Let's Be Fair and Proactive: Ontario Fairness Commissioner Addresses the Situation of Physiotherapy Graduates and Entry to Practice Review
By: Nataliya Zlotnikov, HBSc, MSc

On Fairness 

On June 14, 2021, the Ontario Fairness Commissioner (OFC), Irwin Glasberg, released a letter regarding the situation of physiotherapy residents and entry to practice review. 

This blog summarizes the chronology of events and main points of the Commissioner's letter. We will continue to update this blog as new information becomes available. 

The letter is also linked here, should you want to read it in its entirety. 

If you would also like some reference to today's blog, we invite you to catch up with our two previous blogs on the subject:

• Physiotherapy Competency Exam (PCE) Clinical Component Cancelled for Third Time – Is it Time for a Change?
• Regulating During the Irregular: Canadian Healthcare Professional Licensing Adaptations During COVID

Timeline: What Happened & When? 

Dear Residents, Thank You for Your Persistence! 

Since the 3rd cancellation of the Clinical Component of the PCE on 20 March 2021, the office of the Fairness Commissioner received many e-mails from residents and the organizations that represent them addressing the College of Physiotherapists of Ontario (CPO), Canadian Alliance of Physiotherapy Regulators (CAPR), or both.    

These letters expressed concerns and attested to the hardships that the applicants endured arising out of the cancellation of the exams, coupled with a regulatory framework that is viewed as inflexible.

Embodia would like to extend our gratitude to all the recent grads and physiotherapy community members who refused to just sit back and do nothing.

Your action, initiative, and persistence, even in the face of reproach and possible detriment to your professional standings, have been of great service to the physiotherapy community and to recent graduates.  

Most Common Themes Raised in Letters

• There is a lack of transparent, clear, and effective communication with applicants.
• The CPO has not exhibited a sense of urgency in seeking to ameliorate the situation of the candidates who are still waiting to challenge the PCE nor sought to meaningfully engage with stakeholders on this issue.
• The CPO has not permitted a cohort of applicants who failed to pass the PCE exam in November 2019 to retain their provisional licensure status in circumstances where they are unable to write this examination again.
• Internationally trained candidates have been particularly disadvantaged by the current situation based on personal and financial pressures.

The Commissioner on CAPR's Actions: Responsible & Reasonable

Mr. Glasberg believes that CAPR acted responsibly in deciding to develop and later make available a virtual clinical examination as well as acted reasonably in engaging a third-party consultant to explore the platform issues that lead to the failure of the virtual examination. 

To Be Fair

The Commissioner outlined that there are elements of the current regulatory framework that constrain the college's ability to address the issues mentioned above in a way that the applicants would prefer because the college cannot unilaterally make such regulatory changes.

In order for such changes to be made, the College must approach the Ministry of Health (the Ministry).

The Ministry could then take considerable time to consider whether it would be willing to make any changes recommended by the college. 

In order to address the rigidity of the regulatory framework, the Commissioner recommends that the Working Group consider whether the CPO should set up a fast-track process where the College is able to identify barriers to registration that must be addressed by the Ministry and develop a mechanism through which these issues, along with recommended solutions could be taken to the ministry at the earliest opportunity.  

To date, the CPO has not yet approached the Ministry with a request to make regulatory changes. 

Commissioner Comments on the Entry to Practice Review 

OFC supports the CPO's decision to launch an entry to practice review. 

The OFC Believes That the Working Group Should Consider the Following Issues:

A. Public Interest 

• In order to make sure that there are adequate numbers of qualified, skilled and competent healthcare professionals, regulators need to implement fair and efficient registration processes that are delivered expeditiously in normal times and particularly during emergency situations. 
  • In the past, the OFC office has observed that some regulators exploit the theme of public health and safety as a way of avoiding uncomfortable discussions.

B. Assessment of Risk and Application of Regulatory Discretion 

• A candidate who successfully completes the written examination may receive a provisional certificate provided that the candidate (1) is supervised by a member of the college and (2) has applied to write the PCE clinical examination the next time that it is offered. 
• If, however, the candidate subsequently fails the first attempt at the PCE examination, this individual’s provisional certificate is immediately revoked (regardless of previous experience in the profession and/or whether the individual may have scored just below the minimum standardized passing grade). 
• This result seems particularly harsh since most candidates eventually pass the PCE examination during the second or third try. 
• Recommendation: The current system appears overly rigid and lacks fairness. The Working Group should consider whether the profession should gravitate to a more modern regulatory approach.

C. Communications with Applicants 

• In extreme situations such as pandemics, it is extremely important to establish strong channels of communication with applicants to ensure that applicants have the most up-to-date information. 

D. Composition of Working Group 

• This group should discuss novel approaches and engage in courageous conversations. 
• CPO should ensure that group membership facilitates this objective. 
• The council should consider appointing a PT applicant to the working group. 

Proactive 

The working group will consider the longer-term issues raised here, however, the Commissioner also encourages the CPO to proactively take whatever steps it can to relieve the burden on current applicants to the system. 

CPO Council Meeting  

On the 22nd and 23rd of June 2021, the CPO held their Meeting of the Council of the College of Physiotherapists of Ontario. 

The council meeting was streamed on YouTube Live via Zoom. This meeting was recorded and will be available for anyone interested. 

The CPO introduced a new president, Thersa Stevens (appointed March 2021). Theresa hopes for a progressive, solution-oriented discussion to take place and believes that decisions are most effective when everyone's voices are heard.

One of the pertinent items mentioned was the College Performance  Management Framework (CPMF).

Novel College Performance Management Tool (CPMF)

Ontario is the first province to develop a health regulatory College Performance Measurement Framework (CPMF) that proactively implements international best practices around regulatory performance measurement.

The CPMF is a novel effort developed and released in December 2020 by the Ministry of Health which will complete annual evaluations of all regulatory colleges to ensure that they are protecting the public interest.

The CPMF strengthens the accountability and oversight of the Colleges by providing publicly reported information that is transparent, consistent and aligned across all 26 Colleges on their performance in acting in the public interest, and by identifying benchmark information and best practices Colleges can leverage to improve their performance and ensure that public confidence in the professions is maintained.

The CPMF has been developed together with experts in performance measurement, quality improvement and public reporting, representation from the public and broad representation from the Colleges.

The CPMF covers a wide variety of topics, like how colleges:

• perform as an organization,
• register applicants,
• measure practice improvement of regulated health professionals, and
• process complaints about their registrants.

An Unparalleled Time In History

This blog will be updated as more information becomes available.

In the meantime, let's keep working together, keep paying attention and staying strong in the face of adversity.

The pandemic has caused substantial disruptions to many of our lives, but it also allowed issues such as those addressed in today's blog to come to the surface.

We now stand in a unique moment in history as healthcare professionals. We have the momentum. Let us keep standing together for change, progress, equity, and innovation.   

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Date written: 22 June 2021
Last update: 23 June 2021, 1 PM EST