In response to the recent announcement that CSHBC will increase registration and examination fees for the first time, the College has received several expressions of concern from registrants.
CSHBC understands and is sensitive to the fact that fee increases, particularly significant ones, are challenging for registrants. The decision to raise fees was not taken lightly and was the result of careful consideration. A majority of CSHBC Board member are also registrants and are thus also affected by the fee increases.
In keeping with the College’s commitment to fiscal and administrative transparency, and for the benefit of all registrants, CSHBC offers the following responses to the recently raised concerns.
1. Are the increases the result of the College’s past inaction?
In a sense, yes. Professional regulatory colleges are mandated under British Columbia law to serve their constituents, the public, to protect patients/clients and to maintain the public’s trust in the professions colleges regulate. CSHBC Boards of the past, in maintaining registrant fees that were among the lowest in Canada – while perhaps more palatable to registrants – were not properly meeting their mandate.
Beginning in 2018, a more engaged, strategic, and proactive Board, after careful deliberation and in recognition of its regulatory and fiduciary responsibility to the public and government, determined that CSHBC fees were set artificially low, and had essentially been subsidized for years at the cost of having an adequately resourced administration and regulatory regime for the speech and hearing professions in BC. Beginning in 2017, as the College’s capacity to fulfill its public protection mandate was increased in all aspects – governance, registration, quality assurance and professional practice, inquiry and discipline, and administration – so did its revenue shortfalls, resulting in its first deficit in 2019.
The new fees more accurately reflect the true cost of proper regulatory oversight to protect the public – our constituents – for whom the College is mandated to protect by enforcing standards. Given the number of years past boards had postponed any fee increases (by contrast, CASLPO registration fees in Ontario increased eight times over that same time period), further inaction, including a staggered implementation of incremental increases over a period of years (resulting in staggered and more numerous deficits) was no longer fiscally responsible or tenable.
Recent events in BC forcefully demonstrate that regulatory boards that fail to fulfill their mandates to regulate effectively in the public interest are vulnerable to sometimes drastic Government intervention.
2. CSHBC has regulated speech and hearing professions for 10+ years. Why does it suddenly cost more to regulate?
From its inception in 2009, CSHBC fees have been set artificially low, at the cost of an adequate administration and regulatory regime. While this passed along a cost benefit to registrants for many years, the College was failing in its regulatory responsibilities under the law of BC.
In 2017, the CSHBC staff complement consisted of two full-time employees – the registrar and one other staff member. This was a completely inadequate and unsustainable number of administrative personnel for managing 1,800 registrants and three professions across an entire province (as compared to 8, 16, and 15 staff members at audiology and speech-language pathology regulators in Alberta, Ontario, and Quebec, respectively, at the time). For a decade, CSHBC ‘s core operational areas – including, but not limited to, administration, registration, and quality assurance and professional practice – have been under-staffed, under-resourced, and operating well below their required capacity.
Regulation of health professionals is changing in BC and across Canada, and bigger, more transformative changes are looming on the horizon. CSHBC has seen a significant increase in complaints and instances of unlawful practice. While the number of complaints against Registered Hearing Instrument Practitioners (RHIPs) has dropped to zero with the introduction of practice reviews, complaint matters against Registered Speech-Language Pathologists (RSLPs) have increased by approximately 400% over that same time period. Inquiry and discipline is only one of many operational areas of a regulatory authority’s ambit.
CSHBC is responding to these concerns differently than in the past – for example, by prioritizing more cost-effective quality assurance and professional practice efforts to ensure registrants are meeting practice standards. BC regulators are also operating under greater scrutiny by Government as it strives to ensure that regulators meet their public protection mandates.
As a not-for-profit regulatory authority created by Government under the Health Professions Act, the College is funded entirely by registrant fees. Not-for-profits that exceed certain limits on contingency reserve amounts risk losing their tax status as a not-for-profit public entity. Moreover, regulatory colleges in the health sector are precluded from implementing alternative or creative revenue streams to offset cost burdens to registrants, who receive the benefit of being part of a regulated profession. The College also routinely takes action against non-registrants for using the restricted terms “audiologist”, “hearing instrument practitioner”, and/or “speech-language pathologist” or practicing unlawfully within the scopes of practice of the three CSHBC professions, and such action requires an investment of resources.
