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Scope of Practice

Access the Position statement – Ensuring safe, high quality care: managing evolving scopes of practice of all health professionals.

Scope of practice is a complex, multi-faceted term that is utilized in various contexts. It may be used in reference to the professional life of one individual or entire disciplines. Scope of practice encompasses clinical and non-clinical activities. In medicine, scope of practice can refer to:

What physicians actually do

The unique characteristics of a physician’s current practice, which evolves throughout one’s career. Covering all professional activities, such as patient care, research, teaching, and administration.

What physicians are able to do

The physician’s broad competencies acquired through training, practice and continuing professional development.

What physicians are permitted to do

The professional activities encompassed by the physician’s certification and credentials. Shaped by the regulatory environment in which the physician practices (e.g., license and privileging requirements, protected and restricted acts)

What physicians should do

The physician’s responsibility to model the values and principles of generalism and social accountability. Adapting their practice profile to evolving population health needs and public expectations.

What should guide appropriate boundaries for physicians and other health professionals

Maintaining patient safety and wellness during the uptake of new or redesigned roles, activities and services of health professionals

Access the Royal College Statement on Scopes of Practice, which calls on regulators and governments to respect a set of principles to manage evolving scopes of practice for all health professionals.

** Adapted from research conducted by Sophia M. Kam, PhD(C). Co-Authors: Elizabeth F. Wenghofer, PhD; Rachel H. Ellaway, PhD; Michael T. Yeo, PhD

A physicians’ individual scope of practice can change in various ways

  • The physician may broaden his/her scope of practice by providing a new type of care that they did not in the past.
  • The physician may practice largely as she/he did in the past, but narrow his/her scope by stopping a few specific types of medical care.
  • The physician may significantly reduce his/her scope of practice, focusing in on a specific area of specialized care and a more narrowly defined set of medical services.
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Older physicians are more likely to reduce their scope of practice.

About 6% of physicians aged ‹ 45 report reducing their scope of practice, compared to over 12% of those aged 55-64

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Younger physicians are more likely to increase their scope of practice.

About 11% of physicians aged ‹ 45 report increasing their scope of practice, compared to just over 5% of those aged 55-64

chart: percent of physicians who reduced or increased their scope of practice

Percent of physicians who reduced/increased their scope of practice in the last two years, by age group, Canada, 2013. Source: CMA, CFPC, & Royal College, 2013, National Physician Survey 1

What drivers shape SoP within specialty medicine?

A number of extrinsic and intrinsic drivers mold a physician’s SoP, which can be clustered in terms of:

  • Personal provider (physician) factors – attributes physicians bring with them to any practice environment (e.g. career stage, gender, certification, years in practice, prior practice experience)
  • Environmental (practice) factors – characteristics of immediate practice environment which may change as practice location changes (e.g. geography, patient/community/societal need, available resources, regulatory/licensing requirements, hospital appointment)

Changing scopes of practice across health professions

The scopes of practice of health professionals, including physicians, are evolving to bring new levels of competency and latitude in the diagnosis and treatment of patients. For example, the College of Family Physicians of Canada recognizes Certificates of Added Competence in seven domains of care, such as Addictions, Emergency Medicine, Care of the Elderly and Palliative Care 2. Similarly, through its Area of Focused Competence diploma programs, the Royal College recognizes domains of specialized care in areas such as Transfusion Medicine, Hyperbaric Medicine, and Solid Organ Transplantation 3. Registered Nurses in Manitoba can independently order diagnostic tests and prescribe medications for select patients 4. Pharmacists are now able to prescribe medications, administer drugs by injection and order and interpret laboratory tests in select provinces 5. Nurse practitioners in British Columbia are authorized to prescribe drugs used to treat opioid addiction 6. Alberta allows paramedics to administer a broader array of diagnostic tests such as portable laboratory blood testing and ultrasounds 7. At a national level, physicians, nurses and pharmacists are involved in the provision of medical assistance in dying (MAiD) 8.

The Statement on Scopes of Practice calls on regulators and governments to respect a set of principles to manage evolving scopes of practice for all health professionals. The statement outlines a number of key principles. For example, it encourages robust consultation and collaboration with patients and health care providers as scopes of practice are reshaped. It also proposes that the practitioners scope of practice be firmly rooted in their foundational training and education, augmented throughout ones careers through continuing professional development. This is essential to maintain patient safety and wellness during the uptake of new or redesigned scopes of practice of health providers

Select Key Resources:



Citations:

  1. Canadian Medical Association, The College of Family Physicians of Canada, The Royal College of Physicians and Surgeons of Canada. 2013 National Physician Survey
  2. College of Family Physicians of Canada. Certificates of Added Competence in Family Medicine
  3. The Royal College of Physicians and Surgeons of Canada. Information by Discipline
  4. College of Registered Nurses of Manitoba. Scope of Practice for Registered Nurses (Authorized Prescriber)s (PDF)
  5. Canadian Pharmacists Association. Pharmacists’ Scope of Practice in Canada
  6. College of Registered Nurses of British Columbia. Opioid agonist treatment prescribing standards for NPs coming into effect
  7. Government of Alberta. New tools, treatment options for paramedics and patients
  8. Government of Canada. An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)