The Decibel - Why some doctors are critical of B.C.’s new health care regulations

Episode Date: April 2, 2026

April 1 marked the start of a new regime to regulate health care in B.C. – the first overhaul of the system in 30 years. The Globe’s health reporter and columnist André Picard describes it as the biggest change in the regulation of health professionals the country has ever seen. Today, André explains the changes now implemented – including amalgamation, disciplinary changes and punishment for misinformation – why the B.C. government says they’re necessary, and why some of them have caused controversy. Questions? Comments? Ideas? Email us at [e-mail] Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

British Columbia just started its new regime for regulating health care professionals in the province. This is the biggest change in the regulation of health professionals we've ever seen in Canada, newest law in 30 years. So the reason health care regulation is important is that these bodies are what keep the public safe. You know, they license and they monitor, they set standards for all health professionals. So that's what gives us the ability to go into a doctor or be treated by a nurse or a homeopath and say, hey, I'm going to be safe. I'm going to get good care. Some of these changes are proving controversial, like how professionals will be disciplined and new rules around misinformation. Today, the Globe's health reporter and columnist

Andre Picard will take us through the changes. He'll explain why the BC government says they're necessary and what some of the concerns are and what impact it might have on how health care is regulated across the country. I'm Cheryl Sutherland, and this is the decibel from the Globe and Mail. Hi, Andre, great to have you back on the show. Hi, thanks. So let's start with the basics. How are healthcare professionals regulated in BC? Who is responsible? As in every province, there are colleges that oversee your specific profession. There are many, there's dozens of health professions, and the bodies that provide the licenses, they make sure you have the right education, et cetera. They monitor to, you know, they do various testing sometimes

to go check in your office. You're doing well. And they have the standards for health professionals about being ethical, being competent, et cetera. So before these changes, these colleges were what we call self-regulated. Can you explain what that means? Self-regulated means essentially that the profession takes care of itself. So this goes back in history. We've had this for a long time, that you need a doctor to figure out how well a doctor is doing is essentially the kind of message it is. Like it's very sophisticated, it's complicated, so someone has to have expertise to know if their colleagues are doing right. So that's the fundamental notion under self-regulation. It works for lawyers, engineers, health professionals. That's belief is they don't have to be overseen by

government. They can do it better themselves. And this goes back quite a while, right? Like this goes back to like the 1850s? Yeah, it goes back to sort of the beginnings of modern medicine we have today. There was two different schools of medicine back then. We don't have to get into that. But yeah, it was a way of saying, we're going to show you that we're legitimate and we protect patients, etc. And we're going to do it by setting up an oversight body. And we're going to do it much better than government because we're knowledgeable.

And the belief then was, you know, the public essentially didn't have the knowledge to do this on their own. Much of medicine was all the written medicine back then was. all in Latin. It was designed to keep the public away. So they said, you know, we're going to reassure you. We're going to take care of it with this regulatory body. That's so interesting. So it was in a completely different language. So, you know, even if a patient wanted to know what was going on, they couldn't because they couldn't read it. It was the information for the elite. Wow. Okay. So before we get into what's changing exactly in BC, let's talk about how the colleges interacted with patients before these changes. So what did that look like? Well, most of the

interaction would be this just invisible belief that things are going to be okay. So that's the public. Just assumed that health professionals were going to be good because someone was taking care of that. So that's the important part, but we don't think about it. But largely the interaction was through the complaints process. So if something went wrong, who do you complain to? Will you complain to the college? They investigate and then they make a ruling on whether your health worker failed you in some way. Right. And as we mentioned here, that in this case, the self-regulation would mean that the college would rule on that? Yeah, the college would investigate, the college would rule, and the college was met out discipline. Okay. So why did

BC change the way health care is regulated? Like, what were there concerns about this way of things working? Well, I think the belief is, well, there's been a real movement of patients, you know, having more power in the health care system. So there's this notion that, you know, if people just regulate themselves, it's a little too chummy. They let their call. leaves off a little too easily. It looks like a conflict, etc. So there was that worry. And then this was fueled by a few high-level cases of wrongdoing. You know, the vast majority of health workers do excellent work. They have no problems, the 99%. But there's always the outliers, the bad apples. And there were some cases that were pretty egregious where they didn't get adequate punishment.