Although the College has shouldered much of the increased costs of regulating the three professions, the gap between revenues and expenditures has become unsustainable. That gap between current and required revenues is reflected in the $250 registration renewal fee increase, among others. If fees are not brought into alignment with the true cost of proper regulatory oversight in the public interest in advance of the next registration cycle, the College will remain in a deficit position for longer and with an even greater negative impact to its overall financial position going forward.
3. Why didn’t the College consult with registrants about the increases?
Professional regulatory colleges are mandated under the law of British Columbia to serve their constituents, the public, not the registrants they license to practice and regulate. As such, registrant aren’t “members”. This is completely different from professional associations such as Speech-Language and Audiology Canada (SAC) or Speech and Hearing BC (SHBC) that advocate on behalf of a profession with a mandate to consult with its members on key initiatives.
Accordingly, colleges consult with the Ministry of Health, the arm of government that created them, and are legally and ethically precluded from consulting with registrants in respect of matters such as fees. For obvious reasons, were regulatory colleges to canvas the very health professionals they regulate on behalf of the public, as to whether or not registration fees should be increased, the collective response from registrants would be a resounding no.
Regulatory colleges enforce clinical and professional standards to protect the public and maintain the public’s trust in the College’s professions — it would be inappropriate to seek counsel from registrants about what they believe their fees should be.
4. Why weren’t registrants provided with more notice?
The College appreciates the concern regarding notice of the changes. Bringing fee increases into force requires that the College adhere to Government and Ministry of Health timetables. The College was required to receive the appropriate authorizations before confirming the increase to registrants and bringing them into force in the CSHBC Bylaws. That said, although the approved Bylaw amendments come into force on December 5, 2019, registrants have almost five months before the end of the current registration cycle.
5. Why can’t registrant fees be implemented (or “staggered”) over several years, rather than in one significant increase?
To operate in a fiscally responsible manner, the College must bring fees into alignment with the true cost of proper regulatory oversight by the beginning of the next registration cycle. If fees were staggered, CSHBC’s budget would not be viable, and the College would remain in a deficit position for longer and with an even greater negative impact to its overall financial position going forward.
6. Can registrants pay their fees or the increase through installments or a payment plan?
Unfortunately, no. As not-for-profits under the Health Professions Act, regulatory colleges, particularly small colleges, cannot operate effectively based on an aggregate revenue stream that might be [emphasis added] forthcoming over the fiscal year. In addition, CSHBC cannot offer what would essentially be a credit scheme for payment of a professional license to practice fee. Accordingly, this means that the College cannot offer anything akin to a “payment plan” option for their licenses to practice throughout the registration cycle.
7. Are the fee increases just to pay for the College’s recent expenditures?
No. Going forward, the fee increases will allow the College to regulate the three professions in a more effective and responsible manner, and thus meet its regulatory and fiduciary responsibilities under the law in the public interest.
While the College has recently invested in updating its corporate logo, website, and applicant and registrant portals, the costs of these changes were expensed from previous budgets. The cost of the former was negligible; the costs associated with the latter were necessary to regulate effectively.
In addition, the College will be relocating its office space to the Regulatory Hub in downtown Vancouver, effective November 8, 2019. As the College had already outgrown its current office space, this move was necessary to accommodate additional staff now in place and allows for greater efficiencies resulting from access to shared services, as well as the intangible benefits from collaboration with other regulators.
The creation of the Regulatory Hub, which includes CSHBC and 10 other colleges, is enthusiastically supported by BC’s Ministry of Health. Although additional staff should have been in place years ago to meet the needs associated with regulating three health professions, they are also required going forward to manage current increases in frequency and complexity of complaints, the harmonization of provincial registration regimes nationally, and implementation of a more effective quality assurance and professional practice module.
As long as the College managed 1,800 registrants (a number that, on average, grows by approximately 5% annually) and three professions across an entire province with two full-time staff, inadequate regulatory oversight, and an under-resourced quality assurance and professional practice regime, artificially low registrant fees could be maintained; however, after more than a decade of neglect, the need for immediate and appropriate action can no longer be postponed.
