Virtual Practice Q&A

Jan 13, 2021 | Blog

Q1: Where can I find the Provincial Registration Requirements for Dietitians providing Virtual Care in Canada?

QA-10 Virtual Dietetic Practice Policy. Scroll down on the page to access the policy.

Q2: Is the CDBC planning to make any changes to allow me to practice outside of BC virtually, without having to be registered with a dietetic college in another province?

The CDBC does not have the authority to make these decisions. Healthcare is a provincial jurisdiction, and each province has a Ministry of Health that oversees legislation regulating health professionals. In the case of BC, it is the Health Professions Act (HPA), which sets out requirements for regulatory colleges, while also defining the profession and its scope. While each province has a similar structure, each province has laws that are slightly different. Although not an exhaustive list, here are some examples:

  • Restricted activities can be defined differently in each province.
  • Privacy laws may be similar, but differ in small ways
  • Differences in the definition of dietetics

Each regulatory college in Canada is required to work under the umbrella of its respective provincial legislation, set out by the provincial Ministry of Health (HPA in BC). This legislation is written with a focus on the people living and working in that province.  One of the limitations of having different provincial laws governing dietetics is the lack of clarity on the responsibility of colleges to investigate a complaint about a dietitian registered in two or more provinces. All health professionals are accountable to the province where they are registered and this regulatory relationship is legislated by the Ministries of Health in each province, meaning that a change across Canada would have to be approved by all provincial governments.

Please note that it is important for you to reach out to the dietetic college in the province where your client resides, so you can understand their province’s definition of dietetics, as well as any requirements for taking this client on. Please refer to Q1 for more information.

Q3: What is the definition of Medical Nutrition Therapy (MNT), Nutrition Diagnosis, and Therapeutic Diets? I am trying to determine if I need to register in another jurisdiction by determining whether I am practicing dietetics in that province.

These terms are not defined under the Health Professions Act, nor in the Dietetics Regulation in BC. When determining your requirement to register in other jurisdictions, it is important to know how each jurisdiction defines the practice of Dietetics, rather than MNT, Nutrition Diagnosis, and Therapeutic Diets.

For your information, the following terms were coined by the Academy of Nutrition and Dietetics in the USA in mid-1990 to early 2000s and are now part of the healthcare language used in the US and Canada.

Medical Nutrition Therapy can be paraphrased as an evidence-based approach used in the nutrition care process (NCP) of treating and/or managing chronic diseases, often used in clinical and community settings, that focuses on nutrition assessment, diagnostics, therapy and counselling. MNT is often implemented and monitored by a registered dietitian and/or in collaboration with physicians and regulated nutrition professionals.

Nutrition Diagnosis can be paraphrased as the identification of a nutrition problem that a dietitian is responsible for treating independently, based on data collected during nutrition assessment.

A Therapeutic Diet can be paraphrased as a diet ordered by a physician or other authorized health regulated professional,  that is part of the treatment of a disease or clinical condition, to eliminate, decrease, or increase certain substances in the diet (e.g., sodium or potassium), or to provide mechanically altered food when indicated.

Q4: As a CDBC registrant, I can only see clients who are residents of BC. How is place of residence defined?

In private practice, it may not be necessary to collect PHN information from a client, and in this situation, in order to collect the minimal amount of personal information from a client, you do not have to request this as a proof of residence. It is sufficient for your client to verify address by providing a piece of mail. Acceptable pieces of mail can include bills, a rental agreement, a mortgage statement; anything that is deemed official mail.

If not providing dietetic care (due to residential status) will be detrimental to your potential client, please consult HealthLink BC’s Provincial and Territorial Websites and Helplines to help them get in touch with a dietitian from their home province. Please be reminded that calling 8-1-1, although a common provincial number to access provincial health services, will put the caller in touch with the services provided in the province of call origin (for example, calling 8-1-1 in BC, goes to HealthLink BC, while calling 8-1-1 in Alberta, goes to Alberta Health Services etc.)