I think the one that's really at the heart of this goes back almost a decade to a dentist who And eistostasized a patient. They didn't have the right to do so. That person suffered from serious brain damage. And then to make matters worse, the college essentially gave them a slap on the wrist. They said, well, that's not their fault. Too bad for the patient, right? And this created quite an outcry.

It led to the creation of a report that said we should have a fundamental revamp of the regulatory system. And it took a long time for it to happen, but it's coming into effect April 1st. All this stuff we're seeing the legislation goes right back to this report several years ago. Are there any other examples of cases that led to the government to be concerned about how health care professionals were self-regulating? Yeah, there's several cases. People promoting some bogus treatments for autism, for example. There was one involving rabid dog saliva, which got a lot of press. What happened?

So it was a case of a naturopath who treated a young child with a, rabid dog saliva for a developmental disability. So pretty egregious and they were not adequately punished. Essentially, the college said it was all fine and then when there's a public outcry, they slapped them on the wrist and gave them a punishment. There are chiropractors with anti-vaccine videos, especially during COVID. We saw a lot of that. There was a case recently of, if you remember the Lapu-Lapu tragedy, a lot of people were injured in this mass attack. in Vancouver, and a number of nurses looked at people's patient files, which they weren't allowed to do. They weren't their patients, and they were punished. So these are all kinds of examples that

fuel, you know, the public distrust who say, well, you know, somebody's got to be doing more about regulation and oversight. Okay. So let's talk about this law that's now in effect in BC. What's different now? Like, what are the main points that we should know? Yeah, so there's several things. The first one is they're going to reduce the number of regulatory colleges substantially. There were 22 and that went down to 15 and now it's going to be six colleges. So we kind of saw a merger. They're going to create a superintendent to oversee all the colleges. Right now they operate in splendid isolation. So there's going to be some cohesion there brought to it. The colleges are going to continue to investigate complaints,

but there's going to be a new disciplinary tribunal. So they're going to separate the investigation and the punishment, if you will. There's going to be harsher penalties for health professionals who don't live up to standards. There's going to be more transparency, so the more publishing of information about complaints. There's going to be anti-racism standards. They're going to make knowingly providing false and misleading information a punishable offense, which is an interesting one, to have the ability to make vaccination against some infectious disease is mandatory, a condition of licensing. And again, that comes out of the COVID era. So pretty fundamental changes are coming about.

they all spell less self-regulation. Okay, I was going to ask you. So this is the overall effect of this is that these colleges are no longer self-regulated. Is that the idea? They're no longer entirely self-regulating. So that changed years ago. There were already members of the public. Between one-third and half of boards were members of the public before this.

And now it's essentially all the boards have to be half public members. Okay. So you had quite a long list there. So I'd like to go through some of these points in more detail because some of them are very interesting, some are controversial. Let's start with the consolidation. Why are they consolidating the colleges from, what is the number now, 15 to 6? What's the point of that? I think just to make it less bureaucratic, if you will, more streamlined.

So for example, there's a college of oral health now. So there used to be a college for dentists, one for oral hygienists, et cetera. So they put all the similarly grouped people in. in one college. It kind of makes sense. All the melt people together. Yeah. Yeah. So it's really just a pairing down of the bureaucracy. Okay. And there's also this superintendent, that's a new position. What's their role? They're going to be sort of the oversight of all these bodies. As I mentioned before,

they all operated separately. They had different ways of doing things. Some were much more harsh in their punishments than others. So it's supposed to bring more consistency to the way that health professions are regulated. I think the other important thing they'll do is they make recommendations to the government on who should be on all these colleges. So they're going to be 50-50 health professionals and public. So they're going to make those recommendations. And then the health minister will either approve or they have the ability to reject.

Very few people are rejected in these processes. We'll be right back. One of the changes in this law is around discipline. You mentioned previously the college would investigate and decide on the discipline. How will that work now? Yeah, so it'll be the same thing. The college will investigate. But then when they decided that, yes, there's some kind of breach of standards, they've done something wrong.

Then a whole different tribunal of three people will decide the punishment, essentially. Tell me more about the tribunals. Yeah, so the tribunals will do the discipline part, and they'll have three members. And very specific, have a member of the public. They'll have a member of the profession of the person who's being punished in this case, and then they'll have a specialist in whatever the issue is. So say the issue was sexual interference of some sort, then they'll have someone who has knowledge and expertise in that area.

