Policy Analysis of Scope of Practice Changes to Physiotherapy (Bill 179) and the Newly Regulated Health Profession of Kinesiology (Bill 171)

Across Canada, there remains a high priority placed on Health Human Resources (HHR) policy and planning.
In Ontario, the Regulated Health Professional Act (RHPA) of 1991 is the Act that sets policy and practice standards for self-regulation of individual provider groups. For the first time since implementation, the Ontario Ministry of Health and Long Term Care (MOHLTC) asked the Health Professions Regulatory Advisory Council (HPRAC) in the mid-2000s to discuss the extent to which the mix of current providers regulated under the RHPA was meeting the needs of the population, and still further if the scope of practice for some providers already regulated limited their scope of practice. The ultimate outcome of these discussion, and submissions from provincial stakeholders, was the introduction of new legislation.

Relevant to our research agenda was the introduction of Bill 171 which would provide the necessary structure to regulate the practice of kinesiologists, and Bill 179 which would expand the scope of practice of physiotherapists to include the following seven controlled acts:
1) communicating a diagnosis,
2) treating a wound below the dermis,
3) assessing or rehabilitating pelvic musculature,
4) administering a substance by inhalation,
5) ordering a prescribed form of energy,
6) ordering diagnostics (i.e. x-rays), and
7) ordering specific laboratory tests.

In this research, we conducted document analysis, key informant interviews (n=24) and provincial surveys of kinesiologists (n=241) and physiotherapists (n=292). Ethics approval for this study (with particular attention to the key informant interview and survey portions) was obtained through the University of Toronto Research Ethics Board, and the University of Ottawa Research Ethics Board.

Six key message emerged from our research:
(#1) At the time of this study, most of the regulatory changes that were included under Bill 171 and Bill 179 had not yet taken effect;
(#2) Based on our findings, the necessary education to support either the regulation of kinesiology or expanded scope of practice for physiotherapy remained vague;
(#3) It is clear that the Transitional Council of the College of Kinesiologists of Ontario (TCCKO) and the College of Physiotherapists of Ontario (CPO) have made significant advances with respect to the implementation of Bill 171 and Bill 179;
(#4) Very few of the regulatory colleges outside of kinesiology had opinions regarding the upcoming regulation of kinesiologists, however, given that the expanded scope of practice has the potential for overlap with other disciplines, many other colleges did have opinions and perspective on the advancement of physiotherapy practice;
(#5) The response rate to the provincial surveys was very low and therefore the generalizability of our data are limited.  Responses among those who did respond to the survey were generally very positive towards the proposed changes;
(#6) Both disciplines have argued that Bill 171 and Bill 179 would yield positive outcomes such as improved access to care, but to date there is little evidence to substantiate or refute their claims.

Advisor on Tap:
Michel D. Landry BScPT, PhD
BSc (Ottawa), MSc (UWO), PhD (Toronto), Post Doc (UNC-Chapel Hill)

Bio
Michel D. Landry is the Chief of the Doctor of Physical Therapy Division, in the Department of Community and Family Medicine at Duke University Medical Centre in Durham North Carolina.  He is also an Adjunct Associate Professor in the Department of Physical Therapy at the University of Toronto, and an Adjunct Assistant Professor at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill.  Prior to receiving his doctoral degree, he held clinical and senior management positions within the private rehabilitation sector in Ontario, and within international humanitarian aid and development agencies in Central America and Eastern Europe.  Dr. Landry is a health policy and health services researcher, and his area of current exploration is the interface between available supply (financial and human resources) and increasing demand for health and rehabilitation services across the continuum of care.  He is a proud Canadian, a hockey fan, a Past-President of the Canadian Physiotherapy Association, and a former Career Scientist at the Ontario Ministry of Health and Long Term Care (MOHLTC).  He lectures on the changing structure of rehabilitation services across Canada and internationally, and is a provocative advocate for the moral and ethical necessity to ensure accessible rehabilitation services across the gradient of high, middle and low-income countries.