The Regulation of Health Professionals: An Overview of the British Columbia Experience

Article Outline

• Abstract
• Résumé
• Introduction
• Methodology
• Background
  • Modes and Orders of Regulation
• Agenda Setting and Policy Formulation
  • The Emergence of Self-Regulation
  • Medical Dominance and Scientific Hegemony
  • Conceptions of Health and the Proliferation of Health Disciplines
  • Economic Forces
  • Community Participation
  • Public Accountability
  • Women's Movement
  • Pew Health Professions Commission
• Policy implementation
  • Implementation of the Health Professions Act
  • Barriers to Efficient Implementation
• Evaluation
• Summary and Conclusions
• Acknowledgments
• About the Author
• References
• Copyright

Abstract 

Although regulation is intended to protect the public interest, it also confers certain advantages to the profession with respect to recognition, credibility, and political influence. As more medical radiation technologists become regulated, it is important to understand and appreciate the purposes of regulation as well as its limitations and its implications for the profession. This paper provides an overview of the regulation of health professionals within Canada, specifically focusing on developments within British Columbia (BC).

Résumé 

Bien que la réglementation doit protéger l'intérêt public, elle accorde certains avantages à la profession en ce qui concerne la reconnaissance, la crédibilité, et l'influence politique. Puisque plus de technologues en radiation médicale deviennent réglementés, il est important de comprendre et d'apprécier les buts de la réglementation, de même que ses restrictions et ses implications pour la profession. Cet article fournit un aperçu de la réglementation des professionnels de la santé au Canada, se concentrant particulièrement sur les développements en Colombie-Britannique (C.-B.).

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Introduction 

The issue of professional self-regulation in the health disciplines has been on the agenda of professional groups for many years. Despite a clear public safety mandate, professional self-regulation affords a measure of recognition, legitimization, and political power to a profession. This conflict of interest has led to developments to the legislation governing the health care professions. In Canada, there are more than 30 regulated health professions (Canadian Health Services Research Foundation, 2003) with differences in each province as to which professions are regulated and how regulation is implemented. Currently, medical radiation technologists (MRTs) are regulated only in Ontario, Quebec, and most recently in Alberta. However, MRTs in British Columbia (BC) have also been pursuing designation as a self-regulated profession. Given this, it is timely to present an overview of what regulation is, as well as its purposes, its implications, and its limitations.

To understand how regulation came about, it is important to first understand what problem regulation was intended to address. In the provision of health services, there is an imbalance of knowledge and power between the patient and the service provider. This exposes the patient to a degree of risk, as most lay persons are unable to completely or objectively assess the qualifications, competency, or fitness to practice of a health care provider. The use of regulation has become a widely accepted policy instrument to ensure protection of the public from unqualified, incompetent, or unsafe health care providers. Regulation achieves this through the establishment and enforcement of professional practice and education standards.

This paper will provide a comprehensive examination of the regulation of health professionals in BC, with specific reference to the Health Professions Act (HPA). The paper will explain what regulation is, why regulation is used as a policy instrument, how regulation came to be within BC, and the challenges inherent in the implementation and evaluation of regulation.

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Methodology 

To provide a comprehensive review, an extensive literature search was performed using the following headings: “health profession regulation,” “self-regulation,” “health professions,” and “regulatory policy.” In addition to a literature search, research was also extended to include information from media sources (ie, newspapers), federal and provincial government publications, websites of various health professionals, the transcripts of the Debates of the Legislative Assembly of British Columbia, and individual historical accounts. This variety of sources was meant to provide the necessary diversity to present a balanced view of the social, political and technological factors that influenced the present state of health professional regulation within BC.

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Background 

As defined by Regan, regulation is “a process or activity in which government requires or proscribes certain activities or behaviour on the part of individuals and institutions…and does so through a continuing administrative process [1].” There are two important components to note in this definition. The first is that regulation is not a singular act but, rather, is a continuing process that requires participation and assessment on the part of the government. As such, there is an evaluative process within regulation. This evaluative element is significant, as it contributes to the overall effectiveness of regulation as a policy instrument. The second point to note is that regulation requires administration. How a government chooses to administer regulation will depend on the nature and context of the activity that is to be regulated.