Q5: I am an RD registered outside of BC. My client lives in my jurisdiction for school but is from BC. I have been seeing the client for a few months, and in light of the Covid-19, he/she has returned home to BC to be closer to family. Can I continue to provide dietetic care virtually?

CDBC requires dietitians who practice dietetics (virtually or in-person) in BC with clients who are BC residents to be registered with the College in BC. You are encouraged to review Policy QA-10 Virtual Dietetic Practice and its Guideline.

If you wish to register in BC, please contact info@collegeofdietitiansbc.org. Alternatively, your client may access HealthLink BC to find a local dietitian who can follow him/her in BC.

 

Q6: I work for a National chain grocery store that is launching a Health and Wellness platform. This platform includes a live chat function to access RNs and RDs for information regarding relevant health and wellness questions or concerns they have. Dietitians can direct users to other relevant programs or products available on the platform for a more comprehensive nutrition inquiry. There are no nutrition assessments completed nor treatment plans developed. Do I need to be registered in BC if I am working with this platform as a registered dietitian in another province?

In BC, dietitians would need to be registered with the CDBC to provide service to the BC public.

The CDBC and other Canadian Dietetic regulatory bodies each have different legislation and registration requirements. We expect our registrants to review Policy QA-10: Virtual Dietetic Practice and its Practice Guideline to determine steps to take to ensure they are providing virtual practice safely and legally. BC Dietitians who would like to provide virtual services to clients residing in other provinces are advised to contact the dietetic regulatory body where they want to practice and inquire about registration and practice requirements.

Not knowing what the chat service will look like, other important considerations for this service include whether it will involve the collection and protection of personal client information and the need to address emergency situations. Dietitians in BC are expected to adhere to privacy legislation (section 70 and 71 of the bylaws) and CDBC Standards for Record Keeping, as well as be prepared to address any emergency that may arise while providing virtual services.

Since the grocery store chain may already offer dietitian nutrition consultation services, it may be easy or tempting for dietitians on the chat service to answer more complex questions that require divulging personal information. Will there be a clear process for potentially referring clients on the chat to select individual consultation services, if the need arises?

Q7: I have been asked to provide care for a client who was previously living in Vancouver but has now moved to Alberta. This client currently still has a BC PHN (BC CareCard). Am I still able to follow this client or is it better to handover to an RD in Alberta, as I know we can’t provide care for Alberta residents without being registered in Alberta?

If your client identifies his main province of residence to be BC, this means that you can provide dietetic care virtually for him. If he has moved permanently to Alberta and identifies his primary residence to be Alberta, you are no longer able to provide care and should hand over to a registrant of the College of Dietitians of Alberta (CDA). An Alberta dietitian is not able to provide virtual care to a BC resident, and vice versa. (This does not apply if your client is admitted to hospital in Alberta, of course).  If the client becomes an Alberta resident, it is possible that CDA may have implemented emergency measures for temporary emergency registration during this pandemic. You can review: http://collegeofdietitians.ab.ca/a-message-from-the-registrar-on-covid-19/ for more information. You can also contact the CDA to confirm.

Q8: I had an established therapeutic relationship before my patient moved out of province to be followed by other clinicians. Now that I have stopped seeing the patient and he/she will be working with the dietitian/other health professional in the future, can I consider the direct care relationship discontinued? Am I able to provide a consultation to a clinician working in another province? Is it ok to provide this type of consultation without being registered in that province?

The CDBC is not aware of barriers for virtual interprofessional collaboration. As per CDBC policy Qac-10: Virtual Dietetic Practice:

“12. Provide evidence-informed assessments, interventions and recommendations.

Dietitians who provide virtual consultation to other Dietitians or other health professionals not considered to establish a direct therapeutic relationship with the client. The client in these situations remains under the care of the Dietitian or health professional requesting the consultation.”

