Cosmetic Procedures Initiative Steps to Improve Patient Safety The following timeline describes the College's initiatives to improve regulatory control over the practice of physicians who perform cosmetic and other invasive procedures.

April 2007 Council announces Four-Point Plan to improve oversight of cosmetic surgery and other invasive procedures

The plan includes assessing physicians; revising existing policies; proposing legislation and regulation amendments; and educating the public.

Reference: Four-Point Plan

June 2007 Council proposes the development of a mandatory reporting policy for physicians who change their scope of practice

College policies developed in 2000 relied on physicians to come forward of their own volition. The consequence of voluntary self-reporting is that some physicians do report and undergo the training, supervision and assessment required by the policies, while others do not.

The policies are intended to ensure that a physician has the skills, training and experience necessary to practise in the area in which the physician chooses to practise.

Reference: revised Changing Scope of Practice and Re-entering Practice policies

October 2007 Letter and questionnaire to the profession

Letter to all members advising that those physicians who perform cosmetic procedures will be required to complete a detailed questionnaire about the cosmetic procedures they are providing to patients.

Completion mandatory for physicians performing cosmetic procedures

Information collected from more than 600 physicians included:

where they practice,

services provided in their facility or facilities, and

formal training and continuing professional development that has been completed.

The College is committed to ensuring that all

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members are practising only in areas where they have the required knowledge, skills and training, especially when performing medical procedures that involve significant risk.

November 2007

Council proposes regulatory and by-law amendments to enhance regulatory oversight

Out-of-Hospital Facilities Council approved proposed amendments intended to improve the regulation of out-of-hospital facilities. The proposed amendments were circulated to the profession and other stakeholders for feedback.

Reference: Proposed Amendments to Regulations from December 2007 Dialogue

Use of Titles Council approved proposed amendments to the regulation that will limit the use of titles, that is, how physicians refer or don’t refer to their specialty or certification or lack thereof.

Reference: Proposed Amendments to Regulations December 2007 Dialogue

Fact sheet for the public about cosmetic surgery

Information for the public, including the importance of checking qualifications; issues to consider when contemplating cosmetic surgery; and a list of questions to ask.

Reference: Get the Facts: What you should know about Cosmetic Surgery

February 2008 Council reviews consultation feedback and approves regulation and by-law amendments (some with revisions arising from the consultation)

Council reviewed extensive feedback from the consultation and decided to:

1. Approve the amendments related to regulation of out-of-hospital facilities with minor changes. Next step: submit to government for consideration.

2. Approve the by-law amendments that would permit broader collection of information from physicians related to their practices;

3. Be more precise in by-law governing what is on the public register; and

4. Approve, in principle, a regulation to limit the use of specialist titles, but defer final approval to the April meeting of Council when further analysis of the effects of the proposed amendments is completed and reported.

Reference: Consultation Feedback and Revised Regulations and By-Laws

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April 2008 Council approves regulation amendments to require physicians to be clear and accurate about their credentials and training in their advertising and other communications with patients.

Regulation amendments include that a doctor shall not use a term, title or designation indicating or implying certified specialization or sub-specialization unless he or she is certified by the RCPSC, the CFPC, or formally recognized as a specialist by the CPSO. It also limits the use of the term, title or designation ‘surgeon’ or ‘surgery.’

Next step: submit to government for consideration.

Reference: Regulation Update April 2008 Dialogue

July 2008 Status update on proposed out-of-hospital facilities and use of specialist titles regulations, and related projects to improve patient safety.

Reference: Proposed Regulation Amendments: Status Update

December 2008

Government introduces Bill 141

Bill 141, an Act to amend the Regulated Health Professions Act, 1991 is introduced in the legislature, which, if passed, would give the College the power to make regulations to inspect non-hospital facilities where cosmetic and other invasive procedures are performed under anesthetic.

Bill 141 is introduced in response to the College’s request for regulation amendments to allow for inspections of out-of-hospital facilities where invasive procedures are performed.

In addition, the College seeks an amendment to Section 76 of the Health Professions Procedural Code of the Regulated Health Professions Act to expressly list the extent of the College’s investigative powers (such as observing doctors in their practice and requiring them to answer questions).

Reference: News Release, December 10, 2008

February 2009 Council endorses a proposed exception to the Specialist Titles regulation that attempts to address both the protection of patients and the ability of physicians to accurately describe their practice.

The proposed regulation exception would allow physicians who have focused practices, or who have completed additional training, but are not certified specialists, to describe their practices in their advertising and promotional materials.

