Attached in an email sent to me from the ontario podiatric medical association:
A Proposed Framework for the New Podiatry Model in Ontario
1. Introduction
The HPRAC referral provides a once-in-a-lifetime opportunity to implement a model for the delivery of foot care that fully and effectively responds to the current and foreseen needs of Ontarians and Ontario's health care delivery system. There is a range of "Podiatry" models in Canada and in comparable international jurisdictions. The challenge is to select the best reference point for Ontario.
At a meeting of the ad hoc committee, it was recommended that the committee identify the Canadian province that has the most extensive Podiatry scope of practice and use it as a model. There is no point in going for second or third best. Furthermore, using the most extensive scope of practice as the model for our proposal to HPRAC will help to facilitate the Interprovincial (and international) mobility of practitioners, which appears now to be a priority adopted by every provincial and territorial government.
Furthermore, a current preoccupation of the Ontario government (and HPRAC) is interprofessional collaboration, in order to provide seamless patient care and also to use healthcare practitioners to the maximum of their competencies within their respective scopes of practice. One health care specialization with which podiatrists particularly need to collaborate is orthopedic surgeons. At a recent meeting of the American Podiatric Medical Association in Washington, the President of the AMA (who happens to be an orthopedic surgeon) spoke. He stated that for the podiatry profession to be accepted by medicine in general and orthopedic surgeons in particular, the profession should aim for parity in competencies and parity in standards of practice wherever scopes of practice overlap between podiatry and medicine. The same point has been made in meetings with the Canadian and Ontario orthopedic associations.
The Podiatry models that currently exist in Canada1 have been closely canvassed and the Alberta model has been identified as the one with the most extensive scope. It is not only "tested" but also most likely to promote interprofessional collaboration and to respond to Ontario's requirements for the foreseeable future. Obviously, some aspects of the model will have to be adapted to the RHPA framework and to the particular circumstances and requirements of Ontario's health care delivery system.
2. The Alberta Model
Background
Podiatric medicine has been a regulated profession in Alberta since 1965. From 1924-1965 the profession was regulated as surgical chiropody. There are currently 62 podiatrists registered to practise in the Province.2
To be eligible to practise as a podiatrist in Alberta, one must have graduated with a Doctor of Podiatric Medicine/DPM degree from a program accredited by the Council of Podiatric Medical Education (CPME), plus have completed at least two years' residency at an approved facility and completed Parts 1, 2 and 3 of the National Board examinations. Within the next two or three years Alberta will likely require a minimum of three years' residency.
The Alberta Podiatry Association, the Government of Alberta and the University of Alberta are working together to launch a DPM program at the University of Alberta as part of the Faculty of Medicine and Dentistry to accept students beginning in the 2012-13 academic year. This would mean two DPM programs would be operating in Canada; one planned for Alberta and one currently operating in Québec. The Québec program is not yet CPME accredited, however, and it would take some time for the Alberta program to obtain CPME accreditation as well. Podiatrists in Alberta are also authorized to call themselves Doctor, as well as being authorized to use several other protected titles.
Podiatrists are currently regulated under the Podiatry Act, RSA 2000, c-6. The statutory scope of practice of the profession is as follows:
podiatry
(i) means the branch of the healing arts that treats ailments, diseased conditions, deformities or injuries of the human foot and the leg muscles controlling the foot, and
(ii) includes the examination, diagnosis and treatment of those ailments, conditions, deformities or injuries, but
(iii) does not include the treatment of systemic diseases of bones, muscles or ligaments, or the use of x-ray equipment for purposes other than diagnostic, or the use of anesthetics other than local.
Pursuant to its authority under the Podiatry Act, the Alberta Podiatry Association (the regulatory body) has authorized members of the profession to perform the following activities:
* Cut a body tissue to administer anything by an invasive procedure on body tissue or to perform surgical or other invasive procedures on body tissue below the dermis of the foot or ankle;
* Re-set a fracture of a bone of the foot or ankle;
* Reduce a dislocation of a joint of the toes;
* Prescribe a Schedule 1 drug within the meaning of the Pharmacy and Drug Act
* Dispense, compound, provide for selling or sell a Schedule 1 drug or Schedule 2 drug within the meaning of the Pharmacy and Drug Act for the purpose of treating ailments, diseases, deformities and injuries of the human foot and ankle;
* Administer nitrous oxide gas for the purpose of anesthesia or sedation when treating ailments, diseases, deformities and injuries of the human foot and ankle;
* Order or apply any form of ionizing radiation in medical radiography and nuclear medicine for the purpose of treating ailments, diseases, deformities and injuries of the human foot and ankle;
* Order or apply any form of non-ionizing radiation in lithotripsy, magnetic resonance imaging or ultrasound imaging for the purpose of treating aliments, diseases, deformities and injuries of t he human foot and ankle.
