Across Canada, there is a high priority placed on health human resources policy and planning. Policy makers recently examined the extent to which the mix of current providers, covered under the Regulated Health Professional Act of 1991, and the scope of their practices, were along with the needs of the population. As a result, new legislation was introduced:
- Bill 171 would regulate the practice of kinesiologists, and
- Bill 179 would expand the scope of practice of physiotherapists to include the following controlled acts: communicating a diagnosis; treating a wound below the dermis; assessing or rehabilitating pelvic musculature; administering a substance by inhalation; ordering a prescribed form of energy; ordering diagnostics; and ordering specific laboratory tests.
At the time of this study, most of these changes had not yet taken effect.
This article outlines the research findings of Landry and colleagues, who recently conducted policy analyses of the educational, regulatory, practitioner and overall system implications, of these new Bills. The researchers set out to conduct: an environmental scan (including a document review), key informant interviews with multiple stakeholders across Ontario, and a comprehensive policy analysis.
Processes are in Place
The Transitional Council of the College of Kinesiologists of Ontario (TCCKO) released its competency profile in 2012, and submitted all required documentation to the Ministry of Health and Long Term Care. They anticipate that regulation will occur in 2013.
The College of Physiotherapists of Ontario (CPO) created a process for all physiotherapists in the province who believe they have the required competencies, and who plan to perform any of the controlled acts, to identify themselves. The identification process is only related to treating a wound below the dermis, assessing or rehabilitatating pelvic musculature, and administering a substance by inhalation. There is currently no process for permitting the other proposed acts, no dates specified for when they would be permitted, and no description of what would constitute the required competencies.
Many of the criteria that would describe competency for either profession have not yet been clearly identified by the regulatory authorities and there is concern about time delays between proclamation to implementation of changes in practice.
The health landscape has changed dramatically since introducing the RHPA more than two decades ago. Driven by a range of internal and external factors, ... the locus of care is changing, and the individuals providing services are changing.
At this time, the type of education needed to support these changes is unclear. In kinesiology, there is a wide range of educational programming in Ontario and it is not clear that any further education, beyond a jurisprudence course, is planned in order to qualify for self-regulation. There is also a gap between what kinesiologists believe should be included in the educational curriculum, and what the academic institutions are currently providing.
In physiotherapy, it is clear that the expanded scope of practice encompasses an advanced level of skill. As such, universities are not planning any significant alteration in curriculum, though some are planning to provide continuing educational courses related to the new controlled acts.
Reaction from Other Regulatory Colleges
The feedback from other regulatory colleges has been positive, and while the expanded scope of physiotherapy practice has the potential for overlap with other disciplines, most seem to be adopting a ‘wait and see’ approach. Some were encouraged by the introduction of this new legislation and are now considering the potential of expanded scope of practice within their own disciplines.
Reaction from Practitioners
The response rate of the provincial surveys of practitioners was very low and therefore limited. However, among those who responded, reaction to the proposed changes was generally very positive. Kinesiologists believed that regulation will improve their interactions with others, and will provide them with an improved mechanism to treat patients. Many expressed some degree of confusion or uncertainty about what regulation will mean, and expected requirements.
The physiotherapists plan to use the new acts. However, the controlled acts that physiotherapists are most interested in incorporating into their daily practice are also those that are not yet permissible.
The authors suggest that:
- this study serve as a baseline for further evaluation to monitor true competency among existing and future providers, and the impact of these changes on clinical outcomes, costs, and patient satisfaction.
- solid economic incentives are needed to support the changes along with an examination of where health dollars will be saved;
- the impact of legislative delays on providers, regulators, educators should be examined.
- there be an examination of the impact of compensation that recognizes the higher levels of practice standards and assumption of greater risk.
Reference: Landry, MD, Woodhouse, LJ, Deber, R, Randall, GE, Miller, P, Hicks, A, Stokes, E, Desmeules, F. Thomas, S. Policy Analysis of Scopt of Practice changes to Physiotherapy and the Newly Regulated Health Profession of Kinesiology. Exchange Working Paper Series, Volume 3, Number 1. University of Ottawa, Ottawa, Canada. Available at rrasp-phirn.ca.