Saskatchewan Association of Diagnostic Medical Sonographers

1. Saskatchewan Association of Diagnostic Medical Sonographers SELF REGULATION

2. Topics to be Covered: • What is self-regulation? • What is licensure? • What self-regulation and licensure mean to the SADMS • Seven things to attain with professional self-regulation • Where we have been • What has happened since the 2009 AGM? • Current status of Canadian Provinces and self-regulation • Common myths • Truths • Where we need to go from here • Discussion and Questions

3. What is self-regulation? • the ability to regulate oneself • the ability of a profession to regulate itself • regulate - to control or direct according to rule, principle, or law • it is a privilege delegated by legislature to a health profession • we have always used the term, “licensure” to describe the process and the goal of self-regulation. Self-regulation is the correct term and licensure is only part of the self-regulatory process.

4. What is Licensure? What is Licensure? • Licensure - granting of a license, therefore giving “permission to practice” to a qualified member (this is different from registration) • Registration – is for all members • is one part of a self-regulated profession which is most beneficial in enhancing public safety • must be granted by government through written legislation which specifically allows a profession to license their members • one of the most important of the seven conditions for a profession to attain with self-regulation

5. What is Licensure? What is Licensure? • Key Point: • a profession may conduct business like self-regulatory body, without having written legislation to act as such or license it’s members (example: SAMRT)

6. What Self-Regulation and Licensure mean to the SADMS: • self regulation and licensure allow for accountability of professionals, and public protection • in order for the aforementioned to be possible, the SADMS would have to: • ensure that all SADMS professionals meet entry level requirements and are qualified to practice • set standardsof practice and a code of ethics which all SADMS professionals must follow • require all SADMS professionals to be registered and licensed in order to use the title of the profession • ensure public safety with the establishment of an investigation and disciplinary committee to deal with complaintsabout professional misconduct

7. What Self-Regulation and Licensure mean to the SADMS: • Key point: • we would become and advocate for the public; we would no longer work to serve ourselves

8. Seven Goals to Achieve With Professional Self-Regulation: This is in essence our wish list: • Autonomy 1) we want to be a separate entity 2) we want sonographers disciplining sonographers • Licensing capability • Prohibition of people to work • Name title • Maintaining the SADMS • Bylaws specific to our profession • Scope of practice

9. Where we have been: • 1988 – SADMS became an incorporated, non-profit corporation (Fran Buhr, Della Beal, Gary Kachur, Sharon Harvey, Lynn Underwood- were the founding members) • 1988 – SADMS recommends to Radiation Health and Safety that all operators of diagnostic medical ultrasound equipment be registered sonographers with ARDMS or in a recognized student program • 1989 – College of Physicians and Surgeons, hospitals and clinics are notified of SADMS’s existence and are made aware of the above recommendation set forth by the SADMS • 1990 – SADMS becomes an affiliate member of the CSDMS

10. Where we have been: • 2002 – AGM - self-regulation is first introduced to the SADMS via Denise McIvor (ADSA) presentation • 2003 – AGM - discussion amongst members regarding self-regulation • 2004 – AGM -committee set up to investigate self-regulation • - the need to protect the public became ever so apparent in 2004, when certified sonographers were in short supply and the ensuing applicants were below CARDUP National Competency Profile standards

11. Where we have been: • 2005 – Radiation Health and Safety, and Sask Health were contacted regarding self-regulation; all provinces = little to no progress • 2006 – AGM – discussion by members about if and how to continue the process • 2007 – AGM - Joel Williamson speaks to the membership about self-regulation • - a membership vote was conducted by Janice Lensen (then SADMS President) regarding joining the SAMRT umbrella – vote was favourable

12. Where we have been: • 2009 – Licensure Committee is reconstructed • – consulted and conducted interviews with Brian Salte (lawyer), Steve Webster (Radiation Health and Safety), Karen Davis (president of the SAMRT), Kim Samoila (Workforce Planning, Ministry of Health), and Debbie Lundy (SAMRT Registrar/Treasurer) regarding self-regulation • - talks began and ended with SAMRT (Karen Davis – SAMRT President) • 2010 – and here we are….we need a plan

13. What has happened since the 2009 AGM?? • 2009 – Fall – work was done by the Licensure Committee which left some unanswered questions • - SADMS Executive conducted interviews with the following 5 individuals: • Debbie Lundy (SAMRT Registrar/Treasurer) • Steve Webster (Radiation Health and Safety, Ministry of Advanced Education, Employment and Labour) • Kim Samoila (Workforce Planning, Ministry of Health) • Brian Salte (Lawyer for the College of Physicians and Surgeons) • Karen Davis (SAMRT President) • the interviews conducted by the SADMS Executive revealed conflicting information concerning a union with SAMRT

