HUMAN RIGHTS TRIBUNAL OF ONTARIO
B E T W E E N:
Arthur Keith
Applicant
-and-
College of Physicians and Surgeons of Ontario
Respondent
DECISION
Adjudicator: Jennifer Scott
Indexed as: Keith v. College of Physicians and Surgeons of Ontario
APPEARANCES
Arthur Keith, Applicant
David Baker, Counsel
College of Physicians and Surgeons of Ontario, Respondent
Michelle Gibbs, Counsel
INTRODUCTION
1The College of Physicians and Surgeons of Ontario (the “CPSO”) maintains a public register (the “Register”) that provides doctor-specific information about physicians in Ontario, including whether the physician is a specialist and the body that accredited the physician’s specialty. There are three specialist accreditation bodies that may be noted on the Register: the Royal College of Physicians and Surgeons of Canada (the “RCPSC”), the College of Family Physicians of Canada (the “CFPC”) and the CPSO. The Register is available to the public on the CPSO’s website under the “Doctor Search” function.
2The applicant alleges that the distinction on the Register between CPSO and RCPSC specialists discriminates against CPSO specialists on the basis of place of origin because most CPSO specialists are foreign trained. The applicant asserts that because there is a strong correlation between place of training and place of origin, differential treatment on the basis of place of training constitutes differential treatment on the basis of place of origin.
3The applicant argues that foreign credentials are generally devalued in our society when compared to Canadian credentials. He asserts that because most CPSO specialists are foreign trained and RCPSC specialists are trained in Canada, CPSO specialists are devalued as a group when compared to RCSPC specialists. The applicant alleges that the CPSO contributes to this devaluation by maintaining a distinction on the Register between CPSO and RCPSC specialists.
4The applicant is an American-trained psychiatrist. He has been recognized by the CPSO as a specialist in psychiatry. His specialty in psychiatry is noted on the Register and he is described as a CPSO-recognized specialist.
BACKGROUND
5The following facts are taken from the documents that were filed into evidence and from the evidence of the witnesses who testified before the Tribunal. The Tribunal heard from the applicant and his expert, Dr. Jeffrey Reitz. It also heard from Dan Faulkner, the Deputy Registrar and Director of Quality Management of the CPSO and Danielle Fréchette, the Executive Director, Office of Health Policy and External Relations of the RCPSC, for the respondent.
6For the most part, the basic facts in this case are not in dispute between the parties. What is in dispute is the interpretation of those facts.
7The applicant introduced an expert report from Dr. Reitz over the objections of the respondent. The Tribunal admitted portions of the report that addressed the issue in this case, that being, the distinction between CPSO and RCPSC specialists on the Register. The Tribunal did not permit Dr. Reitz to give evidence on the broad principles of systemic discrimination, human rights and employment equity as that knowledge is within the specialized expertise of the Tribunal. The Tribunal expressly recognized however that Dr. Reitz may give opinion evidence on the connection between the distinction on the Register and the historic disadvantage experienced by foreign-trained doctors.
Specialist Accreditation
8Ontario physicians can obtain specialist certification from the RCPSC, the CFPC and specialist recognition from the CPSO. Although all three bodies recognize medical specialists, the nature and scope of their recognition is different.
9The RCPSC is a national association that oversees specialist physicians in Canada in all branches of medicine and surgery except family medicine. It accredits university programs that train physicians for their specialty practices across Canada and administers oral and written exams for certification. A RCPSC specialist is certified as a specialist across Canada.
10The CFPC establishes standards and training for family physicians. It accredits postgraduate family medicine training for medical schools across Canada. CFPC certification is a nationally accepted certification for family medicine.
11The CPSO is the governing body for physicians in Ontario. It issues certificates to doctors licensed to practice medicine in Ontario. Where a doctor has specialist qualifications, it is noted on the certificate.
12In 2004, the CPSO introduced a policy allowing for the recognition of specialists who received training and certification other than through the RCPSC and CFPC processes. This policy required the development of an implementation plan setting out the application procedure for specialty recognition, criteria, screening and the manner of assessments.
