal with a senior medical practitioner. Ingle said: “Medical professionals have a different level of credibility and can communicate with other healthcare providers, since healthcare is a hierarchical industry. We have had cardiologists and oncologists on staff because they are better at talking to other physicians who are dealing with our patients or insurance.” Having the immediate assessment of medical treatment or a medical emergency, he suggested, helps assistance companies to move quickly in urgent cases.

Licensing requirements Aside from development, is it also necessary to be licensed and continue to practise medicine in a clinical setting in order to maintain skills? For Dr Patel, being a licensed doctor is ‘an absolute must’: “Being a practising physician in my opinion is important to maintaining clinical currency in an environment where changes in healthcare are happening at a rapid pace. Tis enables you to act from a position of authority when discussing clinical issues with colleagues around the world, and when working in the best interests of the insured.” Dr Gillingham considers medical licensure in the country of jurisdiction ‘mandatory’. On whether the medical director should continue to practise, he added: “Active practise [is] ideal unless the assistance physician is diligent about keeping up with the rapidly changing landscape in medicine (technology, role of artificial intelligence, and so forth).”

As an example of this, Dr Quinn said that he maintains a minimum of five clinical shifts per month: “Tis ensures my clinical

46 | International Travel & Health Insurance Journal

relevance and staying up-to-date clinically. Maintaining clinical practice adds value to all decisions made for patients, for leadership and in offering clients the best option at a most challenging time.” Te fact that many decisions have to be made quickly is an important factor here, suggested Dr Quinn: “Having a very well-rounded understanding of identifying pre-existing medical conditions, conditions that can have a rapid onset and are not necessarily related to past medical history, and the risk factors that contribute to many pathologies, is very helpful in making

A medical director’s knowledge and experience can carry weight when a third-party medical provider – not least a local doctor treating the insured – wants to deal with a senior medical practitioner

emergency decisions. Te ability to assess patient needs, best practices and the use of excellent clinical resources is a skill and talent that needs good balance with clinical practice.” He added that decisions to move patients are ultimately for the benefit of the patient’s condition, and not just ‘pressure from the family to get them home’ or just to ‘save insurers money’: “Indeed, having deep experience from both sides of the equation on the evacuation chain and offering best possible decisions to maximise patient outcomes requires a

practising doctor.” At marm, having a medical director who is a licensed doctor is also a ‘must rather than a preference’. Dr Umur told ITIJ: “Broadly speaking, 21st-Century medical directors need to be financially, politically and clinically savvy. Terefore, being a practising doctor is a preferable competency, which is encouraged for medical directors at our company.” Ingle International also prefers medical directors to be licensed and ‘in good standing’, said Ingle: “Being licensed usually results in better quality and better recognition for healthcare providers, as well as the possibility of having a strong network of doctors that they can rely on for additional support who are specialists in their fields.” However, he stops short of saying that being licensed is a must: “You can be an unlicensed physician as long as you have the required experience, background and knowledge.” Physicians can also be non-licensed to practise in the country they are currently in, but licensed in their home country, he suggested, although this may depend on the regulations in the particular country concerned. Whether a medical director is required to be registered and licensed to practise can come down to whether the regulating body determines that their work involves actually ‘practising’ medicine. Tis can be a grey area, as highlighted in a report by a UK medical practitioners tribunal issued in 2016 after a hearing involving an experienced doctor whose work was described as advising travel insurers (the doctor was applying to reregister after registration had lapsed some years earlier, simply due to non-payment of fees). Te report states that an expert witness ‘could not cite any published guidance’ from the relevant authorities ‘on what you actually need a licence to practise to do’. Te doctor’s lawyer submitted that ‘giving medical advice is not defined in law as necessitating registration and/or a licence’, and the tribunal chair noted in the report: “Whilst the Medical Act is explicit about what medical activities cannot be carried out by a non-registered doctor, it is not explicit … regarding what medical activities can be undertaken by a non- registered doctor.” Tere are many ingredients that go together to make a good medical director, but evaluating a case from all sides is the ultimate challenge, concludes Dr Gillingham: “A good assistance physician should be able to consider the needs of all parties (e.g. insurer, member, treating doctor) without compromising patient safety and wellbeing – perhaps the most formidable challenge of the job.” ■

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