Your horse’s various therapists might be a bit on edge these days. That’s because the College of Veterinarians of Ontario (CVO) is proposing to overhaul the Veterinarians Act and the new language would limit their ability to operate.
Background
In Ontario, the Veterinarians Act is the legislative framework that governs the licensing of veterinarians in the province, their facilities and how they practice, and also establishes the governance framework for the regulator, the CVO.
The practice of veterinary medicine has evolved significantly in the past few decades. As some parts of the Act are out of date, having last been updated to any great extent in 1989, the Proposal to Modernize the Veterinarians Act has been circulated for comment through May 30, 2023. The current Act describes the “practice of veterinary medicine” as including dentistry, obstetrics, and surgery; the new Proposal includes a list of 15 activities that would be restricted to veterinarians to perform (see complete list below).
Some of those who practice complementary therapies that are commonly used in the modern horse world are concerned with some recommendations included in the new Scope of Practice. Practitioners of acupuncture, physiotherapy, homeopathy, lasers and magnets, and a broad range of other specialists have raised red flags and are worried that these changes will inhibit or entirely prevent their ability to practice.
The Proposal, in some cases, does allow a vet to delegate their authority to someone who is deemed competent by the vet to perform them, but it’s important to note that vets who do so remain legally responsible for the outcome of the activity. As a result, many vets are disinclined to recommend a service practitioner by name, leaving the choice to the client. If the Proposal is passed as is, those practitioners who continue to practice on a horse that weren’t referred by a vet could be subject to prosecution by the CVO which does have the authority to lay charges.
Limitations of OMAFRA
As per its name, the Veterinarians Act is meant to regulate veterinarians (not other equine health practitioners) and falls under the purview of the Ontario Ministry of Agriculture, Food and Rural Affairs (OMAFRA). The issue is that complementary therapies don’t have an official status with OMAFRA, and it’s the responsibility of the CVO to regulate veterinary services through the Veterinarians Act.
The proposed changes to the Vet Act by a body that is meant to serve veterinarians may inappropriately enshrine a vet’s scope of work while limiting access to other valuable and necessary services.
In comparison, human health in the province is the responsibility of the Ontario Ministry of Health which has 26 health profession-specific Acts including: Chiropractic, Dental, Homeopathy, Massage, Naturopathy, Physiotherapy, and Traditional Chinese Medicine, to name a few. These Acts give the various specialties the authority to regulate the services offered by their member practitioners, including the ability to cancel their license if the situation warrants, or lay charges on those operating without a license.
Interestingly, equine chiropractors are not affected by this modernization process. That’s because prior to the creation of the human Regulated Health Professions Act in 1991, the College of Chiropractors of Ontario established that duly-trained equine chiropractors fall under their regulatory scope. As a result, equine chiropractors were grandfathered into the Regulated Health Professions Act which does not allow for regulation of non-human practice. Since equine physiotherapists, massage professionals, naturopaths, etc. are not part of the human Regulated Health Professions Act, nor are they regulated by CVO, they fall in an unregulated grey space. This lack of oversight could put the public and horses at risk if working with poorly trained or unqualified workers.
The proposed Veterinarians Act does touch on the CVO’s limitations by suggesting that the next step in the modernization process would be changing the name of the CVO to something like College of Veterinary Practitioners, for example “to reflect its expanded role in regulating a broader range of professionals within the veterinary profession.” The proposed changes to the Vet Act in advance of this evolution, however, by a body that is meant to serve veterinarians, may inappropriately enshrine a vet’s scope of work while limiting access to other valuable and necessary services which could make it very difficult to reverse once legislated.
Issues with the Proposal
Both the Ontario Animal Owners Association (OAOA) and the Canadian Physiotherapy Association (CPA, here and here) have submitted formal letters to the OMAFRA. The letters outline their concerns with various sections of the Proposal that are to be strictly performed by veterinarians.
Based on some of these concerns, HorseSport.com asked Jan Robinson, the Registrar and Chief Executive Officer at the CVO, to elaborate on some points. Following are her comments along with relevant sections of the letters from OAOA and CPA.
Diagnosis
- Proposal: “Making or communicating a diagnosis identifying a disease, disorder, dysfunction or condition as the cause of an animal’s signs and presentation.”
The CVO believes that individuals cannot communicate a diagnosis if they’re a non-veterinarian, because they cannot do all parts of a diagnostic work-up such as order and interpret lab work, x-rays, MRIs, etc. That said, they recognize the valuable input of other therapists.
“It’ll be totally reasonable for an animal physiotherapist to look at a clinical assessment, gather their information, look at the kinds of lameness they’re thinking about, and provide some treatment. But they may also say, ‘You know what, I don’t have enough information, you need to ask your veterinarian, see what they say.’ Then they can coordinate together, which would probably result in better care.”
