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Canadian Perspectives on Inter-jurisdictional Mobility. The Agreement on Internal Trade. The Agreement on Internal Trade. What is the AIT?
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Canadian Perspectives on Inter-jurisdictional Mobility The Agreement on Internal Trade
The Agreement on Internal Trade What is the AIT? This is a government agreement developed jointly at the provincial and federal levels to improve the portability of professionals and trades-people between provinces in Canada. The professions were provided a two to three year time period to evaluate current regulatory activity to ensure no undue barriers to mobility were in place.
Mobility demand: With the changing dynamics of our society, where there are frequently two-income families and more frequent job or employer changes in the corporate sector, the ability of qualified professionals and trades-people to move with their family within Canada has a significant impact on the financial well-being of Canadians. SO…for example: If you are a qualified chiropractor/electrician/dentist/etc. in Nova Scotia and considered “safe” for the public there, then why must you prove again that you are “safe” for the public of Saskatchewan?
AIT – Mutual Recognition Agreement for Chiropractic Assumptions • Any measure adopted or maintained relating to licensing should relate principally to competence. Competency is defined as a set of knowledge, skills, and abilities obtained through formal or non-formal education, work experience, or other means required to perform an occupation. This means that the principle criteria for granting licensure should be based on the ability to perform the occupation. • There does not need to be a uniform scope of practice within the chiropractic provincial/territorial jurisdictions to meet the obligations of the Labour Mobility Chapter of the AIT. • In case of legitimate objectives, refer to section 709 of the AIT.
Definitions: Currently Practicing Practitioner Currently Practising Practitioner - Currently practising practitioner means a practitioner registered with a provincial/territorial board: 1. without individual terms, conditions or limitations. 2. entitled to practise the entire scope of chiropractic. 3. in good standing with that province/territory with respect to payments of all fees, fines, costs, penalties or other monetary amounts. 4. who has met minimum practice experience and/or continuing education requirements to maintain his/her licensure with that provincial/territorial board. 5. And, would meet, in the new province/territory, the current experience, language proficiency, immigration status, good conduct requirements, continuing competency stipulations and similar requirements.
Definition: Lapsed Practitioner Lapsed Practitioner - Lapsed practitioner means a practitioner registered or previously registered with a provincial/territorial regulatory body who: • has not maintained his or her active registration/licensure status and not fulfilled the minimum practice experience and/or continuing education requirements to maintain active registration/licensure status in a province or territory prior to the expiration of their registration/licensure. • is in default of paying registration/licensure fees, fines, costs, penalties or other monetary amounts. 3. Lapsed practitioners who have failed to maintain their active registration/licensure status and have not fulfilled the minimum practice experience and/or continuing education requirements associated with his or her licensure, would be able to take advantage of the provisions of the MRA if they regain full registration, without terms, conditions or limitations in that province/territory. This is contingent on the practitioner meeting the current experience, language proficiency, immigration status, good conduct requirements, continuing competency stipulations and similar requirements in the new province/territory. Lapsed practitioners who regain full registration by payment of all outstanding amounts would be able to take advantage of the provisions of the MRA upon regaining full registration/licensure in the province/territory they are coming from.
Standardized Letter of Good Standing This is to certify that has fulfilled the following: 1. Certificate of registration is currently not suspended or revoked; Certificate of registration has never been suspended or revoked; Or Certificate of registration has been suspended or revoked within years. (Please attached details); 2. Has no terms, conditions or limitations imposed on his/her certificate of registrations; 3. Is not currently the subject of a complaint, investigation, or disciplinary hearing which has not yet been disposed of; Has never had a discipline finding made against him/her; Or There has been no discipline finding (including suspension, revocation, fines, warning/cautions, and/or counseling) within years; 4. Has paid all dues and or fees required as a condition of maintaining a certificate of registration; 5. Has completed all mandatory continuing education, quality assurance, and any other peer review obligations required as a condition to maintain a certificate of registration. 6. Other (Please describe).
