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Council Highlights

Council Highlights for October 24, 2024

RCDSO President, Dr. Harinder Sandhu opened the meeting with a discussion on the importance of education and lifelong learning—both for Council and for the profession. Keeping pace with contemporary research and thinking makes for better dentistry and better governance.

Dr. Sandhu highlighted the work of Rainbow Health Ontario (RHO). Their mission is to help health care professionals provide better care to the 2SLGBTQ+ community. Council later heard a presentation from the director of Rainbow Health, Sil Hernandez. RHO’s online learning platform offers CE credits for health professionals—including dentistry. Dentists in Ontario who take online and/or facilitated in-person courses through RHO are eligible for CE points. Dr. Sandhu and other Council members committed to taking a course.

Practice Models and Corporate Dentistry, a project under the Strategic Plan 2023-2025, explores changes that are evolving rapidly in the profession. Dr. Sandhu underlined that modern regulation must keep pace with the developments in practice. There are both issues and opportunities in new practice models and staff have launched a substantive research project on this issue.

Dr. Sandhu highlighted the importance of partnerships in College work and Choosing Wisely Canada  as an example. It is a cross-disciplinary group focused on reducing unnecessary tests and treatments. The goal is to reduce patient harm as well as the demand on precious health resources—particularly in relation to antimicrobial stewardship. In concert with RCDSO Quality Director, Susan Taylor, Choosing Wisely has developed a chairside decision-making tool Taking a Bite out of Tooth Pain: A Toolkit for Using Antibiotics Wisely.

Dr. Sandhu updated Council on two changes to their membership. Public member, Vivian Hu, former Public Health inspector and public health educator, was reappointed for three more years. Council congratulated Ms. Hu. Dr. Sandhu also thanked Dr. Mark Eckler for his exemplary service to Council over the past eight years. Dr. Mark Eckler has stepped away from Council and all his College-related roles, effective October 11th in order to pursue other opportunities. Dr. Sandhu highlighted Dr. Eckler’s  engagement and considered comments that have been so helpful to committees, Council and the College.

Registrar & CEO Update

Registrar & CEO Dan Faulkner provided a verbal update to Council on the following subjects:

Canadian Dental Care Plan (CDCP):

  • The CDCP has seen utilization continues to climb (at September 19/24), over 750,000 Canadian patients received care. Over 18,250 dentists in Canada, which includes over 8,000 dentists in Ontario are seeing patients under the plan. Both Health Canada and the ODA have large scale ad campaigns to public underway.
  • The RCDSO has received a response from the Federal Minister of Health to a letter from the College. We were thanked for our ongoing communications about the program. We had made the Minister aware of our interest in the CDCP on-site audits. As we have communicated, on-site verification is the last step in a claims verification process. The government reaffirmed its commitment to work with all regulators to ensure that process aligns with our current approach. These conversations will continue in Winter/Spring 2025.

Updates to the regulatory and governance landscape included:

  • College submitted a response to Government of Ontario consultation on Preferred Provider Networks in response to discussions at the Ontario College of Pharmacists (OCP). The government is assessing the impact of PPN on employer-sponsored drug insurance sector. Our submission underlined that government policy choices must acknowledge multiple professions are seeing increased corporate ownership and influence. The College will be closely monitoring the OCP’s deliberations.
  • The College of Nurses of Ontario (CNO) released its 2024 Workforce Census. Over 31,000 nurses participated to provide a picture of the demographics of the workforce and barriers related to diversity, equity and inclusion that nurses face.
  • Statistics Canada recently released a report on the economic impact of COVID-19 pandemic on Canadian dental industry. Major disruptions caused by the pandemic caused output from the industry to fall from $18.1B to $15.5B between 2019 and 2020. (This number includes economic outputs and job levels.) However, recovery was rapid and strong. In 2021, output grew to $19 B, above pre-pandemic levels. This pattern continued and by 2023 jobs were 12.5% higher than before the pandemic. Statistics Canada Dentistry

College news

  • In order to achieve accessibility for any individual with disabilities, the College is providing training for all who provide service or have input into policies/practices. This includes Council and Committee member training which will be complete by November 30th.
  • The College recently published two documents to help clarify reoccurring issues.
    • Together with the ODA, we published a document that clarifies the differences between the two organizations. Roles of the RCDSO and the ODA
    • We published a supplement to our Practice Advisory on Social Media use to help guide dentists. PAUSE.THINK. POST.

Practice Models and Corporate Dentistry

As part of the RCDSO Strategic Plan 2023-2025, the Corporate Dentistry Strategic Project aims:

  • to better understand dental practice models that are operating in Ontario;
  • to identify issues and opportunities related to various dental practice models, including corporate dentistry, for patients;
  • to develop options to promote and assure quality of care and ensure effective regulation of dentists regardless of practice model type.

Deni Ogunrinde, Policy Analyst, led an education session which included an overview of key findings from four deliverables– the Jurisdictional Review, Literature Review, Consultation, and Data Analysis. Key highlights included a report on survey results from almost 600 dentists, patients, and other interested parties. The Consultation Summary is available in the Council materials pages 260-280. Council engaged in an open discussion about risks and opportunities for patients.

