Quebec boosts frontline care, rewrites professional rules

Summary#

• This Quebec bill changes how professional orders are regulated and expands what some health professionals can do. The goal is to speed up rule-making, cut red tape, and improve access to care.

• It shifts many approval powers from the government to the Office des professions du Québec (the Office). It also updates scopes of practice for nurses, midwives, optometrists, dietitians‑nutritionists, and therapists.

• Key changes:

  • Lets professional orders adopt some rules without government approval, as long as they follow the Office’s guidelines.
  • The Office, not the government, will approve several types of rules, set diploma requirements for permits, and set ethics standards for order board members.
  • Nurses will be allowed, by future regulation, to initiate and prescribe tests, and to prescribe some medicines, products, and dressings.
  • Midwives can prescribe and give contraception to anyone, screen for STBBIs, and treat certain infections in asymptomatic people who test positive.
  • Optometrists can prescribe and administer drugs and provide primary eye care; those without past permits must complete a 145‑hour training to do so.
  • Marital and family therapists may practice psychotherapy without a separate psychotherapist permit, like psychologists and doctors; the Office can also recognize equivalent authorizations from other provinces.
  • New rules allow pharmacists, under strict conditions, to prescribe or substitute a generic/biosimilar made by a company in which they own shares, and allow manufacturers to pay dividends to banners, chains, or wholesalers.
  • More information will appear on public registers (member number, main practice sector, some permit history). The threshold to call a special general meeting changes to the higher of a fixed number or 10% of members.
  • The Order of Agronomists’ regional sections will be dissolved in 2027; “for pay” is removed from the definition of agronomy practice.

What it means for you#

• Workers and professionals

  • Nurses: Expect new powers to order and prescribe certain tests and medicines once regulations are made. This could speed up care in clinics and community settings.
  • Midwives: You may provide contraception to any person and handle more STI screening and treatment for asymptomatic positives.
  • Optometrists: You can prescribe/administer drugs and deliver primary eye care. If you lack earlier permits, you must complete a 145‑hour course before using the new powers.
  • Dietitians‑nutritionists: Your scope is updated; you can carry out reserved nutrition activities without a doctor’s order, and develop full nutrition treatment plans.
  • Marital and family therapists: You can practice psychotherapy without a separate psychotherapist permit. You must meet training and continuing education rules set by your order.
  • Psychotherapy trainees: The Office may allow certain psychotherapy activities during training under set conditions.
  • Pharmacists: You may, under strict conditions, prescribe or substitute a generic/biosimilar made by a company in which you hold non‑significant shares. You cannot receive improper benefits.
  • Agronomists: Regional sections will end on April 1, 2027; the order’s governance will change. Unpaid agronomy acts can still count as professional practice.

• Patients and the public

  • Faster access: More providers (nurses, midwives, optometrists) can assess, test, and treat common issues, which may reduce wait times.
  • Eye care: Optometrists can handle more primary eye conditions, with referral or co‑management with ophthalmologists as needed.
  • Sexual health: Midwives can offer contraception and some STI services beyond pregnancy care.
  • Transparency: Public registers will show more details about professionals, including member number, practice sector, and certain permit limits or revocations.

• Professional orders

  • Rule-making: You can adopt some regulations without prior approval if you follow the Office’s guidelines. The Office can also issue binding rules that apply to one or more orders.
  • Ethics: The Office sets and enforces ethics standards for your board members, including investigations and sanctions.
  • Billing disputes: A single conciliation/arbitration process for fees will apply across orders, set by the Office.
  • Meetings: Calling a special general meeting now requires the higher of a set number or 10% of members.

• Pharmacies, banners, and manufacturers

  • Dividends: Manufacturers may pay declared dividends to banners, chains, and wholesalers that hold their shares, within existing drug plan rules.
  • Conflicts: Pharmacists’ prescribing/substitution tied to companies where they hold shares is allowed only for generics/biosimilars and under strict limits on ownership and benefits.

• Students and applicants

  • Mobility: The Office can recognize psychotherapy authorizations from other provinces, easing interprovincial mobility.
  • Diplomas: The Office will set which diplomas qualify for professional permits and how orders work with schools on programs.

Expenses#

No publicly available information.

Proponents' View#

• Speeds up updates to professional rules so care can adapt faster to needs.
• Expands front-line care by nurses, midwives, and optometrists, which can reduce wait times and trips to doctors or ERs.
• Improves continuity and clarity in psychotherapy by recognizing marital and family therapists and enabling trainee practice under safeguards.
• Makes registers more transparent, helping the public check a professional’s status and history.
• Simplifies interprovincial mobility for psychotherapy, helping fill workforce gaps.
• Provides clear, unified processes for fee disputes and board member ethics across all orders.

Opponents' View#

• Patient safety concerns if expanded scopes outpace training or if rules vary by order.
• Conflict-of-interest risks: letting pharmacists prescribe/substitute products from companies they partially own, and allowing manufacturer dividends to banners or wholesalers, could influence choices.
• Centralizes power in the Office and reduces government oversight, which some see as fewer checks and balances.
• More information on public registers (like past revocations) may stigmatize professionals after issues are resolved.
• Dissolving agronomists’ regional sections may weaken local member voice and representation.
• Implementation burden: many new regulations must be written, training rolled out, and systems updated, which could cause delays or uneven application across Quebec.