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Chiropody and Podiatry: Regulation of the Profession and the Model of Foot Care in Ontario

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Chiropody and Podiatry: Regulation of the Profession and the Model of Foot Care in Ontario HPRAC_PODIATRY_COVER_BILINGUE_PRINT_072715.qxp_Layout 1 2015-07-27 4:23 PM Page 1 This document contains both information and form fields. To read information, use the Down Arrow from a form field. Chiropody and Podiatry: Regulation of the Profession and the Model of Foot Care in Ontario Volume 1 This page has been intentionally left blank 66…. 56 Wellesley St W., 56, rue Wellesley Ouest, 12th Floor 12e étage Toronto ON M5S 2S3 Toronto ON M5S 2S3 Tel (416) 326-1550 Tél (416) 326-1550 Fax (416) 326-1549 Téléc (416) 326-1549 Web site www.hprac.org Site web www.hprac.org E-mail Courriel [email protected] [email protected] August 31, 2015 The Honourable Dr. Eric Hoskins Minister of Health and Long-Term Care 10th Floor, Hepburn Block 80 Grosvenor Street Toronto, ON M7A 2C4 Dear Minister, The Health Professions Regulatory Advisory Council (HPRAC) is pleased to present this report, which provides an analysis of the current model of foot care in Ontario, considers whether there should be changes to existing legislation governing chiropodists and podiatrists, and examines issues of restricted titles and whether the existing legislation which prohibits the registration of new podiatrists should continue. As part of our assessment process, we completed a jurisprudence review and two literature reviews, which included information on foot care in other jurisdictions. We also conducted two extensive consultation programs with a broad group of stakeholders. In developing our advice, HPRAC follows a process that is thorough, timely and efficient, and reflects the principles of independence, fairness, transparency and evidence-based decision- making. HPRAC’s recommendations related to the regulation of chiropody and podiatry are based on its assessment of the profession’s ability to meet the criteria for a change in scope of practice, and the need for such a change. Using these criteria, HPRAC found that the applicant did not satisfy HPRAC’s criteria for a scope of practice change and that no changes should be made at this time to the current legislation that prohibits the registration of new podiatrists in Ontario. HPRAC did find that changes should be made to titles within the profession and that the list of drugs available to the profession should be reviewed. We look forward to meeting with you to discuss the findings and recommendations in this report. Sincerely, Thomas Corcoran, Chair Rex Roman, Vice Chair Bob Carman, Member Jeanette Dias D’Souza, Member Said Tsouli, Member Chiropody and Podiatry: Regulation of the Profession and the Model of Foot Care in Ontario Report by the Health Professions Regulatory Advisory Council August 2015 This page has been intentionally left blank Table of Contents Executive Summary ....................................................................................................................................... 1 Chapter I: Background on the Referral .......................................................................................................... 5 Referral Question ...................................................................................................................................... 5 HPRAC’s Process ..................................................................................................................................... 5 Part I: The Model of Foot Care ...................................................................................................................... 6 Chapter II: The Foot and Foot Care Delivery ................................................................................................. 7 What is the Foot? ...................................................................................................................................... 7 What is Foot Care? ................................................................................................................................... 8 Where is Foot Care Delivered and How is It Paid For? ............................................................................. 9 Chapter III: Who is the Patient? ................................................................................................................... 13 The Elderly .............................................................................................................................................. 13 Individuals with Diabetes ......................................................................................................................... 13 Aboriginal Populations ............................................................................................................................. 14 Marginalized Populations ........................................................................................................................ 14 Chapter IV: Who Provides Foot Care in Ontario .......................................................................................... 15 Regulated Providers ................................................................................................................................ 15 Unregulated Providers ............................................................................................................................. 20 Chapter V: What HPRAC Heard .................................................................................................................. 22 The First Consultation Program ............................................................................................................... 22 Survey Responses .................................................................................................................................. 23 Chapter VI: Conclusions and Other Considerations .................................................................................... 35 Preventative Care .................................................................................................................................... 36 Part II: Regulation of Chiropody and Podiatry .............................................................................................. 37 Chapter VII: Background on a Scope of Practice Review ............................................................................ 38 What is a Scope of Practice? .................................................................................................................. 38 What are Controlled Acts and Authorized Acts? ...................................................................................... 38 What is the Difference between an Individual and a Professional Scope of Practice? ............................ 39 How Does HPRAC Review a Scope of Practice Increase Request? ....................................................... 40 Chapter VIII: Background on the Referral .................................................................................................... 42 Referral Question .................................................................................................................................... 42 Who is the Applicant? .............................................................................................................................. 42 Why Does Ontario Use the Chiropody Model of Foot Care? ................................................................... 43 Chapter IX: What HPRAC Heard ................................................................................................................. 45 The Second Consultation Program ......................................................................................................... 45 Chapter X: What HPRAC Learned ............................................................................................................... 61 HPRAC’s Assessment of the Proposed New or Expanded Controlled Acts and Authorities ................... 62 Other Proposed Changes ........................................................................................................................ 88 Chapter XI: Conclusions and Other Considerations .................................................................................... 94 Quality-Based Procedures for Foot and Ankle Surgery ........................................................................... 94 Inspection Program ................................................................................................................................. 95 Policy Considerations .............................................................................................................................. 95 Appendix A .................................................................................................................................................. 96 Recommendations & Points for Consideration ........................................................................................ 96 Appendix B .................................................................................................................................................. 98 List of Controlled Acts ............................................................................................................................. 98 Appendix C .................................................................................................................................................. 99 First Consultation Questionnaire ............................................................................................................. 99 Appendix D ...............................................................................................................................................
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