8. Can registrants access resource and expenditure information?
CSHBC revenues and expenditures are reported out annually and published in annual reports and financial statements posted on the Publications page of the website.
In 2017, the CSHBC financial statements, prepared by KPMG, showed a surplus of $129,000+; in 2018, the financial statements showed a surplus of $14,000+; and in 2019, the College showed a deficiency of revenue over expenses of $31,000+. The projected deficit for 2020 is significantly larger.
These numbers forcefully demonstrate that, as the College has increased its capacity to properly and effectively regulate in the public interest – i.e., to fulfill its legal, regulatory, and fiduciary responsibility under the law – the disconnect between registrant fees and the resources required for the College to do its job have become increasingly apparent. Unfortunately, this is the net result of a decade of past inaction and registrant fees being set artificially low at the expense of public protection. The College can no longer subsidize fees at the cost of an adequate administration and regulatory regime for the speech and hearing professions in BC.
9. What about the fees for colleges regulating speech and hearing professionals in other provinces and other colleges in BC?
Other provinces range in the rates of their fees for registrants; however, CSHBC fees are currently among the lowest in Canada. With the fee increases, the College remains mid-range nationally. For example:
- The general registration renewal fee for the College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO) is $765; and
- The general registration renewal fee for the College of Audiologists and Speech-Language Pathologists of Alberta (ACSLPA) is $650.
In addition, several speech and hearing regulators across Canada are currently contemplating additional fee increases. BC’s position relative to the national range will likely drop once again in the near future.
Just as the cost of being a regulated professional varies across the country, it also varies within BC, due to the nature of each profession and the number of registrants. For example:
- The general registration fee for the College of Midwives of British Columbia is $2,340 (228 registrants);
- The general registration fee for the College of Massage Therapists of British Columbia is $600 (5,000 registrants);
- The general registration fee for the College of Optometrists of British Columbia is $1,390 (805 registrants); and
- The general registration fee for the British Columbia College of Nursing Professionals is between $450 and $650 (55,000 registrants).
In BC, all regulators strive to ensure that they are meeting their public protection mandate, while being fiscally responsible. The increased collaboration between BC regulators through initiatives such as the BC Health Regulators, the Regulatory Hub initiative, and efforts to amalgamate illustrate this fiscal responsibility.
Within BC, 21 colleges regulate approximately 118,000 registrants. The smallest has only 78 registrants (College of Podiatric Surgeons of British Columbia), the largest, British Columbia College of Nursing Professionals, has approximately 55,000.
The highest annual fees are paid by registrants of the smaller regulators – this is in line with research findings for both the UK and Australia that show that the larger the register, the greater the economies of scale. On balance, the lower paid occupations pay a higher proportion of their income to be registered than higher paid occupations. Well compensated physicians and surgeons pay $1,685 to their college, while the annual registration renewal fee for lower paid denturists is $1,249.
10. Why doesn’t CSHBC offer professional development for its registrants like ACSLPA in Alberta does?
In BC, professional regulatory colleges are mandated under the law of to serve their constituents, the public, not the registrants they license to practice and regulate. Again, this is completely different from a professional association – Speech-Language and Audiology Canada (SAC) and Speech and Hearing BC (SHBC) operate as professional associations with a mandate to advocate for the speech and hearing professions. Regulatory colleges enforce clinical and professional standards to protect the public. Offering professional development opportunities is the mandate of professional associations, not regulators.
That said, other provinces differ in the extent of their regulatory operations and may function more as an association than a public body, even referring to their registrants as “members”. This is the legacy of a previous era in professional regulation. In BC, colleges operate as public bodies with legal mandates to protect the public.
While the College does not provide services to BC registrants that may be provided by regulators in other jurisdictions, this is because of the differing mandates of the regulator and the professional association, and the relative level of separation between the two. That said, the College enjoys collaborative and positive relationships with both provincial and national professional associations and works with these organizations to meet our respective mandates, which intersect at the point of ensuring safe, competent, and ethical care.
11. How can registrants make their concerns regarding the fee increases known to the Board?
Please either send comments in the body of an email to the Registrar (attn: CSHBC Board of Directors) @ [email protected] or mail a formal letter, addressed to the Board, to the College’s mailing address. All emails and letters received from registrants regarding fee increases will be submitted to the Board.