CPSA’s role in legislative change

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Physicians and physician assistants in Alberta continue to have the privilege of profession-led regulation. CPSA is established by government through legislation and, while operating at arm’s length from government, is accountable to the Minister of Primary and Preventive Care. CPSA is governed by a Council composed equally of regulated members and public representatives appointed by the Minister, ensuring both professional expertise and meaningful public oversight.

Profession-led regulation continues to evolve, and some have expressed concern that this model may be at risk of erosion. Health professionals are uniquely positioned to understand the complexity, risks and realities of clinical practice in ways that external bodies cannot. This expertise allows regulators to set informed standards, assess conduct and competence fairly, and respond proportionately to concerns—always with patient safety and public protection as the primary focus.

Equally important, profession-led regulation supports thoughtful and practical implementation of public policy. By drawing on deep knowledge of the healthcare system, regulators can identify unintended consequences, highlight operational challenges, and contribute meaningfully to policy development. This informed participation strengthens public confidence, supports effective regulation and helps ensure that legislative and policy objectives translate into safe, workable outcomes for patients and the health system.

As Alberta’s medical regulator, CPSA plays an important—though often unseen—role in legislative change. While CPSA does not advocate publicly or take political positions on government policy, we work professionally and collaboratively whenever we can with policymakers and decision-makers, to influence policy direction through expert, evidence-based and practical input that supports profession-led regulation and protects patients. Understanding how legislation is developed helps explain where and how this work occurs.

Lifecycle of legislative change

Legislative change in Alberta typically, though not always, begins long before a bill is introduced in the Legislative Assembly. Government ministries may first begin the process by consulting with stakeholders to better understand the current landscape and potential impacts of proposed changes. CPSA participates in these government-led consultations when invited, providing information on how proposals may affect profession-led regulation, patient safety, public protection, regulated members and the broader healthcare system.

At this stage, CPSA’s role is to answer questions and share regulatory expertise, our unique understanding of professional practice and operational insight. Through this work, we do what we can to influence the direction of policy by identifying regulatory realities, implementation challenges and potential, unintended consequences. While this input informs decision-making, the ultimate policy direction rests with government.

Once developed, a proposed law is introduced in the Legislative Assembly as a bill. In Alberta, bills proceed through three readings:

• First reading is the formal introduction of the bill without debate.
• Second reading focuses on debate about the principle and intent of the bill. This is followed by a committee stage, where the bill may be reviewed in detail and amended.
• Third reading is the final debate and vote.

If passed, the bill receives Royal Assent and becomes law, referred to as an Act.

Legislation implementation

Not all legislation comes into force immediately upon Royal Assent. An Act may come into force immediately, on a specified future date or by proclamation, allowing time for implementation planning. This flexibility is particularly important when legislative changes are complex or require additional regulatory tools.

After an Act is passed, there may be further opportunities to shape how it is implemented. This can include amendments to existing legislation, such as the Health Professions Act, the development of new or revised regulations, or the use of other legislative instruments.

During this phase, CPSA works with Alberta Primary and Preventive Health Services (the Ministry that has legislated responsibility for regulatory colleges), as well as other agencies and departments, whenever we can by bringing forward practical considerations required to implement legislative changes effectively and safely. This is another key point at which CPSA may attempt to influence how policy direction translates into regulatory practice.

Some legislative changes are straightforward and come into force quickly. Others require more time and preparation. A notable example is Bill 21: An Act to Protect Patients (2018), which resulted in new regulatory requirements, including a new standard of practice and mandatory training for physicians. Given the scope and complexity of these changes, a longer implementation period was built in to allow regulators time to prepare guidance, educate the profession and support compliance. That said, CPSA does not always have advance notice of legislative changes and may, at times, become aware of them at the same time as other Albertans.

Limitations of regulatory bodies in legislation

Profession-led regulation is not without challenges. While regulators bring expertise and practical knowledge, public policy is ultimately set by elected officials. At both an organizational and personal level, regulators and staff may or may not agree with the policy direction chosen.

This tension can be particularly evident where legislation mandates specific outcomes or sanctions without flexibility, limiting a regulator’s ability to respond proportionately based on context or professional judgment. While CPSA may raise concerns or practical considerations during consultations, once legislation is enacted, it must be applied as written.

As a regulator, CPSA does not advocate publicly or express opinions on government policy decisions. Our mandate is not political. We are not controlled by government, nor are we adversarial. Instead, we maintain neutral, professional, and collaborative relationships with policymakers to influence policy development through expertise, evidence, and operational insight—even when perspectives differ. Once legislation is duly enacted, CPSA carries out government policy faithfully in service of CPSA’s statutory role and the public interest, recognizing that this deference is an essential component of our democratic system.

Conclusion

CPSA maintains respectful, professional working relationships and fosters open dialogue with elected officials and the public service. This collaboration is particularly important when proposed or enacted policy changes are complex or polarizing. Through these relationships, CPSA works to identify and help address unintended consequences using available legislative and regulatory tools, always with a focus on patient safety and effective regulation.

Our silence in the public space does not mean inaction. Much of CPSA’s work occurs behind the scenes through consultation, technical input, and careful implementation planning. Once legislation comes into force, CPSA’s responsibility is clear: to uphold and apply the law as enacted by elected officials in a manner that protects patients, supports profession-led regulation and maintains trust in Alberta’s health care system. CPSA continues to engage with legislators and the administrative arms of government after implementation, providing feedback on real-world impacts and working collaboratively to address unforeseen challenges as they arise.