Entry to Practice Requirements: This is a key area in ensuring a pan-Canadian assurance of competency. As regulatory boards we are now a portal of entry to practice chiropractic which has implications for all jurisdictions in Canada. The most vital concern for all provinces is the potential concern that one province would be seen as a “weak link” with licensure of candidates that would be significantly less rigorous than other provinces. This was a primary focus of the Mutual Recognition Agreement.
Entry to practice requirements of the MRA: T.1 Provincial/territorial regulatory boards will require all new graduates who apply for registration to pass the examinations of the Canadian Chiropractic Examining Board (the CCEB Written Cognitive Skills Examination and CCEB Clinical Skills Examination). T.2 Provincial/territorial regulatory boards have the option of testing for legislation and ethics (a “jurisprudence” examination), and will do so in such a manner that it does not pose an undue barrier to movement under the AIT. This requirement may be met in one of several ways, for example: • an “open book” style of examination, • timely rewrites if a candidate does not pass, • providing an orientation session instead of an examination, and • other mechanisms suitable to rapidly endorsing the candidate into the province/territory’s jurisdiction.
Entry to practice requirements of the MRA (2): T.6 A requirement for registration with any provincial/territorial regulatory board shall be graduation from a CCEC accredited educational institution or the considered equivalent by the regulatory board. T.9 Provincial/territorial regulatory boards may participate in a CCEB Clinical Skills Examination. The CCEB Clinical Skills Examination shall include the following parameters: • There will be no set number of times that a candidate is allowed to rewrite the CCEB Clinical Skills Examination after failing it. • There shall be a national body responsible for the CCEB Clinical Skills Examination which has representation from each provincial/territorial regulatory board. • The CCEB Clinical Skills Examination should be held a minimum of twice per year, in three Canadian sites where numbers warrant, and shall be made available to candidates in Canada’s two official languages. • The CCEB Clinical Skills Examination should be developed and administered in a cost effective, fiscally responsible manner, and should be reliable, valid, and psychometrically and legally defensible.
Entry to practice requirements of the MRA (3): T.10 If clinical competency examinations, other than the CCEB Clinical Skills Examination, are used in any provinces/territories, such examinations will be compared for equivalency. Where such comparisons have in fact discovered equivalency, provinces/territories will mutually recognize candidates applying for registration. T.11 Candidates must register with one of the provincial/territorial regulatory boards within one year of passing the CCEB Clinical Skills Examination or recognized equivalent.
Potential issues identified: • Ensuring competency for practitioners who had never written Canadian national board exams or were licensed in a province prior to provincial competency exams. - This was a concern in some jurisdictions that there would be a movement of practitioners who would not meet the criteria of the incoming province either now or in the day when they were licensed. This has not proven to be a significant issue as these are primarily older practitioners who have demonstrated competency by a record of providing competent care to the public with no significant regulatory issues arising, compliance with peer assessment requirements, and continuing education/competency provisions.
Potential issues identified (2): • Practitioners who “skip town” and move to another province to avoid disciplinary action. Clearly this is not the intent of the AIT and provisions for a standard reporting and requirement of a letter of good standing and recent peer assessment are tools to ensure this is not misused by errant practitioners. The standardized letter of good standing addressed earlier is a tool used by the regulatory boards to gather the appropriate information.
Common misperceptions: Any provincial license enables you to practice anywhere in Canada. False: Health care is provincially governed by the Acts of each province and regulated by the provincial regulatory College or Board. This has not changed with the advent of the AIT but has reduced some of the repeated testing which could be seen as a barrier to mobility. Practitioners still must apply and be licensed by each regulatory authority in order to practice in a each province.
How is it going so far? Fortunately our imaginations on how the AIT could be misused have allowed us to be prepared for many potential issues in advance. There have been no significant problems to date in the 5 years of implementation of the MRA for Chiropractic. We have been seen as leaders in the professions with a developed and utilized MRA signed by 9 provinces and the Yukon Territory that has been used as a template for other professions to comply with the AIT.