You are not considered to have a direct relationship with the client; rather you would be considered a consultant to the client’s primary RD on site. BC RDs can interact with a client in the presence of other health professionals in the context of sharing their expertise (this would not require the BC RD to register in the other province as they are considered a consultant to the other RD).

Other assumptions involved with this example are that the client had an opportunity to consent to the BC RD being present during their consultation and that the RD on site is responsible for recording  in the client’s health record the client consent for the other RD to participate. The primary RD would be considered responsible for the client’s care, monitoring and re-assessment and maintaining their client health record.

This is a question that involves more than only virtual care as it branches into Policy QA-07 Consent to Nutrition Care and its Guideline, as well as the CDBC Standards for Record Keeping.

 

Q9: As a registrant of the CDBC, am I allowed to see a client virtually who lives in the Yukon?

Yes, this is allowed, given that the Yukon territory does not have its own dietetic college and provided that there is no legislation that would prevent you from doing so.  If not already done, please review the Policy QA-10 Virtual Dietetic Practice and its Guideline for more information about our College’s expectations from registrants for virtual practice. As an example, make sure your liability insurance covers your care of a Yukon resident.

Q10: As a registrant of the CDBC, can I have clients who reside in other provinces? What about in the US? Elsewhere internationally?

Dietitians are governed provincially. Refer to the Virtual Dietetic Practice Guidelines to determine if there is a requirement in the province where you are hoping to practice.

If you are not required to register outside of CDBC, you should:

  1. Disclose to their client that you are not registered as a dietitian in their jurisdiction, and
  2. Become familiar with the provincial/sate/country laws, regulations, standards and guidelines.
  3. Note that some provinces/states/countries require you to contact their regulatory body to inform them that you are practicing dietetics in their jurisdiction.
  4. Reach out to your Insurance Company to ensure that your Liability Insurance covers your practice across jurisdictions.

CDBC has no jurisdiction over you, as a registrant with CDBC if you practice outside of Canada. You must connect with the regulatory body in the State or Country where you are hoping to provide dietetic services. You will need to understand potential limitations on practicing restricted activities, possible additional insurance requirements, considerations regarding obtaining consent for virtual practice, as well as planning for medical emergencies that may occur during virtual appointments.

Q11: I am a contractor RD for a clinic offering small group programs including multiple disciplines, that differ from me in that they are employees. Our clinic is currently only offering virtual coverage. What are the requirements of me to get consent if this client is already seeing other healthcare practitioners at my clinic?

Whether you are an employee or a contractor, you are required to gain consent.

It is important to dissociate between consent to access a client via a virtual platform and the consent you require to provide dietetic care, including the collection of personal information.

First, it is reasonable that a blanket consent form for use of a virtual platform would be adequate if your workplace has consent form terminology such as “access to healthcare services” or similar in its wording. In that instance, if a client consented to the platform for use at your clinic with a previous healthcare practitioner appointment, you could simply document that consent for that specific aspect of healthcare provision has been previously obtained. The consent form must be part of the electronic/paper health record.

Second, you must obtain consent for the collection of personal information and for the provision of dietetic services, including the implementation of a nutrition care plan. This is a separate aspect of consent, which continues until it is removed, or when there is a change in the course of treatment (less than 12-month duration).  Therefore, once you have obtained consent to treat clients, you do not need to get it every time, unless consent is withdrawn.

The College doesn’t provide consent form templates. It is best to consult your interdisciplinary team and your workplace to ensure you are all using similar (or the same) templates.

You are encouraged you to review CDBC’s resources, QA-07 Consent to Nutrition Care Policy and its Guideline, which will provide situation-specific examples and considerations to help guide you while you are revising your online intake form and for additional documentation requirements with respect to consent.

Q12: Do you have an example of a consent form that I can use in my virtual practice?

The CDBC generally doesn’t provide template consent forms because (1) it is possible that the College could incur liability if it is unaware of a specific component of a form that may be needed for specific area of practice (i.e. there is no way to provide a one-size-fits-all template), and (2) the College would be unable to maintain any template forms.

