Physician Assistants (PAs) are highly skilled professionals who provide a range of medical services within health-care teams under the supervision of a physician, acting as physician-extenders to improve access to care. They are broadly trained to complement existing services and improve access to health care. 

Starting April 1, 2025, the College of Physicians and Surgeons of Ontario (CPSO) began regulating all PAs in Ontario under the Regulated Health Professions Act, 1991 (RHPA) and the Medicine Act, 1991. PAs must be registered with CPSO to continue using the title “physician assistant” or “PA” in the province. Hospitals and physicians working with PAs are encouraged to remind them to register with CPSO as soon as possible, if they have not already done so. 

Ontario is now the eighth province to regulate PAs by a provincial medical regulator, joining Alberta, British Columbia, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and PEI. Newfoundland has also passed legislation to regulate PAs, although it has not yet taken effect. 

CPSO’s oversight of PAs will help ensure safe and high-quality health care for patients through clearly defined training, certification, and continuing education requirements. However, regulation is not intended to affect the core way physicians and PAs work together.

Eligibility for Registration

PAs may register with CPSO if they have:

1. graduated from an accredited PA education program offered in Canada or the US and

2. successfully completed a certifying examination in Canada (Physician Assistant Certification Council of Canada – PACCC) or the US (National Commission on Certification of Physician Assistants – NCCPA).

The regulations also include a transitional grandparenting provision to enable two cohorts of trained and currently practising PAs who do not meet the standards and qualifications set out in the regulation to register as members. The provision captures individuals who have successfully completed the Canadian Armed Forces Physician Assistant Program and the Physician Assistant Integration Program, a historical assessment-based program.

To register, PAs are required to create an account to submit an online application form, upload documents, and pay the required fees to CPSO directly through CPSO’s Member Portal. 

PAs Will Continue to Practise via Delegation from a Physician 

Physicians and PAs in Ontario have long practised together through the delegation model, which is effective and well-established. The relationship between physicians and PAs, anchored in the delegation framework, will not change as a result of PA regulation. Delegation allows a regulated health professional (e.g., a physician) who is authorized to perform a controlled act to grant that authority to another person (whether regulated or unregulated) who is not legally authorized to perform the act independently. Delegation is not required for tasks that are not controlled acts (e.g., taking a patient’s history). 

PAs can only perform controlled acts through delegation and with appropriate supervision by a physician, as set out in CPSO’s Delegation of Controlled Acts policy.  Further guidance can be found in the accompanying Advice to the Profession
document. 

PAs’ Scope of Practice Will Not Change 

A PA’s scope of practice will reflect their supervising physician’s scope of practice and is determined by the PA’s own knowledge, skill, and judgment. This means that each PA’s scope of practice will vary according to a number of factors, including the individual’s education, training and experience. 

PAs Will be Required to Participate in a Continuing Professional Development (CPD) Program  

Quality Assurance Regulations (O. Reg. 114/94, General, Part VII) require PAs to participate in a program of CPD and to, each year, provide to CPSO proof of their participation that is satisfactory to CPSO. 

PAs are required to complete the CPD requirements set by their certifying body, which is either the: 

• Physician Assistant Certification Council of Canada (PACCC); or 

• National Commission on Certification of Physician Assistants (NCCPA). 

PAs Must Obtain Appropriate Professional Liability Insurance  

All regulated health-care professionals, including PAs, must have professional liability protection. PAs are required to hold at least $10 million in professional liability insurance issued by a company licensed to carry on business in the province. 

Physicians, Institutions, and PAs Will Have Reporting Requirements 

Effective April 1, PAs will become regulated members under the Regulated Health Professions Act, 1991 (RHPA). As such, any requirement under the RHPA to report a member of a College, or for a member of a College to make a report, will include PAs. More information about reporting requirements can be found in the Guide to Legal Reporting Requirements. 

More details on PA registration, delegation, and other topics are available on CPSO’s website. If you have further questions, please get in touch with CPSO at inquiries@cpso.on.ca or contact an Advisor at 416-967-2617.