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

H P R A CH ealth P ro fess ion s R eg u la tory

A d visory C ou n c il

H P A R BH ealth P ro fess ion s A p p ea l

an d R eview B oard

M in is te r o f H ea lthan d L on g -Term C are

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 (www.hprac.org)

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