Quebec professional law as an obstacle to interprofessional care
Bibliographic record
Abstract
I argue that Quebec professional law poses an obstacle to the implementation of interprofessional care in the healthcare system. Interprofessional care is distinct from multi-professional care. The former requires different types of professionals to work in a thoroughly integrated fashion, constantly communicating and collaborating, sharing knowledge and decision-making responsibility. The latter only requires patients to be seen by different types of professionals; it allows for minimal communication and little or no sharing of tasks, knowledge and responsibilities. In Chapter 1, I describe Quebec's professional system—the legal regime that regulates all professions in the province. One of the central characteristics of this system is the fact that it organizes professions into reserved scopes of practice, which determine the types of activities that professionals are legally entitled to perform. In Chapter 2, I describe the history of the professional system, in order to expose the reasons for which professional law acts as an obstacle to the implementation of interprofessional care. I argue that these reasons are rooted in history. I give an overview of the general historical context, and show how the professional system and the healthcare system are historically intertwined. I then focus on a key actor in the emergence of these two systems: the Castonguay-Nepveu Commission. I argue that this parliamentary commission's report laid the conceptual foundation for today's professional and healthcare systems. I focus on the ways in which the Commission rationalized its proposals using a discourse whose essential features persist to this day in professional law and the professional system. In Chapter 3, I describe how the Commission's discourse contributes to perpetuating dynamics that obstruct the implementation of interprofessional care. Professions are separated from each other in rigid and unproductive ways. Professions' incentives towards collaboration are decreased. The team ethos that is necessary for true interprofessional care is undermined by professional rivalry. I conclude that in order to truly implement interprofessional care in the healthcare system, our understanding of professions and professional regulation must change. Otherwise, future reforms of professional law will fail to remove the obstacles to interprofessional care that I describe.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.026 | 0.017 |
| Scholarly communication | 0.012 | 0.004 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.007 | 0.008 |
| Insufficient payload (model declined to judge) | 0.010 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".