The administration of different health authorities and different workplaces have policies and procedures in place for privacy protection and the College defers to these employers to determine what works best for them.

Q13: ZOOM for Healthcare is the video conferencing option my workplace is offering. Does the College have a list of tele-conference options that I can use or not use?

The College cannot make recommendations about virtual practice platforms to use and defers to the Privacy office/committee at your workplace to recommend/mandate appropriate platforms. You might find what you are looking for in the PHSA Virtual Practice Toolkit. Various platforms are compared and recommended for use in public healthcare settings and for different functionalities.

Q14: I work for a national clinic that offers a paid membership program with different levels of service. One level of service includes access to my nutrition/cooking/grocery shopping tips and recipes, and pre-made diet plans for conditions such as diabetes, high blood pressure, heart health. Do I still need to register with other provincial Colleges, where required, or to inform other provincial Colleges of my contact with paying clients, or is this unnecessary since I do not have direct RD involvement with them?

In this specific case, you are not providing individualized nutrition plans for individual clients. Moreover, you are providing general tips, recipes etc., for healthy eating. However, while this information is in the public domain, you are considered to be practicing dietetics as defined in the BC Dietitians Regulation. In BC, Dietetics is defined as :

the assessment of nutritional needs, design, implementation and evaluation of nutritional care plans and therapeutic diets, the science of food and human nutrition, and dissemination of information about food and human nutrition to attain, maintain and promote the health of individuals, groups and the community

While this is the definition in BC for dietetic practice, other jurisdictions may have different interpretation of what it means to practice dietetics. It is recommended that you connect with the regulatory body for dietetics in each jurisdiction you plan to practice, to determine their definition of the practice of dietetics as well as the requirement for registration.

If your specific situation differs from the above example, you are encouraged to connect with the CDBC to help you make an informed decision at info@collegeofdietitiansbc.org.

Q15: If I create a private group on Facebook for my clients to write about their weekly nutritional success and challenges/ask nutrition questions, would be considered secure enough? Or if there is a more secure platform that would achieve a similar result?

Facebook is not a secure virtual platform. There are considerations when inviting clients to join the Facebook group:

  • Do all clients use Facebook?
  • Do you provide an alternative for clients who don’t?
  • Are clients clear that even in a Facebook private group, private data isn’t secure?
  • Are you able to enforce professional boundaries and avoid crossing over into sharing personal details about your life or eliciting extraneous personal information about your client?
  • Your group description should be clear that there is a risk of privacy breach for clients agreeing to participate in Facebook group activities.

You should consider choosing a more secure and more accessible platform on which to conduct your practice. The PHSA Virtual Practice Toolkit has options that allow for secure storage of client data.

Q16: Am I able to provide an initial consult over phone without visualizing a client that I have never met? My clients Extended Benefits Provider declines reimbursing the client where there has not been a virtual consult where I can physically see the client by video. Many of my clients do not have access to video platforms. Does the CDBC allow initial phone consults and if so, how can I help my client get reimbursed?

You must use your clinical judgement to determine if a phone call is sufficient for an initial consult. If there is significant risk to your client in doing so, then establishing a manner with which to visualize the client (a virtual video connection or series of photographs at a minimum) is pertinent. Do you have access to a mutual person, perhaps a caregiver, nurse or family member who can corroborate and help to provide you with a clear understanding of your client’s nutrition-related issues?  This could include elements of a Subjective Global Assessment such as waist circumference or monitoring for pitting edema and can include important third-party anecdotal weight/appearance/intake history.

The other thing to consider, is that if you deem the client to be at high enough nutrition risk that you are unable to satisfactorily proceed with an initial consult over the phone, perhaps he/she needs in-person intervention. These could include advocating for added home supports or even a hospital admission. The bottom line is that you should consider client/public safety first. The College has no jurisdiction over the requirement by an Extended Benefits Provider to see a client in-person in order for the client to be reimbursed. In this unprecedented time, it is worth finding out if the Extended Benefits Provider is changing policy to facilitate ease of access to and reimbursement for virtual healthcare coverage.