13In 2007, the CPSO completed development of and began using an individualized functional procedure to assess internationally-trained candidates for specialist recognition. The process begins with a paper assessment of the physician’s training, experience and certifications. It is followed by surveys completed by the physician’s peers and co-workers, and culminates in an on-site evaluation of the physician’s clinical practice. The on-site assessment is performed by a physician who is recognized by the CPSO as a specialist in the field/area of medicine in which the candidate seeks specialist recognition and whose medical practice is similar to the candidate’s practice. The on-site assessment involves a review of patient records, observations of clinical interactions of the candidate and interviews with the physician’s peers and co-workers.
14Pursuant to the Regulated Health Professions Act, 1991, the CPSO is responsible for maintaining a Register, which makes information on its members, including specialist status, available to the public. Section 49(1) of the CPSO’s General By-Law prescribes the content of the Register. It requires the Register to note the physician’s date and place of birth, where the physician went to medical school, when the physician graduated from medical school and a description of the physician’s postgraduate training. If the physician has been certified by the RCPSC or the CFPC, the Register must note that fact, the date of certification, the discipline or sub-discipline in which the physician is certified and whether the physician was certified by examination and, if not, by what process.
15In November 2008, the CPSO’s website was changed to allow for CPSO- recognized specialists to be noted on the Register.
The Applicant
16The applicant was born in Texas and graduated from medical school in the United States in 1979. He was certified as a specialist in Psychiatry by the American Board of Psychiatry and Neurology (“ABPN”) in 1987 and obtained further certification as a sub-specialist in Forensic Psychiatry from the ABPN in 1996. The applicant re-certified his sub-specialty with the ABPN in 2006.
17In 1992, the applicant was licensed to practise medicine in Ontario however his specialty in psychiatry was not recognized by the CPSO. At that time, the only pathway to obtain specialist certification in Ontario was through the RCPSC or the CFPC.
18In 1990, the applicant wrote the written RCPSC exam. He failed the exam the first time he wrote it and passed it in 1992. The applicant took the oral RCPSC exam three times and was unsuccessful each time. The applicant was subsequently advised that the time to obtain RCPSC specialty recognition had expired. He was advised further that he could apply for renewed eligibility, but he did not do so.
19In 1993, the applicant began working as a staff psychiatrist at a private health care facility in Ontario. From 1994 to 1998, he worked as a staff psychiatrist at the Mental Health Centre Penetanguishene.
20The applicant left Ontario in 1998 for the United States where he practised his speciality and subspecialty. He returned to Ontario in 2003 and worked as a psychiatrist doing forensic work at the North Bay Psychiatric Hospital. He remains at that hospital today, although its name has changed to the North Bay Regional Health Centre-North Bay Campus.
21The applicant’s application for recognition as a specialist in psychiatry was granted by the CPSO’s Registration Committee in April 2007.
22After receiving his specialist recognition, the applicant made a request for his information to be updated on the CPSO’s Register. At that time, his specialty was described as “none.” He repeated this request several times. He was advised by the CPSO on November 2, 2007 that it was working with IT staff to make significant changes to its website, including adding specialist recognition after the CPSO grants such certification. The CPSO’s representative offered to contact anyone the applicant might wish to confirm his specialist status, authorized the applicant to provide her name and email address for the purpose of any such contact, and suggested that the applicant was free to use the letter from the CPSO confirming his speciality certification as he deemed fit.
23On April 16, 2008, the CPSO amended the Register to include the applicant’s specialty in psychiatry, with the additional information that the specialty was “CPSO recognized.” This information was inserted manually by the CPSO because the changes to its website were not complete.
24On February 16, 2009, the CPSO amended the information on the Register concerning the applicant. His specialty was listed as psychiatry, with the additional information “CPSO recognized specialist”. That description remains on the Register today.
25A physician with RCPSC accreditation is noted on the Register as a “RCPSC specialist”.
