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Head-to-head
In this column, the OOAQ president shares opinions inspired by the current events within Quebec’s professional system. This is an invitation to pursue an individual and collective reflection.
Throwing out the baby with the bath water...
version française
Marie-Pierre Caouette, M.O.A., présidente
In this year of celebrations, there are
still some issues we cannot rejoice at. We have entered head-on into an era of
change. Certain paradigms underlying the reform of Québec’s professional system
under the influence of the 70s’ revival are being questioned. The current
situation has shaken some of our values and traditions. Such turbulence requires
openness and vigilance in order to stay the course on coherence.
The Professional Code celebrates its 35th
anniversary
On February 1, 1974, the Professional Code came into force following
its adoption by the National Assembly of Québec. The birth of a professional
system aimed at protecting the public was then applauded. This world-unique
system would later become the centrepiece of our society’s functioning. Today,
it boasts 326,000 members from 51 professions regulated and governed by 45
professional orders involved in every strategic areas of society, namely: health,
human relations, engineering, land development and sciences, law, administration
and business.
Despite this increased presence, the population is still ill-informed about the
difference between the mission of a professional order and that of an
association. Several individuals mistake professional orders for these old
merchant guilds whose primary concern was the wealth of their members. Yet,
professional orders were entrusted with the responsibility of protecting the
population. They are the owners of a delegated power allowing them to exercise
strict control over the competence and integrity of their members through, among
other things, admissions, professional inspection and disciplinary committees.
Thirty-five years after its adoption, the professional system's mission is upset
by a will to “redefine the concept of public protection”, its fundamental value.
Operation mobility
To counter the workforce shortage as a result of an aging population, society
must switch to a “solution” mode. Boldness is required to rally the troupes
around the implementation of projects that will allow society to take on a new
direction. The obligation for Québec orders to pursue, with Canadian regulatory
bodies, their reflection on ways to improve workforce mobility is no doubt
necessary. It bears reminding, however, that in terms of accessibility of
services, the OOAQ has been provident and proactive in the support of Québec
universities, helping them increase their number of graduates. For the past
eight years, the OOAQ has shown leadership in recruiting members from Belgium, a
country whose Master-level graduates in speech-language pathology receive
training similar to that offered to our members. With only 25 speech-language
pathologists/audiologists upon the enforcement of the Professional Code,
the order now has some 2,000 speech-language pathologists and audiologists, more
competent than ever, serving the population. With a growing number of members
whose average age is in the early thirties, the question of accessibility of
services given the aging of the population is different from similar other
professional orders.
Effective April 1, 2009, the encouragement to deliver a “permit on permit” to
candidates authorized to practice their profession in a Canadian province whose
regulatory body does not necessarily have the same admissions and control
mechanisms regarding professional practice, sends shivers down the spine of
professional orders. Indeed, the obligation to work with members whose training
and competencies vary considerably could lessen the powers of the admissions
committee and increase the burden of proof for the inspection committee. Time is
required to plan the harmonization of the admissions criteria and the processes
to evaluate competencies from coast to coast, and beyond boarders. Despite our
active involvement and support for this pertinent society project, the sustained
pace imposed by the current situation gives us reasons to worry at times about
the upholding of public protection.
A renewed commitment to the Québec population
Under the circumstances, it is with determination that the Québec orders adopted
the following resolution: “On this 35th anniversary of the enforcement of the
Professional Code, professional orders under the Québec
Interprofessional Council unanimously reiterate to the population their
commitment to ensuring the competence and integrity of their 326,000
professionals and contributing, to the best of their ability, to the advancement
of the Québec society.”
Objective: Competent accessibility?
Greater workforce mobility is not the only solution to improving accessibility
of services. The strategic planning of resources also appears to be a fruit-bearing
avenue. The new Plan d’accès aux services pour les personnes ayant une
déficience is a fine example of this.
Optimizing the organization of services is a noble and necessary objective in
the current and future demographic and economic context. No one can dismiss
virtue. This is a unique opportunity to review and evaluate our practices. The
world has changed in 30 years. How can we object to a project that proposes a
better planning of service continuity and the emergence of innovative practices
without being fingered as a corporate defender? Yet, the proper elements must be
examined in order to succeed. The quality of services and especially the
competence of those who offer such services should never be compromised for the
sake of accessibility.
Workforce shortage or brain drain?
The new Plan d’accès proposes to reduce waiting time and offer services
within a reasonable timeframe. Although it will allow the population access to “a
kind of services”, in practice it will not necessarily offer
all the services we envision for everyone. This is a major clash in
values which we, scientists, must face at a time where research and technology
offer evaluation and treatment possibilities that were unimaginable up until now.
Yet, Québec has never had as many practicing speech-language pathologists and
audiologists and they will continue to grow in numbers as never before over the
next years. In a context where many question the specificity of our evaluations
and treatments, it is not surprising to see the downfalls of the public sector
with regard to attracting and retaining professionals. While a growing number of
graduates opt for private practice, several seasoned professionals leave the
public sector after having undergone a major overhaul of their duties, leaving
them with the feeling that public protection is being jeopardized. All these
passionate professionals are on a quest for a workplace in tune with their
fundamental values.