The members can no longer appeal these decisions, right? But they can request a review. Like, what's the difference? Yeah, I think that's sort of, we don't know if it's a splitting of hairs. So there's a, you know, that was a big complaint. oh, we can't appeal anymore. And they say, well, you can review. So I don't know exactly what the difference is.

Presumably, they'll just say, no, we reviewed it, and it's fine. You know, there's a lot of little tidbits in this law that we don't know how they're going to play out over time. And then the results of these rulings will be made public. Are there concerns around that? Yeah, there's been some concerns. People say there's a belief that everything was going to be published. Now the government has come around and said, no, vexatious claims. Frivolous claims will not be published in any way the way it is now.

So that concern was alleviated a little bit. But there is a concern that, you know, say a doctor does something fairly minor, but, you know, they admit I did wrong and they get a slap on the wrist and that's made public. That can really harm them. That can, you know, their patients will look, ooh, look, my doctor was found whatever, guilty by the tribunal. I don't want to go to that doctor anymore. or he or she will look bad to their peers.

So there's a concern that if you publish everything, even where people, you know, a lot of these things are actually just settled. The health professional goes, yes, I failed. And they say, here, go to remedial training. And it's a very, it's a good process. Everybody agrees. But if you just publish, you know, so-and-so found guilty, then you miss all that nuance.

Right, right. I mean, the argument on the other side, I'm guessing to make all these things public is to have more transparency. Yeah, so that's an important part of what the government's saying, we want more transparency. And, you know, I guess because I'm a journalist, I believe it's better to err on the side of transparency than secrecy. The secrecy doesn't serve anyone. It's what's gotten a lot of health professionals in trouble in the past that we find out later that these rulings were made. We never knew about them.

It makes them look worse, even if they're not really awful. Finally, let's talk about the new rules around interacting with patients. So we're talking about misinformation and preventing discrimination. First, what are the rules around misinformation? Well, now spreading misinformation is going to be seen as a breach of professional standards. That's already the case now, but it's just becoming more explicit in the law. So we had these cases of people saying that vaccines, you know, cause you to walk backwards or all kinds of crazy claims like that.

and complaints are made and then people are put through the process. But now there's going to be, I guess, a specific category, which is probably appropriate for our modern world. Now the concern, and I think one that's important for health professionals, is who's going to decide what's misinformation? You know, often we say something works and it doesn't. So at what point does this become truth-telling as opposed to misinformation? I think that one's going to be really hard for colleges to juggle.

So the other point here is around discrimination. A lot of the government's messaging about this law focuses on protecting patients from discrimination. Can you tell me more about how the law is addressing that? Yeah, so this goes back to there is a report called In Plain Sight, which looked at racism within the BC health systems, focused specifically on indigenous peoples. We know they get treated very badly in our health system across the country. And BC decided to take this on. So what's going to happen is the colleges will probably insist that people do things like anti-racism training, for example, which I have to say is standard in a lot of BC institutions already.

But it'll just become part of your licensing process over time. The other aspect of it that the minister talked a lot about was making it easier for people to complain, especially people who have their doubts about the system. So we know that a lot of indigenous people get mistreated and they don't make complaints. And why do they not make complaints? Because they don't trust the system. So now they're going to be told, well, listen, there's members of the public here. It's going to be easier for you to file a complaint. It's going to be heard.

We're going to have culturally appropriate standards to listen to your complaint. So just trying to modernize it to integrate what's in the modern world. We've been talking about some of the concerns around this new law. But overall, how are people responding? Have people been favorable, the changes? Like, what are we hearing? Well, you know, this law was introduced in 2022. It's been a long time coming.

I think it's fair to say that a lot of health professionals were not happy with it from the get-go. They're still not happy with it. You know, the doctors of BC has campaigned against this. A couple of years ago, there was actually a recall, a launch. They tried to get the premier actually taken out of office over this law. It failed. It didn't meet the stand. for a recall. But it gives you a sense of there's some real passion here. So some people are

very, very passionate about the notion of professions being entirely independent. Others, you know, the nurses are a little more laid back on this. They say, you know, we agree with most of the, we agree with the gist of it, but we're concerned that the government has to act ethically as well, just like health professionals. Natural paths, for example, have been very outspoken about this because they're afraid that, you know, they say, we think about medicine differently, therefore you're going to say everything we do is misinformation and we're going to be picked on.