The Application
26The Application was filed with the Tribunal on December 24, 2008. At that time, the applicant alleged the CPSO’s failure to individually assess his qualifications as a specialist between 1992 and 2007, and its reliance on specialist certification by the RCPSC, discriminated against him on the ground of place of origin. The applicant alleged further that after he was recognized as a specialist by the CPSO in 2007, the manner in which he was permitted to describe his specialty pursuant to Regulation 114/94 and the way the CPSO describes his specialty on the Register created a discriminatory distinction between him and RCPSC-certified specialists on the basis of place of origin.
27By Interim Decision dated November 19, 2010, 2010 HRTO 2310, the Tribunal held the allegations relating to the pre-2007 conduct or policies were untimely and as such, they could not be heard. The Tribunal held further that the post-2007 policies and practices, including the regulatory prohibition, are part of a series of incidents that relate to the issue of how the applicant’s credentials are described to the public once he was granted CPSO recognition of his specialty. The Tribunal held only the following allegations could proceed to a hearing:
The prohibition in Regulation 114/94 made under the Medicine Act, 1991 preventing the applicant from identifying himself as a specialist, between 2007 and the present;
The description of the applicant’s specialty as “none” following the CPSO’s recognition of his specialty in 2007, until April 2008;
The description of CPSO members certified by the RCPSC as “Permanent” following the CPSO’s recognition of the applicant’s specialty in 2007, until February 2009;
The description of the applicant’s specialty as “CPSO Recognized” between April 16, 2008 and February 16, 2009;
The description of the applicant’s specialty as “CPSO Recognized Specialist” from February 16, 2009 to date.
28By Interim Decision dated April 3, 2012, 2012 HRTO 679, the Tribunal removed Her Majesty the Queen in Right of Ontario as represented by the Minister of Health and Long-Term Care (the “Ministry”) with the consent of the applicant. The CPSO did not take a position on the removal.
CPSO Data
29At the applicant’s request, the CPSO produced data concerning the demographics of CPSO and RCPSC specialists in Ontario. For the period January 1, 2007 to October 4, 2012, 6% of CPSO specialists attended a medical school in Canada, and 11% of CPSO specialists were born in Canada. For the same period of time, 75% of RCPSC specialists went to medical school in Canada and 56% of RCPSC specialists were born in Canada.
30The applicant asserts that this data reveals two basic facts: CPSO specialists are foreign and RCPSC specialists are Canadian.
PRELIMINARY ISSUE
31The applicant sought to file with the Tribunal various articles and reports on the barriers experienced by foreign-trained doctors. The Tribunal did not allow these articles to be filed because this case is not about the accreditation of foreign trained doctors and their ability to practice medicine in Ontario. The Tribunal held the applicant’s claim relating to the failure to accredit foreign-trained specialists in Ontario prior to the development of the CPSO policy in 2007 was out of time.
32That being said, the Tribunal accepts that foreign-trained doctors have experienced historic barriers in their ability to practice medicine. These barriers may well include the under-valuation of their credentials. It is unlikely that this fact is in dispute when the CPSO developed its policy in recognition of and in an attempt to remove the barriers facing foreign trained doctors and their ability to be recognized as specialists in Ontario.
ANALYSIS
Place of Training and Place of Origin
33The applicant alleges that he was discriminated against on the basis of his place of origin. He asserts that because most people are trained in their place of origin, place of training becomes a proxy for place of origin. He relies on the case of Bitonti v. College of Physicians and Surgeons of British Columbia, [1999] BCHRTD. No. 60. The applicant’s personal situation supports this argument in that he was born and trained in the United States.
34The CPSO data also supports the applicant’s assertion. For the period January 1, 2007 to October 4, 2012, 94 percent of CPSO recognized specialists attended medical school outside of Canada and 69 percent were born outside of Canada. For the place of birth statistic, data was not available for 20 percent of CPSO- recognized specialists. It is likely that a significant portion of the 20 percent were born outside of Canada. Thus, there appears to be a high correlation between the percentage of physicians trained outside of Canada and those born outside of Canada. It is a reasonable conclusion that doctors trained outside of Canada are, for the most part, born outside of Canada.
