Regulated Health Professionals and Equivalent Program Training

The Ontario Divisional Court (ODC) recently addressed the issue of equivalent program training in the context of a regulated health profession (in this case, psychology). At issue was whether or not an applicant who had completed a PhD in Developmental Psychology in a non-accredited program could be registered as a psychologist authorized for supervised practice by the College of Psychologists of Ontario (CPO).

Becoming a Psychologist in Ontario

To practice as a psychologist in Ontario you first need to obtain a doctorate in psychology. The next step to becoming a clinician is the completion of an internship. Following this, you must complete the registration process with the College of Psychologists of Ontario (CPO). That involves a year of supervised practice and the successful completion of written and oral exams in your areas of declared expertise.

Qualifications

Section 12 of Regulation 74/15 made under the Psychology Actof Ontario sets out the requirements to become registered for supervised practice.

12.(1) To qualify for a certificate of registration for a psychologist authorizing supervised practice, an Applicant must comply with the following non-exemptible registration requirements:

1. The Applicant must have obtained a doctoral degree,

i. from a psychology program that is accredited by the Canadian Psychological Association or by another accrediting body that has been approved by Council for that purpose,

ii. from a psychology program that is considered by a panel of the Registration Committee to be equivalent to a program described in subparagraph i, or

iii. (not relevant here)

One Applicants Dilemma

The psychologist in question in the ODC decision (the applicant) had obtained his Ph.D. in Developmental Psychology from Queen’s University in 2010. His doctoral program was not accredited by the Canadian Psychological Association. He faced two hurdles when he applied for registration in 2015. The first was that his doctorate program was not accredited by the CPA. He would have to demonstrate that his education was the equivalent to an accredited program. Unfortunately, his second problem stemmed from the fact that the equivalency requirement now in place (Reg 74/15, per the above), and had just passed, was more difficult to overcome than the one that had been replaced. The old requirement was that he had obtained a doctoral degree from a program of study with content that is primarily psychological in nature. It was likely that his doctorate from Queens would have been found to be equivalent under the old requirement.

The CPO Decision

Since his Ph.D. program at Queens was found not to be equivalent and since the requirements were non-exemptible, the applicant was denied registration at the CPO level. Only his degree work was considered given the meaning ascribed to the word program in the Regulation. His past experience was not. In coming to their decision, the CPO provided the psychologist with their criteria for establishing equivalence.

The CPO's Published Criteria for Establishing Equivalence

1) The doctoral degree awarded by the program is equivalent in academic level to a doctoral degree from a Canadian university. 2) The degree is offered at an institution that is:

1. a Canadian institution that is legally authorized to grant the degree,
2. an institution in the United States of America that is accredited by an accrediting body recognized by the United States Secretary of Education as a reliable authority concerning the quality of education or training offered by institutions of higher learning or by another accrediting body approved by Council, or
3. an institution that is based in a country other than Canada or the United States of America that is considered to be equivalent to an institution described in sub-paragraph A by a foreign credential evaluation service that is a member of the National Association of Credential Evaluation Services or by another foreign credential evaluation service approved by Council.

3) The program is offered within a department of psychology or delivered by an identifiable core faculty of doctoral trained psychologists that assume responsibility for the program. 4) The program is clearly and publicly identified and described as a psychology program in its brochure, website, and descriptive materials. 5) The program clearly and publicly communicates in its brochure, website, and descriptive materials its intent to train professional psychologists. 6) The program has an identifiable body of students enrolled in it. 7) The program has an identifiable core faculty of psychologists responsible for delivering the program. The core faculty members each hold a doctoral degree in psychology. 8) The program requires that students maintain a minimum of 3 years of full-time resident graduate study or a part-time equivalent of 3 years of full-time resident graduate study. 9) The program requires candidates to demonstrate either undergraduate or graduate competence in the five core content areas for psychology, by passing suitable evaluations in each of the five areas or by successful completion of at least one half-year graduate course, or an advanced undergraduate course (beyond a first-year introductory course) in each of the five areas:

1. Biological bases of behaviour;
2. Cognitive affective bases of behaviour;

Ill. Social bases of behaviour;

1. Psychology of the individual; and
2. Historical and Scientific foundations of psychology.

10) The program includes graduate level instruction in the foundations of professional psychology, including:

• Assessment and Evaluation;
• Intervention and Consultation;
• Scientific and Professional Ethics; and
• Research Design and Test Construction.

