The professionals who deliver healthcare—physicians, nurses, pharmacists, physiotherapists, and dozens of other regulated professions—are held to standards established by their regulatory colleges. These standards define what competent practice looks like, what conduct is expected, and what happens when practitioners fall short. Professional standards protect the public by ensuring that those licensed to practice meet and maintain qualifications. But regulatory systems also face criticism for protecting professional interests, operating without adequate transparency, or failing to address emerging challenges in healthcare delivery.
The Regulatory Framework
Health professions in Canada are regulated provincially. Each province has legislation governing health professions, establishing regulatory colleges with authority over licensure, standards, and discipline. A physician in Ontario is regulated by the College of Physicians and Surgeons of Ontario; in British Columbia, by the College of Physicians and Surgeons of British Columbia. While professions are similar across provinces, regulatory bodies are separate.
Regulatory colleges perform several functions. They set requirements for initial licensure—education, examinations, and other qualifications new practitioners must meet. They establish standards of practice that define competent care. They investigate complaints and discipline practitioners who fail to meet standards. They may require continuing education or practice reviews to maintain competence.
Self-regulation—the principle that professions regulate themselves—is the historical model for health professions. Regulatory colleges are typically governed by councils that include elected members of the profession. The rationale is that peers best understand professional practice and can set appropriate standards. Critics argue self-regulation creates conflicts of interest between public protection and professional interests.
Entry to Practice
Becoming a licensed health professional requires meeting educational requirements, passing examinations, and satisfying other criteria. Medical education takes years; nursing education is substantial; even professions with shorter training have demanding requirements. These barriers ensure that those licensed have demonstrated basic competence.
International graduates face particular challenges. Credentials obtained elsewhere may not be recognized. Additional training, examinations, or supervised practice may be required. The process can take years and cost substantially. While ensuring competence is appropriate, critics argue recognition processes are unnecessarily difficult and contribute to healthcare workforce shortages while internationally trained professionals remain unlicensed.
Interprovincial mobility affects licensed professionals. Someone licensed in one province cannot automatically practice in another; additional provincial licensing is required. While mutual recognition agreements ease some transitions, fully portable national licensure doesn't exist for most health professions.
Standards of Practice
Practice standards establish what competent practitioners should do. These might address clinical procedures, documentation requirements, informed consent processes, infection control, prescribing practices, and countless other practice elements. Standards evolve as evidence and practice change; regulators must update standards to reflect current knowledge.
Standards balance prescription and discretion. Overly prescriptive standards might not accommodate clinical judgment or varied patient circumstances. Overly vague standards might not provide meaningful guidance. Finding appropriate specificity for different practice areas challenges standard-setters.
Interprofessional practice creates standards challenges. Healthcare increasingly involves team-based care with multiple professions working together. Standards established by separate professional regulators may not address interprofessional collaboration well. Scope of practice boundaries—what each profession can and cannot do—may create barriers to effective team care.
Complaints and Discipline
When patients or others believe practitioners have failed to meet standards, they can complain to regulatory colleges. Colleges investigate complaints, determine whether standards were breached, and take appropriate action. Disciplinary outcomes range from advice or guidance for minor issues to license revocation for serious misconduct.
Disciplinary processes balance multiple interests. Complainants deserve fair consideration of their concerns. Practitioners deserve due process before professional consequences. The public deserves protection from dangerous practitioners. These interests sometimes conflict; process design attempts to balance them.
Transparency in discipline has increased but remains incomplete. Many colleges now publish discipline decisions, allowing public access to information about practitioners who have been disciplined. But complaint processes before outcomes are reached may be confidential, and the discipline system's overall functioning may be opaque to the public it's meant to protect.
Critiques and Reform
Self-regulation faces persistent criticism. Professional regulatory bodies may prioritize professional interests—reputation, income, autonomy—over public protection. Council members may identify more with colleagues than with the public they're meant to protect. Discipline may be lenient toward peers. These concerns have prompted reforms in some jurisdictions to increase public representation and reduce professional dominance of regulatory bodies.
Regulatory fragmentation creates inefficiencies and gaps. Each profession regulated separately means multiple parallel systems. Interprofessional issues fall between regulatory jurisdictions. Some jurisdictions have moved toward consolidated regulation, combining multiple professions under single regulatory bodies. Others maintain profession-specific regulation but improve coordination.
Competence assessment throughout careers poses challenges. Initial licensure demonstrates baseline competence at one point in time; ensuring ongoing competence requires continuing education requirements, practice assessments, or peer review. But evidence on what approaches actually maintain competence is limited, and requirements vary across professions and jurisdictions.
Questions for Consideration
Should health professions continue to regulate themselves, or should regulation be more independent? How can credential recognition be improved for internationally trained professionals? Should professional licensure be national rather than provincial? How transparent should regulatory proceedings be? What role should patients have in professional regulation?