Q17: Does the CDBC have any guidance for private practice dietitians having requests for conducting home visits for more "urgent" referrals. I personally don't feel comfortable doing these right now given how difficult it is to maintain a 2m distance, the fear of the SARS-CoV-2 virus spread by going to multiple homes and the lack of protective equipment to me or my client.

As a regulated health professional, you are responsible to determine situations where virtual dietetic care is not appropriate and when in-person care is needed. Virtual care should be equivalent to in-person care and provide the same quality and safety of dietetic services. There should always be appropriate coverage for home cares to ensure that vulnerable patients receive the care they require. Refer  to CDBC policy QA-06: Right to Refuse Treatment for more information.

In an urgent referrals situation, the College expects that you would provide an in-person visit, while following the proper infection prevention protocol as per the BCCDC and PHSA resources for  infection prevention protocols and proper Personal Protective Equipment. However, if a virtual appointment can be considered to provide equivalent care as in-person, you may find that tasks such as enteral nutrition assessment, delivery and monitoring can be completed virtually and with interprofessional collaboration.

When in-person clinical care is required, use your clinical judgement to determine the shortest appointment length possible and focus on physical assessments only. The remainder of each visit (education, informed choice discussion, prescriptions, counselling, information sharing, support) should be delivered virtually wherever possible. Refer to the PHSA Covid-19 Virtual Health Toolkit for more information.

In order to conduct in-person visits in the safest way possible, consider:

  • Maintaining a distance of two metres from your client, their support staff and family wherever possible,
  • Wear PPE and practice hand hygiene as available to you and as per your health authority guidelines,
  • Where appropriate, ask extra support people and family members in the home to refrain from entering the room where you are conducting your appointment
  • Schedule time between visits to reduce client overlap and to ensure time to doff PPE appropriately and to disinfect surfaces
Q18: I am a student in the UBC Dietetics Program. Today during class, we were discussing dietetic regulation in regard to promotions and/or brand partnerships, specifically through social media, and how they vary between the different provincial colleges. My question was if a dietitian was registered in BC and Ontario for example, would their online content have to comply with both sets of regulations simultaneously? Or just the province where they physically are in at the time?

First, in order to practice dietetics in BC, you must be registered with CDBC. In order to practice dietetics in Ontario, you must be registered with CDO.

As you may know, professional regulation is a provincial jurisdiction. Therefore, each province has its own legislation, requirements and standards. If you are registered in more than one province (or state in the US for example), you are accountable to all legislation applicable. A simple way to answer your question is that you must be compliant with the most “demanding” requirement/standard. For example, if a province requires that you always use your title in online publications, but the other doesn’t, you must make sure that you always use your credentials. But let’s take a closer look at your question with social media and partnership/brand promotion.

If you intend to use your future title on social media (Registered Dietitian, RD, or in some provinces Nutritionist), you must be registered in the province where you are using your title. For example, if you reside in BC and plan on offering dietetic services in BC and have a social media practice available throughout Canada, you need to be a CDBC registrant. Your online content must abide by the regulations governing you in BC. If you are registered in Ontario as well, you must also abide by regulations in Ontario.

The CDBC Bylaws, section 74, Marketing sets the expectation regarding promotion and brand partnership. A CDBC registrant must not “endorse or lend himself or herself as a registrant to the advertisement of any property, investment or service for sale to the public unless such property, investment or service relates directly to dietetics.”

In BC, it is the BC Dietitians Regulation. Dietetics is defined as:

the assessment of nutritional needs, design, implementation and evaluation of nutritional care plans and therapeutic diets, the science of food and human nutrition, and dissemination of information about food and human nutrition to attain, maintain and promote the health of individuals, groups and the community”

To better understand the CDBC’s expectations on this topic, you may find it helpful to access CDBC’s Marketing Standards. It is a good overview of the considerations any dietitians must undertake in order to practice ethically.

