On June 23, 2018, the RMTAO Board of Directors met with Corinne Flitton, Registrar, and Katherine Molnar, Director of Corporate Services, of the College of Massage Therapists of Ontario. The purpose of the meeting was to seek clarification on several key issues in order to better understand the reasoning for the fee increase and determine whether there could be other alternatives that would ease the financial burden on registrants while also fulfilling the CMTO financial requirements.
The CMTO provided clarification in a number of areas to help understand the background behind the registration fee increase. These areas included cost recovery from complaints and discipline, internal practices, financial position and planning, entry-to practice requirements, and by-law changes.
On June 18, 2018, the College of Massage Therapists of Ontario announced changes to the registration and certification examination fees. These changes include an increase of $187.00 for general certificate registration fees, resulting in a registration fee of $785 for 2019, and an increase of $180.00 combined for both the Multiple Choice Examination (MCQ) and Objectively Structured Clinical Evaluation (OSCE) entry to practice examination, resulting in a total examination fee of $1,380.00.
In preparation for the meeting with representatives from the CMTO, the Board of Directors reviewed the publically available documents from the CMTO including, but not limited to, the audited financial statements for 2017, briefing notes provided by members of the CMTO staff and Council committee members, and the CMTO Workplan Report which details specific projects and initiatives that are linked to the College’s strategic and operational objectives. Further research was undertaken including the registration fees and complaints and discipline case numbers for other regulatory colleges, and disciplinary trends.
Financial prudence is of the utmost importance for any organization. In addition to the best practice of having three to six months operating capital in reserve, the CMTO must also maintain a reserve in the case of an extensive disciplinary or legal action, maintain a fund for the accreditation process which will hold educational institutions to account for their processes, and maintain a fund for research that is based in the public interest.
Further, there are administrative requirements that are necessary to demonstrate proactive regulatory oversight. This would include an effective quality assurance program, and many other projects and initiatives that are outlined in the CMTO Workplan.
The RMTAO Board of Directors gained additional information and clarification on cost recovery from complaints and discipline, internal practices, financial position and planning, entry-to practice requirements, and by-law changes.
Cost Recovery from Complaints and Discipline
The expense for complaints and discipline is the second largest expense as outlined in the financial statements at $2,375,028.00. The cost recovery for these expenses is listed at only $36,707.00. The CMTO indicated that there are over 200 outstanding issues, and that the first quarter saw 46 new matters brought forward, a 30% increase over 2017. The human and financial resources required to investigate these matters has also increased with the larger number of complaints, particular with the increased number of sexual abuse cases being reported to the College. The Board inquired as to why there is not a higher level of cost recovery to off-set the large expense represented by the complaints and discipline process.
The CMTO is required to follow the example of case law that states an organization cannot destitute an individual through the use of fines or levies. The destitution level set by the CMTO is $100,000.00 but in some cases, the amount may be less for some registrants to become destitute.
In general, there is a determination as to whether the cost of the pursuit of the fine or levy justifies the collection of the fine or levy. The RMTAO understands that the decision to pursue recovery costs must be balanced by the cost required to achieve that recovery.
The RMTAO also understands that modernizing and expanding capacity for the development and delivery of the Professional Conduct Department is costly, yet necessary for public protection. The Board inquired as to why the investigations into complaints are seemingly more complicated and requiring more human and financial resources than other healthcare related investigations. The College has had an increase in number of sexual abuse cases which require more complex investigations. In addition, the CMTO is encountering an increased number of criminal charges being laid against RMTs for sexual assault, which further increases the complexity of the investigations due to the requirement to continuously monitor criminal proceedings in addition to undertaking their own investigation.
The CMTO Workplan outlines the required day-to-day tasks, as well as all internal projects and initiatives. The Workplan includes the administration of the Regulated Health Professions Act (RHPA), the development of courses, metrics and learning resources for the new quality assurance program, the development of new iterations of the standards of practice, the development of a new practice resource on the analysis of risk, updates to the regulations for professional misconduct, and other internal business requirements.
The development of the new quality assurance program will be based on the scope of practice, evidence-informed practice, and critical thinking models and will require specialized staff and resources. Additionally, regulatory reform requires a more sophisticated and powerful system development that requires new software for data mining and corresponding procedures. All of the internal processes require the appropriate staffing levels and specialized training or qualifications.
The financial analysis provided for 38 full-time staff members at the CMTO. A 2017 report indicates a staffing compliment of 22, and results in a ratio of staff to registrants at 1:621. This ratio is higher than most other healthcare professions, and the allowance for additional staff members will reduce this ratio and will allow the CMTO to better serve registrants. Staffing expenditures are the largest expense, but this is not unusual for any organization.