35On the basis of the applicant’s background and the CPSO data, I am prepared to assume in this case that a distinction on the basis of foreign training is a distinction based on place of origin. The issue before me is whether the applicant has established, on a balance of probabilities, that he has been discriminated against on this basis.
Distinction Devalues CPSO Specialists
36The applicant argues that maintaining a distinction between CPSO specialists and RCPSC specialists on the Register devalues CPSO specialists who are predominately foreign trained. He relies on the evidence of Dr. Reitz to support this argument.
37Dr. Reitz is a professor of sociology and R.F. Harney Professor of Ethnic, Immigration and Pluralism Studies at the Munk School of Global Affairs at the University of Toronto. He has a depth of experience in sociological research and teaching in ethnic relations and immigration, and employment.
38Dr. Reitz testified that the statistical evidence produced by the CPSO indicates a very strong social correlation between route to specialist status and immigrant status supporting a conclusion that CPSO specialists tend to be foreign-trained and RCPSC specialists tend to be Canadian-trained. He asserts that the fact that immigrants are overwhelmingly concentrated in the CPSO specialist category, together with the fact that immigrant qualifications are viewed as meeting a lower standard than Canadian qualifications, make it quite likely that the CPSO category will acquire a negative perception in the eyes of the public, potential employers and other users of the information on the Register. In general, he believes that where there is an over-concentration of immigrants in a particular category, whether that category is a job class, community or profession, there is a devaluation of that category.
39The CPSO challenges the evidence of Dr. Reitz. It argues that if a physician is CPSO recognized, he/she may be more likely to be foreign-trained because the policy was designed to assist those physicians, but if a physician is foreign trained, he/she is not more likely to be CPSO recognized. The CPSO relies on the 2010 National Physicians Survey (the “NPS”) and its own data to support this argument. The NPS provides the following information regarding those specialists who responded to the survey:
a. 34.4% of all specialists in Ontario are born outside of Canada.
b. 90.8% of Ontario specialists are RCPSC certified.
c. 99.2% of Ontario specialists born outside of Canada are RCPSC certified.
d. 99.7% of Ontario specialists born in Canada who completed their medical training outside of Canada are RCPSC certified.
40The interpretation of the statistical data from the NPS is in dispute between the parties. In my view, it is difficult to interpret the data from the NPS and marry it with the CPSO data in part because the CPSO data distinguishes between CPSO and RCPSC specialists in Ontario with respect to their place of birth and place of medical school, and the NPS provides further information about the RCPSC specialists alone. In addition, the information from the NPS is from those physicians who responded to the survey. The two groups from which the data is obtained are different.
41I am not sure what conclusion can be drawn from the NPS other than the fact that most specialists in Ontario are RCPSC certified, even when they are foreign born or foreign trained. It seems to me that this conclusion is relevant to a different question than the one posed in this Application, that being, whether the RCPSC accreditation process adversely impacts foreign-trained doctors.
42What the NPS data does show is that the pool of CPSO specialists in Ontario is small when compared to RCPSC specialists because most specialists in Ontario are RCPSC certified. Even though there may be fewer CPSO specialists in Ontario, the CPSO data shows that a low percentage of them are trained in Canada. Thus, for the purpose of this analysis, I accept the proposition put forward by Dr. Reitz that CPSO specialists are predominately foreign trained or “immigrants” as he describes them.
43Dr. Reitz’s theory that certain groups are devalued because of their immigrant make-up has some intuitive appeal. However, the difficulty with his theory is that it is completely devoid of context. Dr. Reitz gave the example of the devaluation of clerical work because of the over-representation of women in that job category. In his example, the devalued group is homogeneous. The question that arises in this case is whether group devaluation because of immigrant status can occur in a profession that appears to be inherently diverse. According to the NPS data, 34 percent of all specialists in Ontario are born outside of Canada. There is no analysis by Dr. Reitz as to how the medical community has responded to the clear diversity in its profession.