The next consideration to determine where you need to be registered is whether you are providing dietetic care to a client (virtually or not), or simply posting general online content. If you are providing virtual care, you need to be registered in BC and all requirements and standards will apply.

  • Virtual Dietetic Practice is defined in the CDBC Virtual Dietetic Practice Policy as the “provision of dietetic services (e.g. counseling, consultation, monitoring, teaching, etc.) which involves any type of intervention with a client who is remotely located from the dietitian providing the service. It may include telephone, videoconferencing, email, apps, web-based communication and wearable technology (excludes social media and public appearances where advice is provided to the public at large). Virtual dietetic practice can occur within a jurisdiction and across provincial, territorial or national borders.”
  • Client is defined by the CDBC Virtual Dietetic Practice Policy: Client: an individual and/or their substitute decision maker, or a group of individuals, with whom a dietitian has an established professional relationship with the intent to deliver dietetic services.”.

If you have developed a therapeutic client relationship, and the client is across provincial jurisdictions, it is important for you to understand the requirements for registration in the province where your client resides. If you are simply posting general content (i.e. developing and sharing a healthy recipe, reviewing, or writing a post about a literature review or research you conducted etc.), you are not providing specific client-based dietetic care. If your dietetic practice is not establishing client care or follow-up on an established therapeutic relationship with a client, you are not required to register in any province other than where you reside.

Lastly, it is important to consider that the regulatory College in any province where you practice dietetics, is not the only body governing dietitians’ practice. Although the provincial Ministry of Health sets the standards and provincial laws mandating the College’s jurisdiction over its registrants, there are some provincial and federal laws that can supersede the College. A few examples, although not an exhaustive list, include:

  1. The laws governing patient/client privacy in Canada. You can read about this example in the CDBC Privacy Guide, which outlines that Private Practice Dietitians in BC who have BC-based clients must meet PIPA, a provincial-based set of privacy laws, while dietitians who have clients residing across provincial borders, as subject to PIPEDA, a set of federal laws.
  2. The Cannabis Act is a set of federal laws that registrants must abide by. And now that cannabis is legal for sale and use, it can be pertinent for dietitians to be aware of how this affects their practice and their ability to promote/provide information about these products.
Q19: Is there a lawyer you suggest I contact to help develop contracts with clients and ensure I do not miss any policies I should be following?

You are encouraged to reach out to your Liability Insurance Provider to help determine your requirement for a lawyer. The CDBC cannot recommend legal counsel.

Q20: I am considering expanding my private practice to include virtual group sessions. What are the considerations for this from the College perspective? I want to be sure I am practicing legally and am not missing important information.

As with in-person group sessions, it is important to remember that individual participants within a group may have differing comfort levels with sharing personal health information among each other. While consent must be obtained to collect personal health information and provide dietetic care, it is important to remember that consent must also be obtained in a virtual setting, such that participants understand and provide consent for the use of a virtual platform and all the risks associated with its use. For more information on virtual dietetic care, you are encouraged to consult the PHSA Virtual Care Toolkit and the Virtual Dietetic Practice in the age of COVID-19 post.

The following points are not meant to be an exhaustive list of considerations. If you have more specific questions, please contact the College for help.

In planning virtual care with residents of BC, here are some considerations:

  • Verify that your clients are residents of BC. Refer to Q3 for information on how to determine place of residence.
  • Confirm that you have access to a high quality and secure virtual connection.
  • Evaluate if you are accessible. Is it easy and convenient for clients to make appointments with you?
  • Check if your client records keeping are confidential and secure. Per CDBC Standards for RecordKeeping section 5: “Dietitians ensure reasonable measures are in place to maintain the security of client health records.”
  • Consult with your Liability Insurance Provider to prepare a plan in the instance that:
    • client records are stolen, or
    • you are unable to respond to an emergency, such as calling 911
  • Plan for contingency. Is there an option for alternative RD care if you are unavailable for a virtual appointment?

