Are Non-Regulated Health Care Professionals Substandard?

Most Canadians understand that the main mission of a health regulatory College is to protect the public from health care providers who are not practicing according to government mandated practice guidelines.

However, by listening to this message from regulatory Colleges many people may now have a bias toward seeking their health care solely from regulated providers who are working under their supervision and guidance. Canadians may be missing out on the skills and expertise of non-regulated health care providers who may actually be a more appropriate match for their particular needs.

So Are Non Regulated Providers Not Qualified?

It may be understood by extension that, because the provider is not regulated, they have received subpar education and training in their chosen modality or that the method of their treatment is simply substandard or ineffective. Not so.

I am a regulated kinesiologist and a non-regulated personal trainer, strength and conditioning coach, yoga teacher, and holistic nutritionist. In 2006 and 2007, I served as President of the Ontario Kinesiology Association. At Queen's Park in Toronto in the spring of 2007 I delivered a presentation to then Minister of Health and Long-Term Care George Smitherman.

On behalf of all kinesiologists in Ontario, I asked that our growing profession become regulated. I emphasized that there was a clear and present danger to the public because of our growing number and the sheer number of skills and treatment approaches that kinesiologists were using with their clients across our massive scope of practice in Ontario. It worked. 

With the establishment of the College of Kinesiologists of Ontario, regulation was eventually granted to the kinesiology profession in 2013. Now the real work of setting up our profession began. As you can appreciate (and probably identify with!), it's been a daily push to consistently assert ourselves as qualified movement experts in a noisy rehabilitation space. And after all of our efforts our clients still can't spell 'kinesiology'!

People Just Doesn't Care

Most people (and possibly also health care practitioners themselves) are challenged to clearly grasp the true differences between regulated and non-regulated health care providers. This lack of understanding is common and concerning. And perhaps people don’t really care!

What our clients do care about is whether they get their personal pain point resolved as quickly as possible - for the least amount of money. They also like to enjoy the experience with their treatment provider along the way. They care if their insurer will reimburse them for as much of the treatment session cost as possible. So when we get right down to it - it's quite likely that simple. Regulated or not they say - just help me feel better!

Unregulated - But Specially Skilled

If people believe that they should only be working with regulated health care professionals, they may be missing out on special skills and talents of non-regulated health care providers. 

This perception may also lead the public and health care professionals of different stripes to believe that all non-regulated health care providers should be considered ‘complementary or alternative’ therapists (so as a ‘B’ option).

It may be understood that this large variety of therapists (like nutritionists, personal trainers, yoga and Pilates instructors, Reiki practitioners, exercise physiologists, osteopathic manual practitioners and athletic therapists) do not have the same high level of skill as regulated health care professionals.

It follows then, that we may make the assumption that this non regulated provider could quite possibly treat a client or patient in an inappropriate, unethical and unskilled fashion and could cause harm. Well, yes! In other words - we don’t know what is happening with a non-regulated provider. It’s just like the Wild West if you aren’t working with someone who is practicing within the guidelines of a regulatory College!

But, at the same time, regulation does not automatically assure a high level of competence. Perhaps we'd like to assume this is the case to keep things simple - but it isn't always a straight line. A non regulated health care provider is quite likely also highly skilled!

So let's not be too hasty here. I argue that this may not the case. It may, in fact, be quite misleading should the public perceive this correlation as true.


So Are Regulated Providers Truly More Qualified?

I realize that Colleges and their members clearly understand that when a profession is regulated it does not mean they are more ‘acceptable’ or qualified to practice than any other health care professional.

We know that a regulated professional is accountable to a government body rather than to the self-governing body of non regulated pros. Regulated providers are held to account for many areas of professional practice to maintain a high standard for the good of the public they serve. 

However, some groups like non regulated health care professionals, college and university health science educators, employers, insurers, and the general public may not understand this difference. Certainly I know that many of our clients do not understand the difference! And this is dangerous.

Are Non Regulated Pros Maybe Not Dangerous Enough?

It is understood that among the criteria for regulating a health care profession in Canada is that there must be a significant enough number of providers currently in practice AND a real or perceived threat of harm to the public as a result of the providers’ treatments before an application for regulation would even be considered for examination by a Ministry of Health and Long Term Care (MOHLTC).

A complementary or alternative therapy provided by a non regulated provider may have smaller numbers of practitioners or simply not be perceived as harmful enough (i.e. not have enough documented complaints to the MOHLTC) to warrant the time, process, and expense of achieving regulatory status. So there's that.

What About Dually Registered or Qualified Practitioners?

We realize that many regulated health care providers are often dually credentialed in another regulated or unregulated health care discipline in order to work with a wider range of clients or, better yet, focus their practice in a unique way by niching down to treat a particular kind of client.

Those that are dually credentialed may also add another discipline to their practice in order to increase their income (they may get access to payment through extended health care benefits plans this way). They may also be able to satisfy a desire to explore another area of interest to complement their original discipline.

A Healthy Overlap

There are helpful overlaps in the scopes of practice of most health care professionals. This allows for excellent continuity of care for our clients. We also all practice slightly differently and that is our magic – our secret sauce – and may be just the thing our clients need for their recovery or progress journey.

The motivation for us to understand how and when to cross-refer a client who needs different care than a healthcare provider in our own discipline speaks to the integrity, knowledge and the professionalism of us as the referring health care provider.

The health care provider is no less a professional should they aim to help their clients and decide to seek further knowledge and training in a complementary or alternative therapy themselves or if they make a successful referral to a non-regulated therapist. This referral only benefits the clients they serve.

We're All On The Same Team

There is room for all health care providers. Our clients are better off when we cooperate, collaborate and appropriately cross-refer to each other. Ignorance, an incomplete understanding, or misinformation about another therapist’s training/perspective/skill is not a reason for the dismissal of a treatment option.

It’s a narrow-minded and perhaps a dangerous perspective to intentionally or unintentionally communicate our opinion about a non-regulated health care professional to someone who may well need the specialized care of a non-regulated provider.

Good Therapists Consistently Get Good Results

All good physical and mental therapists will rise to the top no matter what their regulated status. It is our responsibility to each other and to the public to educate ourselves about all regulated and non regulated providers in our treatment space - for the good of the clients we treat. Let’s support our regulated and non regulated colleagues with good referrals and, most of all, encourage great outcomes.

For more information about the health care professions regulated in Ontario under the Regulated Health Professions Act (1991) read more here: https://www.health.gov.on.ca/en/pro/programs/hhrsd/about/regulated_professions.aspx