Users: at the heart of our reflections and actions
Access to free services offered by competent professionals remains a major
challenge when it comes to public protection. We must keep in mind that the
objective of the Plan d’accès aux services is to initiate a profound reflection
and move toward reorganization, not to meet the plan’s requirements
within specific deadlines.
The concepts linked to ecosystemic intervention could help further our
reflection. No doubt, everyone is entitled to services, but is
everyone receptive to or does everyone need
the same services? Along with the steps taken in his or her environment, each
stakeholder should ask him or herself a few questions, namely: “Do the new
directions taken within my team respect the principles governing public
protection? In the drafting of intervention objectives, does my analysis take
into account the ability for the user and his or her family to commit to the
rehabilitation process I consider most favourable? Under given circumstances,
according to my clients’ availability, is my intervention significant to them at
best, if not optimal? Am I comfortable with my work environment, based on the
limits imposed by the entrusted mandate, which at times may contradict my
professional development goals?”
Our professional identity primarily focuses on a central element: the expert’s
mandate. However, our daily functions call on a host of other roles, namely that
of communicator, professional, health promoter, collaborator (1). In
some instances, our willingness to act as consultant to enable individuals and
their caregivers to gain quicker access to the world of speech-language
pathology and audiology can make a substantial difference in the lives of many
of our fellow citizens. The most important thing is to maintain transparency and
competence through our actions.
Informing to better protect
Throughout this extensive service reorganization process, decision-makers must
not underestimate the vulnerability of individuals affected by communication
disorders or the complexity of evaluation and treatment activities carried out
by speech-language pathologists and audiologists. Fostering a better use of
resources in the field and a greater complementarity among stakeholders should
not, in any way, entail a substitution of professional designations. Such a
scenario could create confusion and cause considerable harm to the population.
For the OOAQ, public protection can only be ensured through improved access to
services offered by speech-language pathologists and audiologists. Now more than
ever, we must explain and specify the nature of our services to our partners and
users as well as our various roles and possible partnerships with certain
partners. The Order’s role, and by extension its members’ role, is to inform, as
only through information can we empower individuals.
Complementarity with partners
Before considering entrusting partners with activities calling on the over-all
competence of speech-language pathologists and audiologists, employers could
optimize their work by reviewing the list of tasks that reduce these
professionals’ efficiency, whether it be making and confirming appointments,
manufacturing materials, making photocopies, disinfecting materials, making low-profit
interventions with partners that lack basic knowledge in language, for example,
or travelling on a vast territory too difficult to cover or to points of service
whose number is unrealistic. Without too much effort, the list could go on and
on.
Speech-language pathologists and audiologists are not all in the same boat when
it comes to determine the type of tasks that could be entrusted to a partner.
For example, everyone agrees that it could be profitable for a speech-language
pathologist to implement a language stimulation group lead by
partners trained by speech-language pathologists to
enable young children and their parents to access some type of service while
waiting for specific speech-language pathology evaluation and treatment
services. These few hours could ensure optimum reach. However, the user would
have to receive the information necessary to allow him or her to understand the
advantages and limitations of the proposed service. On the other hand, it is
difficult to imagine referring individuals with duly identified speech-language
or hearing disorders to a service group lead by partners. Moreover, once the
analysis and reorganization of services is completed, the Plan d’accès must keep
its promises with regard to adding specialized resources in speech-language
pathology and audiology. It is imperative that we avoid, in certain environments,
depriving one individual for the sake of another merely to respond to certain
performance criteria within a specific timeframe.
Dialogue and vigilance
Finally, one can only acknowledge that we are passengers aboard a train whose
cruising speed is forever increasing. Attempting to put the brakes on projects
that propose a new direction for society whose themes are based on a vision of
the future and strategic planning would entail risking derailment and major
consequences.
We must combine our competencies and experience to ensure strong collective
leadership allowing us to make history. It is our duty to influence the
direction of these projects and to make sure they stay the course for the
benefit of the population. Now more than ever, I invite you to reflect and
exchange views to make sure these major accessibility principles become levers
of improvement in the quality of services, acting together as a hub for a
greater quality of life for our fellow citizens.
It is possible to be open to change without being naïve, and prudent without
being reactionary. Showing creativity and an ability to adapt after a sound
dialogue process does not mean giving up our values, the quality of our services
or public protection. Vigilance does not mean opposition to change. At the onset
of a new era of professionalism and the start of a “better together”
construction site, let us make sure that the baby won’t be thrown out with the
bath water...
(1) List taken from the work in progress by a piloting team aimed at establishing a profile of essential competencies for speech-language pathologists and audiologists in Canada, as well as a pan-Canadian model for clinical competence standards (work based on the CanMEDS 2005 model).
Notes Biographiques
