Proposed Amendments to the General Regulation (O. Reg 532/98)
under the Physiotherapy Act, 1991 — Part III Registration

About the Proposed Changes

Background

In order to be registered with the College of Physiotherapists of Ontario (“the College”), an applicant must meet a number of criteria that are defined under Part III Registration of the College’s General Regulation. An important requirement is an obligation to successfully complete an entry to practice competency examination. The Physiotherapy Competency Examination (PCE) assesses a candidate’s ability to meet the essential competencies of physiotherapy practice and is broken down into two components: written and clinical. The same examination is administered to all applicants for registration in Ontario, regardless of where they obtained their educational qualifications.

For new applicants, the College uses a two-part registration process. The first is an obligation, defined in the College’s Regulation that requires applicants to successfully complete the written component of the national examination. Those who do this are then eligible to be granted a Provisional Practice Certificate and practice under supervision as a Resident. The level of supervision required varies depending on the knowledge, skills and clinical judgement of a Resident.

The second part of the process is the successful completion of the clinical component of the national examination. Successful applicants can then be granted an Independent Practice Certificate. If an applicant is unsuccessful at the clinical examination, their provisional practice certificates expires and they can no longer practice as a physiotherapist until they have passed that component. The Regulation also forbids them from applying for another certificate of provisional practice.

In response to the COVID pandemic, the written examination was moved to a virtual format in August 2020 and has been available to applicants. However, due to ongoing failures and delays in its administration, the clinical examination has not been provided either in-person or virtually since November 2019. The number of applicants waiting to complete the examination continues to grow. At this time, the College has approximately 1000 people in Ontario who are waiting to complete the clinical component of the examination.

Those individuals who were successful in the written examination, and who are registered with the College have been able to work under supervision with a Provisional Practice certificate. The College has continued to extend these certificates in an ongoing way.

The challenge the College is dealing is that the Regulation does not contemplate the exceptional circumstances relating to the pandemic and the resulting extended clinical exam delays. As such, the Regulation does not consider registering applicants with an Independent Practice Certificate without successful completion of a clinical examination.

At its October 14, 2021 meeting, Council approved proposed amendments to the General Regulation under the Physiotherapy Actto address and allow for specific registration exemptions. Prior to submitting these proposed changes to government, they must be circulated to registrants and other stakeholders for feedback. If the proposed changes are ultimately approved by the government, these amendments would allow the College, in exceptional circumstances (i.e. public health crisis, ongoing exam unavailability) to:

• permit former Provisional Practice Certificate holders to reapply once for a Provisional Certificate if they have been unsuccessful on a previous attempt of the clinical examination;
• permit an alternative pathway for an applicant to move from a Provisional Practice Certificate to an Independent Practice Certificate; and
• incorporate a provision for an Emergency Registration Certificate.

Proposed Amendments

The College proposes the following amendments to Part III Registration of the General Regulation under the Physiotherapy Act, 1991.

In exceptional circumstances:

1. Permit applicant to reapply for Provisional Practice Certificate if unsuccessful on the clinical examination.

   To be granted a Provisional Practice Certificate by the College, the applicant must be registered to take the next available clinical examination. If the applicant is then unsuccessful in the clinical examination, the applicant loses their Provisional Practice Certificate and must re-attempt the clinical examination. During this time, the applicant is no longer registered and cannot reapply for a Provisional Certificate. As a result, some applicants who failed the clinical examination prior to the pandemic have been unable to practice as a physiotherapist nor complete a clinical examination.

   The proposed amendment would allow the College to grant a Provisional Practice Certificate to those applicants who have failed the clinical component on one previous occasion in exceptional circumstances (i.e. exam unavailability). The applicant could also be subject to additional requirements and/or be subject to terms, conditions and limitations placed on their certificate by the Registration Committee.

2. Permit registration for an Independent Practice Certificate based upon practice hours.

   Under the Regulation, successful completion of a clinical examination is currently an exemptible requirement. Despite this, the College’s Registration Committee has never waived the entry to practice examination requirements for an applicant. This amendment would make it clear that the Committee is able to waive the exam and use alternative tools to assess or confirm competency in exceptional circumstances such as during a public health crisis or due to prolonged examination unavailability.

   The proposed amendment would define a clear set of rules that apply to the exemption to the clinical exam requirement under defined parameters and only in cases of exceptional circumstances. This exemption would only apply to applicants if they:

   • hold a provisional practice certificate;
   • have completed at least 1200 clinical practice hours over the previous 12 months;
   • have completed at least 600 clinical practice hours over the previous 6 months at the same facility;
   • have no concerns raised by their supervisor; and
   • have no conduct history internal or external to the College.

   Through this exemption, the applicant could also be subject to any additional requirements and/or be subject to terms, conditions and limitations placed on their certificate by the Registration Committee.

3. Create an Emergency Registration Class

   The College currently has three classes of registration: Provisional, Independent, and Courtesy. The proposal is to add a fourth class of registration for Emergency Assignment. This class of licensure would apply only under an emergency situation, such as response to a public health crisis as confirmed by the Government of Ontario. The proposal to add an emergency class is consistent with other Ontario health professions. Comparable examples can be found in related provincial legislation such as the Nursing Act and Pharmacy Act.

   An Emergency Practice Certificate would limit the holder to practice for a set time and in a set circumstance/setting. The Emergency Certificate would only be valid for a 60-day period, with the ability for the Registrar to renew if the situation persists.