44A further problem with Dr. Reitz’s theory is that devaluation on its own is not sufficient to prove discrimination. There must be evidence of adverse treatment or disadvantage resulting from the differential treatment. One looks to historic disadvantage to understand the impact of the differential treatment, not to eviscerate the need to prove current disadvantage in the specific case.
45The other difficulty with Dr. Reitz’s evidence is that the applicant does not belong to the devalued group. Dr. Reitz testified that American credentials are valued higher than or at least on par with Canadian credentials. There is no evidence that American-trained physicians are a disadvantaged group. Thus, the harm asserted by the applicant is really one of being associated with the devalued group even though he is not a member of that group.
46A further problem with Dr. Reitz’s evidence is that it presumes CPSO specialists and RCPSC specialists are the same. In his evidence, Dr. Reitz stated if the qualifications between CPSO and RCPSC are truly equivalent, the CPSO is inviting the public to wonder what the difference is between the two by maintaining the distinction on the Register. The question arises as to whether his opinion holds weight if the two groups are not equal. The distinction on the Register may reflect their substantive differences, not devaluation.
47In his report, Dr. Reitz states the “CPSO has stated formally that status as CPSO Recognized Specialist is equivalent for all purpose to RCPSC Specialist status”. There is no documentation by the CPSO where it has used the words “equivalent” or “equivalency” when referring to CPSO recognized specialists and RCPSC specialists. This point was conceded to by both Dr. Reitz and the applicant.
48The applicant relies on an internal memo of the CPSO dated September 18, 2003 from the then Deputy Registrar Dr. John Carlisle where he uses the words “specialist for all purposes” when describing CPSO recognized specialists. The subject of the memo is “recognition of physicians for specialists billing”. The applicant extrapolates from this statement that “the CPSO clearly accepted, that those who met the standard for CPSO recognition met the same basic standard for practice of a particular specialty as was met by those certified as specialists by the RCPSC”.
49The CPSO is the governing body for physicians in Ontario and is mandated to regulate Ontario’s medical profession in the public interest. The fact that CPSO recognized specialists must meet certain standards of practice does not mean that they are the same as RCPSC specialists.
50There is no evidence that any assessment has been done of the CPSO recognition process and the RCPSC accreditation process to support the conclusion that CPSO specialists and RCPSC specialists are the same. In fact, there are significant differences between the two processes. The RCPSC is exam-based and the CPSO is a functional assessment. The RCPSC is national in scope and the CPSO is provincial. The RCPSC accredits specialists and the CPSO recognizes their expertise. The RCPSC develops national standards and the CPSO deals with licensing to practise medicine in Ontario. If a physician is certified by the RCPSC, it suggests broad-based skills in all aspects of a specialty class. The functional assessment by the CPSO looks at what the physician is doing at the present time and determines whether he/she is practicing at the level of competence of a specialist in that particular work. A successful practice assessment by the CPSO does not mean general specialization as it does for RCPSC specialization.
51Although discrimination is not defined in the Code, it has been consistently defined by the Tribunal and the courts to mean adverse treatment or a distinction which creates a disadvantage, on the basis of a prohibited ground of discrimination. See Andrews v. Law Society of British Columbia, 1989 CanLII 2 (SCC), [1989] 1 SCR 143; Ontario (Director of Disability Support Program) v. Tranchemontagne, 2010 ONCA 593 at para. 90; Hendershott v. Ontario (Community and Social Services), 2011 HRTO 482 at para 41.
52The applicant must do more than provide an opinion that the distinction on the Register devalues CPSO specialists in an abstract way because of the make-up of the group. He must adduce evidence that the distinction on the Register results in adverse treatment because his place of origin. I will now turn to the applicant’s evidence in this regard.
Evidence of Adverse Treatment from the Register
53The applicant alleges that he was excluded from employment because of the distinction on the Register. He relies on advertised job postings in psychiatry that required RCPSC certification as a job pre-requisite. The issue is whether the distinction on the Register had anything to do with the job requirements in advertisements for psychiatrists.