Modes and Orders of Regulation 

Within regulation there is a continuum of modes and orders. Although this paper does not describe the full spectrum, Table 1, Table 2 illustrate the most common modes and orders that exist to regulate health professionals within Canada. It is important to note that these modes and orders are not mutually exclusive but instead can be applied to varying degrees.

Table 1. Modes of Regulation

Data from Alderson, D and Montesano, D [2].

Table 2. Orders of Regulation

Data from Alderson, D and Montesano, D [2].

Modes of regulation are the mechanisms through which individuals are granted the privilege or right to perform certain activities [2]. These privileges may be exclusive and hence restrictive; or, at the other end of the spectrum, privileges may be general and more inclusive. The more restrictive modes create exclusive rights to practice through the administration of practice licenses. This mode has the potential to offer the greatest protection for individual members of the public; however, it is also the most resource-intensive mode to administer. Inclusive modes of regulation are the least restrictive. For example, the administration of a practitioner registry incurs very little cost, as it does not require complex or onerous pre-entry screening requirements for practitioners. This mode of regulation is more likely to recognize the various avenues through which practitioners become qualified, and thus offers little assurance of minimum standards of practice. Arguably, this is not best suited to health professional regulation.

Orders of regulation consist of the “institutions, structures, and laws whereby a profession is actually regulated [2].” Practically, this comprises the organizational structure and procedures that determine the specific process of regulation. At one end of the spectrum is direct state control. In this instance, the government assumes responsibility for the establishment of standards of practice, as well as all aspects of administration and governance of a particular profession. The opposite end of the spectrum is indirect state control.

Section 92 of the Canada Constitution Act 1867 grants authority to the province to regulate the delivery of health services. However, the province may choose to delegate its authority to another group, such as the profession. This is termed self-regulation. In this instance, the profession does not operate insulated from the public. Instead, the laws enacted by the government will dictate the structure and procedures the governing body must adhere to in order to maintain their self-regulatory status. In Canada, this usually includes public representation on the governing body. The governing body is then responsible for setting entry-to-practice requirements, establishing professional standards, investigating complaints, and exercising disciplinary powers. Self-regulation is well suited to health care providers because of the distinct body of knowledge that they possess in contrast to the state's limited knowledge of professional practice issues. This paper focuses on self-regulation.

Self-regulation reduces the financial burden of regulation. Voluntary standard setting transfers the bulk of the bureaucratic structure associated with regulation outside of the government [1]. It also provides an alternative to lengthy and costly legal proceedings, which incur a cost to both the public and the complainant. Finally, regulation provides an avenue for complaints, competency assessment, and disciplinary action outside of the realm of union agreements and employment standards, which can be potentially long and cumbersome processes that are often avoided. However, this cost-benefit to the government must be balanced by the potential costs resulting from ineffective governance by the designated profession.

Ultimately, the decision of whether and how to regulate a health care profession rests with the provincial government. Using the benchmark of public interest and safety, the province must evaluate each individual profession to determine its regulatory status, and balance this with the need to be fiscally responsible with public resources. The challenge lies in determining the best interests of the public.

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Agenda Setting and Policy Formulation 

The Emergence of Self-Regulation 

Using self-regulation to meet the public safety interest is not a recent phenomenon. Within Canada, several overlapping social and political factors have led to the adoption, establishment, and evolution of legislation governing the health professions. These factors will be briefly discussed under the following headings: medical dominance and scientific hegemony; economic forces; conceptions of health and the proliferation of health disciplines; community participation; public accountability; and the Pew Professions Health Commission.

