As-of-right licensing and expanded scope of pharmacists
This is the second in a series of articles on Bill 60 and its implications for health sector stakeholders.
See our first article regarding integrated community health services centres here.
June 2023 Update
On June 9, 2023, three draft regulations under Your Health Act, 2023 were released indicating that as-of-right licensing may not be as expansive as initially anticipated in this article. As discussed below, when as-of-right licensing was first announced, it appeared as though it would have broad applicability and would enable healthcare professionals licensed outside of Ontario to provide services, such as virtual care, to Ontarians. Instead, the draft regulations restrict the applicability of as-of-right licensing by only making it available as a temporary measure to certain healthcare professionals who have applied for licensure in Ontario and who only provide professional services in or on behalf of an Ontario public hospital, the University of Ottawa Heart Institute, or a long-term care home.
One of the most significant changes from Your Health Act, 2023 (the Act) is the introduction of as-of-right licensing for healthcare professionals. As-of-right licensing allows healthcare professionals, including physicians, who are licensed in other provinces and territories in Canada to practice in Ontario, without needing an additional approval or licence. The Act would expand the definition of “physician” and of other regulated health professionals in the Public Hospitals Act and several other healthcare related statutes to implement these changes. For example, the current definition of “physician” in the Public Hospitals Act, which includes a member of the College of Physicians and Surgeons of Ontario, would be expanded to include “or another prescribed person”. Similar changes would be made to the definition of “registered nurse” and “registered nurse in the extended class” (among others). We expect that the regulations, once available, will prescribe members of other provincial regulatory colleges.
The licensing process for healthcare professionals wanting to practice in another Canadian jurisdiction is currently lengthy, complicated and costly. Although we do not yet have the benefit of the regulations, the Act has the potential to improve access to care by relaxing regulatory requirements for out-of-province healthcare professionals. At the same time, there may be other implications and risks for hospitals and other healthcare organizations who credential and employ health professionals, including with respect to confirming competency. Despite the potential changes, hospitals and other healthcare organizations will continue to have a duty to only credential and hire qualified healthcare professionals.
As-of-right licensing has the potential to improve access to not only in-person care, but virtual care as well. Currently, while providing virtual care from their home province to patients in other jurisdictions, most health professionals must comply with the licensing requirements imposed by the regulatory college where they are licensed to practice as well as the college of the jurisdiction where a patient receiving virtual care is located. With as-of-right licensing, a licensed health professional located anywhere else in Canada could provide virtual care to patients in Ontario without an Ontario licence.
Ontario’s as-of-right approach to licensing is a stride towards the implementation of pan-Canadian licensure, which would allow healthcare providers to practice in any Canadian jurisdiction under one licence. The Canadian Medical Association (CMA) has been advocating for pan-Canadian licensure for many years, as part of the solution to the health workforce crisis. A recent poll of CMA members found that 95 per cent of physicians and medical learners support pan-Canadian licensure to improve access to care.
Ontario is not the only province taking steps towards a pan-Canadian licensure. Although not as expansive as Ontario’s as-of-right licensing, the Council of Atlantic Premiers recently announced that it will be implementing a new physician register as of May 1, 2023. The register will allow physicians to practice in any of the four Atlantic provinces without any additional licensing requirements. In British Columbia, the College of Nurses and Midwives recently approved revisions to the College’s bylaws to enable a multijurisdictional form of nursing registration in the future.
Expanding pharmacists’ scope of practice
The Act also includes amendments to the Pharmacy Act, 1991, which would expand pharmacists’ scope of practice to include the assessment of conditions for the purposes of providing medication therapies. This means that Ontarians may soon be walking into their local pharmacy to have a condition assessed for which they would have previously attended a walk-in clinic. Pharmacies will have to adapt from not only a structural standpoint, allowing for examination rooms for patient interactions, but also from a staffing perspective to ensure that the more traditional roles surrounding prescription dispensing can be maintained. While pharmacists would be permitted to assess a condition for the purpose of providing medication therapies, their scope has not been expanded to include communicating a diagnosis to an individual. This continues to be a controlled act that only certain health professionals are authorized to perform.
This is the latest in a series of expansions to pharmacists’ scope of practice by the provincial government. On January 1, 2023, amendments to the General Regulation under the Pharmacy Act, 1991, came into force, authorizing pharmacists to prescribe medications for 13 minor ailments such as insect bites and urinary tract infections.
The Canadian Pharmacists Association has long advocated for the expansion of the scope of practice of pharmacists, describing them as “an underutilized health-care resource in many parts of Canada.” Pharmacists played a pivotal role in the vaccination effort throughout the COVID-19 pandemic, helping ease some of the burden on the healthcare system. The Act will hopefully provide pharmacists with the opportunity to continue to ease this burden by allowing them to provide more patient care in the community.
Bill 60 was referred to the Standing Committee on Social Policy on March 1, 2023. It will need to go through a third reading at the Legislative Assembly of Ontario before it can receive Royal Assent and be proclaimed into force. We will continue to monitor Bill 60 and provide updates in this series of articles. For more information on Bill 60 and the new “as-of-right” licensing rules, please reach out to any of the key contacts listed below.
Special thanks to BLG articling student Bailey McMaster for her research assistance.