54The applicant argues prospective employers obtain information about a candidate’s job qualifications from the Register. There is no evidence before the Tribunal that this is so. Even if that is the case, information about a candidate’s specialty accreditation or recognition is provided by the candidate in his/her job application and curriculum vitae. The applicant’s own experience supports this finding.
55The applicant admitted in his evidence that when communicating with prospective employers in relation to advertised job postings, he specifically advised them that he was not certified by the RCPSC, but was a CPSO-recognized specialist. He admitted further that this information was contained in his C.V. and was stated expressly in his communications with prospective employers. For example, in response to a job posting for psychiatrists at Providence Care (Queen’s University) in July 2009, the applicant inquired whether the positions required Canadian specialist certification or whether specialist certification by a foreign organization with CPSO and OHIP recognition would suffice. The applicant stated he was recognized as a specialist in psychiatry by the CPSO and OHIP, but did not have a RCPSC credential.
56The applicant gave a further example of a job posting that he applied for at the University of Western. He argues that he was not successful in obtaining a position with the University of Western because of the information contained on the Register. This conclusion is purely speculative on his part. There is no evidence that the reason the applicant did not obtain this position was because of the information on the Register.
57The applicant’s real claim is the failure of prospective employers to recognize his CPSO status. The applicant pursued this claim in two human rights complaints against Correctional Service of Canada (“CSC”) and the Canadian Forces (“CF”) regarding job postings that required RCPSC certification. In those cases, the applicant argued his CPSO certification should have been accepted as sufficient qualification for the positions. The Canadian Human Rights Commission (the “CHRC”) dismissed the CSC complaint on a number of bases including its finding that RCPSC certification was a legitimate and justifiable requirement for the position for which the applicant had applied. The CF complaint was dismissed as being outside of the jurisdiction of the CHRC because the complaint was really a challenge to the RCPSC, a provincially-regulated entity. In dismissing the CF complaint, the CHRC noted the CF had valid, non-discriminatory reasons for requiring RCPSC certification.
58The decisions of the CHRC were judicially reviewed by the applicant to the Federal Court. Both applications were dismissed. See Keith v. Correctional Service of Canada, 2011 FC 690.
59On further appeal to the Federal Court of Appeal, the court dismissed the applicant’s appeal concerning the CSC complaint. It upheld the appeal regarding the CF complaint because it ruled the CHRC should have taken jurisdiction over the complaint and investigated the CF’s reliance on the RCPSC requirement. The CF complaint was returned to the CHRC for further investigation. With respect to the applicant’s complaint that his CPSO certification should have been accepted as sufficient qualification for the positions, the Court of Appeal stated:
This last aspect of the complaint has nothing to do with discrimination but has to do rather with professional qualifications equivalence. The Commission has no authority or expertise to perform professional equivalence assessments, and rightly declined to do so. See Keith v. Correctional Service of Canada, 2012 FCA 117, para. 75.
60The applicant has failed to establish that he was denied jobs because of the information contained on the Register.
61The applicant also claims the distinction on the Register prevented him from entering private practice. The Register did not prevent the applicant from entering private practice. The contents of Regulation 114 prevented him until December 2010 from holding himself out in public as a psychiatrist.
62The CPSO began work in 2007 to recommend a change to Regulation 114. The Regulation was subsequently amended in December 2010. The applicant asserts the College delayed requesting an amendment of Regulation 114. This assertion is not borne out by the evidence. A draft regulation was submitted to the government by the CPSO in May 2008. Any delay that occurred in amending Regulation 114 lies at the feet of the government, not the CPSO. The government was removed from the Application, with the applicant’s consent, on April 3, 2012.
63In any event, the applicant’s claim in this regard is also speculative in nature. The applicant has never been in private practice at any time during his medical career. The vast majority of his career has been spent in hospitals and correctional facility settings as a staff psychiatrist. There is no evidence that the applicant attempted to engage in private practice even though OHIP issued him a specialists billing number effective April 18, 2007 and Regulation 114 was amended in December 2010.
