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Study of Registration Practices of the
COLLEGE OF CHIROPRACTORS OF ONTARIO, 2007

  1. 1. INTRODUCTION
  2. 2. BACKGROUND OF THE REGULATORY BODY
    1. a. Legislation
    2. b. Protected Titles
    3. c. Definition of the Profession
    4. d. Labour Market/Economic Trends
    5. e. New Developments Within the Profession
    6. f. Staffing
  3. 3. REGISTRATION PRACTICES
    1. a. Registration Requirements and Application Process
    2. b. Documentation Required from Internationally Trained Individuals
    3. c. Credential Assessment (Third Party and/or Internal)
    4. d. Academic/Program Requirements
    5. e. Work Experience Requirements
    6. f. Examinations
    7. g. Language Requirements
    8. h. Fees
    9. i. Third Parties
    10. j. Typical Length of the Registration Process
    11. k. Accredited Programs
    12. l. Internal Review/Appeal Process
  4. 4. BRIDGING PROGRAMS
  5. 5. MUTUAL RECOGNITION AGREEMENTS
  6. 6. APPLICANTS’ INTERACTIONS WITH REGULATORY BODY
    1. a. Nature and Frequency of Communication
    2. b. Backlogs
    3. c. Complaints Regarding the Registration Process
  7. 7. CHANGES SINCE THE 2005 SURVEY
  8. 8. REGISTRATION INFORMATION AND STATISTICS
  9. 9. SOURCES

ISBN 978-1-4249-6446-8 [HTML English version]


1. INTRODUCTION

The Office of the Fairness Commissioner (OFC) undertook a study of registration practices of Ontario’s regulated professions during the fall and winter of 2007–2008. The purpose of the study was to understand each regulated profession’s 2007 registration practices and to establish baseline data and information to enable the OFC to measure progress as it fulfills its mandate under the Fair Access to Regulated Professions Act, 2006.

This report reflects the registration practices of the College of Chiropractors of Ontario as of December 31, 2007. Information in this report was gathered from:

The College of Chiropractors of Ontario also provided registration information and statistics for 2005, 2006 and 2007 through a standard spreadsheet designed by the OFC.

An analysis and summary of the findings for all of the regulated professions is contained in the OFC’s Ontario’s Regulated Professions: Report on the 2007 Study of Registration Practices.

2. BACKGROUND OF THE REGULATORY BODY

a. Legislation

The College of Chiropractors of Ontario (CCO) operates in accordance with the Regulated Health Professions Act, 1991, the Chiropractic Act, 1991 and the regulations under those acts.

b. Protected Titles

Every practising chiropractor in Ontario must be registered with CCO in order to use the professional title “chiropractor,” any variation or abbreviation of it or an equivalent in another language.

Members of CCO are authorized to use the title “doctor” when providing or offering health care to individuals in Ontario.

c. Definition of the Profession

Chiropractic facilitates the restoration and preservation of the body’s neurological and biomechanical integrity. This is achieved through the diagnosis, treatment and prevention of dysfunctions and disorders of the spine and joints and their effects on the nervous system. Chiropractors primarily treat these dysfunctions and disorders using joint manipulation, often referred to as adjustment, and other manual techniques. The practice of chiropractic focuses on the relationship between structure (primarily the spine and joints) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health. Any interference in this relationship is known as a subluxation, which may influence organ system function and general health.

CCO members are authorized, subject to the terms, conditions and limitations imposed on their certificates of registration, to perform certain authorized acts. They can communicate diagnoses of the dysfunctions and disorders described above; they can move the joints of the spine beyond a person’s usual physiological range of motion using a fast, low-amplitude thrust; and they can put a finger beyond the anal verge for the purpose of manipulating the tailbone.

d. Labour Market/Economic Trends

Chiropractic is a very young profession, with over half of its practitioners under the age of 40. The number of individuals entering and graduating from the Canadian Memorial Chiropractic College, the only accredited chiropractic college in Ontario, is increasing yearly. One reason for the growth of the profession is the growing research and public awareness of the benefits of chiropractic as a natural and holistic health care profession.