College staff will consider feedback from the October 2024 Council meeting in the development of options for the draft ‘Report on Key Research Findings & Options’. Council will see draft of the Report, including options, for discussion at the December 2024 Council meeting. The final Report with options will be shared with Council for its approval in early 2025.

Release and Transfer of Patient Records

RCDSO’s Release and Transfer of Patient Records Practice Advisory was last updated by Council in August 2007. In part, it describes dentists’ legal and professional obligations for the release, duplication, and transfer of patient records.

Under the applicable legislation, dentists are permitted to charge a fee for these services. RCDSO’s Practice Advisory has historically advised dentists that they may charge a fee consistent with the direct costs incurred by the dentist.

Based on more recent analysis, it has been determined that this guidance is not consistent with the legislation or the direction of the Information and Privacy Commissioner of Ontario (IPC). Both impose more strict limitations on the fees that dentists may charge, anchored to the amount of reasonable cost recovery.

The IPC states that “reasonable cost recovery” does not mean “actual cost recovery,” or full recovery of all the costs borne by a health information custodian. It further concludes that the use of the word “reasonable” to describe cost recovery suggests that costs must avoid creating a financial barrier for patients.

To ensure accuracy, to protect dentists from complaints to the IPC, and to promote the public interest, RCDSO’s current Practice Advisory has been updated. Both the RCDSO’s Practice Advisory and the ODA’s Practice Advisory are prepared to answer questions and provide guidance to dentists concerning setting appropriate fees for duplication, release, and transfer of patient records.

Choosing Wisely Toolkit

Choosing Wisely has developed a chairside decision-making tool Taking a Bite out of Tooth Pain: A Toolkit for Using Antibiotics Wisely. RCDSO Quality Director, Susan Taylor, presented on behalf of a working group, a chairside toolkit designed to guide clinicians in their practice, and to give them practical tools to communicate with patients. Participants in the working group included dentists, family physicians, infectious disease specialists and quality improvement experts.

This work has been sponsored by Choosing Wisely Canada and has adapted proven practices in improvement and implementation science. The World Health Organization estimates that bacterial AMR was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths. The data shows that almost 10% antimicrobial prescriptions come from dentistry, and that many of those may not be clinically appropriate.

The toolkit addresses tooth pain, and highlights that in most situations, a patient who presents with tooth pain doesn’t require antibiotics, and that their pain can best be addressed by treating the underlying cause. It is a peer-reviewed, chairside resource that includes decision aids, a prescription pad, office posters and FAQs for patients and health care professionals.

Council endorsed Taking the Bite Out of Tooth Pain: A Toolkit for Using Antibiotics Wisely and the addition of the RCDSO logo and recommended that the toolkit be distributed to registrants and the public.

Pension Governance Committee Restructuring

The College Pension Plan is a combination of a Defined Benefit (DB) and a Defined Contribution (DC) Plan. The College established a Pension Governance Committee of Council in 2018 in order to manage risks associated with the Defined Benefit Pension Plan (closed to new enrollment in 2007). In 2025, the shift of the DB plan to a buy-out annuity means the College will have no further obligations. A staff-run oversight committee will be sufficient to manage the less complex Defined Contribution Plan.

Council determined that the Pension Governance Committee should be disbanded and replaced with a staff-led Pension Committee. The Pension Committee will be composed of the Chair (or designate) of the Finance, Audit & Risk Committee (also a Council member), up to two management representatives, two program staff and up to two elected staff members. The new Pension Committee will launch in 2025.

Professional Liability Program (PLP) divestment

Council has directed staff to design and deliver a procurement process to transfer the Professional Liability Program (including current liabilities and staff) to a third party, with the goal of allowing the program to continue to operate, under separate ownership.

PwC, in consultation with the Procurement Review Group and legal counsel, is now receiving formal expressions of interest. These will be reviewed by the Procurement Review Group and PwC. A subset of successful proposals will move to the second phase of the transaction process.

A By-law is being developed, informed by input from the PRG and by the key elements approved by Council, to establish what each registrant must obtain as minimal insurance requirements to ensure that the public is protected.

The RCDSO will continue to keep the profession informed as the process progresses. In the meantime, PLP staff will continue to assist you. New and existing PLP cases will be processed as they always have been.

Governance

Over the fall there have been a number of changes to Council membership:

  • James Colliver, public member, who serves as Chair of the Professional Liability Committee, was reappointed to Council for a three-year term from October 8th, 2024 to October 7th
  • Vivian Hu, public member, who serves as Chair of the Patient Relations Committee, was reappointed to Council for a three-year term from November 28th, 2024 to November 27th, 2027.
  • Mark Eckler, who has served Council for eight years as a professional member, resigned from Council effective October 11th, 2024. Dr. Eckler served as the Chair of the Finance, Audit and Risk Committee and was a member of the Pension Governance Committee.

Council decided that the most prudent step was to leave District 4, Dr. Eckler’s position vacant until the election taking place on December 11th. The Executive Committee will review whether any interim appointments are needed for committees and will report to Council in December.

Next Meeting

The next meeting of Council will be a virtual meeting via Zoom on December 5th, 2024, for a half day. The meeting will also be livestreamed.