Considerations in the Regulation of Osteopathy in Canada
When approaching the regulation of Osteopathy in Canada, the global landscape must be taken into consideration. Which countries have regulated it? How have they regulated it?
One document that is consistently used as a reference, when evaluating and discussing osteopathy, is the Benchmarks for Training in Osteopathy published by the World Health Organization. This document is widely accepted by education providers, professional associations and governments around the world.
The WHO document describes two pathways that are presently seen in osteopathic education: Type 1 and Type 2.
- Type 1 is the primary standard and it is defined in detail by the W.H.O.
- Type 2 is described as an “add-on” pathway, that must produce graduates “demonstrating the same competencies of osteopathy as graduates of Type 1 programs”. The WHO document does not define the “add-on” pathway in any detail, except for saying that it is an option for health professionals.
It is a common misconception that Type 1 means “full time” and Type 2 means “part time”. Type 1 programs, as defined by the W.H.O. Benchmarks, “can be full-time, part-time or a combination of the two” and a variety of such programs exist internationally.
Primary Type 1 Standard
All countries that have regulated osteopathy focus on Type 1 benchmarks as the primary educational standard. In some countries, universities are offering these programs as a degree, in other countries, private independent colleges are offering these programs as a diploma. The difference is due to legislation around degree-granting, and not a reflection of the quality of the program content.
Some countries have also elected to include type 2 “add-on” pathway programs in their accepted education requirements post regulation.
- In the UK, for example, all osteopathic educations program accepted by the General Osteopathic Council are similar to Type 1 benchmarks with the exception of one Type 2 “add-on” pathway that is exclusively for physicians. The UK has defined Type 2 clearly because the WHO document leaves it quite open ended.
- The European Union has also listed Type 1 as its primary standard, and opted to include the Type 2 “add-on” pathway, defining it somewhat.
Conflict Around Type 2
Obviously, when it comes to the regulation of osteopathy, any Canadian province should include the Type 1 as the primary standard, even if no such school’s exist in that province. Simply because it is the international gold standard and Canada should seek nothing less that the highest international standard.
Where provinces need to take caution is in whether to include the Type 2 “add-on” pathway or not. There are two sides to this debate.
CON: Type 2
The argument against the inclusion of an “add-on” pathway to osteopathy.
Osteopathy is not an add-on. It is a profession unto itself like Chiropractic or Physiotherapy. There are no short-cut pathways to chiropractic or physiotherapy, and there should be no shortcut pathway in osteopathy.
One Type 1 program in Canada, for example, has students in its program from a variety of backgrounds due to the Type 1 nature of its content allowing it to do so. However, its student population also includes physicians and physiotherapists. These professionals have chosen the comprehensive Type 1 standard instead of the other Type 2 options that are also available.
This is entirely because osteopathy is not an “add-on” and only full and comprehensive Type 1 programs hit the WHO Benchmarks. Many current Type 2 graduates are not “demonstrating the same competencies of osteopathy as graduates of Type 1 programs” as the WHO document explicitly mandates.
PRO: Type 2
The argument for the inclusion of an “add-on” pathway
In this camp there are 2 sides;
one group that wishes to keep Type 2 undefined, and;
one group that wishes to define it
The undefined Type 2 environment is ripe for diploma mills so it is imperative to define Type 2, if is to be accepted at all.
When defining any Type 2 “add-on” pathway, it must be defined on two levels
- Who would qualify for the “add-on”?
- The UK has only opened it to physicians
- some Canadian Type 2 schools are offering the “add-on” pathway to those with education in physiotherapy, chiropractic, massage therapy, personal training, athletic therapy, and kinesiology. These professions are nowhere near the competency level of a physician in terms of prior competencies in anatomy, physiology, biomechanics, etc.
- Some Canadian Type 2 schools are offering the “add-on” pathway to those with no health care background at all which is problematic for obvious reasons.
- What educational content would be required in both theoretical and clinical training?
- Theoretical subjects; anatomy, physiology, biomechanics, osteopathic theory & principles, osteopathic treatment skills, contraindications/red flags, ethics etc.
- Supervised clinical training and practice
- the WHO defines this at 1000 hours of supervised clinical training and practice.
- Regulated countries like the UK and Australia go further and include the following parameters
- training must be done in dedicated clinical teaching facilities,
- supervised by professional osteopathic manual practitioners.
OSTCAN believes that to secure Canadian osteopathy its due respect on a global level, it is critical that Canadian professional associations must only accept osteopathic education standards that are in keeping with the highest international standards. It is imperative to align with what is being done in countries that are regulated at the highest international standard.