Laying the Groundwork for Physician Assistant Regulation

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College oversight expected to come into force in 2024

CPSO is consulting on proposed regulatory changes required to bring physician assistants (PAs) under the College’s oversight.

On June 3, 2021, Bill 283, the legislation enabling CPSO to regulate PAs, received Royal Assent. The government has signalled the legislation and the College’s oversight will come into force in 2024.

The move would make Ontario the fourth province to have its PAs regulated by the provincial medical regulator, following in the steps of Manitoba, New Brunswick and Alberta. In March, Saskatchewan introduced legislation to regulate PAs.

PAs are health care professionals specifically trained to support physicians in managing their practice, acting as physician-extenders to improve access to care. PAs work very closely with physicians and are permitted to perform controlled acts through delegation.

Given the relatively small number of PAs in Ontario — in 2021, there were approximately 540 practising PAs — the creation of a stand-alone health regulatory college was deemed impractical by the government.

While legislation has been passed to initiate the process of regulating PAs, much of the necessary work to complete this process relied on the development of regulations under the Medicine Act, 1991. CPSO worked closely with the Canadian Association of Physician Assistants and other stakeholders to develop these changes.

While the regulatory amendments proposed are CPSO’s to make, government must approve and enact the changes.

In drafting the regulations, CPSO aimed to set high-level expectations in line with the principles of right-touch regulation.

Enabling Mechanism

One of the regulatory amendments needed relates to how PAs are authorized to perform the controlled acts listed in the Medicine Act, 1991. The draft regulation articulates when and how PAs can perform controlled acts in keeping with the current practice of delegation. The draft regulation stipulates:

  • A PA member shall only perform controlled acts if delegated to by a physician, with the exception of psychotherapy, which cannot be delegated.
  • PAs may not sub-delegate a controlled act that has been delegated to them.
  • The conditions in which a physician may delegate an act and a PA may accept the delegation of this act (e.g., where the act is within the physician’s scope of practice and the PA has the competence to perform the act).

Unlike other Canadian jurisdictions that regulate PAs, this approach does not contemplate identifying specific supervisory relationships between a physician and a PA. Rather, and in keeping with the current delegation framework, it enables greater flexibility to support PAs as they support multiple physicians in multiple settings.

Registration (O. Reg. 865/93)

The existing Registration regulation sets out entry to practice requirements for CPSO members. The general, non-exemptible standards and qualifications for physician members will also apply to PAs, and do not require amendments. These include good character, payment of relevant fees and acquiring professional liability insurance, among others.

Amendments are proposed to set out the registration requirements for PAs. Namely, that an applicant:

  • Be a graduate of an accredited or approved degree-granting program designed to train PAs; and
  • Obtain either Canadian certification or the equivalent American certification.

The proposed changes also include giving Council the ongoing power to approve new education programs and accreditation bodies as the PA profession expands, and to support the inclusion of internationally educated PAs over time.

In drafting the regulations, CPSO aimed to set high-level expectations in line with the principles of right-touch regulation.

The draft regulation also includes a transitional grandparenting provision to enable two cohorts of trained and currently practising PAs who do not meet the standards and qualifications set out in the proposed regulation to register as members. The provision captures individuals who have successfully completed the Canadian Armed Forces Physician Assistant Program and the Physician Assistant Integration Program, a historical, assessment-based program that enabled internationally educated physicians to become PAs.

Quality Assurance (O. Reg. 114/94, General, Part VII)

Changes are also proposed to support the development of a continuing professional development (CPD) program for PAs, similar to what is in place for physicians.

Professional Misconduct Regulation (O. Reg. 856/93)

The Professional Misconduct regulation will equally apply to CPSO’s PA members. However, one minor amendment is required to add “physician assistant” to the existing “conduct unbecoming a physician.”