HD8 - Study of the Appropriate Criteria in Determining the Need for Regulation of Any Health Care Occupation or Profession


Executive Summary:
There is a growing sense that, although well-intentioned, health professions regulatory goals, structures, and mechanisms are increasingly out of synchronization with health care delivery processes. Moreover, as the pace of change in health care delivery accelerates in response to the new emphases on competition, health care outcomes, efficiency, and patient-focused care systems, the incongruence between the regulatory framework and the needs of the health care industry will be exacerbated. An urgent question facing policy makers and health professionals is: "How can health professions regulation achieve its primary objective of protecting the public from harm without unnecessarily restraining progress in health care delivery systems?"

Virginia is not immune to the rapid pace of change in health care and has been grappling recently with a variety of issues surrounding the regulation of health care professionals. Over the last several years the Board of Health Professions and the General Assembly have been faced with numerous requests from health professional associations interested in further regulation of their professions. In 1996, the issue of licensure of respiratory therapists in the Commonwealth was brought before the General Assembly. Respiratory therapists were certified, and obtaining licensure would have represented a greater degree of regulation for that professional group. The Virginia Hospital and Healthcare Association raised objections to the additional regulation of Virginia health professions based on "the premise that cross-training and cross-functioning of health care professions in their employment was desirable" and the fear that additional regulation of health care professions would preclude such workplace changes. The ensuing discussion of the respiratory therapy licensure issue resulted in a desire by the General Assembly to conduct a more wide-ranging study of the issue of health professions regulation in general and led to the study that produced this report. Over five years had passed since the current criteria used for regulation of health professions in Virginia were adopted. The Pew Health Professions Commission in 1995 had issued a widely circulated report on health care workforce regulation that initiated a national discussion of this issue. Thus, the timing was right for a review of health professions regulatory criteria utilized in Virginia. In its 1996 session, the Virginia General Assembly passed House Bill 1439, subsequently codified as Chapter 532 of the 1996 Acts of the Assembly, that amended the Code of Virginia section relating to the regulation of health professionals by the Board of Health Professions (§ 54.1-2409.2). This new section of the Code of Virginia required the Board of Health Professions to study and prepare a report for submission to the Governor and the General Assembly by October 1, 1997 on the appropriate criteria to be used in determining the need for regulation of any health care occupation or profession. Six principles to guide the selection of appropriate criteria were included in the study legislation. The study charge was to produce findings and recommendations on the appropriate criteria to be applied in determining the need for regulation of any health care occupation or profession. A broad study was mandated by the legislation, to include an examination of the current health care delivery system, the current and changing nature of health care settings and the interaction of the regulation of health professionals with a number of other areas of regulation. The study was to include, but not be limited to, reviewing and analyzing the work of publicly and privately sponsored studies of reform of health workforce regulation in other states and nations. Finally, the study was to be conducted in cooperation with Virginia academic health centers with accredited professional degree programs.