Expanding professional practices 101

Expanding professional practices (EPP) is one of the pillars of the Legault government’s 2022 health care reform (Plan santé). There, it is presented as one of the main solutions for addressing the labour shortage. Extensive work is currently being done on this issue, and major changes could ensue in the way work is organized in health and social services; there could also be a major revision of the Professional Code.

Expanding the scope of professional practices: what does it mean?

The government has not put forward any official definition of the expansion of professional practices. However, we can understand it to mean that acts formerly performed by specific job titles will be transferred to, or shared with, other job titles. This can be done through regulatory or legislative changes, through directives from the employer, or simply through changing habits in the workplace at the local level. The transfer can be from physicians to professionals, between professionals, or from professionals to technicians. In other words, expanding the scope of professional practices is something that can affect all professionals and technicians.

The Plan santé asserts that expanding the scope of professional practices will increase autonomy, interdisciplinarity and access to care. That’s not wrong, but EPP does raise many issues that we need to think through if we want to avoid major pitfalls and reach our objectives.


Expanding the scope of professional practices is carried out in parallel to a project to modernize the professional system. Although there are similarities between the two projects, they are not the same thing. The first is specifically intended to ensure that professional responsibilities are shared within the health and social services system. The second is intended to update and loosen the regulatory framework for professions in health and social services and elsewhere.

What has the government done so far?

The Legault government foregrounded the expansion of professional practices from the moment the Plan santé was tabled in 2022. However, only recently has the project started to take concrete form with the government’s announcement of 18 priorities. These priorities would affect a number of job titles represented by the APTS:

Some of the proposed changes are quite specific. For instance:

  • Recognizing diagnostic assessment in the mental health sector.
  • Authorizing physiotherapists and occupational therapists to prescribe examinations related to physical rehabilitation.
  • Eliminating the requirement for nutritionists to obtain a medical prescription.
  • Creating a new job title for phlebotomists.
  • Authorizing collective prescriptions to adjust or end the use of medications in radiation oncology.

Other proposed changes are broader and vaguer, and it is obvious that they will require much more work. This is the case, for instance, with the proposal to “maximize the contribution of some workers in targeted areas of mental health.”

Work on these projects will be carried out from 2023 to 2025, and we can expect professional orders to be closely involved. The APTS, for its part, has already begun wide-ranging projects related to the expansion of professional practices.

See the Ministry’s 18 proposals (in French)

What we are hoping for… and what we are watching for

Judging from the survey completed by over 4,000 APTS members across the province, expanding the scope of professional practices is raising hopes, along with many concerns. Expanding the scope of professional practices is a sensitive, complex manoeuvre and could have very different repercussions depending on the workplace and job title. This is why we need to carefully monitor the situation to ensure we reduce risks and maximize benefits.


The consultation we carried out enabled us not only to gain a better understanding of what you’re dealing with on the ground, but also to adopt an official political position that respects our members’ experiences and opinions. You’ll find a full description of our position here.

The APTS is open to a process to expand the scope of professional practices, but under certain conditions:

  • the involvement of workers: You are the ones with the skills, expertise and experience on the ground that must guide the ministerial action. This is why it is important that your voice – represented by the APTS – be heard, as soon as work gets under way.
  • special attention to your conditions of practice: Depending on the approach taken, expanding the scope of professional practices could be beneficial for access to services, professional autonomy and interdisciplinary collaboration, or it could exacerbate workload, compromise the quality of services and devalue the professions concerned. An understanding of the different areas of expertise is essential, and improving your conditions of practice must be an ongoing concern.
  • a serious workforce planning exercise: Expanding the scope of professional practices could be beneficial, but it is important to understand why. The needs of Quebecers, their evolution, the number of people required and available to meet them – these are facts that can’t just be made up. Blind reform is pointless, even dangerous.
Write to us!
  • Have you witnessed changes in practices or directives that promote the expansion of professional practices?
  • Have you been approached by your employer on this issue?
  • Have you noticed practices on the ground that are akin to expanding the scope of professional practices and that seem to be in the process of being officially implemented?

Contact us by completing the form provided.