Appropriate Training Required to Assess Patients Who Want Sex Reassignment Surgery

Physicians are reminded of their responsibilities and the training requirements needed when completing prior approval forms and assessments in support of a patient’s request for OHIP insured sex reassignment surgery (SRS). The Ministry of Health and Long-Term Care has told the College that it has encountered instances where physicians have completed the form and assessed patients without having the necessary training in this area of expertise.

A provider must be trained in the assessment, diagnosis, and treatment of gender dysphoria in accordance with the World Professional Association for Transgendered Health (WPATH) Standards of Care that are in place at the time of the recommendation for Sex Reassignment Surgery (SRS).

In light of this, the College is reminding physicians that they must have training in the WPATH standards of care to accurately assess their patients for sex reassignment surgery.

In 2016, Ontario expanded access to medically necessary sex reassignment surgery by allowing qualified providers throughout the province to assess patients and recommend them for surgery. The criteria for OHIP insured SRS are set out in the Schedule of Benefits for Physician Services, Appendix D, under Regulation 552 of the Health Insurance Act. Prior approval from the Ministry of Health and Long-Term Care is required in order for the service to be insured.

Depending on the type of surgery sought, a prior authorization request completed by a physician or nurse practitioner must include either one or two supporting assessment(s) from appropriately trained providers confirming that OHIP’s funding criteria are met.

The second or supporting assessment must come from a different, appropriately trained Ontario physician, nurse practitioner or a registered nurse, registered psychologist, or registered social worker.

The Ministry has developed a website dedicated to providing health-care professionals with information about SRS and OHIP. This website can be accessed at: http://www.health.gov.on.ca. Physicians seeking training in transgendered health care and WPATH standards of care can contact Rainbow Health Ontario.