The Future in Alberta
The (Alberta) Podiatry Act will be revoked very soon, perhaps as early as this Fall, at which point the Podiatry profession, like all of the other regulated health care professions in Alberta, will be brought under the Health Professions Act.3
Pursuant to a draft regulation ("Podiatrists Profession Regulation") prepared by the Ministry of Health for review by the podiatry profession and other stakeholders, the "restricted activities" to be granted to the podiatry profession under the Health Professions Act are as follows:
Restricted activities
12(1) A regulated member registered on the general register or on the courtesy register may, within the practice of podiatry and in accordance with the standards of practice, perform the following restricted activities for the purpose of diagnosing and treating ailments, diseases, deformities and injuries of the human foot:
(a) to cut a body tissue, to administer anything by an invasive procedure on body tissue or to perform surgical or other invasive procedures on body tissue below the dermis of the foot and ankle;
(b) to set or reset a fracture of a bone of the foot or ankle;
(c) to reduce a dislocation of a joint of the toes;
(d) to prescribe a Schedule 1 drug within the meaning of the Pharmacy and Drug Act
(e) to dispense, compound, provide for selling or sell a Schedule 1 drug or Schedule 2 drug within the meaning of the Pharmacy and Drug Act for the purpose of treating ailments, diseases, deformities and injuries of human foot and ankle;
(f) to prescribe or administer nitrous oxide gas for the purpose of Anesthesia or sedation when treating aliments, diseases, deformities and injuries of the human foot and ankle;
(g) to order or apply any form of ionizing radiation in medical radiography and nuclear medicine for the purpose of treating aliments, diseases, deformities and injuries of the human foot and ankle;
(h) to order or apply any form of non-ionizing radiation in lithotripsy, magnetic resonance imaging or ultrasound imaging for purpose of treating aliments, diseases, deformities and injuries of the human foot and ankle;
(2) Despite subsection (1)(e), a regulated member performing the restricted activity described in that subsection shall not distribute, trade or barter for money or valuable consideration or keep for sale or offer for sale a Schedule 1 drug or a Schedule 2 drug within the meaning of the Pharmacy and Drug Act but may distribute or give away a Schedule 1 drug or a Schedule 2 Drug without expectation or hope of compensation or reward.
Self-restriction
13(1) Despite any authorization to perform restricted activities, regulated members must restrict themselves in performing restricted activities to those activities that they are competent to perform and to those that are appropriate to the regulated members area of practice and the procedure being performed.
(2) A regulated member who performs a restricted activity must to so in accordance with the standards of practice.
3. Proposed Plan for Ontario
Scope of Practice Statement
The scope of practice statement as it currently appears in section 4 of the Chiropody Act, 1991 would be expanded as follows:
The practice of podiatry is the assessment or diagnosis of the foot and ankle and the treatment and prevention of diseases, disorders or dysfunctions of the foot, ankle and legs muscles controlling the foot by therapeutic, orthotic or palliative means.
Authorized Acts
Adapting Alberta's "restricted activities" to Ontario's RHPA controlled act framework would result in a list of authorized acts along the lines of the following:
1. regulations. (Expansion of the current authorized Communicating a diagnosis identifying a disease or disorder of the foot or ankle as the cause of a person's symptoms. (Expansion of current authorized act.)
2. Cutting into subcutaneous tissues of the foot and ankle, including bony tissues. (Expansion of current authorized act.)
3. Setting or casting a fracture of a bone or a dislocation of a joint in the foot or ankle. (New authorized act.)
4. Administering, by injection into feet or by inhalation, a substance designated in the act. (Expansion of authorized act)
5. Prescribing or dispensing drugs designated in the regulations. (Expansion of authorized act.)
6. Applying or ordering the application to the foot or ankle of a form of energy designated in the regulations. (New authorized act.)
Additional Authorities
Pursuant to the Operation of Approved Hospitals Regulation (sections 9 and 10) under the (Alberta) Hospitals Act, RSA 2000, c H-12, Alberta's podiatrists are entitled to Hospital privileges (i.e. admission and release of patients, ordering diagnostic tests, access to operating facilities), which are administered at the health region level. Amendments to the Hospital Management Regulation (Regulation 965) under the (Ontario) Public Hospitals Act would be required to provide Podiatrists with the same privileges in Ontario.
Alberta's podiatrists are entitled to order all lab and diagnostic tests as deemed necessary to their practice of podiatric medicine. Ordering laboratory tests is not a restricted activity in Alberta, but podiatrists are issued practitioner IDs by the Ministry of Health and Wellness in order to be able to bill the Alberta Health Care Insurance Plan for the tests they order.
Amendments to Regulation 682 under the (Ontario) Laboratory and the Specimen Collection Centre Licensing Act would be required to provide podiatrists with the same privileges in Ontario, as well as amendments to Regulation 552 under the Ontario Health Insurance Act in order for the lab tests ordered by podiatrists to be covered by OHIP.
Payment to medical specialists is authorized under the Physicians' Schedule of Benefits for direct referrals from podiatrists. Amendments to Regulation 552 under the (Ontario) Health Insurance Act would be required to provide podiatrists with the same privileges in Ontario.
Regulatory Framework
The new regulatory model would include the following major features:
* The Chiropody Act, 1991 would be revoked and replaced by the Podiatry Act, 200?
* The College of Chiropodists would be continued as the College of Podiatrists
* The profession would mean the profession of Podiatry
* The Scope of Practice statement would be amended to include specific reference to the ankle, as well as the foot
* The Class of Members concept would be removed. Persons continuing to be limited in their practice to the current Chiropody authorized acts would be distinguished by conditions and limitations attached to their registrations and would be identified as such on the College's web site.
* The "podiatric cap" (i.e. Subsection 3 (2) of the Chiropody Act, 1991) would be revoked.
