Health professional regulation in historical context: Canada, the USA and the UK (19th century to present)
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Health professional regulation in historical context: Canada, the USA and the UK (19th century to present) Tracey L. Adams
Abstract Background: There is no widespread agreement over what form healthcare professional regulation should take, and the evidence base concerning the effectiveness and fairness of regulatory systems and practices is limited. Those urging policy change argue there is a need to modernize; however, there is much we can learn from reviewing the history of healthcare professional regulation. Main body: An overview of the history of regulation in Canada, with consideration of the United States of America and the United Kingdom, is provided. Self-regulating professions emerged in the nineteenth century, influenced by a variety of stakeholders responding to local concerns for healthcare quality, access and professional training. Regulatory practices changed over the course of the twentieth and twenty-first centuries in response to changing stakeholders and shifting interests. Conclusions: Reviewing the history of healthcare professional regulation reveals lessons to inform policy in a range of settings. Keywords: Healthcare professional regulation, History, Canada, US, UK
Background Regulation is necessary to ensure that healthcare professionals provide valued expert services safely and in a manner that benefits the public. Although professional regulation can take many different forms, in the West, it has historically involved legislative mechanisms to govern entry to practice and the conduct of practice of professional occupations. However, there is no widespread agreement over what form healthcare professional regulation should take, and the evidence base concerning the effectiveness and fairness of regulatory practices is limited. Concern has been raised about the effectiveness of prevailing regulatory practices; there are calls for innovation and renewal [1, 2]. The COVID-19 pandemic Correspondence: [email protected] Department of Sociology, The University of Western Ontario, London, Ontario N6A 5C2, Canada
has further laid bare deficiencies in existing systems [3]. It has become commonplace in some Western countries to argue that “modernization” is needed, as if regulatory solutions can only be found by jettisoning previous practice and starting from scratch. However, there are lessons to learn from the past. Understanding the factors and forces shaping healthcare professional regulation historically can enhance understanding of our present and inform our decisions about the future of regulation. This paper builds on research on the history of professional self-regulation in Canada, with consideration of the United States of America and the United Kingdom as well [4, 5]. This research explored the regulation of healthcare professions from the mid-nineteenth century to the present, considering how regulation has varied across time and locale and exploring the major concerns, debates and stakeholders shaping regulatory outcomes. Drawing on this research, this paper addresse
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