The profession was delisted from the Ontario Health Insurance Plan on December 1, 2004, notwithstanding the growing popularity of chiropractic. This loss of government funding has reduced accessibility to chiropractic for lower-income people and vulnerable sectors of society. Fortunately, however, many private health insurance plans and the Workplace Safety and Insurance Board provide coverage for chiropractic services.

e. New Developments Within the Profession

Ontario chiropractors have traditionally provided acupuncture treatment. Therefore, the passage of the Traditional Chinese Medicine Act, 2006 will affect the profession. Chiropractors may continue to provide acupuncture treatment as an adjunct therapy within the scope of practice of chiropractic and in accordance with CCO’s standards of practice; however, those who do will be prohibited from using the protected title­s “traditional Chinese medicine practitioner” and “acupuncturist” unless they are registered with the College of Traditional Chinese Medicine and Acupuncturists of Ontario.

f. Staffing

The CCO staff consists of eight full-time employees, two of whom are involved in the registration process. CCO also hires one consultant to work on a part-time basis as needed.

3. REGISTRATION PRACTICES

a. Registration Requirements and Application Process

In order to be eligible for registration with CCO, applicants must meet all of the following requirements for registration:

Upon successful completion of all examination requirements, all candidates, domestic and internationally trained, will received a registration form and may apply for registration. To be registered with CCO, all applicants must submit the following documents:

b. Documentation Required from Internationally Trained Individuals

i. Standard Documentation

Registration requirements, including documentation, are the same for both domestic and internationally trained candidates.

ii. Options for Applicants with Unavailable/Destroyed Documents

To date, CCO has not encountered an applicant who was unable to provide documentation supporting his or her academic credentials. However, in such a case, the applicant would have to submit evidence such as a sworn affidavit attesting to his or her previous academic training. All the normal requirements for registration would remain the same for such applicants.

c. Credential Assessment (Third Party and/or Internal)

CCO does not assess the academic credentials of applicants. Academic credentials of chiropractic programs in Canada are assessed by the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards and internationally by the Councils on Chiropractic Education International (CCEI).

d. Academic/Program Requirements

The academic requirement for becoming licensed as a chiropractor in Ontario is the successful completion of an accredited chiropractic program. All accredited chiropractic programs are a minimum of four academic years of full-time study totalling no less than 4,300 hours. These programs includes courses in anatomy, biochemistry, physiology, neurology, embryology, principles of chiropractic, radiology, immunology, microbiology, pathology, nutrition, therapeutic modalities, treatment management and clinical sciences related to diagnosis. In addition to the academic elements of the program, chiropractic education includes an internship of hands-on clinical experience under the direct supervision of qualified chiropractic faculty.

e. Work Experience Requirements

There are no work experience or practical experience requirements to become registered with CCO beyond the practical experiences that a graduate from an accredited chiropractic program will have. All graduates of accredited chiropractic programs will have completed an internship program that will have prepared them for entry to practice.

f. Examinations

The following examinations must be successfully completed by all applicants seeking registration with CCO.

i. Canadian Chiropractic Examining Board Examinations

The CCEB administers a total of four examinations: the Basic and Applied Sciences Examination (Component A), the Clinical Decision Making and Diagnostic Imaging Examination (Component B), the Clinical Skills Evaluation Examination (Component C), and the Practitioner Assessment Examination. The first three exams are written by students or graduates of accredited chiropractic programs seeking registration for the first time. The Practitioner Assessment Examination is written by chiropractors who have received the CCEB certificate but have not been in practice in Canada or have been absent from the practice in Canada for some time.

Candidates who fail to achieve a passing score on a CCEB examination and wish to rewrite it will be required to retake and pass the entire examination. They must reapply for an exam; they will not be rescheduled automatically.

A candidate is allowed a maximum of four attempts to pass CCEB examinations. If a candidate is unsuccessful after the third attempt (second rewrite), the CCEB will provide the candidate with a Performance Report by subject matter. A candidate applying for a fourth attempt (third rewrite) will be required to wait one year from the date of the last unsuccessful examination. Candidates are urged to obtain remedial training before their fourth and final attempt.

Retabulations of exam scores are provided to applicants if they send a written request that is received in the CCEB office within 12 weeks of the final day of writing. The score forms will be hand graded and compared to the computerized scoring. A candidate’s score may increase or decrease on a retabulation.

Component A — Basic and Applied Sciences Examination

This exam is the first of three that an applicant is required to pass in order to be awarded a Certificate of Registration by the CCEB.

Component A tests a candidate’s proficiency in basic and applied sciences and has two sections. The candidate is allowed three hours for each section.

Component A may be written up to two years before a candidate’s graduation from an accredited chiropractic college. An applicant may also write this exam if he or she has already graduated. Component A is offered three times a year — in January, April and September — at a venue determined by the CCEB. Candidates must pass Component A before they can write Component B.

