With the passing of Bill 46 and the fact that Physiotherapy Alberta is now known as “The College of Physiotherapists of Alberta” I thought it would be a good time to do an article on the role the College plays in regulation of physiotherapists in Alberta, the ongoing history of regulation in Alberta, and how physiotherapists build and maintain the public trust.
Bill 46 was enacted by the Alberta Government to ensure that health profession regulators do not engage in association activities and that we “stay in our lane” so to speak. As a result, we now have a college and an association in Alberta which play two distinctly different roles for physiotherapists. By the end of this article, I hope to highlight recent changes and what regulation means to “the public interest.”
What is the role of the College of Physiotherapists of Alberta?
The purpose of regulation is to provide a process by which the government can ensure protection of the public interest. Regulators do this by:
- Setting and enforcing practice and professional standards.
- Registering only qualified and competent professionals.
- Ensuring registered physiotherapists are of good character and reputation.
- Administering a continuing competence program.
- Investigating public and patient concerns about physiotherapy services received.
- Supporting registrant understanding of and adherence to their regulatory responsibilities.
Self-regulation is an approach to regulation historically used by governments to delegate regulatory powers to the professions. Across Canada provinces and territories have employed members of the public and the profession to carry out regulatory responsibilities. Regulation can look a bit different depending on the profession and province or territory, but most regulators carry out the activities listed above, with the goal of protecting the public and the public interest. The Health Professions Act (HPA), the Physical Therapy Profession Regulation, the Government Organization Act and the College’s Bylaws are all put in place to create a system of regulation for the physiotherapy profession in Alberta.
At one time, the governing councils of regulatory bodies were predominantly made up of regulated members of the profession, with few members of the public represented. This is where the term self-regulation comes from. With Councils composed largely of the professionals being regulated, the profession was charged with regulating itself in the interests of the public. However, the approach to regulation is ever-changing, and to find the right balance and protect the public interest, Alberta recently increased requirements for the number of public members involved in regulatory committees and councils.
What is “the public interest”
What really is “the public interest” you may ask? I quickly found out it is not that simple, as there is quite a bit of academic debate on it. I find this definition from Walter Lippmann a pretty good example that captures the bigger picture:
"Public interest is what people would choose when they see clearly, think rationally, and act disinterestedly and benevolently."
All in all, there are many articles from many different regulatory organizations that discuss “the public interest.” The concept began as an economic theory initially put forth in the 1930’s to help regulate certain industries and professions to benefit and protect the public.1 There are competing theories on how regulation should occur, but the majority of governments have settled on regulation and a focus on “the public interest” as mainstays.
The history of physiotherapy regulation in Alberta
Here in Alberta, like most of Canada, the regulation of physiotherapy has evolved. The medical profession drove the idea of regulation for various reasons in the nineteenth century and through the twentieth century regulation continued to expand to other professions. Alberta was one of the later provinces to adopt the concept of regulation with physiotherapists, existing as an association called the Chartered Society of Physical Therapists until the mid-eighties.
Once the Physical Therapy Profession Act was passed in September of 1985, we became regulated as a profession by the Province of Alberta. Physiotherapists were first registered to the College in 1986. The HPA was later passed in 1999 but professions were brought in over time with physiotherapists being added in 2011. The HPA currently governs 30 health professions and has gone through amendments and updates since it was enacted. In creating the HPA legislators were seeking to achieve the following goals:1
- The public will have a better understanding of the accountability of health professionals and their regulatory colleges through common processes to register health professionals, investigate and resolve complaints, and discipline practitioners.
- Health professionals will have more flexibility in how they practice because scopes of practice would no longer be exclusive to a single profession.
- Who can perform restricted activities, or higher-risk procedures, will be strictly enforced by the HPA.
- Issues that affect health professions as a whole can be more easily addressed by the HPA.
Regulation requires professions to create Bylaws, standards of practice and codes of ethical conduct that apply specifically to each profession. The idea being that those who know the profession best are able to regulate in a way that provides protection of the public specific to that profession, while also ensuring that the public perspective is incorporated into the Bylaws, standards of practice and codes of ethical conduct.
Trends in regulation
Regulatory frameworks have historically changed as regulators and governments continually work to improve regulation. Current trends in regulation nationally and internationally include two routes:5
- Increasing public oversight by adding public members and members of government to councils. This increases public involvement in regulation and helps to ensure the public interest is served.
- Increasing regulatory oversight with additional bodies or committees run by those at arms reach of the profession.
In Alberta, the government has opted to increase public involvement on Council by increasing the number of public members to 50% of voting members of a council.
Out of country but still within physiotherapy, we have examples from the United Kingdom and Australia, who have one regulatory board that governs multiple professions. Each profession may still provide input through either their own board or a committee, but the actual regulation is carried out independently by a superboard comprised of multiple public and professional members. British Columbia varied this trend slightly with recent passing of legislation to combine regulatory colleges into a smaller number of regulators overseeing several similar professions. It is not yet clear how this will play out, as the transition is ongoing.
Moving back to recent developments in Alberta, we have also seen the separation of dual mandate organizations into separate colleges and associations through Bill 46, Colleges have been required to cease “association functions”, and changes have been proposed to the role of the Alberta Teachers Association. Bill 46 has been mentioned frequently on our website and in our newsletters but seems to have garnered little media attention to date. The removal of disciplinary functions from the Alberta Teachers Association has caught much more attention from the media but appears aligned with the mandate of regulated health professions in Alberta.
Building the public’s trust in physiotherapists
Because the title of physiotherapist is protected, the expectation of the public is that physiotherapy services in any hospital, clinic, or other setting are going to be a performed by a qualified professional and that the patient will receive safe, effective, quality services. In 2016 while I was president of Physiotherapy Alberta, I was able to attend a conference hosted by the International Network of Physiotherapy Regulatory Authorities. I met delegates from many countries who are just starting down the road of regulation and obtaining title protection. It was concerning that in those countries anyone could call themselves a physiotherapist or practice physiotherapy and how that would erode the public’s trust.
All regulated health professions in Alberta are required to have continuing competence programs as a mechanism to maintain their proficiency and reduce the risk of practitioners becoming unsafe in their practice. Continuing competence programs serve to keep practitioners up to date and current in evidence-based practice and evolving positively over the course of their career.
Having a pathway for the public to address their concerns is another important role of health profession regulators and further supports the public’s trust of the profession. The public should know they have someone that is looking out for their interests and is able to act on a complaint or concern regarding the practice of physiotherapists. Having an effective complaint process is another step in ensuring public trust.
In the end, what does regulation mean for the physiotherapist? It means that there is a system that:
- Serves the public and focuses on the public interest
- Assures that those who purport to be a regulated health professional are regulated and meet the requirements and expectations of the profession
Demonstrating that physiotherapists take public interest and the work of the College seriously supports physiotherapists’ ongoing role as regulated health professionals .