B.C.'s Bill 36 comes into force on April 1.Chris Young/The Canadian Press
On Wednesday, a new law will take effect in B.C. that will usher in the biggest change in the regulation of health professionals the country has ever seen.
Bill 36, the Health Professions and Occupations Act, is a sprawling piece of legislation, with 645 provisions over 276 pages.
Among other things, it will:
- Reduce the number of regulatory colleges to six from 15;
- Create a superintendent to oversee all the colleges;
- Implement government-appointed boards that include members of the public;
- Allow colleges to continue to investigate complaints but create a disciplinary tribunal to impose penalties;
- Increase penalties for those who breach professional standards;
- Increase transparency by publishing information on all complaints;
- Make knowingly providing false or misleading information to patients a punishable offence;
- Impose anti-racism standards;
- Make vaccination against some infectious diseases a condition of licensing.
But the most fundamental change is one that is not stated explicitly: It strikes a blow to self-regulation.
Providers, opposition criticize coming B.C. law that changes how health professionals are regulated
Doctors and patients, how do you feel about B.C.’s regulation changes? Share your thoughts
In Anglo-American countries like Canada, professionals such as medical practitioners, lawyers and engineers are largely self-regulating, meaning they set standards of practice and manage discipline.
What B.C. has done is strip them of some of those powers, some of that privilege.
Naturally, some health professionals don’t like the change, starting with doctors.
But the argument against unfettered self-regulation is that health professionals tend to protect the profession over patient safety.
There is too often a lack of transparency and public accountability. The bad apples linger too long.
When self-regulation began, in the mid-1800s, the argument was that professionals needed autonomy to set standards, control entry, and enforce ethics, because they possessed complex knowledge not understood by the public.
Arguably, that is no longer the case. Society is much less paternalistic. Knowledge is no longer the sole purview of the elite.
Law overhauling regulation of health professionals in B.C. set to take effect
The B.C. Conservatives have attacked Bill 36 relentlessly, arguing that it’s a striking example of the ruling New Democrats’ over-reach and love of bureaucracy. But they haven’t proposed an alternative other than the inadequate status quo.
Conservative health critic Anna Kindy has argued the necessity for the legislation has never been clearly expressed. But that’s not true.
The legislative overhaul has its origins in an inquiry into the dysfunctional College of Dentists. In a scathing 2018 report, regulatory administration expert Harry Cayton recommended almost all the changes. His critiques were embraced by an all-party committee of the B.C. NDP, Liberals and Greens. (There were no provincial Conservative MLAs at the time.) The In Plain Sight report, which exposed widespread racism in the health system, added to the calls for change, as did a steady stream of media stories of malfeasance by health professionals.
(To be clear, the vast majority of health professionals are qualified, competent, and ethical, but disciplinary regimes are designed for the tiny minority who are not.)
What all those reports had in common were calls for better protection of patients, and more transparency in the disciplinary process.
The new law delivers on those. In particular, getting the voice of patients into the regulatory process is long overdue.
Which doesn’t mean Bill 36 is perfect.
The streamlining of colleges is welcome, but the three-layered disciplinary process seems excessively bureaucratic.
How members of college boards will be chosen is not clear; there is a danger here of partisanship poisoning the well.
Transparency is key to the credibility of disciplinary processes. Currently, only some decisions on “serious matters” are made public.
But, under the new legislation, all complaints against health professionals will be public, even if they are frivolous or malicious. There are also no appeals allowed in disciplinary rulings.
Both of those are patently unfair.
It’s not clear either why the regulatory colleges have been granted statutory immunity – meaning they can’t be sued, unless they act in “bad faith.” Accountability cuts both ways; if practitioners are held accountable, their regulators must be too.
Under the new law, investigators have sweeping powers to inspect and seize medical records without a court order. Those powers must be kept in check.
At the same time, claims that patient-practitioner confidentiality no longer exists are clearly not true.
Regulating health professions and professionals is a tough, complex job, and will only become more so with the advent of artificial intelligence, virtual care, personalized medicine and more.
What we are seeing is state-sanctioned collegial regulation make way for state-directed bureaucratic regulation.
Neither is perfect. But we must focus on the end goal: Ensuring patient safety. That trumps professional autonomy.
Doctors and patients, how do you feel about B.C.’s regulation changes?
This week, B.C.’s Bill 36 will take effect, marking the province’s biggest change to how healthcare professionals are regulated in decades. We want to hear from B.C. health professionals and their patients about how they feel about the changes. Do you think these regulations will make a difference? Has it affected your plans for your career? Patients, what have you heard from your providers? Share your story in the box below.