Component B — Clinical Decision Making and Diagnostic Imaging Examination

This exam is the second of three that an applicant is required to pass in order to be awarded a Certificate of Registration by the CCEB.

Component B tests an applicant’s proficiency in clinical decision making and diagnostic imaging and has two sections. Section One has a maximum of 120 questions, and Section Two has a maximum of 75 questions. The candidate is allowed three hours for each section.

Component B may be written up to six months before an applicant’s graduation from an accredited chiropractic college. An applicant may also write this exam if he or she has already graduated.

Component B is offered three times a year — in January, April and September — at a venue determined by the CCEB. Component B may not be written in the same exam session as Component A. An applicant must pass Component A first.

Component C — Clinical Skills Evaluation

This exam is the third of three that an applicant is required to pass in order to be awarded a Certificate of Registration by the CCEB.

Component C tests an applicant’s clinical skills and consists of 10 Objective Structured Clinical Examination (OSCE) stations. The candidate is allowed three hours for the exam.

Candidates may write Component C after they pass both Component A and Component B; if they have graduated from an accredited chiropractic college; or if they are within two months of graduation and have completed all their academic and clinical course requirements.

Component C is offered three times per year — in March, June and November. Component C must be written within three years of an applicant’s successful completion of Component B. If more than three years has elapsed, Component B must be rewritten.

A Certificate of Registration is awarded to individuals who pass all three CCEB examinations. The CCEB will forward a copy of the successful results of an individual’s examinations to CCO.

Practitioner Assessment Examination

The Practitioner Assessment Exam is available to licensed chiropractors who have been designated by a provincial regulatory board in Canada as being qualified or required to undertake the exam. It is designed to assess the knowledge, skills, aptitudes and attributes required to be a competent chiropractor in Canada. Candidates who pass this exam will be awarded a Letter of Competency. A copy of the results will also be forwarded to CCO.

This exam is taken only at the request of CCO and is intended for chiropractors who previously obtained a Certificate of Registration from the CCEB but who have been practising outside of Canada or have been altogether absent from active practice. Other applicable circumstances could include a return from a health-related absence, disciplinary action or cognitive impairment issues. This list is not exhaustive; registrars of licensing bodies sometimes contact the CCEB office for other cases.

The Practitioner Assessment Exam tests clinical skills, clinical decision making and diagnostic imaging. Candidates are allowed four hours to complete the clinical decision making section and 90 minutes to complete the diagnostic imaging section. Finally, the Objective Structured Clinical Examination (OSCE) portion consists of 10 stations, which the candidate is allowed two hours to complete.

The Practitioner Assessment Exam is offered three times per year — in February, May and October. The exam venue is determined by the CCEB. The exam takes two days: one day for the clinical decision making and diagnostic imaging sections, and one day for the OSCE.

ii. CCO Legislation and Ethics Examination

One of the last stages of the registration process is the Legislation and Ethics Examination administered by CCO. All study materials, including regulations, standards of practice, policies and guidelines, are provided to applicants upon receipt of the $180 examination application fee, application for examination, photo identification and final transcript. Applicants are granted one rewrite if they fail the examination.

g. Language Requirements

In order to be registered with CCO, an applicant must be fluent in either English or French. Although CCO does not require specific language testing results from applicants whose first language is not English or French, fluency in one of these languages is effectively a prerequisite for successfully writing the series of required examinations.

h. Fees

CCO Fees (all inclusive)

CCO Legislation and Ethics Examination (includes study materials)

$180

Registration application fee

$50

Certificate fee for first year of practice

$325

Renewal of active certificate for each year of practice (after first year)

$850

CCEB Examination Fees

CCEB Component A — Basic and Applied Sciences

$675

CCEB Component B — Clinical Decision Making and Diagnostic Imaging

$675

CCEB Component C — Clinical Skills Evaluation

$1,350

Practitioner Assessment

$1,350

Application cancellation

$150

Change of exam site

$100

Retabulation

$150

Performance breakdown

$150

i. Third Parties

Name of Third Party Relationship to Regulatory Body

Canadian Chiropractic Examining Board (CCEB)

The CCEB sets and administers knowledge-based and clinical exams, which are taken by all graduates of accredited chiropractic programs seeking registration with their provincial professional regulator.

Canadian Chiropractic Association (CCA)

The CCA is a voluntary association of chiropractors in Canada, which informs the public about the benefits of chiropractic care, promotes the integration of chiropractic into the health care system and facilitates chiropractic research.

Canadian Chiropractic Protective Association (CCPA)

The CCPA is the largest professional liability insurance provider for chiropractors in Canada.

Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards

The Federation is a national association of provincial and territorial chiropractic licensing authorities and accredited educational programs. Its responsibility is to accredit, recognize and certify the quality and integrity of chiropractic programs, encourage excellence in education within chiropractic programs and inform the public, the chiropractic profession and the educational community regarding the nature, quality and integrity of chiropractic education.

Councils on Chiropractic Education International (CCEI)

CCEI is the international council of national and regional accrediting bodies.

j. Typical Length of the Registration Process

It may take a graduate of an accredited chiropractic program from one month to more than one year to pass all required exams and become eligible for registration. The application process can take as little as five to seven business days once an applicant has become eligible for registration and has submitted all supporting documentation.

Candidates for registration who have not registered with CCO within two years of completing their CCEB examinations may be required to rewrite their examinations. Eligible candidates for registration are encouraged to complete the process for registration in a timely manner following completion of the CCEB examinations.

k. Accredited Programs

In order to be registered by CCO as a chiropractor, a candidate for registration must have graduated from a chiropractic education program accredited or recognized through reciprocal agreement by the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards. The only chiropractic programs currently accredited in Canada are at the Canadian Memorial Chiropractic College (CMCC) in Toronto and l’Université du Québec à Trois-Rivières (UQTR) in Quebec.

The Federation is a member of the Councils on Chiropractic Education International (CCEI), along with the following other international accrediting bodies: European Council on Chiropractic Education (ECCE), the Council on Chiropractic Education Australasia (CCEA), and the Council on Chiropractic Education United States of America (CCE US). All graduates of chiropractic programs accredited by a CCEI member are recognized by the Federation and are eligible to sit the relevant examinations in Canada and, upon completion of the requirements, be registered in Ontario.

l. Internal Review/Appeal Process

Under the Regulated Health Professions Act (RHPA), when the Registrar has doubts about whether an applicant meets the requirements for registration or proposes to impose terms, conditions or limitations, or to refuse an application, the application is referred to the Registration Committee. Graduation from an accredited chiropractic program is a non-exemptible requirement for registration. Any requests to be exempted from the exemptible requirements are referred to the Registration Committee.

The Registration Committee of CCO consists of three members of Council, two elected professional members and one publicly appointed member.

In the circumstances outlined in the RHPA, an applicant who is not satisfied with a Registration Committee decision may request a review by the Health Professions Appeal and Review Board (HPARB). An applicant has 30 days after the Registration Committee issues a notice to request a review by HPARB.

4. BRIDGING PROGRAMS

CCO does not provide a bridging program. However, internationally trained individuals who have graduated from an accredited program in chiropractic and who have been licensed in another jurisdiction may take the Practitioner Assessment Examination of the CCEB in order to become eligible to write the Legislation and Ethics Examination of CCO. Formerly licensed chiropractors who have been away from the practice for an extended period may also take this examination.

5. MUTUAL RECOGNITION AGREEMENTS

Canada has a mutual recognition agreement (MRA) for the chiropractic profession, signed by all provincial and territorial chiropractic regulators, with the exception of British Columbia. The purpose of the MRA is to allow for easier labour mobility across Canada by enabling qualified chiropractors to practise in any Canadian jurisdiction without facing undue barriers. Provincial legislation differs somewhat from province to province, and CCO, like other regulators, requires successful completion of the Legislation and Ethics Examination.

6. APPLICANTS’ INTERACTIONS WITH REGULATORY BODY

a. Nature and Frequency of Communication

E-mail, telephone, fax and regular and registered mail are routinely used by CCO to convey notices to its applicants regarding registration matters. Registration Committee decisions are sent by mail.

b. Backlogs

The application process for registration routinely takes as little as five to seven business days after CCO’s receipt of a completed application and supporting documentation. However, CCO may experience backlogs in processing registration applications following administration of the Legislation and Ethics Examination.

c. Complaints Regarding the Registration Process

Concerns or complaints that cannot be managed by the Registration Coordinator are addressed by the Registrar or, in prescribed circumstances, by the Registration Committee.

7. CHANGES SINCE THE 2005 SURVEY

The Ministry of Citizenship and Immigration conducted a survey in 2005 to collect information about occupational regulatory bodies in Ontario. The following changes to CCO’s registration practices have occurred since the 2005 survey:

8. REGISTRATION INFORMATION AND STATISTICS

Definitions used in these tables:

Alternative class of licence: a class of licence that enables its holder to practise with limitations; additional registration requirements must be met in order to be fully licensed. The College of Chiropractors of Ontario has no alternative classes of licence.