Medical Dominance and Scientific Hegemony 

Within North America, the earliest efforts to regulate the medical profession date back to the 17^th century in Virginia [3]. At that time, laws were passed to help control the excessive fees charged by medical practitioners. Shortly thereafter, Massachusetts passed a law regulating surgeons, physicians, midwives, or others who were “employed at any time about the body of men, women or children, for preservation of life, or health [3]” in an attempt to control “quackery”. The notion of controlling quackery has since evolved into power struggles between the dominant medical profession and what medical practitioners often considered to be fringe professions such as chiropractic medicine, acupuncture, and midwifery.

These sentiments have prevailed within Canada, well into the 20^th century [4], [5], [6]. Within BC, the earliest public discussions about the legitimacy of health care providers and the control of medical and paramedical education date back to 1973 [7]. The recognition of these hegemonic attitudes was a prelude to the development of more equitable regulatory legislation.

Conceptions of Health and the Proliferation of Health Disciplines 

Advances in science and technology combined with increased federal spending spurred the introduction of a myriad of “other” health care disciplines in the 1960s and 1970s. Federal grants to postsecondary institutions during 1960-1970 enabled universities and colleges to graduate more health professionals, not only in number but also in variety [5]. In 1974, the Right Honourable Marc Lalonde, the Federal Health Minister, commissioned one of the most influential health reports of its time. The report, A New Perspective on the Health of Canadians, emphasized the role of health promotion and illness prevention in health care instead of the more traditional concept of health care as the treatment of illness.

Because of its scope and authority, the Lalonde report brought awareness and credibility to health care disciplines outside of the dominant medical field [8]. Public approval of alternative health care practitioners was already rapidly increasing [5], and this warranted attention by the provincial governments, which then needed an efficient and effective way of recognizing and monitoring these emerging health care services. Concurrently, the more recent evolution of evidence-based practice in health care disciplines required the abolition of out-of-date practices and a means for establishing and enforcing standards of practice within the respective professions [5].

Economic Forces 

Discussion about the increasing costs of health care was prevalent in the 1970s and 1980s [7], [9]. The introduction of the British Columbia Medical Plan in 1965 increased the provincial burden of the cost of health care. As a result, the government was looking at ways to manage costs by encouraging more community-based, integrated health care and by encouraging the use of alternative health care practitioners to reduce the use of (the more expensive) physician services. An endorsement of these services meant the government needed a means of ensuring the safety of these services. Further regulatory legislation was then required to include these alternative practitioners. Personal litigation in the area of medical practice was also contributing to rising costs. Regulation of the health disciplines was regarded as a means to address these conflicts before they reached the judicial system [4].

Community Participation 

An increase in individual and public participation in social policy became prevalent during the 1960s [8], [10]. The increased role of the public led to the creation of community health boards and entrenched the rights of members of the public to participate in matters relating to the governance of the health care system. This change in philosophy was evident in a BC government report released in 1974, Health Security for British Columbians. The report addresses an array of issues, but specifically included a discussion around the need for public participation on hospital boards and professional colleges. This sentiment was echoed in other provinces, particularly Ontario (Towards a Shared Direction for Health, 1987) and Quebec (Les services de santé et les services sociaux, 1987). These reports reinforced the need for public participation in regulating health professions.

Public Accountability 

Throughout the 1980s, the issue of public accountability received an increasing amount of media attention. Within the context of health care, this was associated with the ongoing issue of medical dominance and the ability of a self-regulated profession to meet the public interest criteria. In Ontario, this issue was embodied by a situation whereby the College of Physicians and Surgeons of Ontario refused to pass a regulation requested by the government [11]. The regulation requested that the college provide advanced notification to the public about physicians who extra bill (that is, physicians who bill at a rate greater than prescribed by provincial government or who bill for services not described by the provincial insurance plan). The college could not defend its inaction on any public interest grounds.

British Columbians expressed similar concerns about the powers of the College of Physicians and Surgeons of British Columbia. They were accused of preventing members from accepting referrals from, or making referrals to, chiropractors. The College allegedly went so far as to prevent one of their members from leasing office space in the same building as a chiropractor [4]. Distrust of the College's motivations and intentions were later expressed during the Debates of the Legislative Assembly. This development elevated public scrutiny of the means by which the government monitored regulation processes and eventually led to amendments in regulatory legislation.

