Across Canada, governments are exploring new ways to improve access to healthcare. Workforce shortages, increasing demand and an aging population are prompting discussions about expanded scopes of practice across many health professions. These conversations are important and necessary, with thoughtful modernization offering opportunities to improve access. The challenge is ensuring that, as healthcare evolves, Canadians can continue to have confidence in the standards that protect quality and safety, alongside responsible stewardship of finite healthcare resources in a climate of increasing economic uncertainty.
Eye care offers an important example of why these principles matter.
Canadians benefit from an integrated vision care system that spans prevention, diagnosis, treatment and rehabilitation. Across that continuum, many professionals contribute important expertise. Within the clinical realm, ophthalmologists, optometrists, opticians and orthoptists each play distinct but complementary roles. As patient needs become increasingly complex, collaboration remains essential.
Across several provinces, governments are considering or implementing expanded scopes of practice for non-MD healthcare professionals, including greater responsibility for diagnosis, diagnostic testing and clinical procedures. Some proposals extend further to surgical procedures currently performed by medical and surgical specialists. In eye care, as an example, ophthalmologists – medical doctors and eye surgeons who have completed medical school, earning an MD degree, followed by a minimum of five years of residency training – have extensive specialized training and experience in the medical and surgical treatment of diseases affecting the eye and surrounding tissues.
Proposals from optometry include requests to perform laboratory and diagnostic tests, intraocular laser procedures and minor eyelid surgery without training, assessment or credentialing equivalent to the established standards for medical and surgical practice.
Ophthalmologists remain committed to working with governments and other eye care professionals to explore evidence-informed approaches to improving access across the continuum of eye care. Opportunities may include strengthening interprofessional collaborative models of eye care, improving referral pathways and system integration between primary and specialty care, enabling healthcare professionals to practise fully within their existing training and expertise through appropriate resources and system supports, and responsibly leveraging technologies such as tele-ophthalmology and artificial intelligence. Where scope expansion is identified as an appropriate means of further improving access, the relevant medical and surgical subject matter experts should be meaningfully engaged in evaluating proposals that involve medical and surgical care.
Canada’s standards governing medical and surgical practice have evolved over decades through collaboration among universities, accrediting organizations, regulatory authorities and subject matter experts. University medical education, residency training, national accreditation, independent certification through the Royal College of Physicians and Surgeons of Canada, provincial licensure and ongoing professional accountability together establish nationally recognized standards for medical and surgical care. These interconnected systems exist first and foremost to protect patients, not professional interests.
As governments consider proposals involving expanded clinical responsibilities of non-MD healthcare professionals, the question goes beyond whether new educational pathways or competency assessments can be developed. The more important question is whether the education, clinical experience, assessment and ongoing oversight are demonstrably commensurate with the complexity, risk and clinical judgment required of the responsibilities being assumed. Any alternative pathway should demonstrate an equivalent standard of competence and safety through rigorous, transparent and independently governed educational, accreditation and regulatory processes, so that expanded access does not inadvertently result in different standards of care for Canadians.
Sound public policy depends on considering diverse perspectives while ensuring that the expertise informing a decision is aligned with the question being asked. When proposals involve increasingly complex medical and surgical care, medical and surgical specialists responsible for educating, supervising and independently assessing the competencies involved bring essential expertise to evaluating whether the preparation, assessment and oversight are appropriate for the responsibilities under consideration. Evidence-informed policy is strengthened when this expertise is integrated with the broader public interest that governments are entrusted to serve.
Ultimately, this is a question of stewardship. Every healthcare policy eventually becomes personal. Every decision about education, accreditation and professional responsibility will one day affect someone’s parent, spouse, partner, child or friend. Canadians deserve confidence that the standards protecting those they love are rigorous, transparent, publicly accountable and appropriate for the responsibilities entrusted to all healthcare professionals.
As governments continue to modernize healthcare, expanding access and preserving trust should never be competing objectives. The strongest health systems achieve both.
Author
Dr. Nina Ahuja, BScHons, MD, FRCSC, CHE, is President of the Canadian Ophthalmological Society, Clinical Professor in the Department of Surgery, Division of Ophthalmology at McMaster University, a practising ophthalmologist, and past President of the Association of Canadian University Professors of Ophthalmology. She has held national leadership roles in medical education, healthcare governance and physician advocacy, including providing expert testimony before the Senate of Canada on national eye health policy.