A Comparison of the Regulation of Health Professional Boundaries across OECD Countries

Increased attention has been paid recently to the issue of the regulation of professional boundaries. In this paper, we undertake an international comparison of the regulation of health professional boundaries across the OECD countries of Canada, the U.S., the U.K. and Australia. Our case studies focus on the inter-professional boundary negotiation between medicine and nursing and the intra-professional boundary negotiation between domestic and internationally trained physicians. Our analysis draws upon the complementary interdisciplinary theoretical perspectives of institutional economics and the concept of professional closure from the sociology of professions. In applying these lenses to the two case studies in these four country contexts, we reveal that there has been a shift in the context of professional regulation towards a more coordinated national approach to licensure. There has also been a broad scale move towards breaking down at least the regulatory barriers to inter-professional collaboration between physicians and nurses which has included the expansion of the scope of nursing practice to take up traditionally exclusive domains of medicine. The seemingly protectionist professional regulatory policies vis-a-vis international medical graduates also seem to be breaking down primarily through government measures. Overall, there has been an increased permeability of professional boundaries both inter-professionally and intra-professionally, and market-oriented systems seem to be in a better position to overcome medical dominance than state-led ones, even though they do not change the main rules of regulation at the macro-level.