11) The program includes training and evaluation of competence in interpersonal relationships through coursework, practica, or internship. 12) The program requires practicum training of at least 600 hours, of which at least 300 hours are devoted to direct, face-to-face patient/client contact, and at least 150 hours consist of supervision. Supervision must be by practitioners who are registered to practice psychology in the jurisdiction in which the services are provided. 13) The program requires a pre-doctoral internship of at least 1500 hours. The pre-doctoral internship must be approved by the program and must be completed after the practicum training and before the doctoral degree is conferred. Supervisors of the pre-doctoral internship must be practitioners who are registered to practice psychology in the jurisdiction in which the services are provided.

The Applicant's Position

The applicant acknowledged that he has not met the formal requirements as his doctoral program was not accredited. However, he claimed that his education and training are such that he more than qualifies to work as a psychologist under supervision and he included a plan for further training under the supervision of a registered psychologist. Since graduation he had completed thousands of hours of clinical work under the supervision of registered psychologists in Ontario. He had also made extensive contributions to the profession by way of his publications, peer-reviewed articles, training manuals and presentations to other psychologists in accredited programs both nationally and internationally. He sought review of this refusal by HPARB.

The HPARB Decision

These guidelines were of assistance but ultimately non-binding on HPARB. HPARB found that applicant did not meet the criteria, and also denied him registration. The board concluded that the applicant's only option was to complete a second doctorate from an accredited program. The applicant appealed the HPARB decision to Divisional Court.

The ODC Decision

At issue on appeal wast the reasonableness of HPARB's decision that the applicant's program did not meet the requirements set out in Regulation 74/15 as it was not equivalent to a psychology program accredited by the Canadian Psychological Association. The standard of review was reasonableness. Since HPARB is a specialized tribunal with expertise to review the evidence presented in a review of a registration application, its decisions are entitled to deference. An HPARB decision can be unreasonable only if there is no line of analysis within the available reasons that could reasonably lead the tribunal from the evidence to the conclusions reached. The Court found that HPARB jad reasonably interpreted the word “psychology program that is considered ….to be equivalent to a program…..” to mean that, notwithstanding its concerns about fairness, the Regulation required a comparison of the applicant's Ph.D. program and a psychology program accredited by the Canadian Psychological Association or by another approved accrediting body. In addition, the Court agreed with some of the concerns that had been raised by HPARB, including:

• It is in the public interest and the interest of fairness to registrants to review a registrant's actual education and experience not just the requirements of their Ph.D. program to ensure that their overall education and experience meet the expectations of the College;
• The applicant would likely have met the requirements in existence at the time he obtained his Ph.D. since the requirement prior to 2015 was simply that the doctoral degree be from a program of study “with content that is primarily psychological in nature as required in the guidelines”
• An ability to augment educational qualifications would enable individuals who have chosen psychology as their profession and have doctoral degrees in psychology, to demonstrate that they meet the requirements of the College without having to obtain a second doctoral degree in psychology;
• These modifications to the existing regulatory requirement are consistent with the legislative mandate to protect the public by ensuring that members have met the requisite professional standards;
• The applicant holds verifiable qualifications including a Ph.D. in psychology, extensive experience, and significant national and international contributions to learning in psychology, yet cannot qualify under the 2015 Regulation to become a registered as a psychologist with the College (even though he may well have qualified under the Regulation extant at the time he earned his Ph.D.); and
• The Regulation may create an unintended advantage to those who obtained their degrees outside of Canada and the U.S. as they may experience more flexibility in determining whether their degree is “substantially similar” to an accredited program in Canada or the United States.

In addition to the above anomalies, the court was sympathetic to the applicant's frustration with HPARB's findings that he did not meet the requirements under the new regulation and that he was forced to complete another Ph.D program, however, the court noted that:

• The wording of section 12 of Regulation 74/15 is that “a program” must be accredited or equivalent;
• The word “program” is not a defined term. However, it is always used in the singular (“a program” or “the program”); and, therefore,
• The Board’s interpretation that those words refer only to the PhD program the Appellant was enrolled in, is reasonable.

Moreover, the court noted that neither HPARB nor the court has the authority to overturn the Committee’s decision because the Regulation is not reasonable or fair. Furthermore, given the definition of "program", this court could not consider the applicant's actualeducation and or experience, outside of his doctoral program to determine whether his qualifications are equivalent. The 2015 requirements set out in section 12 of Regulation 74/15 are “non-exemptible” and they refer to “a psychology program that is … equivalent ” As a result, the ODC concluded it could not interfere despite the Regulation being both unfair and unreasonable. At Wise Health Law we are respected health law lawyers and litigators. Our firm was founded in 2013 by Valerie Wise and has offices in both Toronto and Oakville, Ontario. We specialize in health and administrative law, and focus on helping health professionals, public hospitals, and national and provincial health professional associations, among others, find solutions to their legal and regulatory problems. Contact us online, or at 416-915-4234 for a consultation.

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