“If the true intent is to ‘modernize’ the Veterinarians Act, then enabling others to use their own professions skills, then to make and communicate their own diagnoses, is a missing element to the Proposal.”
The CPA notes that “While only a veterinarian can make a medical diagnosis, animal physiotherapists are skilled in making a pathofunctional diagnosis (e.g. diagnosing the pathology in how a patient is functioning). It is not the goal of animal physiotherapists to make a medical diagnosis. Our practitioners make diagnoses that veterinarians do not make (e.g. a sacroiliac joint dysfunction, a weakness of the abdominal muscles that is contributing to back pain, strains of muscles, myofascial restrictions, etc.) These ARE diagnoses, and because they aren’t ‘medical diagnoses’ taught in veterinary school, they are the types of diagnoses that many veterinarians look to animal physiotherapists to make.”
The OAOA agrees and adds that “Human doctors are no longer the only ones allowed to make a diagnosis. This has allowed allied health practitioners to make and communicate their own professional diagnoses. Their diagnoses often use the term ‘dysfunction’ – spinal dysfunction, muscle dysfunction, joint dysfunction, etc. If the true intent is to ‘modernize’ the Veterinarians Act, then enabling others to use their own professions skills, then to make and communicate their own diagnoses (within their respective scopes of practice) is a missing element to the Proposal.
“[The OAOA suggests] that veterinarians be the only ones allowed to make a MEDICAL diagnosis, and allow others to make and communicate their own diagnoses (physical diagnosis, rehab diagnosis, chiropractic diagnosis, traditional Chinese medicine diagnosis, etc.)”
Fitness & Soundness
- Proposal: “Performing an assessment to determine the fitness or soundness of an animal, or a group of animals, on which it is reasonably foreseeable that a person will rely on the assessment”
The CVO notes that “this is a very specific activity that only a veterinarian can do, and it’s about sales. Think of an individual selling a racehorse to another individual; they have to go through a fitness assessment to do that. That’s the signature of a veterinarian and that’s what that refers to. It is not about assessing for the purposes of clinical signs related to treatment. So we’re thinking that we might have to alter that language a little bit so people are clearer.”
The OAOA comments that “many other people in the animal health industry are currently engaged in this practice, e.g. physical therapists, chiropractors, massage therapists, etc. with ‘animal specific’ training. They perform these assessments to help decide if an animal is fit to compete in an event, progress an exercise program, or return to normal activities.
“A non-veterinarian assessment is different than a veterinary assessment. They evaluate things that a traditional veterinary examination does not … Physical therapists, chiropractors, and other allied animal health practitioners should be given further exemptions to perform an assessment to determine the fitness or soundness of an animal or group of animals.”
The CPA letter is silent on this issue.
Acupuncture & Dry Needling
- Proposal: “Performing a procedure on tissue below the dermis”
The CVO says, “We’re in the middle of a study on acupuncture, just like the study we did on forms of energy. And the reason for that is because we don’t want to make a decision just based on what’s happened in the past or what our opinion might be. What we want to do is make sure we’re looking at the literature, we’re looking at risks that are identifiable, we’re looking at who’s actually being taught to do acupuncture on animals.”
“It would limit an animal owner from accessing acupuncture or dry needling services at a time when access to veterinary services is strained, both now and into the foreseeable future.”
The CPA says, “This authorized activity would prevent animal physiotherapists from using acupuncture or dry needling as part of their treatment plan. Animal physiotherapists that are performing needling techniques have a degree in physical therapy, a certification in animal rehabilitation, a certification in dry needling and/or acupuncture, and an additional certification in animal needling/acupuncture. This amounts to hundreds of hours of education to acquire this skill set. It is surprising that an exemption was not provided for skilled non-veterinarians who use needling in their practice, especially when acupuncture and dry needling are not core competencies for veterinarians and the shortage of veterinarians in general, let alone veterinarians with acupuncture training, would preclude many animal owners from being able to access this service.”
The OAOA echoes this sentiment, saying: “Non-veterinarians are performing acupuncture and dry needling. Animal physiotherapists, animal chiropractors, and animal acupuncturists, are able to safely transfer the skill of acupuncture/dry needling to an animal patient.
“The consequence of restricting this activity, without providing further exemptions, limits non-veterinarian allied animal health practitioners to fully help their animal patients by restricting the tools they would typically utilize in their practice. Furthermore, it would limit an animal owner from accessing acupuncture or dry needling services at a time when access to veterinary services is strained, both now and into the foreseeable future.”
Energy
- Proposal: “Applying or ordering the application of a form of energy prescribed by the regulation under this Act.”
According to the CVO, most low-risk forms of energy work, cold laser, etc., are examples of non-conventional therapies that will not fall under the authorized activities. The CVO already has a position on high-risk forms of energy following an extensive study which is outlined on its website here.