The RMTAO Board inquired into cost-saving measures in other areas, including better controlling administration costs including office space rent. The RMTAO understands the need to be in a downtown location with multi-modal transportation that allows for easy accessibility for registrants, applicants and other stakeholders. The downtown location reduces transportation costs for staff members to meet with the Ministry of Health and Long-Term Care, the Ministry of Advanced Skills and training, and other stakeholders also located in downtown Toronto. There are also regular meetings with other Colleges through the Federation of Health Regulatory Colleges of Ontario, and all other Colleges with which the CMTO meets are also located downtown Toronto. Furthermore, with this location there is access to a larger pool of candidates for staffing purposes. The RMTAO does not dispute the reasoning for requiring a downtown office space location.
Financial Position and Planning
The CMTO is currently in a good financial position. However, their financial analysis and forecasting indicates that if this fee increase is not undertaken that they will be in a financial position that does not demonstrate prudent financial management.
The Board of Directors stated that they thought it would be reasonable to think that the CMTO would have seen this situation developing and prepared the profession through a series of gradual increases in order to lessen the impact on the members of the profession. The CMTO indicated that they could see the trend but were not certain that an increase was required. This spring, with the financial forecasts provided by the external auditor, it became clear that an increase was necessary. The financial requirements moving forward will demand significant investments in structural software, staff recruitment and training, and the projects and initiatives approved in the CMTO Workplan.
While the RMTAO understands that the financial forecasting has outlined the reality moving forward, we still believe that financial prudence can be accomplished while also allowing for financial security for registrants.
The increase in number of open discipline cases and new discipline matters brought before the CMTO is concerning, not only as it relates to the proposed fee increase, but also as it relates to the professional standing and competence of the massage therapy profession as a whole. The RMTAO inquired whether this issue could be addressed by the CMTO before an individual enters the massage therapy profession, whether through filling gaps in education or identifying individuals unsuitable for the profession early in their education.
An individual that has committed no offence and/or acted contrary to the law or the rules of an institution cannot be refused an education of their choice if they have satisfied the entrance requirements and there is space available. It would be a human rights violation to an individual’s right to education. Although the CMTO can visit educational institutions, and has in the past, they require an invitation from the school and regulations do not currently allow the CMTO to mandate school visits.
The CMTO is highly supportive of the process of accreditation for massage therapy schools, providing a large portion of the financial support. Accreditation will allow a standardization of massage therapy education across Canada, ensuring that all schools are teaching at the same level, and operating at the same standard. Accreditation is a positive step forward in ensuring that massage therapists newly entering the profession all practice to the same high standard.
In order to facilitate the fee increase, a change in the CMTO by-laws is required. The current by-law mandates an automatic increase in fees by the rate of inflation every year. This new revision would allow for the CMTO Council to review the fees and potentially increase the fees up to the rate of inflation after this single larger increase for 2019. There would be no mandatory increase, and any future increase would potentially not need to be as high as the rate of inflation.
The RMTAO is pleased with some of the significant changes to the by-laws, especially the removal of the requirement of the mandatory automatic fee increase every year. However, we also believe that the single significant raise in fees included in the by-law change is too significant of an increase and represents a significant financial burden on registrants.
The RMTAO Board of Directors has sent a letter to Lisa Tucker, RMT, President of CMTO Council, requesting that the CMTO adjust the fee increases to be implemented over a two (2) year period. The proposed adjustment would be an increase of $100.00 for the registration fees in 2019, and a further increase of $87.00 in 2020. This would provide the CMTO with the necessary funds to ensure financial prudence, while providing registrants with a more attainable fee requirement.;
In addition to the request to stagger the increase in registration fees over a two year period, we requested no further increases in registration fees for the following three (3) years. From that point forward, the request is to stay with the proposed by-law change stating that each year the CMTO Council would examine the audited financials and may raise the fees up to the rate of inflation but they are not mandated to do so.
While we understand the requirement for financial prudence, we do not agree with an increase in the registration fee that is unduly onerous for our members. The RMTAO will continue to fight for our members and for all Ontario RMTs to ensure they will be able to build and maintain a successful practice without undue burden and without prohibitive fee requirements. We will continue to hold the CMTO Council accountable to the day-to-day realities of Ontario RMTs when making decisions, ensuring that RMTs can have a say in CMTO decision making processes rather than simply complying with a top down directive.
A copy of the letter sent to the CMTO can be downloaded below.