BC proposes new college for diagnostic and health professions

On December 9, 2016, the BC Ministry of Health issued a news release proposing a new college for diagnostic and health professionals. What does this have to do with Medical Physics? Read on.

Background

While "Health" is a Federal Ministry in Canada (and have 'Acts'), healthcare is administered and executed at the provincial level. This means that the bulk of health care legislation resides in provincial Acts and, subsequently, legal provisions for administering health care (insurance plans), funding for hospitals and other facilities, and administering and paying for services are through the province. In so doing, each province has a variety of healthcare-related Acts to follow through with these obligations, including a Health Professions Act that defines who can deliver healthcare services. 

Here is a simple search on CANLII on 'health professsions acts'. As you'll see, some provinces have a single Act and make changes when new 'professions' of import and need are defined, whereas other Acts are more complex. Often coupled with such Acts are reference to some type of body (organization, college, etc) that has an authority -independent of the government- to determine if an individual has the academic and/or clinical background to be a healthcare professional. Through legislation, the provincial government can empower an organization to regulate a profession. This simple framework exists for most professions in healthcare. 

But today's delivery of healthcare requires many different types of skills and knowledge sets, and often healthcare needs outpace the speed of legislation. This phase difference can result in medical errors. Take for example, a recent series of incidents related to pathologists in Canada. An inquiry into those errors suggested that more work needs to be done in establishing credentials, national standards, quality assurance procedures and processes, and accountability. Much of this can be accomplished through sound organizations which are firmly committed to patient safety. Such organizations may be empowered through legislation to be 'self-regulating' such that they, among other things, are 'gate-keepers' of the profession that can regulate entry into the profession. These colleges exist for many health professionals. Regulation, often through the mechanism of a college, helps define accountability, which is the bond of trust between healthcare professionals.

Medical Physicist as a Profession in Canada

At the time of writing this post, outside of Quebec, the phrase 'Medical Physicist' does not exist in any provincial legislation. And even within Quebec, the phrase 'Medical Physicist' is only used in the context of the Hospital Insurance Act and in reference to collective bargaining units (i.e., how they get paid). There are some important radiation safety documents published by provincial and federal agencies that specifically refer to a "Medical Physicist", often preceded by "qualified", and followed by "cerftied by [CCPM/ABR/etc]". 

At the Federal level, the most commonly cited example of the use of "Medical Physicist"  is Safety Code 35 : Safety Procedures for Installation, Use and Control of X-ray Equipment in Large Medical Radiological Facilities: 

"There must be a Medical Physicist or Radiation Safety Officer to act as an advisor on all radiation protection aspects during the initial stages of construction of the facility, installation of the equipment, and during subsequent operations. Medical physicists are health care professionals with specialized training in the medical applications of physics."
"The medical physicist /radiation safety officer must:

1. possess qualifications required by any applicable federal, provincial, or territorial regulations or statutes and be certified according to a recognized standard, such as for medical physicists, the Canadian College of Physicists in Medicine;"

and that individual must have achieved a measure of competency.

And at the provincial level, one example in the use of "Medical Physicist" is in BC's Diagnostic Accreditation Program (www.dap.org) which spells out who can perform acceptance testing and quality assurance on various diagnostic imaging technologies.

While such mentions are important for ensuring quality in patient care, the profession itself is not "protected". Traditionally, the profession of 'Medical Physicist', if only by name, is regulated by the 'employer'. While the situation in Canada does not render itself to misjudgements in hiring a 'qualified' Medical Physicist, a gap in regulating the profession exists, and as evidenced for Pathologists mistakes can happen.

I don't want to get into a detailed conversation over whether the profession of Medical Physicist should -or should not- be regulated in Canada. There is an excellent post in the COMP Point-CounterPoint (see April 2015, page 53) that discusses the pros and cons of this at length. The goal of this blog is to take a snapshot of the status today, particularly in BC.