Women's Movement 

Since the 1960s, more women were seeking higher education, participating in the workforce, and occupying a greater number of senior positions [12]. Concurrently, women were challenging discriminatory social practices and policies. The paternalistic attitudes of both the government and the medical community were especially targeted by women's rights activists. One article in the Toronto Star [13] entitled, “Women Seek Better Health Care” pressed the government to recognize midwifery as a profession in light of a general dissatisfaction with the medical profession, which was characterized as being insensitive to and ignorant of the specific medical concerns of women. This is only one of several examples of the demands that women were making in their efforts to urge government to support and endorse health care practices that were considered secondary to the practices of the male-dominated medical field.

Pew Health Professions Commission 

The Pew Health Professions Commission was established in the United States in 1989 to examine the health care workforce with respect to cost, availability, and quality. This commission lasted 10 years and released a series of influential reports. Of particular interest in Canada were the reports of the Taskforce on Health Care Workforce Regulation. This taskforce was mandated to identify and explore new approaches to regulation that would better serve the public interest [14]. Several recommendations and initiatives resulted from this taskforce, many of which were subsequently adopted into health professional regulatory legislation in Canada [15].

The collective influence of these factors provides the sociohistorical context for the development of regulatory legislation within BC. Canada was emerging from its post-World War II period with an increased sense of empowerment among its citizens. Traditional institutions and beliefs were being questioned, and individuals demanded a greater voice in public policy and governance. Diversity within BC and in Canada as a whole was increasing, thus giving rise to greater demands regarding the variety and quality of the services available in the health care sector. However, the costs of health care were also increasing. Universal health care, investment in health promotion and illness prevention, and the availability of new technologies all contributed to this cost. The provincial government, by virtue of its authority through the Constitution, needed to formulate policy that would address and ensure not only the safety of these health care services but implement policy that was financially viable.

Although well-intended, early legislation governing self-regulation created opportunity for professional interests to guide decision making at the expense of the public interest. This not only reinforced the power inequities between the medical profession and the public, but also—by creating exclusive scopes of practice—promoted turf wars among the various health care practitioners whose practices overlapped.

Amendments to legislation over the past 20 years have tried to address these issues. Early legislation did not allow more than one discipline to perform the same practice. Initially each profession was governed by a separate act that established specific scopes of practice for each profession. Conflicts arose when each profession sought its own designation (or practice-specific act). Two common examples of this conflict include the practice of spinal manipulation by chiropractors and physiotherapists and the management of labour and delivery by midwives and doctors. Since then, many provinces have introduced “umbrella legislation,” ie, legislation intended to govern all health professions equally under the same act. Umbrella legislation creates uniform standards for all professions and therefore discourages favouring of one profession over another. British Columbia's Health Professions Act (HPA) is an example of umbrella legislation. A brief description of how a profession is designated under the HPA follows.

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Policy implementation 

Implementation of the Health Professions Act 

For a health profession to self-regulate, it needs to be designated as a profession under the HPA. The association of a health profession may make an application, or the minister may choose to investigate a health profession in the absence of an application. In either case, the minister will conduct an investigation to evaluate the degree of risk to the health and safety of the public from “incompetent, unethical or impaired practice of the profession [16]”; to evaluate and assess the degree of supervision necessary or desirable for a person practicing the profession; to determine the scope of practice of a profession; and to determine and evaluate what educational training exists for the proper education and training of persons within the health profession.

Public notice of such an investigation is made and information is collected from public hearings, professional associations, relevant organizations, or affected persons, as well as all other colleges in each profession regulated by the Act. In 1991, the responsibility of reviewing applications and conducting investigations was allocated to the Health Professions Council (HPC). The HPC was a 6- to 9-person advisory body appointed by the government to make recommendations about the regulation of a profession to the Minister of Health and the Minister Responsible for Seniors. The council was dismantled in 2002 because of fiscal constraints experienced by the BC government [2]. At present, the responsibility of investigation and review lies with the Minister of Health.

