On November 1, 2021, the CDBC Board of Directors approved amendments to the College’s bylaws that are subject to the notice as described in section 19(6.2) of the Health Professions Act (HPA). The proposed amendments include:
- addition of Finance and Governance Committees
- ability for the Quality Assurance Committee to form a panel
- Registrar’s authority to dispose of complaints under section 32(3) of the Act
- updated approved programs of study
- updated marketing rules around prohibiting the use of “specialist”, “specializing”, “expert”, “expertise”, or synonyms thereof that suggest a recognized specialty, special status or accreditation.
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During the consultation period and shortly after, staff received comments on updated marketing rules. All comments were reviewed carefully and the CDBC would like to share an open response with all registrants for consistency and transparency.
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Section 19(1) of the HPA defines what a Board may make as bylaws. Subsections k.3 and k.4 enable a Board to make a bylaw to recognize registrants as specialists in a field of their profession and specify how they may hold themselves as specialists in a field. That section should not be read as the HPA acknowledging that all registrants are specialists in their profession. To the contrary, the intent of that section is to ensure that a specialization within a health profession must be defined and regulated by that College’s Board.
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Although the CDBC recognizes that many Dietitians may focus their practice in one domain, the entry-level competencies in dietetics and the license allow Dietitians to work in any aspect of dietetics of their choosing. This is in contrast to Physicians, for example, whereby specialities are recognized, and built into the education and license, so they may only work in specific areas of medicine.
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The CDBC’s intent in making these amendments came from two sources of input: complaints received over the last 5 years, and recent public engagement and consultation with the BC Public Advisory Network (BC-PAN). This network “brings the public voice and perspective to multiple health regulators in the province.”
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In consulting with the BC-PAN for the marketing policy documents, the CDBC heard that public advisors expected health professionals to market their services clearly, accurately, in plain language, resulting in a way that promotes trust. Advisors offered rich feedback on why they saw value in Dietitians and where it was felt that the CDBC and Dietitians could market more clearly what they have to offer.
For example, advisors commented on the unique ability for Dietitians to adapt therapeutic diets for diabetic or various cancer conditions according to a client’s ethnic foods and personalized preferences. Another example was the ability for Dietitians to provide a culturally sensitive and individualized assessment of a person’s nutrition status in the context of their health and, as a result, a tailored nutrition care plan.
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Last year, complaints by members of the public about marketing in private practice counted for over half of the complaints received, while only 7% of CDBC registrants have reported working in private practice (based on HPA requirements to report workplace information). Members of the public who made these complaints voiced confusion, uncertainty, and concern when marketing alluded to a specialization or additional training that appeared questionable, specifically when there was a qualificative added to the title. For example, members of the public might find descriptors such as “Thyroid Dietitian” or “Natural Fertility Dietitian” confounding, whereby dietitians have the potential of implying defined and additional training in specific body systems. In actuality, the titles are self-proclaimed with no standardization nor guarantee of added competency, leading to potential misleading of members of the public.
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The CDBC follows a process when establishing a new bylaw. After identifying a risk to address, and in reviewing existing data to support it, the CDBC chooses an approach to design the regulatory response. From a policy-making point of view, the College aims for consistency, and this is why our legal counsel suggested several terms in addition to “specialist” and “synonyms thereof” as proposed amendments. Our lawyer’s advice was the result of a thorough environmental scan of existing Canadian regulatory bylaws for marketing and the analysis of the efficiency of different regulatory approaches. CDBC considered different wording, looked at the jurisprudence and focused on addressing the issues being seen in complaints. The bylaw consultation is an important step as it allows CDBC to better understand and assess the impact of proposed changes on registrants and the public, and leaves room for revision and developing new tools to support the implementation of the changes.
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As a result of the feedback registrants shared with CDBC, whereby other BC health regulators use the words “expert” and “expertise” in the marketing of their profession, we are taking another look at the wording and reconsidering how to articulate more clearly on the intent of this new amendment. That is, to prevent Dietitians from adding qualifiers to their title that allude to a specialty and prevent misleading the public. We remain mindful of being risk-specific in our regulatory approach and not overregulating or creating a set of circumstances that would go against our intention of protecting the public.
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In the comments we received, “nutrition expert” was pointed out as an example of marketing that is commonly used by Dietitians and we understand that the proposed bylaw changes would prevent Dietitians from using these words in their marketing, which would impact online visibility and search engine analytics at large. That said, expressions used for the purpose of marketing services and knowledge may not be used as a regulated health professional title. “Nutrition expert” when used as a title is problematic because it is not regulated in BC and could be applied to anyone. A prospective client may not understand why they should choose a Dietitian over another “nutrition expert” who is not regulated and unaccountable to the public if they use the same terms to describe themselves.
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College staff agree with the comments that were made on recognizing dietetic education and training, and that the public is well-served in knowing that Dietitians are the only regulated health professionals who spend 5 years of undergraduate education acquiring nutrition knowledge and skills. From a right-touch regulation point of view (finding balance between under and over-regulation) and public understanding, we acknowledge that there is a need for Dietitians to be able to market “nutrition expertise” and “specialized knowledge in nutrition” given that it is fundamentally what a Dietitian graduates with. Dietitians are still permitted to market education credentials (degrees, diplomas and certifications) and the focus of their practice.
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With that in mind, the College is of the view that we need to find a way to balance marketing options without undermining the credibility of the title Dietitian. While the bylaw notice period closed on February 3, our virtual “door” is never closed, and our team has a responsibility to address comments received. We are consulting with our lawyer to consider a revised wording. We will review your comments with the Ministry of Health and how we respond to it before filing. We will also continue engaging with partners such as other BC Health Regulators, other dietetic regulators and inform everyone of the result of this consultation.
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Registrants will also be kept informed of the changes, a transition time for implementation similar to the one for testimonials, and any support resources such as a discussion of the changes, interpretation for practice, and supporting examples. We have heard that registrants would like to receive more frequent communication and reminders when we consult on policy decisions, and it is well-noted.
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