N.S. government introduces bill to regulate sick notes, reduce fees for health-care professionals

The Nova Scotia government is eliminating some instances in which employers can require staff to provide sick notes from a doctor, and is giving itself ultimate power to make decisions about the scope of practice for regulated health-care professionals.

Health Minister Michelle Thompson introduced the sweeping legislation on Tuesday during the opening of the spring session of the legislature. Thompson said the bill addresses the fact that things need to be done differently in order to improve the health-care system.

She said doctors and patients alike have long complained about sick notes.

"This has been a waste of valuable time for our physicians," she told reporters during a bill briefing. "It has also been a waste of time for Nova Scotians whose time could be better spent staying at home, getting better."

Under the changes, which come into effect in July, provincially regulated employers will only be allowed to request a sick note from employees who are absent for more than five consecutive working days, or who have already had two non-consecutive absences of five days or less due to illness or injury in the previous 12 months.

A Labour Department official said it is estimated the change will save physicians in the province about 50,000 hours of work per year in total. The government is also reviewing other forms employers require doctors to fill out to ensure they are necessary. If they are, the government could take the step to require the employer to foot the bill for the physician's time.

'Opening the door' on licensing

The other major changes included in Tuesday's bill relate to the 21 regulated health-care professions and their scope of practice.

When the bill comes into force, people who are licensed to work in other parts of Canada would not be required to pay an application fee to work in Nova Scotia and, if they agree to move here to work, the government will pick up the tab for the first year of their licensing fees in Nova Scotia.

Regulatory bodies will also be required to process applications within five business days. That applies to professionals including doctors, nurses, paramedics, physiotherapists, dentists and pharmacists.

Thompson said the changes would not affect the ability of regulators to ensure professionals working in the province are safe and qualified to provide patient care.

"This isn't about lowering the bar," she said. "It's really about opening the door."

Making changes to scope of practice easier

One of the most notable changes in the bill relates to scope of practice.

In the past, such changes would require legislation; Tuesday's bill will allow changes to be made through regulations, meaning they can happen more quickly and without requiring debate in the legislature.

Thompson said it's a change that's been discussed with regulators for some time and is about being more nimble. Generally, the minister said she would only expect changes to come when they are advanced by a regulatory body.

However, the standard laid out in the legislation says that changes must be in the public interest and must include consultation with a regulator. That means any change would ultimately fall to the government to advance.

"It's not really an interest right now that we would enforce something," said Thompson, downplaying the suggestion that the government could act in a way that is not in keeping with the wishes of a regulator.

"The colleges are also looking at ways to be nimble and ways to, you know, use their full scopes and expand them in order to support primary care, as an example."

Thompson pointed to recent changes to expand the scopes of practice for nurses and pharmacists as examples of changes that were brought forward by regulators and received the government's support.

Opposition says regulators should have final say, not cabinet

Dr. Gus Grant, CEO of the College of Physicians and Surgeons of Nova Scotia, said in an interview that he's in favour of expanding scope of practice but added that experts must decide how far is too far.

"I think it's absolutely essential that we maximize the training of our health workforce and maximize it through safely expanding their scope of practice so as to allow people to take full advantage of their training," he said.

"Having said that, it needs to be done with the voice of expertise in the room. And the expertise about nursing is nurses, the expertise about pharmacists is pharmacists, and medicine will be medicine."

Grant said his sentiment about scope of practice also applies to accepting credentials of doctors trained outside of Canada, which is something Thompson's bill also touches on.

"When I saw that language in the legislation, I paused and I thought, this is a slippery slope. And it's investing in authority, in government that is not really related to government expertise or political expertise. It really needs the voice of medicine, medical educators, medical regulators to make those decisions."

Liberal Leader Zach Churchill welcomed efforts by the government to speed up efforts to expand care for patients through moves such as broadening scopes of practice, but he said final say should rest with professional regulators.

"Patient safety is also at risk here and they have standards around patient safety that I do not believe cabinet has," he told reporters.

NDP Leader Claudia Chender said it's the job of regulators to determine what is an appropriate scope of practice. She said she was waiting to hear more from regulators, who only received a copy of the bill on Tuesday.

"That's why they exist — they regulate in the public interest," she told reporters. "So they are the ones that should be the arbiters of that, not Tim Houston and his cabinet. It doesn't make any sense."

Changes in Tuesday's bill related to scope of practice and regulatory fees would not come into effect until regulations are developed. But Thompson said she expects that work to be complete later this year.

"We want this to move quickly. We're not dragging our feet."