In addition to the considerations mentioned above, for providing care OUTSIDE of BC, you must first consider the following:

  • Verify where your potential clients reside.
  • For care outside of BC, but within Canada, review QA-10 Virtual Dietetic Practice Policy and Virtual Practice Guideline (scroll down on the page), to determine if you need to be registered in another jurisdiction.
  • For care outside of Canada, confirm if the jurisdiction where you intend to have clients has a regulatory body that governs dietitians. If so, you should connect with them to determine your requirement for registration with them.
  • Consult the applicable legislation. What is the definition of dietetics in that jurisdiction? Are you practicing dietetics?
    • If there is a regulatory body in that jurisdiction, they may have a definition of dietetics and it may differ from the one in BC.
    • If not, you are required to follow the definition of dietetics, and comply with policies and legal requirements as they relate to you as CDBC registrant. All of the considerations in the above bullet (when practicing within BC) will apply to you.
  • Evaluate if you are accessible. Is it easy and convenient for clients to make appointments with you, given a likely time zone difference?
  • Confirm if your liability insurance cover you for practice outside of BC. This includes instances where your client records are stolen or lost, or if you are unable to respond to an emergency during a virtual session with a client.
Q21: Can I provide Insulin Dose Adjustment education to a client virtually? Or must it be in-person?

The Diabetes Q&As give guidance on this practice. The College doesn’t dissociate whether your teaching and dose adjustment occur in person or virtually. There are no restrictions in place from a College perspective to affect your practice. You are encouraged to check with your workplace policies, if applicable, to determine any scope restriction in this regard.

Q22: I am working for a company that is considering a national program whereby dietitians have peer leaders/dietetic assistants working under them to support them in delivering nutrition information to groups or individuals. I am wondering how it works in BC in terms of the organization of roles and responsibilities without crossing regulated health professionals/scope of practice boundaries.

If you are not a CDBC registrant, CDBC has no jurisdiction over you, unless you practice dietetics in BC. In order to practice dietetics in BC (virtually or in-person), you must be registered with CDBC. For more information about becoming registered in BC, please have a look at the Registration Page for Registrants from other Canadian Colleges.

Having said that, the Dietitians Regulation in BC defines the practice of dietetics as: “the assessment of nutritional needs, design, implementation and evaluation of nutritional care plans and therapeutic diets, the science of food and human nutrition, and dissemination of information about food and human nutrition to attain, maintain and promote the health of individuals, groups and the community“.

If you are supervising staff on dissemination of nutrition information, you will need to understand their scope of practice. In BC, we do not have “dietetic assistants”, as you provided as an example in your initial inquiry. If the staff you are supervising are practicing dietetics in BC, they must be registered with CDBC to do so. However, if the information they are disseminating is in the public domain (i.e. Canada’s Food Guide etc.), then this is not considered practicing dietetics. You may want to confirm with your dietetic regulatory body what your role is in terms of delegation of tasks to a staff member. In BC, a delegation of tasks (on behalf of the CDBC registrant) can occur if the task is within the dietitian’s scope of practice AND the dietitian is able to provide ongoing monitoring of the staff member’s ability to perform the task while also accepting accountability for the staff member’s actions. This definition may be different in your jurisdiction.

It is also important to consider how one becomes a “peer leader” including how they are recruited to become coaches and what the pay or incentives look like. It is an importance consideration in the context of dietitians’ Code of Ethics and CDBC Policy QA-09 Marketing/Sales/Conflict of Interest because dietitians may not participate in multi-level marketing strategies or pyramid sales business models.

Q23: I am going to register with another provincial regulatory body, while continuing to hold CDBC registration. I am also certified as a health coach. Can I see my patient virtually across provincial jurisdictions as a health coach while I wait to become registered in the other province?

