The Case for Professional Regulation

Regulation is a legal process by which a government authorizes a health profession to perform specific controlled acts within their defined scope of practice. A controlled act is a health care activity that has the potential to cause harm if a person who is not qualified or skilled performs it. There are 13 controlled acts listed in Ontario’s Regulated Health Professions Act (RHPA). An example of a controlled act relevant to the practice of genetic counselling is “communicating a diagnosis”. Other high risk health care activities that genetic counsellors regularly engage in include recommending and ordering genetic testing, interpreting genetic test results, assessing family and medical histories to establish risk, and consulting with non-genetic health care providers. Regulated health professions are governed by a Regulatory College that ensures their members are competent, accountable to the public and in compliance with the RHPA.

The primary goal of regulation is to protect the public from harm. It legally restricts controlled acts to health professionals who are qualified to perform them. Once a profession is regulated, its title also becomes protected, so that it becomes illegal for someone who is not recognized by the profession’s college to use that title. Regulation ensures that only qualified, competent professionals are practicing under the title of “Genetic Counsellor”. It also makes that profession accountable to the public, with a mechanism in place for complaints and disciplinary action.

That depends. In the US, over 30 states have issued licensure for genetic counsellors and many more states have legislation under review. To date, genetic counselling is an unregulated health profession in all Canadian provinces. Currently, genetic counsellors who perform controlled acts (like ordering a genetic test or communicating a diagnosis) do so under institutional medical directives, provincially-issued medical directives, or direct written delegation by a physician to perform a controlled act for a specific patient. Regulation is a long and complex legislative process and puts the onus on the profession to demonstrate they meet eligibility criteria. Forming the OAGC-ACGO has been an important step towards the pursuit of regulation.

• Regulation will ensure that anyone practicing under the title of “Genetic Counsellor” in the Province has the required training and certification to practice, affording the highest degree of assurance that patients will receive safe and high quality care.
• Regulation may allow genetic counsellors to provide certain services autonomously (ordering certain genetic tests, communicating genetic test results, making referrals), making their services more accessible.
• Regulation will allow for more patients to receive genetic services: Allowing genetic counsellors to work to their full scope of practice will shorten waiting lists for many Ontarians seeking genetic services.
• Regulation protects the public by making the profession accountable, with a transparent mechanism for complaints, reporting and the disciplinary processes.
• Regulation decreases liability on healthcare systems / other health care providers who work with and/or delegate medical acts to genetic counsellors.

Across Canada, genetic counsellors are working together to promote safe and accessible services despite the lack of formal regulatory colleges. Some alternatives to legal regulation that are currently in place or being proposed include:

• Delegation of specific restricted acts by a medical body to a designated group of health professionals via medical directives or delegated medical function.
• Creation of a public voluntary registry of genetic counsellors who meet the training and certification criteria set out by the association, and encourage institutions to hire, and patients to seek services from only registered genetic counsellors.
• Look at novel alternative legislative solutions/pathways (perhaps at a national level) to overcome some the financial, political and critical mass barriers that exist at a provincial level.