Regulating health professional scopes of practice: comparing institutional arrangements and approaches in the US, Canada, Australia and the UK

Abstract

Background Fundamentally, the goal of health professional regulatory regimes is to ensure the highest quality of care to the public. Part of that task is to control what health professionals do, or their scope of practice. Ideally, this involves the application of evidence-based professional standards of practice to the tasks for which health professional have received training. There are different jurisdictional approaches to achieving these goals. Methods Using a comparative case study approach and similar systems policy analysis design, we present and discuss four different regulatory approaches from the US, Canada, Australia and the UK. For each case, we highlight the jurisdictional differences in how these countries regulate health professional scopes of practice in the interest of the public. Our comparative Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis is based on archival research carried out by the authors wherein we describe the evolution of the institutional arrangements for form of regulatory approach, with specific reference to scope of practice. Results/conclusions Our comparative examination finds that the different regulatory approaches in these countries have emerged in response to similar challenges. In some cases, ‘tasks’ or ‘activities’ are the basis of regulation, whereas in other contexts protected ‘titles’ are regulated, and in some cases both. From our results and the jurisdiction-specific SWOT analyses, we have conceptualized a synthesized table of leading practices related to regulating scopes of practice mapped to specific regulatory principles. We discuss the implications for how these different approaches achieve positive outcomes for the public, but also for health professionals and the system more broadly in terms of workforce optimization.

Limitations and Recommendations for Advancing the Occupational Therapy Workforce Research Worldwide: Scoping Review and Content Analysis of the Literature

“…For example, the USAID funded the “SUDA project” (co-led by the World Confederation of Physical Therapists and Humanity and Inclusion) which implemented a capacity-building project in three French-speaking Sub-Saharan African countries; the project used international-level expertise to bolster professional associations, create resources sharing among stakeholders, and improved physical therapist educational standards in these countries [ 84 , 85 ]. Research and developments on strengthening associations and regulation for other professions also have been ramped up [ 86 , 87 , 88 , 89 ]. We are unaware of similar, externally funded workforce research and development projects for the occupational therapy field.…”

Professional regulation, profession-state relations and the pandemic response: Australia, Canada, and the UK compared

“…One of the goals of the regulatory change was to improve workforce flexibility. As a result, scopes of practice in this regulatory scheme are flexible, variable, and not clearly defined ( Leslie et al, 2021 ; Pacey et al, 2016 ). These changes altered the relationships between professions and the state, creating regulators that are autonomous and arms-length from the state, but still subject to government oversight.…”

“…For example, some regulate single professions, while others regulate multiple. Moreover, scopes of practice are more flexible for some professions than others ( Leslie et al, 2021 ). The focus of regulation has shifted somewhat to prioritize protecting the public from professional malpractice and diminished competence.…”

“…Some nations may have been better positioned than others to make workforce changes because of their systems of professional healthcare regulation. Professional regulation varies cross-nationally, even among nations that are culturally and socially similar ( Leslie et al, 2021 ). In nations like Australia, Canada and the United Kingdom, professional regulation has until recently been characterized by exclusive scopes of practice, and inter-professional tensions surrounding jurisdictions or scopes of practice.…”

The need to capture the unharnessed expertise of overseas educated nurses working as care support workers in their host country

“…Like its other contemporaries such as Australia, the United States and Canada, the United Kingdom has a range of language, practice, registration and education regulatory requirements for internationally educated applicants (Leslie et al, 2021; Nursing & Midwifery Council [NMC], 2018). Time has lapsed with costly retakes of these tests, and now these internationally qualified nurses have attained citizenship in their host countries, working as unqualified grades of staff.…”