When practicing any profession in another province, you are outside the jurisdiction of CDBC. Because your practice concerns providing care to residents outside of BC, your questions about practicing as a health coach there should be directed to that province’s dietetic regulatory body.

Q24: I am planning to resign as a full registrant. If I decide to teach Nutrition online do I need to be licensed with CDBC?

In order to practice dietetics in BC, you must be registered with the CDBC. In BC, per the Dietitians Regulation, the practice of dietetics is defined as “ the assessment of nutritional needs, design, implementation and evaluation of nutritional care plans and therapeutic diets, the science of food and human nutrition, and dissemination of information about food and human nutrition to attain, maintain and promote the health of individuals, groups and the community“.

If you are providing information that is otherwise available in the public domain (for example, Canada’s Food Guide) AND you are not facilitating a professional therapeutic relationship with client(s) (for example, performing full assessments and/or  providing medical nutrition therapy), your actions are not limited to those provided by a dietitian, and so you do not need to be registered with the CDBC.

It is important to note that where your virtual audience is located will also determine your requirements for registration. If your audience is located outside of BC, you are encouraged to have a look at QAC-10 Virtual Dietetic Practice, which will provide considerations in cross jurisdictional practice. Please be in touch with dietetic colleges in other provinces if you audience is outside of BC, to determine their definition of what it means to practice dietetics and their requirements for you to provide virtual nutrition classes.

If you decide to resign from the CDBC, you may no longer use the title of “Registered Dietitian”, nor may you refer to yourself as a former dietitian, as it implies an element of credibility that the CDBC can no longer verify.

Q25: Do I need a business license when practicing in Private Virtual Practice? Is there licensing I would need if I operate as a sole proprietor?

Your requirement to register as a small business is an aspect of practice that you will need to follow up with. The CDBC has no jurisdiction on how you set up your private practice. You may choose to start at this BC government website. However, it is important to note that if you choose to register a small business, your business name should not include the term “dietitian”, since a business name can be registered for years, while CDBC registration renewal is annual. The CDBC cannot monitor which of its registrants in good standing has a small business or the specific details of the business name.

Q26: Are there circumstances under which I can use a non-healthcare specific virtual platform? What are some considerations?

For a ‘lunch and learn’ style session, whereby you are providing a general nutrition topic, without developing a therapeutic relationship with any of the audience, it seems reasonable that a generic (non-secure?) form of a virtual platform (i.e., not healthcare specific) could be used. In this capacity, you are not practicing dietetics and the act of joining your session, can be seen as implied consent.

For a session where you are providing personal recommendations in a group setting, you will need to assess the need to use a more secure virtual platform, such as one listed in the PHSA Tool Kit (available on Q12). Consent will be required for (1) platform use (and its limitations and risks), and (2) provision of specific nutrition-related care. In the case of personal recommendations in a group setting, limitations in privacy among group participants who are sharing personal health information must be considered in a similar fashion as if you were to host an in-person group setting.

Many platforms have participant-friendly tutorials that can provide them with troubleshooting, as well as information about the risks and benefits of the platform. You may wish to refer your participants to these types of resources in order to best prepare for virtual sessions.

In terms of documentation for both types of sessions, you should consider retaining a record of your presentation (slides, recordings, outlines) as well as any marketing materials you may use to advertise the sessions, based on sections 70 and 74 of the CDBC bylaws.

Q27: What are some considerations for liability when providing a virtual cooking class to minors?

Per the Infant Act, which includes anyone under 19 years of age, disclaimers, limitations of liability and waivers are not enforceable, even if signed by a parent/guardian. It is recommended that you confirm coverage of your professional liability for the practice of virtual cooking classes for minors. Consider if you feel you personally want to take on the risks associated with this activity. You are encouraged to reach out to your liability insurer to determine if “special risk insurance” might cover you.

 

It is unlikely that an indemnity agreement, signed by the parents/guardians will hold up in court.

Recent Posts