Are the Health Professions Self-Regulators Doing Their Jobs?


Professional self-regulation is anchored on the principle that professionals can be depended upon to protect the public by putting ahead of their own the well-being of those they serve. It is extended to the health and other professions to avoid governments having to retain the substantial knowledge and expertise necessary to regulate directly those conducting sophisticated professional activities. Self-regulation is a privilege delegated to the health professions by governments respectfully confident that it will be discharged faithfully in the public interest.

That confidence, at least in the medical profession, has been shaken recently by the increasing incidence of addiction and deaths attributable to opioid over-prescribing and of charging patients willing to pay for preferential access to some diagnostic and other procedures, a direct contravention of the Canada Health Act. Yet, strangely, the general tenor of discussion tends to look to Canada’s provincial and federal governments to do something to rectify these clearly medical/surgical issues rather than to the Colleges of Physicians and Surgeons that hold the power of self-regulation in each province. Is the confidence of governments in the self-regulating professions misplaced? Is it the interest of the profession itself that is being protected rather than the public interest? Is it that the self-regulating bodies are placing too much of their confidence in the professional integrity of their members and need to increase their investment in and tighten up their regulatory processes? Or is it that the self-regulators are benignly ignorant of what is really going on in the professional practices they are supposed to be regulating? Important questions of this type need to be answered, and soon!

The principle of professional self-regulation is worthy of preservation. On it rests the confidence of the general public that each health professional, whether physician, surgeon, nurse, physiotherapist, dentist, or whatever, will keep the welfare of his or her patients top of mind at all times. On it rests also the confidence of the democratically elected governments formally charged with protecting the public interest. Once lost, professional practice would quickly become just like every other commercial activity in which the public interest is protected by a combination of the heavy hand of direct regulation by governments and the principle of caveat emptor.

The confidence of governments and the public in the efficacy of self-regulation of the medical profession (and perhaps of other health professionals) has been badly shaken. Its rebuilding is urgently required.

Authored by members of the Queen’s Health Policy Council:

Don Drummond
Chris Simpson
Duncan G. Sinclair
David Walker
Ruth Wilson

One thought on “Are the Health Professions Self-Regulators Doing Their Jobs?

  1. Dennis Kendel

    From my personal experience with the College of Physicians & Surgeons of Saskatchewan, the College only laid charges of unprofessional conduct against physicians for unethical billing practices when cases were referred from a 6 member peer review committee. This Joint Professional Review Committee (JMPRC) had 2 MDs appointed by the College, 2 appointed by the Medical Association and 2 appointed by the Minister of Health. If the committee determined that a physician billed inappropriately but without deliberate intent , it simply ordered recovery of money inappropriately billed. If it thought the physician had deliberately billed unethically, it referred the matter to the College for possible disciplinary action. If it felt the physician had billed illegally, it referred the mater to the Justice Department for possible fraud prosecution. What impressed me with that process was the high degree of integrity exercised by the 6 physicians on the JMPRC without regard for which agency appointed them to the committee. Committee decisions to refer to the College of the Attorney General were almost always unanimous because when peers detect unethical behavior they call it.


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