What can professional regulators do about society’s biggest problems?

From climate change to social inequities to artificial intelligence, society is facing a range of challenging, complex problems.

At first glance, these issues may seem out of scope for healthcare regulators. But Zubin Austin, professor at the Leslie Dan Faculty of Pharmacy, says regulators actually can play a role in helping address these issues. He recently published an article in the Journal of Medical Regulation, the professional journal of the U.S.’s Federation of State Medical Boards, that introduced regulators to thinking about these complex problems.

“In the absence of a clear answer, the default of most regulators has been to say that’s not our problem to solve. Issues like climate change, artificial intelligence, and political polarization are huge problems, but given their duty to protect and advocate for the public, regulators have at least some role to play in solving those problems,” says Austin. “The specific role may not be clear yet, but this work is meant to bring attention to and highlight the urgency of addressing these issues.”

Healthcare regulators, for example the Ontario College of Pharmacists, and professional associations, for example the Ontario Pharmacists’ Association, have different but important roles for healthcare professionals: While professional associations advocate on behalf of professionals, regulators represent the public interest and ensure that professionals are meeting minimum standards and competencies. Regulators are often led by professionals themselves, but also include representatives form the public and from government.

A pharmacist, educator and researcher, Austin has been leading research focused on professional regulation and the role of regulators in assessing “soft skills” such as communication and conflict management in professional roles. In recent years, his research has evolved to examine how the role of regulators in managing more complicated problems.

“Historically, once you knew what the problem was, there was a fairly clear pathway to solving it. If a professional made a technical error or has bad communication skills, they can take courses to improve,” says Austin. “We’re now in an era where the problems that regulators are dealing with are astonishingly complicated, and they are really struggling to figure out what their role is and what to do about them.”

These issues are known as “wicked” problems, not because they are evil or immoral, but because there they are extremely difficult to solve and solutions may have unintended consequences.

Regulation could help tackle carbon emissions from healthcare system

One such problem is climate change. Healthcare as a whole has a large carbon footprint – research shows that nearly 5 per cent of carbon emissions in Canada are from the healthcare system, including infrastructure and the supply chain. Healthcare facilities generate huge amounts of waste in the process of keeping equipment and supplies clean and sterile.

Pharmacy in particular has a substantial carbon footprint. Pharmaceuticals and the pharmaceutical supply chain generate significant emissions and waste.

“As citizens, professionals, and regulators who are interested in the safety of the public, we all have to start addressing climate change.”

“As citizens, professionals, and regulators who are interested in the safety of the public, we all have to start addressing climate change. One of the ways is through climate-conscious practice, which goes beyond ‘reduce, reuse, recycle’ to a more intentional approach to reduce climate impacts of healthcare work,” explains Austin. “Well-intentioned individual efforts to reduce carbon impacts have minimal impact, so this is where regulators can have a role in this wicked problem.”

Because pharmacists regularly interact with their regulators throughout their career – from students to licensing exams to annual license renewals – there is tremendous opportunity for regulators to exert some influence and develop policies that would compel professionals to practice climate-conscious pharmacy.

“But they’re reluctant because it’s complicated and political, there may be resistance from members, and unanticipated consequences might happen – hence, it’s a wicked problem,” says Austin. “But just because it’s a wicked problem is not an excuse to say that we can’t do anything and it’s someone else’s job. It means that we need to think about these issues carefully and find ways to address these problems.”

Commentary on wicked problems receives international recognition

Austin is currently working on a series of articles for the Journal of Medical Regulation focused on the role of regulators in addressing a variety of wicked problems. The first article in the series, co-authored by Aly Háji, a lawyer and pharmacist, was selected by the journal’s editorial board to receive the 2023 JMR Award for Excellence in Editorial Writing, which was presented at the Federation of State Medical Boards’ annual meeting this week.

“In medical regulation, we sometimes face wicked problems involving regulatory policy, which are challenging and resist solution,” says Dr. Mark Bechtel, the journal’s editor in chief. “The manuscript helps frame challenging issues that medical regulators often face and provides some insight and direction, and it warns against developing regulatory solutions that result in unintended consequences that evolve into more intractable problems.”

Austin says the recognition from the journal is important because it helps draw more attention to a topic that he cares deeply about.

“The fact that this particular topic won an award from the most impactful journal in its field signifies interest and attention from regulators,” says Austin. “Awards like this really do signpost and drive interest in the work itself, which is really important.”

Ultimately, Austin says that healthcare professionals and regulators are working toward the same goals and regulation is one tool to ensure high-quality patient care.

“It’s easy sometimes to think that regulators are out to get professionals, but they have the same objective as professionals do – safe and effective practice,” says Austin. “Regulators provide guidance and guidelines for safe and effective practice, and they’re available to help pharmacists with decision-making in difficult situations. There’s a lot of potential to make a difference by working together.”