Health Care Practitioners: An Ontario Case Study in Policy Making

John H. Gryfe is an oral and maxillofacial surgeon practising in
Toronto.

By 1875, provincial legislation in Ontario had defined the professions
of medicine, dentistry, and pharmacy, recognizing each as different
elements of health care. Medicine was philosophically considered care
for the total body, while dentistry represented health care as a
specialized discipline. Pharmacy uniquely combined health care and
commercial enterprise. Each discipline had in common human disease
management rooted in scientific method. Despite numerous attempts to
expand health-care recognition, these three professions remained the
only members of a very elite club until the 1980s.

In 1982, responding to a series of reports submitted in the 1960s and
1970s, the Progressive Conservative government initiated creation of new
Regulated Health Professions legislation, with a view to keeping “a
watchful eye on the legislation and behaviour of the professions in the
future.” Studied, shaped, and rewritten by a Liberal government
elected in 1985, the legislation ultimately saw the light of day as the
Regulated Health Professions Act (RHPA), enacted by a Bob Rae-led NDP
majority in 1991. With this bill, Ontario replaced the original
threesome with 24 regulated professions. Each profession was allowed
self-regulation, but the RHPA identified and defined each profession’s
scope of practice and range of authorized acts that could be performed.

This decade-long exercise became the focus of Patricia O’Reilly’s
doctorate thesis on which Health Care Practitioners is based.
Researchers seeking specific information on the RHPA, rather than
general readers, are the most likely audience for the book.