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Health professional criminal behavior and clinical incompetence are distinct concepts that both endanger the public. In this paper, we compare and contrast these concepts using the case of convicted Canadian health care serial killer Elizabeth Wettlaufer, who also exhibited a pattern of clinical incompetence throughout her career. As one Canadian province is proposing changes to self-regulation to become more like the United Kingdom, we highlight four ways to improve protection of the public in a self-regulating system. These include meta-regulation, standardized hiring practices, increased transparency by regulatory bodies and improved communication across regulators and other agencies.