Regulating, De-Regulating and Changing Scopes of Practice Is it a Question of Why or Why Not? Presentation by: Robert Morton, Vice-Chair, HPRAC Health Professions Regulatory Advisory Council to the 2003 CLEAR Conference in Toronto, ON September 12, 2003

Disclaimer The enclosed material represents the views of HPRAC and is not endorsed by the Ministry of Health and Long-Term Care The Criteria Review is an internal project developed by HPRAC to update its policy documents There have been no referrals made to HPRAC on any of these issues

RHPA Organization 21 Regulatory Health Professional Colleges

Ontario’s RHPA System RHPA - umbrella legislation for all health professions HPPC - Health Professions Procedural Code - applies equally to all regulated health professions 21 Profession-specific Acts - describe the scope of practice and any controlled acts authorized to a profession 23 health professions are regulated by 21 regulatory bodies 13 hazardous “controlled” acts in the RHPA Performance of these acts is restricted to members of profession(s) authorized to use these acts

Statutory Functions of HPRAC Advise the Minister on, –regulation/deregulation of health professions –amendments to the Acts and regulations –any matter referred by the Minister –quality assurance programs –the effectiveness of patient relations programs –effectiveness of complaints/discipline related to sexual misconduct Review the effectiveness of the RHPA

HPRAC’s Criteria Review What is it? Internal HPRAC-driven project to review and potentially update the criteria for regulation, de-regulation and changing scopes of practice in the health professions What is the purpose? –The review will guide HPRAC’s review of its two key policy documents:  Request for Regulation under the RHPA  Request for Change in Scope of Practice under the RHPA

HPRAC’s Criteria Review Why now? 10+ years since the RHPA was proclaimed 15+ years since the Health Professions Legislative Review (HPLR) Changes have occurred in the regulatory sphere due to:  technology  demographics  economics  professional education and development Section 11 of the RHPA: The Advisory Council has the duty to provide advice to the Minister on: “whether regulated professions should no longer be regulated.”

Criteria Review Process Step 1 - Jurisdictional review Conducted from Feb - Apr 2003 Reviewed criteria and process in other Canadian provinces, the U.S. and the UK Determined that the criteria for regulation and changing scopes of practice used in Ontario are similar to most other jurisdictions (with a few exceptions) Identified trends and emerging issues

Criteria Review Process Step 2 - Discussion Paper Developed by HPRAC in June 2003 Identifies key issues Stimulates discussion of key issues with respect to criteria for regulation (sunrise), de-regulation (sunset) and changing scopes of practice Seeks stakeholder input until Nov 28, 2003 Paper is available for download from HPRAC’s website (

Criteria Review Process Step 3 - Revised policy documents HPRAC will review and potentially revise its internal policy documents based on a review and analysis of all relevant information

Trends and Emerging Issues Based on research conducted during the jurisdictional review: –Emergence of telemedicine and Internet-based medicine –Collaborative scopes of practice –“Sunset” reviews of regulated professions –Economic issues (cost/benefit analysis of regulation - to public, professions and regulators) –Evolutions in education and accreditation standards

Trends and Emerging Issues –Efficacy of a profession’s treatment modalities and its relationship to harm –Least regulation possible –Importance of public interest principles and continuing problems defining the public interest

Panelists Criteria for Regulation: Jo-Ann Willson, Registrar, College of Chiropractors Criteria for De-Regulation: Rob Alder, Chair, HPRAC Criteria for Changing a Profession’s Scope of Practice: Sharon Saberton, Registrar, College of Medical Radiation Technologists