Psychologists Practicing to Scope: The Role of Psychologists in Canada's Public Institutions

CPA ScopesCanadian Psychology Assn Logo


Within Canadian healthcare systems there is a misalignment between what regulated health providers can do by virtue of their licenses and what other legislation or regulation permits them to do within publicly funded health care systems. While current discussions around optimizing scope of practice are important in recognizing the skills and expertise of health care providers through regulationi, it is important first to create legislation and regulation that supports health care providers practicing to the scope that their licenses already permit.

For example, a psychologist in Ontario has the regulatory authority to diagnose mental illness but cannot initiate a period of mandatory supervision in the event of acute harm to self or other. Further, that same psychologist working within a publicly funded institution may not be able to initiate treatment for a mental illness they have diagnosed and have the regulatory authority to undertake.

The impact of this misalignment is not inconsiderable. Psychologists are Canada’s largest group of specialized and regulated mental health providers, outnumbering psychiatrists about 4:1. Only one-third of people in need seek and receive mental health careii; this because of stigma but also because mental health treatments provided by the public sector are in limited supply. Legislation and regulation within public health systems creates barriers and bottlenecks to accessing care; barriers which are not determined by the availability of suitably trained and regulated healthcare providers.

A great deal of attention has been paid to reducing wait times for assessment and treatment of common physical health conditions but not nearly sufficient attention has been paid to the same need when it comes to mental and behavioural health disorders. This lack of parity is especially significant in light of the facts that one in five persons will experience a mental health problem in a given yeariii and that depression will shortly become the second leading cause of disability adjusted life years worldwideiv. In Canada, mental illness costs the workplace 33 billion dollarsv and the economy over 50 billion dollars annuallyvi.

In order to understand the magnitude of the misalignment between scope and practice, the Canadian Psychological Association undertook a survey of psychology discipline chiefs and practice leaders in public institutions (hospitals, outpatient clinics and university clinics). Over forty respondents from departments across the country were asked a series of questions regarding practice privileges held by psychologists in their institutions. The intent was to assess the degree of alignment between the scope of practice of psychologists and what they are permitted to do in Canada’s public institutions.


Emergency Medicine Training & Practice in Canada: Celebrating the Past & Evolving for the Future

EMT 2016Postgraduate Emergency Medicine (EM) training and certification in Canada currently consists of two separate training pathways that are overseen by two autonomous national colleges. The Royal College of Physicians and Surgeons of Canada (Royal College) and the College of Family Physicians of Canada (CFPC) independently offer EM residency training programs with differing training requirements and objectives (FRCPC-EM and CCFP(EM), respectively). Each program was originally intended to fulfill differing societal and healthcare needs. In reality, the products of these training programs significantly overlap, and have evolved to meet population needs differently than their initially intended roles as outlined by the two colleges, leading to substantial debate within the Canadian EM community.

Project Parameters:

The prime objective shared by both the Royal College and the CFPC is to ensure that expert EM graduates provide high quality EM care for patients presenting to emergency departments (EDs) across Canada. The Collaborative Working Group on the Future of Emergency Medicine in Canada (CWG-EM) was constituted in 2013 to provide recommendations to the Canadian Association of Emergency Physicians (CAEP), the CFPC, and the Royal College and was composed of seven (7) members: a Chair, and two (2) members appointed by each of CAEP, the CFPC, and the Royal College. The Terms of Reference of the CWG-EM, including roles and responsibilities, membership, and decision making process, are provided in Appendix A of the final report. The following report describes the activities, findings, and recommendations of the CWG-EM, with the ultimate goal of outlining a path forward that enhances EM training and care in Canada. Informed by the past and present state of EM training and practice, the CWG-EM report is fundamentally focused on charting a course for the future of emergency medicine in Canada.                                                                          


Regulated Nurses, 2015

CIHI Logo CIHI RN 2015                                            


This report highlights current trends in nursing practice in Canada across a variety of demographic, education, mobility and employment characteristics. The report highlights data from three groups of regulated nursing professions:

  • registered nurses (RNs, including nurse practitioners or NPs)
  • licensed practical nurses (LPNs) and
  • registered psychiatric nurses (RPNs).

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Health Workforce Policies in OECD Countries: Right jobs, Right Skills, Right Places


logooecd enHealth Workforce Policies in OECD Countries 2016

OECD Health Policy Studies (2016), OECD Publishing, Paris

Health workers are the cornerstone of health systems, playing a central role in providing health services to the population and improving health outcomes. The demand and supply of health workers have increased over time in all OECD countries, with jobs in the health and social sector accounting for more than 10% of total employment now in several OECD countries. This publication reviews key trends and policy priorities on health workforce across OECD countries, with a particular focus on doctors and nurses given the preeminent role that they have traditionally played in health service delivery.


OECD (2016), Health Workforce Policies in OECD Countries: Right Jobs, Right Skills, Right Places, OECD
Health Policy Studies, OECD Publishing, Paris.

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An Undisciplined Economist Robert G. Evans On Health Economics, Health Care Policy and Population Health

                                                                                                     Available June 2016!

logoBarer Book 2016

Edited by Morris L Barer, Greg L. Stoddart, Kimberlyn M. McGrail and Chris B. McLeod

Incisive analysis of health policy issues in Canada by a pioneering health economist.

For four decades Robert Evans has been Canada’s foremost health policy analyst and commentator, playing a leadership role in the development of both health economics and population health at home and internationally. An Undisciplined Economist collects sixteen of Evans’ most important contributions, including two new articles.

The topics addressed range widely, from the peculiar structure of the health care industry to the social determinants of the health of entire populations to the misleading role that economists have sometimes played in health policy debates. Written with Evans’ characteristic clarity, candour, and wit, these essays unabashedly expose health policy myths and the special interests that lie behind them. He refutes claims that public health insurance is unsustainable, that the health care costs of an aging population will bankrupt Canada, that user charges will make the health care system more efficient, and that health care is the most important determinant of a population’s health.

An Undisciplined Economist is a valuable collection for those familiar with Evans’ work, a lucid introduction for those new to the fields of health economics, health policy, and population health, and a fitting tribute to an outstanding scholar.

Robert G. Evans is professor emeritus of economics and a founding member of the Centre for Health Services and Policy Research at the University of British Columbia.
Morris L. Barer is professor in the School of Population and Public Health at the University of British Columbia.
Greg L. Stoddart is professor emeritus of clinical epidemiology and biostatistics at McMaster University.
Kimberlyn M. McGrail is an associate professor in the School of Population and Public Health at the University of British Columbia.
Chris B. McLeod is assistant professor in the School of Population and Public Health at the University of British Columbia.

Available Here

Health Canadacihr logo1This initiative has been generously funded by grants from Health Canada and the Canadian Institutes of Health Research. The views expressed here do not necessarily reflect those of the funders.