So there's those concerns that how is it going to be implemented fairly. A lot of the complaint has been from more conservative members who just don't believe in government intrusion. They don't want regulation, period, right? So they don't believe they're not very enthusiastic when there's more regulation. I've heard that some healthcare professionals have concerns, about freedom of speech. Can you tell me what that's about

and are these concerns valid? Yeah, I think there's real concerns that there's not adequate legal protections for a couple of things. One, if there is a complaint about you or are you going to get due process? So there's a Globe and Mail editorial about this. The belief of our editorial board at the globe

is that this is an overreach legally, so there's not enough protections. And the other part is health professionals want to be able to speak out. and they don't want the government be able to say, well, that's misinformation or that's unethical. When they're saying things that are completely legitimate, when you say wait times are 10 weeks and that's unacceptable, can the government turn around and say, well, they're nine weeks, that's misinformation. You know, we want our health professionals to speak freely because they do speak for the public.

They do have knowledge. So, again, it's finding the balance. And I think a lot of this stuff will play out over time. I think we know from history that there will be failures on both sides, you know, that governments are going to go too far. There's still going to be some complaints that are not heard adequately. There's no magical solution to this. There's no perfect way of regulating, especially something complex like medicine.

Can things be changed after the fact? I mean, it sounds like there's a very tricky balance to hit here. So, yeah, could things change? Yeah, things can change. You know, we have laws. you have the fundamental work of the law, but then you have regulations. And the regulations are ultimately what matters. The minister has already said she's going to make one change.

I think this was just a mistake they made, but it was about traditional Chinese medicine. And they neglected to say that they have to have a license. It has to be a licensed profession like others. So a very easy fix, but it's an example of showing that they're showing that they do have some flexibility on this. But I don't think on the fundamentals there will be any movement. What kind of impacts do you see this law having? Will health care professionals perhaps leave the province? Well, you know, I think we saw some of that in the media, people saying, like, this is untenable.

I'm losing my freedom of speech. I'm losing my ability to self-regulate. I'm going to quit. Unfortunately, I think that's become sort of a reflex of health workers these days because there is shortages to just say, oh, we're all going to quit. But they're not all going to quit. Maybe some will. But I think overall, I don't think this is. the kind of legislation that's going to push a lot of health professionals out of the province,

not like, say, something in Quebec with Bill 2, which was a much more fundamental attack on where they could practice, how much they're paid, et cetera. They lost hundreds of people, and then the bill was rescinded. But this is very different. 99% of health professionals will never have a complaint about them. They don't care, right? This legislation is written for the bad apples, of which, thankfully, there are very few. So we're talking about BC, but will this have ripple effects outside of BC? Like, might we see some changes in other provinces? I think those are inevitable.

This has kind of been a trend. You know, this notion of self-regulation is really an Anglo-American thing. It's only really existed in countries like the U.S. and Canada and Australia and Britain. And actually, Britain has already gone the way of B.C. several years ago. So they got rid of a lot of self-regulation. I think other provinces are going to look at some of this. and go, hmm, you know, six colleges. You know, Ontario has 27.

That's appealing to get rid of some bureaucracy. And I think other provinces, you know, we have more conservative governments, they're going to go like, oh, we're not touching this because we don't believe in overregulation and overreach. So I think there's going to be some changes, but probably not as dramatic as in BC. BC tends to be a province of extremes. So when they do stuff, they really do it. Andra, you've described this change as imperfect but overdue.

Do you think this change in BC will work to fix the problems that the province was trying to address? You know, I think it's going to change some things, some modernization. I think the really important part is getting that patient voice integrated into the disciplinary process. I think that was missing. We had a little bit of, we had some public members of boards who voluntarily changed, over time and that's good. But I think there's never going to be a perfect process. There's always going to be people who fail the public and don't get punished adequately. There's always going to be some who do the right thing and because it's not exactly to the rules, they're going to be punished

unjustly. I don't think we'll ever lose those cases on the margins, which is what we tend to write about in the media. But I think overall it's not going to have a big impact on the vast majority of health workers. Andre, always great to have you on the show. Thank you so much. It's always a pleasure. Thank you. That was Andre Picard, the Globe's health reporter and columnist.

That's it for today. I'm Cheryl Sutherland. Our intern and associate producer is Finn Dermow. Our producers are Madeline White, Rachel Levy McLaughlin, and Mahal Stein.

Our editor is David Crosby. Adrian Chung is our senior producer, and Angela Pichenza is our executive editor. Thanks so much for listening.