14. What has happened since the 2009 AGM?? Conflict 1 – Urgency to join with SAMRT now or be left behind

15. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Karen Davis Interview: • there was no hurry to join with SAMRT in the fall of 2009: • Milissa – Do you need an answer from us by November 7, 2009? • Karen – No. The meeting that I am going to have on the 7th really is just about the name change and a CEO. It is going to be more of an information meeting because these are huge decisions that we need to make. I can’t even see how we are going to get a name change passed through. • Milissa – And to rewrite the bylaws by the 18th is really not likely. • Karen – Yeah. • Milissa – So there is no urgency on our part? Or yours? • Karen – Right. We have time…if this is going to happen it won’t happen overnight.

16. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Kim Samoila Interview: • there was no hurry to join with SAMRT in the fall of 2009: • Milissa – Hi Kim I just wanted you to clarify what you meant in your Oct 26th reply regarding “not to rush with submitting a proposal for this year.” • Kim - Not to be negative, but if you rush and put together a proposal for this year, government may very likely reject your proposal…(for a joint proposal) to go through this year, it would have to be a life or death situation. The chance of a proposal going through this year is very unlikely. It also does not help us that there is not any other regulation for Ultrasound throughout the entirety of Canada. The Minister might not be comfortable moving forward being the first province to do this (licensure). Being the first is definitely a drawback. She cautions us to maybe not rush into it this year with any proposal.

17. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Kim Samoila Interview: • there was no hurry to join with SAMRT in the fall of 2009: • Kim – To her, for either group, any legislative changes would be extremely tough this year. Especially with only four pieces of legislation being passed in Saskatchewan per year. If a public health risk (ex: everyone quitting and moving out of the province) was in effect, then we would have a better chance. This year it would have to be an extremely strong case as to why we need to be regulated. Ultrasound could try working through a proposal for the upcoming year, unless we can join with an existing (solid) group. If regulation in other provinces happens first, it would definitely help our case.

18. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Kim Samoila Interview: • there was no hurry to join with SAMRT in the fall of 2009: • Kim - Watch carefully what is going on in the country because that will be huge in helping us along. When we pitch our proposal to government, it needs to focus on public protection and safety. Use what other provinces do as a model. It’s tough for a group to say that we want to be the first, she cannot see the government accepting legislation for Sonographers unless other provinces were moving in that direction as well. A strong public safety argument would be needed. If the country starts to move toward self regulation, it would be a very strong case for Saskatchewan as well.

19. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Karen Davis Interview: • we could join with the SAMRT at any time: • Milissa – So even if we take a step back to learn more…it’s (joining with SAMRT) always an option? • Karen – Absolutely. The door will always be open in working together to bring you in. In talking with our Council and educated members, it is believed that we can all be together.

20. What has happened since the 2009 AGM?? Conflict 2 – Bylaws had to be rewritten between November 7th-18th, 2009 to include Ultrasound as a 5th discipline under SAMRT

21. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Karen Davis Interview: • it would be impossible to rewrite bylaws in a short period of time: • Milissa – I have been told that to rewrite bylaws, it takes years. • Karen – Oh yeah…It has been a headache. I have been working with Brian Salte on ours. It has been a long process.

22. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Karen Davis Interview: • name change was not to include Ultrasound: • Karen – (the name change is to include) Our MRI guys, because their radiant energy is at such a low spectrum. To call them MRT’s isn’t true. I am hoping to look at Medical Imaging and Therapeutic... • Milissa – So you are going to try to choose a name that is all encompassing? • Karen – Yes, without it being too long.

23. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Steve Webster Interview: • it would be impossible to rewrite bylaws in a short period of time: • Milissa – They say that between November 7-18, 2009, they are going to rewrite the bylaws. • Steve – They cannot rewrite the bylaws, that has to be amended by a vote of the membership. • Steve - The vote on the 7th isn’t so that you can be included in their group. There must have been a misunderstanding because they are changing their name to the College of Diagnostic Imaging Therapies and Technologists, (to get away from the “Radiation” title) is to include MRI…not Ultrasound.

24. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Karen Davis Interview: • Karen is against having 2 sets of bylaws: • Milissa – Are you against having separate bylaws for each discipline? • Karen – Yes, because we have never had separate bylaws. We have always been under the same one. • Milissa – If we were to possibly join, we are different from the other disciplines… • Karen – I don’t look at you guys as very different. • Milissa – I was talking to Brian Salte (Counsel for the College of Physicians and Surgeons) and he said that there can be two sets of bylaws. Would you be opposed to that? • Karen – Me personally, I think so, because it is just that much more. We don’t have ourselves in order to hold up our obligations without having to worry about more work. It is a lot of work.

25. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Brian Salte Interview: • there could be two sets of bylaws: • Milissa – For instance, if SADMS were to join a multidisciplinary college, could there be two sets of bylaws. • Brian – Sure. You would have two different kinds of members. Bylaws would be applicable to each body. The dental professionals used to be under the same regulatory body, but split off a number of years ago. Now each discipline has their own set of bylaws (Dental Discipline Act template).

26. What has happened since the 2009 AGM?? Conflict 3 – We would have to lose our autonomy

27. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Karen Davis Interview: • the SADMS would not maintain their autonomy: • email sent to Janice Lensen of April 21, 2009: “Thank you for clarifying your position, but I must say that your email took me a little by surprise. In the last 2 years that we have been talking about bringing the Ultrasonographers into our association (regulatory body), it has never been stated that your wish has been to remain autonomous and separate from our group…If your position on this matter changes then we can initiate talks at that time to bring the Ultrasonographers into SAMRT as full members of a distinct discipline, but not an autonomous Association.”

28. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Karen Davis Interview: • the SADMS would not maintain their autonomy: • Email sent to Jen Roesler on October 23, 2009: • Karen Davis’ – Again, if you want to be separate, then we are done discussing things

29. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Karen Davis Interview: • the SADMS would not maintain their autonomy: • Milissa email to Karen Davis – November 4, 2009 - In reference to an email dated April 22, 2009 to Janice Lensen (then SADMS President).  Is this still your position, regarding sonographers and our wish to remain autonomous upon the proposed joining with SAMRT? • Karen email to Milissa in response - I do not have the email to reference, but if you are meaning that we will not entertain you joining us for regulation only and want to be autonomous from us then yes it still stands.

30. What has happened since the 2009 AGM?? Conflict 4 – The SADMS will have to dissolve

31. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Karen Davis Interview: • the SADMS would have to dissolve: • Milissa – So the SADMS in your eyes, would not exist? • Karen – Right. • Milissa – I have been told that it could… • Karen – That is not the model that I would like to see. I would like to see us work on a model where it’s not, because I know how dysfunctional that can be.

32. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Brian Salte Interview: • the SADMS would NOT have to dissolve: • Milissa – We were told that SADMS would dissolve with a College formation. Can it remain like the SMA for the College of Physicians and Surgeons? • Brian – It would have a different mandate. It is healthy to have professional promotion separate from the professional regulation. It is difficult to have one organization do both, acting for members and the public. It would enhance the profession, but it would not have any public protection role of significance. Different professions split it different ways. • Milissa – So the SADMS does not have to dissolve? • Brian – That is correct.

33. What has happened since the 2009 AGM?? Concerns regarding a union with SAMRT

34. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Debbie Lundy Conversation: • SAMRT disarray: • Debbie – I don’t know why you would want to join us now…we are in chaos. We have 500 members and we only get 50 out to our AGM. No one will volunteer to sit on our committees. We keep rewriting the Bylaws to no avail. There is no hurry for SADMS to join. The SAMRT would entertain the thought of the SADMS joining at anytime….The name change for the SAMRT had nothing to do with Ultrasound.

35. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Brian Salte Interview: • we should be wary of SAMRT’s current situation: • Brian – Were I in your position, I would want a clear idea. If I was joining somebody else, it’s like a professional partnership or marriage. You want a pretty fair idea who you are marrying before you jump into the relationship.

36. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Steve Webster Interview: • the SADMS would be a subservient group of the SAMRT: • Steve Webster: The SACLXT was looking at becoming an Associate type of membership under the SAMRT, but after hearing what the SAMRT wanted…they were looking at the SACLXT as a subservient group to them. This might be the same situation for the Ultrasonographers (smaller group taken under SAMRT’s wing) and I don’t know if that is necessarily to your benefit.

37. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Karen Davis Interview: • the SAMRT needs the SADMS’s manpower: • Milissa - I understand that you have some problems with participation. • Karen – We are getting very apathetic. It is very difficult to get people out…we hold a conference and 80 people show up. Out of 580, to me that is poor. • Milissa – So is there no one to plan your Spring Conference? • Karen – Nobody has stepped up so far. • Milissa – It’s tough when you don’t have people wanting to be informed. • Karen - Nobody is willing to step up and sit on Committees or even Council. We actually had to have a vote this year because we had three people running for two seats, and three years before that we didn’t have a full Council. It’s kind of nice to see that we are starting to reach people again. But it’s a struggle.

38. What has happened since the 2009 AGM?? Realizations

39. What has happened since the 2009 AGM?? • we would have carried out professional suicide (under the current conditions and restrictions imposed by SAMRT) • it was impossible to execute under the proposed conditions and time frame (knowing what we know now, it was impossible to achieve) • another alternative may exist in our quest for self-regulation our identity, autonomy and assets are protected – SAMRT is still an option if different circumstances and stipulations surface

40. What has happened since the 2009 AGM?? • WHAT WE HAVE LEARNED: • Steve Webster Interview: • the new proposal: • Steve - What he was going to suggest next week, was that this process (what he is proposing…umbrella legislation) will be time consuming. He would need people from each Association (preferably in Saskatoon) that could meet on a regular basis, without costing the Associations money. These individuals would then take back information to the Executive, which they can disseminate to the membership. Next year while you are having your annual meeting, we may be in a position to approach the membership to outline what we are doing and how this legislation will look and how they (the membership) would benefit from it. How it would provide them with licensure and self regulation.

41. Where are we now? • the SADMS has been invited to participate with the Medical Diagnostic Legislative Working Group, which was orchestrated and developed by Steve Webster • this group is composed of: • Saskatchewan Association of Diagnostic Medical Sonographers • Saskatchewan Society of Medical Laboratory Technologists • Saskatchewan Association of Medical Radiation Technologists • Saskatchewan Cardiology Technologists Association • Saskatchewan Association of Combined Laboratory and X-Ray Technicians

42. Where are we now? • the MDLWG is based on umbrella Legislation • the common goal is self regulation and amendments to current legislation (lab) • as a participant of the Medical Diagnostics Legislative Working Group, a business case has been required from the SADMS • a meeting with the Ministry of Health is tentatively set for October 14, 2010; it is anticipated that a template will be suggested for the participants of the MDLWG

43. Where are we now? • Miranda (your 2010-2011 president) will be attending the meeting on Oct. 14th and will post a blog on the secure webpage with updates; it is the Executive’s hope that this meeting will provide further direction

44. Current status of Canadian Provinces and self-regulation • New Brunswick – act for legislation is currently at the lawyers; going at it alone (55 members) • British Columbia – no movement to date; Lab & X-Ray joint proposal sent to government • Ontario – next available date to resubmit request for self-regulation = 2013 • Nova Scotia – proposition to join with NSAMRT • Alberta – no movement to date • Newfoundland and Labrador – labour shortage; no movement to date

45. Common Myths: • “We will get paid more” – no evidence of this • “Our fees are going to be over $700” – if there are more volunteers, there will be less administrative cost • “Other people will not be able to do our job” – no exclusive practice; for example, entertainment ultrasound and emergency physicians doing point of care ultrasound

46. Common Myths continued: • “People will lose their job if they are unable to meet minimum standards” – nearly all Saskatchewan sonographers currently practicing in the province would meet the standard for which we would set for obtaining a license; those who do not meet the standard could be grandfathered into the college by a process that may place restrictions on their practice, this will not unjustly restrict individuals or unjustly hinder service to the public

47. Truths: • we would determine who qualifies to be a sonographer in Saskatchewan • we would determine minimum practice standards, and if qualifications were not met, you could not call yourself a sonographer (or whatever we choose to call ourselves) • the college can not remove a sonographer from the profession for improper conduct, etc. – more likely restrictions • it is possible to operate a college for sonographers in Saskatchewan

48. Truths continued: • in many forums, the definition of a profession is one that is self-regulating and autonomous • not being self-regulated limits our ability to participate in health policy discussions at many levels • almost every provincial association in Canada is actively pursuing self-regulation • disciplinary hearings cost approximately $10,000-20,000

49. What happens next?

50. SADMS’s possible future plan • discussion to carry on direction • our Association needs to get organized and focused • we need a 10 year plan: • increase in membership dues to build a reserve • formation of self regulatory required committees (discipline and investigation) • new bylaws must be drafted to reflect a regulated profession • new membership forms, where new membership classifications will be added • increased member participation • non-profit incorporation – corporations branch adds the act to our file (transferring over of status)