Preparing for a new future of naturopathic medicine in Ontario
The process of Transition
Getting the New Rules Right
The Naturopathy Act and a new College for the naturopathic profession in Ontario is about much more than a change in who regulates naturopathic medicine in Ontario. The vision of the profession extending back to the 1980’s, and a major focus for OAND efforts and resources, has been to have a new foundation in legislation that helps to create new opportunities for collaboration, and contributes to the growing respect and understanding of the value of naturopathic medicine.
That is why the naturopathic profession is concerned that the government-appointed Transitional Council is having a challenge in developing the new rules for the profession under the Naturopathy Act. The goal is for these new rules to be approved and the new regulatory College in place by March, 2013.
When Transitional Council consulted on the draft regulations last fall, there was a clear consensus in the profession that the proposed new rules did not properly capture the scope of practice of the profession, and would create barriers to collaboration and integration of NDs that would both impact patient care, and limit the potential contribution of NDs to the healthcare system.
This profession’s view builds on the new scope of the profession in British Columbia. Jason Boxtart ND, the Chair of the Canadian Association of Naturopathic Doctors, said “The CAND supports legislation and regulations that ensure naturopathic doctors can practice to the full extent of their education and training. The professional associations, regulators and educational institutions in Canada, through the Canadian Naturopathic Coordinating Council (Chaired by the CAND) recognize the Scope of Practice and regulations in place in British Columbia as a “national scope of practice” for use in all jurisdictions. The CAND supports the OAND and all other provincial associations in their efforts to obtain effective and appropriate regulations for NDs in line with the BC model.”
Despite a widespread consensus in the profession that the proposed approach would needlessly leave Ontario as one of the most restrictive places to practice naturopathic medicine, Transitional Council chose to make no substantive changes. Council did issue a series of “Fact Sheets” intended to provide a rationale for their recommendations, but these lacked reference to any evidence about safety or training concerns, impacts on patient care, what is permitted in other jurisdictions, or broader health policy considerations.
The OAND and the profession remain engaged in efforts to work with the Ontario government to help identify needed changes to the draft regulations. At the same time, the OAND remains determined to build a stronger working relationship with Transitional Council, in keeping with best practices for a self-regulating health profession.
Getting transition right creates the potential for NDs to more fully emerge as a primary care profession. Particularly for patients interested in a more natural approach to health, it is important that NDs be able to use all their skills and training like they can in other jurisdictions, and be able to fully take their place as a collaborative and integrated profession.
Why a new foundation?
Ontario’s 1200 Naturopathic Doctors have been regulated since the 1920s under the Drugless Practitioners Act. Being the only health profession outside of the Regulated Health Professions Act has created many barriers to collaboration with other health professions and integration into the health care system. Antiquated legislation also makes it difficult for Ontario NDs to use all their skills and training, and to be able to introduce new therapies that are being safely and effectively used by NDs in places with more modern rules.
The 2007 Naturopathy Act moves the profession into the same regulatory framework as all other professions, and for the first time provides the profession with a clear scope and six controlled acts: diagnosis, prescribing, administering a substance, examinations and treatment beyond the openings of the body, blood draws, and manipulation. The Act also provides patients with proper confidence that there are the same mechanisms as other professions to allow complaints and discipline to be addressed fairly and effectively.
Ultimately, this new foundation recognizes the choice of naturopathic medicine as part of the mainstream of healthcare and provides the basis for more understanding and respect for the profession and practitioners, and helps NDs to more fully emerge as a primary care profession in the eyes of the public.
NDs and the Health Care System
This new foundation for the profession comes at a time when Ontario’s health care system is facing major challenges.
The growing cost of the health care system is clearly threatening its sustainability. Today, 43% of Ontario revenue is going to health care (Conference Board of Canada 2011). Unless new approaches are taken, health care costs will consume 80% of Ontario spending by 2030, taking resources away from all other provincial priorities (TD Economics 2010).
Little can be done about cost pressures resulting from population growth, inflation, and an aging population. But other cost drivers can be limited through new approaches. Most chronic diseases, from diabetes to cancer, are the product of modifiable health risks. The enrichment factor, including drug costs, new technologies and changing patients’ expectations can also be shifted (Ontario Ministry of Finance 2010). Changes in these areas are critical to sustaining the health care system.
New Approaches are Needed
Disease prevention is widely recognized as key to savings in the health care system (Toronto Star 2011). 80% of Ontarians over the age of 45 have a chronic disease (Ontario Ministry of Health and Long Term Care 2007). Over a million Ontarians have been diagnosed with diabetes, and this number is expected to increase by more than 60% over the next decade (Canadian Diabetes Association 2010). 80% of Canadians aged 20 to 59 have at least one of five major modifiable health risks, including hypertension, elevated cholesterol, and obesity (Makrides 2010). Pharmaceutical costs are rising fast, and recently overtook physicians as the second largest area of health spending in Ontario (TD Economics 2010). Nearly one third of drug costs are for conditions that are the result of modifiable health risks, including high cholesterol, high blood pressure, diabetes and stomach ulcers (Globe and Mail 2010). In fact drug costs are a particular impact for Ontario, where benefits are some of the most generous in the country (TD Economics 2010).
There is increasing recognition that NDs offer solutions to many of the biggest challenges in health care. The profession has been building awareness that NDs are clinically trained to play a larger role in the delivery of primary care, and to ensure that NDs are recognized for their unique expertise in wellness and addressing preventable risk factors, including chronic diseases.
The care provided by NDs contributes to managing major cost drivers in the public system through several avenues; NDs are experts in addressing prevention and modifiable risk factors, provide patients with alternatives to pharmaceuticals, provide a more personalized approach to medicine that is increasingly in demand, and provide access to primary care in particular for those wanting an alternative to conventional medicine.
With the clear challenges to the sustainability of the health care system, it is important that NDs be able to use all of their skills and training to provide patients with the care they want. Patients of ND’s are inherently proactive with their health thereby creating savings for the public healthcare system.
Other professions are also making changes to respond to increasing patient expectations that their health care choices will be respected. The new CPSO policy on Complementary/Alternative Medicine recognizes and supports patient-centred care, including respect for preferences, to incorporate non-allopathic approaches from their MD and other practitioners. Recognizing the legitimacy of non-allopathic therapies for primary or secondary care helps to foster a culture of respect for patient choice and for health care professionals practicing complementary medicine, and provides another foundation for improved collaboration.
Canadian Diabetes Association, Cost of Diabetes in Ontario, 2010
Conference Board of Canada, 2011 Budget: Controlling Growth in Health-Care Spending is Key to Budget Commitment to Balance the Books, website.
Globe and Mail, Insurers Focus on Prevention, January 3, 2010
Makrides L, Sawatzky C, Petrie J, Veinot P. Modifiable health risks in Atlantic Canadian employees: a 5-year report. Health Promot Int. 2010 Dec;25(4):384-93.
Ontario Ministry of Finance, Ontario’s Long Term Report on the Economy, 2010, Chapter 3.
Ontario Ministry of Health and Long Term Care, Preventing and Managing Chronic Disease – A Framework, 2007, p.3
TD Economics: Charting a Path to a Sustainable Health Care System, 2010, Pages 4-11.
Toronto Star, Illness Prevention Will Save Taxpayers Money: McGuinty, May 9, 2011.