Medical Physicist as a Profession in British Columbia

So where are we today? Since inception, the British Columbia Association of Medical Physicists (BCAMP) purposes are:

a) to represent the interests of medical physicists practising within British Columbia; 

b) to promote within British Columbia the recognition of the importance of certification by the Canadian College of Physicists in Medicine (CCPM) and to encourage eligible society members to become Members or Fellows of CCPM; 

c) to promote and encourage the development of scientific knowledge towards the applications of physics to medicine; 

d) to further the exchange and publication of scientific and technical information relating to the science and practice of medical physics; 

e) to promote educational opportunities in those disciplines which support the science and practice of medical physics; 

f) to assist in the development and protection of professional standards in the discipline of medical physics, and 

g) to link to the activities of other societies, associations or organizations, whether provincial, national 

Since 2012 there has been more rigour directed at including "Medical Physicist" within the BC "Health Professions Act" (it's a quick read... don't be scared!). As you'd guess, many professions are not included in this (rather old) legislation. In order to be included on this list, the Minister of Health needs to be convinced that the practice of that profession may involve risk of physical, mental or emotional harm to the health, safety or well-being of the public, particularly -in the case of Medical Physicists- in regard to technology, including instruments and materials, used by practitioners of the health profession. Within the Act, the Minister has the authority to determine if the public would benefit from regulating that profession. 

The Coalition College of Diagnostic and Health Professions

Of notable omission as a Health Care Profession are Medical Radiation Technologists. For a decades' long effort, the BCAMRT has been working towards creating a regulated college. During that time, other organizations, such as the BC Society of Laboratory Science (www.bcsls.net), have equally been working towards this goal. Rather than introducing professions into the Act one-at-a-time (and ensuring there was proper framework for a regulatory college if needed) the Ministry of Health opted for a different approach. Basically, the steps for any profession could follow a standardized trajectory:

1. Determine the type of profession it is. This might mean looking at the specifics of the qualifications  (education and training) of the profession.
2. Determine if the profession fits within the context of the Health Professions Act. 
3. Spell out what specific restricted activities *to the patient* the professional undertakes. Note, we're not talking about activities like QA'ing a machine, but rather those activities done to the patient, that only health professionals should do.

Of notable importance is that, given 3, it becomes pretty obvious that many professions may share restricted activities. 

With the government's blessing, various organizations have embarked on pursuing an 'Umbrella' College for 'Diagnostic and Health Professions'. 

So, now getting back to that news release, it mentions that the Ministry of Health is:

"...proposing to establish a new college of diagnostic and therapeutic health professions to enhance patient safety and quality of care in British Columbia. 

The new college would initially oversee four types of health-care professionals: respiratory therapists, radiation therapists, clinical perfusionists and medical laboratory technologists."

While eleven professions were examined by the Ministry (including Medical Physicists), these four were chosen for the first 'phase' of professions which would be self-regulating through a Coalition College. Thereafter,  

"Once the new college has been substantially implemented, the ministry will continue its work on regulatory options for a number of other diagnostic and therapeutic health-care occupations, including nuclear medicine technologists, medical radiography technologists, magnetic resonance imaging technologists, medical laboratory assistants, cardiology technologists, diagnostic medical sonographers and medical physicists."* 

*bolded by author

Medical Physicists as a Regulated Profession in BC

Clearly our allied health professionals value the work Medical Physicists undertake: no better example of this is through the Canadian Partnership for Quality Radiotherapy (www.cpqr.ca), where Medical Physicists play leadership roles in creating the gamut of technical guidance documents. The fact that Medical Physicists are explicitly mentioned in important provincial and federal documents is important in itself; however, fundamentally, the profession is not legally recognized in any province. The very fact that Medical Physicists have been brought to the attention of law-makers is important. 

Similar processes are unfolding throughout Canada, where provincial legislators are beginning to understand what Medical Physicists do. 

Medical Physicists are health professionals responsible for assuring the safe and effective delivery of radiation to achieve a diagnostic or therapeutic result by overseeing and managing technical aspects of the use of radiation in medical applications; implementing and overseeing quality assurance programs for accurate patient dosimetry and quality imaging; and, assuring compliance with relevant legislation and regulations.

Defining the profession in provincial jurisdictions is still going to take some time. But we are one step closer.