The CPA says, “When it comes to ordering or applying diagnostic imaging, this authorization is appropriate. When it comes to therapeutic forms of energy such as shockwave, laser therapy, ultrasound, electrical muscle stimulation, microcurrent, electromagnetic field therapy, etc., most veterinarians have no training in their ordering or application. If they do, it’s because they have taken a rehabilitation course, most likely taught by a physiotherapist. Conversely, the safe use of electrotherapeutic modalities (the forms of energy in question) is a core competency of every physiotherapy degree program. Electrotherapeutic modalities are not restricted under the Regulated Health Professions Act (RHPA) for humans. This authorized activity has the appearance of regulatory overreach.”
The OAOA adds that, “It is concerning that ‘therapeutic forms of energy’ are even included as Authorized Activities, as electrotherapeutic modalities are not protected under the Regulated Health Professions Act (RHPA) for human health care. This restriction further hinders non-veterinarian animal health practitioners, that are trained in the use of therapeutic forms of energy, from using the tools at their disposal to fully rehabilitate their animal patients.”
Non-Vets Speak Out
There are plenty of concerned non-veterinary practitioners adding their comments, including Theresa Gilligan of Fort Erie, ON, who practices Ayurvedic medicine and is certified in cranial osteopathy, a neuro myofascial practitioner, and specializes in postural alignment. “This proposed change significantly effects my ability to work,” she remarked. “As osteopaths, physiotherapists, and postural specialists, we offer different approaches than veterinary medicine alone can provide. We emphasize the analysis of tissue patterns and postural deficits while also considering spinal dysfunction from ill-fitting tack or pathology to organ function and its implications on physical lameness.
“The proposed regulation of non-vet health services by the CVO has a significant personal impact on my practice. Specifically, it affects the use of various modalities such as neural tissue repatterning, PEMF, and Class 3b lasers, which I employ regularly. Additionally, the CVO’s attempt to restrict other professions from diagnosing lameness, despite their education and capacity to do so within their scope of practice, hinders the professional autonomy.
“Lastly, I have concerns regarding transparency and legality around vets claiming equivalence in knowledge and education with other professionals when it cannot be adequately substantiated. These regulations potentially limit the ability to provide the best possible care for clients and it’s the animals that suffer.”
Barbara Lee is the co-owner of the Niagara Canine Conditioning Centre in St. Catharines, ON, a registered physiotherapist with a diploma in canine rehab and a certification in small animal acupuncture and dry needling with over 40 years of experience as a physiotherapist and 10 in animal rehab.
“I do have concerns as a physiotherapist practicing animal rehab as I believe I play a valuable role in providing specialized care to my patients. Many veterinarians are not trained in manual therapy, modalities and various exercise therapies. In my practice I use my manual therapy skills, LASER therapy, therapeutic ultrasound, EMS, TENS, acupuncture, massage and knowledge of various exercises on land and in the water to rehabilitate animals. These are not part of a veterinarian’s skill set unless they have done further education in rehabilitation.”
Recognizing that the wording in the new Act is causing a great deal of concern and confusion, Robinson of the CVO is happy to answer any queries. “If groups or individuals have questions, they can reach out to me at the College (through Kim Huson khuson@cvo.org) and we can chat further.”
For further information on the modernization of the Veterinarians Act, visit the CVO website here.
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Proposed List of Authorized Activities to be performed by Veterinarians:
1. Making or communicating a diagnosis identifying a disease, disorder, dysfunction or condition as the cause of an animal’s signs and presentation
2. Performing a medical assessment to determine the fitness for purpose or soundness of an animal, or group of animals, on which it is reasonably foreseeable that a person or organization will rely on the assessment.
3. Ordering laboratory tests on an animal or on specimens taken from an animal.
4. Prescribing, compounding, dispensing, or selling a drug
5. Performing a procedure on tissue below the dermis
6. Performing a procedure below the surface of a mucous membrane
7. Performing a procedure on or below the surfaces of the teeth, including the scaling of teeth and occlusal equilibration
8. Performing a procedure on or below the surface of the cornea
9. Setting, immobilizing, or casting a fracture of a bone or a dislocation of a joint or a severed tendon
10. Administering a substance by injection or inhalation, or monitoring of such
11. Moving the joints of the spine beyond the animal’s usual physiological range of motion using a fast, low amplitude thrust
12. Putting an instrument, arm, hand, or finger, i. beyond the external ear canal, ii. beyond the point in the nasal passages where they normally narrow, iii. beyond the larynx, iv. beyond the opening of the urethra, v. beyond the labia majora, vi. beyond the anus or cloaca, or vii. into any other natural or artificial opening into the body
13. Applying or ordering the application of a form of energy prescribed by the regulations under this Act
14. Performing upon an animal any manual procedure for the diagnosis and/or treatment of pregnancy, sterility, or infertility, inclusive of ova and embryo transfer
15. Performing allergy testing