Once a profession has been designated a health profession under the Act, the Lieutenant Governor in Council will prescribe a name for the college, the title(s) to be used, the services that may be performed, and the limits or conditions on services that may be performed by the health profession. The Minister of Health will then appoint the persons to the first board of the college and specify a date by which the first election of the board must be held. The makeup of the board is covered by the Act; it must consist of a minimum of 3 elected registrants of the college and a minimum of 2 persons appointed by the minister. The persons appointed by the minister must make up at least one-third of the membership of the board and need not be registrants of the college, thus providing a means for public participation. The board may then establish by-laws (with the approval of the Lieutenant Governor in Council or deposited with the Minister of Health) to govern the college in accordance with the HPA. Thereafter, the board must report annually to the Minister of Health.

Barriers to Efficient Implementation 

Designation as a regulated profession is usually sought, as it legitimizes the profession in the eyes of the public, thus lending political power to a professional group. By asserting professional authority and ownership over particular activities of a profession, the profession can potentially ensure its viability by gaining a monopoly over a particular area of practice; promoting its professional esteem within the medical and public community; and strengthening its bargaining position as it relates to compensation by the provincial government [17].

As mentioned previously, once designated, the activities of the college are well prescribed under the HPA. The college's duty to protect the interest of the public supersedes all activities to advance the political, economic, or professional interests of the members. As a result of these restrictions imposed by regulation, political lobbying and professional claims to practice must take place before a decision to regulate a profession has occurred, with the intent to influence the outcome of that decision.

In light of this, the decision to designate a profession may not always be solely based on the merits of a profession's application. There exists a potential for larger, more politically savvy and dominant groups to have their agendas influence government decision making. An example of this is well described by Boase [17], who discusses the differences in provincial funding and regulation between chiropractors and physiotherapists in the early 1970s in Ontario. Boase observed that, although both professions were regulated under the Drugless Practitioners Act, chiropractors enjoyed a preferred economic position in relation to the Ontario Health Insurance Plan (OHIP) relative to physiotherapists. Physiotherapy was a female-dominated profession that enjoyed a close association with the dominant (paternalistic) medical profession. The majority of physiotherapists worked as staff therapists in hospital settings, with relatively few in private practice, that went unrecognized by OHIP. Consequently, physiotherapy services were funded by OHIP only upon referral by a medical doctor.

Conversely, chiropractic medicine was a male-dominated, independent profession that lacked the medical legitimacy enjoyed by physiotherapy. Chiropractors did not practice within hospital settings, and instead held private practices and could bill OHIP for their services without referral by a medical doctor. Boase attributes this difference in funding status to the sophisticated lobbying techniques chiropractors used to achieve their professional goals. Political activism, a willingness to cooperate, and a strong financial position emerged as factors that influenced chiropractors' professional status and thus contributed positively toward their status within OHIP, creating advances toward chiropractor self-regulation.

In contrast, physiotherapists, who relied on their recognition by medical colleagues, were not well organized and lacked the “political sophistication, aggressiveness, and commitment of male-dominated groups [17]; as a result, they and limited their opportunities for independent practice and made fewer advances toward self-regulation. Boase goes further to suggest that gender differences in these two groups may have also contributed to the discrepancy in recognition. The above case illustrates the role of political savvy and de-emphasizes the role of the dominant beliefs in the implementation process. However, despite lobbying efforts, dominant beliefs can also be a factor in determining whether or when regulatory acts are implemented.