Applicant: a person who has applied to start the process for entry to the profession.

Applicant actively pursuing licensing: an applicant who had some contact with CCO within the year specified.

Inactive applicant: an applicant who had no contact with CCO within the year specified.

Member: a person who is currently able to use the protected title or professional designation “chiropractor.”

Languages in which application information materials were available
Language 2005 2006 2007
English

Yes

Yes

Yes

French

Yes

No

No

Other(s)      
Countries where internationally educated applicants were initially trained in chiropractic
Applications received 2005 2006 2007
Largest number

Canada

Canada

Canada

Second-largest number

United States

United States

United States

Third-largest number

Australia

Australia

Australia

Fourth-largest number

 

 

 

Fifth-largest number

 

 

 

Staff employed by the College of Chiropractors of Ontario
Number of staff 2005 2006 2007
Involved in registration process

1

1

1

Involved in appeals process

1

1

1

Jurisdiction where members were initially trained in chiropractic (before they were granted use of the protected title or professional designation in Ontario)
Members Ontario Other Canadian Provinces USA Other International TOTAL
Total members

N/A

N/A

N/A

N/A

3,696

Non-practising members1

N/A

N/A

N/A

N/A

312

1 The non-practising category consists of retired members and inactive members.

Applicants processed by the College of Chiropractors of Ontario in 2005

 

Jurisdiction where members were initially trained in chiropractic (before they were granted use of the protected title or professional designation in Ontario)
In 2005 (Jan. 1 to Dec. 31) Ontario Other Canadian Provinces USA Other International TOTAL
New applications received

149

3

1

1

154

Applicants actively pursuing licensing

149

3

1

1

154

Inactive applicants

0

0

0

0

0

Applicants who met all requirements and were authorized to become members but did not become members

0

0

0

0

0

Applicants who became members

149

3

1

1

154

Applicants who were authorized to receive an alternative class of licence but were not issued a licence

N/A

N/A

N/A

N/A

N/A

Applicants who were issued an alternative class of licence

N/A

N/A

N/A

N/A

N/A

Applicants processed by the College of Chiropractors of Ontario in 2006

 

Jurisdiction where members were initially trained in chiropractic (before they were granted use of the protected title or professional designation in Ontario)
In 2006 (Jan. 1 to Dec. 31) Ontario Other Canadian Provinces USA Other International TOTAL
New applications received

161

2

1

0

164

Applicants actively pursuing licensing

161

2

1

0

164

Inactive applicants

0

0

0

0

0

Applicants who met all requirements and were authorized to become members but did not become members

0

0

0

0

0

Applicants who became members

161

2

1

0

164

Applicants who were authorized to receive an alternative class of licence but were not issued a licence

N/A

N/A

N/A

N/A

N/A

Applicants who were issued an alternative class of licence

N/A

N/A

N/A

N/A

N/A

Applicants processed by the College of Chiropractors of Ontario in 2007

 

Jurisdiction where members were initially trained in chiropractic (before they were granted use of the protected title or professional designation in Ontario)
In 2007 (Jan. 1 to Dec. 31) Ontario Other Canadian Provinces USA Other International TOTAL
New applications received

171

2

2

1

176

Applicants actively pursuing licensing

171

2

2

1

176

Inactive applicants

0

0

0

0

0

Applicants who met all requirements and were authorized to become members but did not become members

0

0

0

0

0

Applicants who became members

171

2

2

1

176

Applicants who were authorized to receive an alternative class of licence but were not issued a licence

N/A

N/A

N/A

N/A

N/A

Applicants who were issued an alternative class of licence

N/A

N/A

N/A

N/A

N/A

9. SOURCES

Canadian Chiropractic Association. www.ccachiro.org. Last accessed: May 5, 2008.

Canadian Chiropractic Examining Board website. http://www.cceb.ca/. Last accessed: February 28, 2008.

Canadian Chiropractic Protective Association website. http://www.ccpaonline.ca.

Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards website. http://www.chirofed.ca/english/index.html. Last accessed: 28 February 2008.

College of Chiropractors of Ontario website. http://www.cco.on.ca/. Last accessed: February 28, 2008.

Councils on Chiropractic Education International website. http://www.cceintl.org/. Last accessed: February 28, 2008.

Health Professions Appeal and Review Board website. http://www.hparb.on.ca. Last accessed: May 5, 2008.

Representatives of the College of Chiropractors of Ontario met with staff of the Office of the Fairness Commissioner on January 25, 2008, to provide further information for this study.