With new rules reorganizing the regulation of health professionals in B.C. taking effect on Wednesday (April 1), the main association representing the province’s doctors is warning that the new setup disempowers providers and could prompt physicians to retire early or move away.
“At a time when every province is ramping up their recruitment and retention efforts, with inter-provincial mobility of physicians becoming easier, we don’t want to do anything that’s going to harm our own recruitment and retention strategies,” said Dr. Adam Thompson, president of Doctors of B.C., in an interview.
The Health Professions and Occupations Act passed the B.C. legislature in 2022, setting up a major overhaul of the colleges and disciplinary bodies that oversee practitioners ranging from surgeons to psychologists. Changes have been staggered, with the main reforms coming into effect this week.
The number of colleges is being reduced from 15 to six. Practitioners will no longer be able to elect board members; instead, the health minister will now have the final say over all appointments. And each board will be required to have an equal number of public members and practitioners, where colleges used to require a majority of board members to come from the licensed professionals being regulated.
The discipline process is being similarly weighted toward more government control. Previously, at least half of the members of disciplinary panels were required to be licensees, but that is now reduced to one-third.
And the appeals process is now being limited to internal reassessments. Previously, there was a statutory right to appeal to the B.C. Supreme Court, but this will now be limited to judicial review. This only allows an appeal on procedural grounds, not a reconsideration of the decision itself.
These changes are based on recommendations from a 2019 report by professional regulation and governance expert Harry Cayton, who detailed the downsides of self-regulation within the College of Dental Surgeons and made recommendations for broad changes to all the health-related colleges to ensure public confidence.
Doctors of B.C. acknowledged in internal engagement communications that there are some positive changes in the new legislation, including measures to combat racism and account for Indigenous cultural practices.
But Thompson says that doctors weren’t properly consulted during the development of the bill, and that some of the changes stemming from the Cayton report do not address challenges faced by medical doctors.
“Physicians historically have always been very good at self-regulation,” he said.
And he said the appeal reforms result in a loss of procedural fairness.
With more government control over health professions, Thompson also worries about politicization in both regulatory and disciplinary decisions.
“There’s a potential risk that you could get a political bias come into the college,” Thompson said.
All of this means B.C. could be seen as a “less physician-friendly environment,” he said, leading to early retirements and fewer doctors moving here. This, amidst a well-documented shortage of health-care workers at all levels.
Health Minister Josie Osborne pushed back on the idea that the new rules open the colleges up to politicization.
“I think the opposite is actually true,” she said. “I think we must remember first and foremost this act is about protecting the public interest. It’s about protecting public safety.”
Osborne said the new process provides “direct accountability” to the public, as opposed to college board members making decisions to benefit those they oversee.
“I would say that this helps to increase the integrity of the profession, that these are the types of guardrails and oversight that we need,” she said.
The Health Ministry responded to the concerns raised by Doctors of B.C. by arguing there is a “robust” internal appeals process under the new rules, and that the changes to college organization will mean board candidates are chosen by merit and competence, preventing them from being “beholden” to the profession.
The ministry also says the minister’s role is restricted to selecting screened-in candidates, thus limiting political interference.
B.C. Conservative Health critic Anna Kindy questions the basis for these changes, calling for the government to put the brakes on implementation.
“What they’ve done is they extrapolated what happened with dentists to all of health care,” she said.
She is particularly concerned about government “insiders” being appointed to oversee the profession, rather than practitioners themselves.
“There’s no input from the front lines,” she said.