The regulation of the professions of acupuncture (traditional Chinese medicine) and midwifery are examples of this. Despite their long history of practice, the medical community regarded both professions as fringe disciplines. In the case of midwifery, it was regarded publicly as an outdated practice “with no place in a modern maternity service [18]” and was further marginalized by prevailing attitudes in the male-dominated medical profession [5], [13]. Recognition of midwifery services in Canada's history is completely lacking other than in rural and aboriginal populations. The persistence of the practice in these areas is usually related to the lack of physician services. However, even this practice was threatened by propaganda claiming the midwifery was unsafe [18]. Acupuncture, as part of the philosophy of traditional Chinese medicine, was similarly disregarded. One physician arrogantly made the following remarks in an editorial letter in 1974 to the Globe and Mail:

…With respect to acupuncture in particular, the theory based on traditional Chinese philosophy of Ying and Yang, seems to me at least, to be Alice in Wonderland and even embarrasses, I believe, the academic Chinese [19].

Eventually, after more than 25 years of lobbying by alternative medicine practitioners, women's groups, and fellow sympathizers—and amid ever-increasing public approval and use of those services—BC regulated midwifery in 1995 and acupuncture in 1992, with further legislation passed to incorporate traditional Chinese medicine in 2000. In Ontario, midwives were slated to become a regulated profession in 1986 but did not achieve that status until 1994. It was the dominant societal beliefs of western culture that delayed the recognition of these professions in Canada. These examples illustrate how political savvy and prevalent social attitudes can positively or negatively influence the implementation of self-regulation. However there are other, more practical issues that affect whether self-regulation can be effectively translated into practice.

It should not be assumed that, once designated, a profession will have adequate knowledge, experience, or resources to govern itself in the public interest. The experience of the College of Acupuncturists in British Columbia (CABC) exemplifies this. Once established in 1996, the CABC went through what was self-described as a “rocky” beginning. They were characterized as “frustrated by the lack of knowledge on the part of some members of the acupuncture practitioner community as to the meaning of governance of the profession in the public interest [20].” One issue that the CABC encountered was the drafting of bylaws concerning the “grandparenting” of acupuncturists, which is the process of recognizing experience or credentials either where no formal records exist or where new standards have been established. This created a conflict among members of the college who had recent credentials versus those who did not. In attempting to resolve this conflict, the issue of public interest took a back seat to the issues of academic esteem among members of the profession. The issue was later resolved through intervention of the Health Professions Council (HPC).

Another threat to the implementation process is the size or economic viability of a professional group. Small professional groups may not have the financial resources necessary to monitor professional standards and to handle complaints. This is by no means, however, an indication of the need for regulation. Such issues have been identified in Alberta with midwives and acupuncturists [21] and in BC with clinical perfusionists and ultrasonographers [22].

Finally, the entire premise of self-regulation is based on an unfounded assumption that a college will behave altruistically and in the best interests of the public [23]. There exists the potential for conflict of interest to arise in the duties of the college, such as setting minimum competency levels, establishing standards of practice, and evaluating credentials. Although the college has a duty to protect the interests of the public, there are also potential benefits to the profession by creating academic or professional esteem (with high standards and rigorous evaluation) or increasing the number of registrants (with lower standards and more lax monitoring or evaluation). Furthermore, the duties of a college may fail to recognize other public interest issues such as labour shortages. Issues of standard setting and evaluation become contentious when one considers the difficulty encountered by migrant workers in becoming registered with a college when moving between provinces or countries. This is evidenced by the existence of initiatives by Human Resources and Social Development Canada, such as the Foreign Credential Recognition Program and the Agreement on Internal Trade [24].

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Evaluation 

A major concern with the use of self-regulation as a policy instrument is the potential costs to society that result from the ineffective or inefficient administration of standards [1]. As such, it is important that any model of regulation undergoes regular review to ensure that it maintains currency and that the outcomes are consistent with the goals. The difficulty with health professional regulation, however, is determining how to measure the intended outcome—namely, public safety or public interest. Most performance evaluation measures measure only what the regulatory legislation has produced. This includes the number of colleges created, the number of complaints registered, and the number and type of disciplinary actions, to name a few. These means of evaluation are retrospective, reactionary, and, at best, weak indicators of the effectiveness of self-regulation. More complex evaluation measures would attempt to measure whether regulation is doing what is intended.

