Models in Professional Regulation: Choices for Atlantic Canada?

Abstract

This paper will identify existing models of professional regulatory reform that could ensure a single licensing process that results in multi-jurisdictional licensure. The paper will also distinguish models or ad hoc arrangements that fail to achieve such a result. This is a timely topic in Canada because its professional regulatory framework is being examined for modernization. The Canadian professional regulatory framework for health care providers is a legacy of the Constitution of 1867. It can be characterized as a Federation of 13 different jurisdictional systems with each province or territory having exclusive jurisdiction over regulation of its health professionals. This results in differing entry to practice requirements, standards of practice, classes or categories of registration and transfer criteria for eligibility from other provinces. The United States nursing state board regulators, the Australian Commonwealth, and their state governments have moved from their original regulatory frameworks to modern ones. Their models are more supportive of mobility, cross-border virtual care, education, and health provider professional development and well-being. Aside from recent discussions in the 4 Canadian Atlantic provinces, there has been little will, effort, or advancement to modernize the regulatory framework in Canada to support multi-jurisdictional licensure. This paper aims to briefly describe 6 existing models that support multijurisdictional licensure. In the fall of 2022, the 4 Atlantic Premiers (akin to state Governors in the US) asked each of their medical regulatory authority (akin to State Medical Boards) to develop a licensing system such that physicians could practice in all 4 Atlantic provinces without the need to acquire multiple licenses. Two models will be discussed that meet this recently stated objective of the Atlantic Premiers while the others do not.