64The applicant relies on Halpern v. Canada (Attorney General), 2003 CanLII 26403 (Ont. C.A.) and Re Blainey and Ontario Hockey Association, 1986 CanLII 145 (Ont. C.A.) to support his argument that harm results from a distinction that reinforces pre-existing stigma and stereotyping. It is unclear to me how these cases help the applicant when they both involve clear examples of adverse treatment: Halpern, the exclusion of same-sex couples from civil marriage and Blainey, the exclusion of a girl from a hockey league comprised solely of boys. These cases do not stand for the proposition that stigma and stereotyping in the absence of concrete disadvantage constitutes discrimination. In this case, there is no evidence of harm arising from the distinction on the Register.
65The applicant draws the analogy to the adopted but not yet implemented proposal of the Law Society of Upper Canada (“LSUC”) to create two pathways to lawyers being called to the bar in Ontario: the exam-based and the articling pathways. There was no evidence before the Tribunal regarding this proposal, no evidence as to whether the two pathways would be noted on the LSUC website and no evidence of disadvantage relating to the two pathways. None of these facts can be presumed.
66Even if there was evidence before the Tribunal concerning the LSUC, the applicant’s analogy is not helpful because his case does not involve two pathways created by the CPSO to specialization. This case involves the CPSO recognizing the different national and provincial pathways to specialization on its Register.
67The applicant also relies on the new approach by the RCPSC to adopt a functional approach to certification, as well as an exam-based approach. The adoption of the functional approach occurred after the Application was filed and the applicant has not been subject to it. Even if the applicant had been affected by the change at the RCPSC, it is similar to the LSUC in that it involves two pathways by the same institution. Like the LSUC, there is no information before the Tribunal as to how the different pathways will be noted on the website of the RCPSC.
68The Register is mandated to provide the public with information about medical doctors authorized to practise medicine in Ontario. The CPSO’s General By-Law requires it to include where the doctor went to medical school, when the doctor graduated from medical school and a description of the doctor’s post-graduate training. If the doctor has been certified by the RCPSC or the CFPC, the Register must note that fact, the date of certification, the discipline or sub-discipline in which the doctor is certified and whether the doctor was certified by examination and, if not, by what process. Accurate information about qualifications enables members of the public to make informed decisions about their health care, including which practitioner to attend for this care.
69Members of the public are entitled to the information contained on the Register including information about how the doctor obtained specialty status. The public should know if the accreditation is national in scope. They are entitled to know if the specialist has been accredited or recognized. The CPSO distinguishes between RCPSC accreditation and CPSO recognition because they are different processes with different breadth. The distinction is not discriminatory because there is no evidence of harm that results from it. The disadvantage experienced by the applicant is that potential employers require RCPSC accreditation. That requirement does not involve the CPSO.
70The applicant claims that in 2007, his specialty status was stated as “none” even though he had completed the CPSO recognition process. The uncontradicted evidence is that when the CPSO unveiled its process in 2007, the Register had to be revamped to include a descriptor for CPSO recognized specialists because this pathway did not exist when the website was originally created and launched. The failure to note the applicant’s specialty had nothing to do with his place or origin. It was the result of a website that needed overhauling. In the interim, the CPSO offered to confirm the applicant’s specialty status with third parties. When the applicant complained about the delay, the CPSO manually inputted his information in 2008.
71In conclusion, the distinction on the Register between RCPSC and CPSO specialists is not discriminatory because there is no evidence that it results in any adverse treatment or disadvantage. The applicant may well be disadvantaged because he does not have RCPSC certification. However, that disadvantage results from the fact that potential employers require RCPSC certification. Whether that requirement is bona fide depends on the particular job at issue and involves the employer, not the CPSO. The applicant may believe that barriers exist to obtaining RCPSC accreditation. That issue must be raised with the RCPSC.
72For these reasons, the Application is dismissed.
Dated at Toronto, this 1st day of October, 2013.
“Signed by”
Jennifer Scott
Vice-chair