To date, the most significant evaluations of the Health Professions Act (HPA) are a result of the Seaton Report (1991) and the legislative review by the HPC. The Seaton Commission examined the jurisdictional disputes that were occurring under the system of exclusive scope of practice and made recommendations that resulted in the 1993 amendment to the HPA. In 1994, the HPC conducted a legislative review of the HPA that resulted in the report, Safe Choices: A New Model for Regulating Health Professions in BC, released in 2001 [25]. The HPC's report generated several recommendations; some of these included the establishment of quality assurance committees and continuing competency programs within colleges, which appears to be a significant step toward incorporating an evaluation process within the structure of the college. When the government of BC dismantled the Health Professions Council in 2002, it removed an objective and prospective means of evaluating the HPA at arm's length from the influence of both the government and professional groups.

Unfortunately, the quality assurance programs encouraged by the HPC are currently subject to much debate. There continues to be difficulty in defining quality and competence across the spectrum of stakeholders within the health care system. Despite reports of successful quality assurance programs, there is an overall lack of objective and compelling evidence that these programs will lead to improvements in patient care and outcomes [2], [3], [15], [26], [27], [28]. Further research and collaboration are needed to assess the impact of regulation and quality assurance programs on public safety.

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Summary and Conclusions 

The regulatory process in BC has gone through significant evolution since the inception of the HPA. These changes can be attributed to changing social conditions and the lessons learned from other provinces, such as Ontario, whose leadership has provided direction for legislators in BC to create a regulatory process that attempts to minimize the negative “side effects” of regulation.

Unfortunately, without a formal assessment and review process, it is difficult to determine whether the provincial government is meeting its responsibility to ensure that health care services are delivered by qualified and competent practitioners. Although regulation has been widely accepted and implemented across Canada, there remains to be found compelling evidence that wholly supports regulation as a means of protecting and advancing the interests of the public. Given this, no other models have been forwarded that can address the shortcomings of regulation. Finding compelling evidence is hindered by the difficulty in making comparisons and conclusions regarding the current models of regulation because of the discrepancies in health professional regulation legislation between provinces as well as between countries. Compounding this, there is no agreement on how to measure the outcomes of regulation.

Given the lack of financial resources that are available to the health care system, it is unlikely that significant investigation to explore alternatives to regulation will come about soon. It is therefore up to the provincial government, the professional member associations, employers, academic organizations, and members of the public to ensure that the present regulatory system is operating as efficiently as possible in an effort to acknowledge and provide a forum to address issues of public safety in health care.

One of the most recent amendments to the HPA allows the regulation of more than one profession by a single college. It is by this amendment that the disciplines of medical radiation technology and medical laboratory technology hope to be designated. The British Columbia Association of Medical Radiation Technologists and the British Columbia Society of Laboratory Science submitted a proposal for a joint regulatory college in July of 2007; a copy of the proposal is available online at http://www.bcsls.net/pages/rep-regcollege.html. This collaboration resulted after significant efforts on behalf of both organizations over the past 10-14 years to seek designation under the HPA. Despite recommendations by the HPC to regulate both professions, neither profession has attained self-regulatory status.

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Acknowledgments 

The author thanks Mark Fettes for guidance in the initial preparation of this manuscript and the reviewers for their feedback.

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About the Author 

Stephanie Aldridge is a radiation therapist at the British Columbia Cancer Agency. She received her Diploma in Radiation Therapy in Vancouver in 1996 and her Bachelor of Science from Anglia Polytechnic University in 2004. She has recently completed a Masters Degree in Educational Leadership at Simon Fraser University. She has had the pleasure of working in Victoria, BC, Saskatoon, Saskatchewan, and Wellington, New Zealand. She presently teaches in the radiation therapy program at the BC Institute of Technology and the Fraser Valley Centre. Her professional interests are patient and clinical education.

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