Specific criteria for style and format must, however, be met. Physicians must include their own specialist or sub-specialist information, in keeping with the existing requirements of the regulation; and the phrase, “practising in” must

Reference: Proposed Regulation Amendments February 2009 Dialogue

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precede any descriptive terms, i.e., “Dr.X, General Practitioner practising in anesthesia.” There are also restrictions on the use of some terms. ‘Surgeon’ and ‘surgery’ can only be used by certified or recognized surgeons; ‘plastic’ can only be used by certified or recognized plastic surgeons.

April 2009 Government passes Bill 141, Regulated Health Professions Amendment Act, 2009

The Health Professions Procedural Code of the Regulated Health Professions Act, 1991 is amended,

a. to permit investigators acting under section 76 of the Code to make reasonable inquiries of any person, including the member who is the subject of the investigation, and requiring a member of a health college to cooperate fully with an investigator;

b. to permit health colleges to make regulations providing for the direct observation of members in their practices.

Reference: News Release, April 6, 2009

Council directs that a working group be struck to provide advice and Council leadership to the Out-of-Hospital Premises Inspection Program as it moves through the phases of program development and implementation.

The working group will oversee the development of the program, including establishing standards of practice; and inspection protocols for non-hospital premises where procedures are performed under the administration of various types of anesthesia specified in the regulation.

June 2009 Council approves a by-law to establish a committee that will oversee and assist with the operational components of the inspections system created through Council’s proposed Out-of-Hospital Premise regulation amendment.

This oversight Committee will be known as the Premises Inspections Committee and will be in effect once the regulation amendment has been finalized and enacted by the Ontario government.

Reference: FAQs about the Out-of-Hospital Premises Inspection Program July 2009 Dialogue

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Council further amends the proposed regulation on Use of Specialist Title and resubmits it to government.

After two extensive consultations on Use of Specialist Titles, Council decided to revise the original draft regulation to enable Otolaryngologists – Head and Neck Surgeons and Ophthalmologists to use the term ‘plastic’ (facial plastic, oculoplastic, ophthalmic plastic) in their practice descriptions.

The revised regulation will require physicians to be clear and accurate about their credentials and training in their advertising and other communications with patients.

Reference: Accuracy, consistency in promotional materials September 2009 Dialogue

November 2009

Council approves Premises Inspection Regulation; proposed regulation now with government.

Council’s regulation amendment proposal submitted to government in spring 2008 was reviewed by the Ministry of Health and Long-Term Care. College and MOHLTC collaborated in giving detail to the proposed regulation; revised regulation submitted to Council in November 2009 for final approval. Council approves proposed regulation, which is now with government. College optimistic that it will come into force in early 2010.

Reference: Council Approves Premises Inspection Regulation December 2009 Dialogue College Moves to New Inspection Process December 2009 Dialogue

April 2010 On April 9, 2010, an amendment to Regulation 114/94 under the Medicine Act adding Part XI, Inspection of Premises where Certain Procedures are Performed came into effect.

The profession was notified that the Regulation applies to two groups of physicians:

Those who are already performing procedures in an out-of-hospital premises at the time the Regulation came into effect on April 9, 2010. The College shall ensure that an inspection is conducted of these premises within 24 months from the day the Regulation came into force; and

Those who intend to perform procedures in the future. Physicians are not permitted to begin using these premises until the premises passes an inspection or passes an inspection with conditions. The College shall ensure that an inspection is conducted within 180 days from the day the College receives notification from the physician.

Premises Inspection Program

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December 2010

On December 3, 2010, an amendment to Regulation 114/94 - Part II, Advertising - under the Medicine Act, came into effect.

In December 2010, the Government of Ontario, in consultation with the College, enacted a regulation that changes how physicians are allowed to describe themselves to the public to ensure that their qualifications and training are conveyed in a clear, accurate and consistent manner.

When physicians are referred to in any advertising or promotional materials, the new rules require that the physician’s credentials must directly follow their name and must be stated in unabbreviated form. Physicians who are certified or formally recognized in writing by the College as specialists, must state their area of specialty or sub-specialty in full. Where the physician is not certified or formally recognized in writing by the College as a specialist, they must state that they are a General Practitioner, using that term, and not the abbreviated, “G.P.”

See attached article for complete details.

Reference: New rules govern how physicians can describe themselves Issue 4, 2010 Dialogue ONTARIO REGULATION 114/94 GENERAL Part II Advertising

Updated February 17, 2011