Restricted Titles and the Regulation of Health Professionals in Ontario

“What's in a name? That which we call a rose by any other name would smell as sweet.”

Not so for an Ontario-based audiologist with a doctorate degree in audiology, who last year was found guilty of professional misconduct by the College of Audiologists and Speech Language Pathologists, suspended for 3 months and along with other steps, ordered to pay a fine of approximately $100,000 for inappropriately using the abbreviation ‘Dr.’ before her name. For this audiologist, it was important to be able to use the honorific ‘Dr.’ and she challenged the College’s decision to Ontario’s Divisional Court on the basis that she had a constitutional right to use it. She made the not unreasonable argument that there was no difference between a four-year degree on the eyes (for an optometrist), four years on the mouth and teeth (a dentist) and four years on the ears (an audiologist). Audiologists diagnose, treat and manage hearing problems and balance disorders. In Ontario, physicians, dentists, chiropractors, optometrists, and psychologists are among those allowed to use the abbreviation ‘Dr.’ before their name. Audiologists are not.

The Divisional Court Decision

Ontario’s Divisional Court decided her College’s decision was entitled to deference and upheld the decision. See the Divisional Court decision here. In essence, the audiologist could not use the abbreviation even though the other health professionals listed above, could. The court said:

“Unlike the five health professions authorized to use the “Doctor” title, no class of audiologist certificate required an applicant to have passed a licensing examination. Furthermore, unlike the other professions, audiologists were not entitled to communicate a diagnosis as the cause of an individual’s symptoms”.

This decision was largely based on provisions within the Regulated Health Professions Act (‘RHPA’), including a provision which states:

Restriction of title “doctor”

33(1) Except as allowed in the regulations under this Act, no person shall use the title “doctor”, a variation or abbreviation or an equivalent in another language in the course of providing or offering to provide, in Ontario, health care to individuals. 1991, c. 18, s. 33 (1).

It might seem unfair, illogical even. But this can be a harsh reality and a source of confusion for some who believe they are entitled to use the abbreviation ‘Dr.’, including some holders of doctorate degrees who can find themselves prevented at law (by the RHPA and The Medicine Act, among others) from using this abbreviation or the title ‘Doctor’. The reason has less to do with verifying those using the title ‘doctor’ (or a variation, abbreviation or equivalent in another language) have appropriate qualifications and training, and everything to do with the various Colleges’ mandate of protecting the public through regulation in Ontario. First, you have to be a member of one of the groups of health professionals with prima facie entitlement to use the title (see section 33(2) of the RHPA). Second, even if you are a member of one of those professions, if you are not registered with the relevant regulatory College in Ontario, say the College of Physicians and Surgeons of Ontario, or the College of Chiropractors of Ontario, you cannot use the title ‘while providing or offering to provide healthcare in Ontario’. A primary objective for the Colleges seems to be preventing confusion among members of the public. Among others, a problem can arise for:

• ‘Doctors’ from other jurisdictions working in research, consulting or teaching roles in Ontario, but not registered with an Ontario College; and
• Ontario health professionals who let their Ontario registration lapse and take time out, say, for business, or other endeavors.

Whether or not the health professional will be deemed to have inappropriately used a ‘restricted title’ will be determined by the relevant College, by applying the law to the facts of that situation. What some health professionals may find surprising is that even where a College has no jurisdiction over them, insofar as they are not members of the College, the College can still take legal action impacting the health professional directly, pursuant to the ‘public safety’ mandate. Some health professionals may therefore find themselves ‘named and shamed’ in the ‘Unregistered Practitioners’ page of the relevant College for their profession in Ontario, and possibly facing another penalty, which can include an injunction or other legal sanction.

Concluding Thoughts

Ignorance of the RHPA provisions (and other related Acts) on this issue does not constitute a defence, and health professionals with concerns about how these provisions might apply to them are advised to seek legal advice. For advice and guidance on health law matters, contact Wise Health Law.Our experienced lawyers focus on helping health professionals and national and provincial health professional associations, among others, find solutions to their legal and regulatory problems. For the convenience of our clients, we have offices in both Toronto and Oakville, Ontario, and are easily accessible. Contact us online, or at 416-915-4234for a consultation.