Registered Cardiology Technologists (RCTs) are medical professionals specifically trained in the testing, monitoring, and evaluation of the function of patients’ hearts. The highly sensitive tests they perform, such as Holter monitoring, ECGs, and stress tests, are crucial in the prevention, diagnosis, and treatment of cardiac conditions. Given that cardiac testing involves such a vital organ and is essential in maintaining patient cardiac health, it is absolutely pivotal that these tests are performed by those with the skills and training required to do so properly.

However, currently in Ontario, formal education as a RCT is not required to perform Cardiology Technology duties and tests in clinics and hospitals. In fact, there is no legal requirement for any certification, training, or education in order to perform cardiac tests. While certification with the Canadian Society of Cardiology Technologists is preferred, it is not a requirement; as long as a hospital or clinic is willing to approve of it, legally anyone is able to perform cardiac tests regardless of experience.

Since no standard of education is being enforced, hospitals and clinics will often offload RCT duties and cardiac tests onto professionals that lack the appropriate training. Most often these tasks will be given to already-overworked Nurse Practitioners, but are also being given to lab technicians, and even secretaries and clerical staff. This offloading is mostly done in an attempt to reduce staffing costs, but it ultimately results in an increased risk to patients, increased labour costs to hospitals, and an inequal quality of care throughout the province.

When Cardiology Technology duties are performed by someone insufficiently trained, they are significantly more likely to incorrectly interpret a test, fail to recognize an emergency situation, or deliver inappropriate care, all of which put patients in unnecessary risk. As cardiac tests are highly sensitive, insufficiently trained personnel are also likely to produce inferior test data that is unclear, does not show all relevant areas, or is simply incorrect. These inferior tests require more time for cardiologists to interpret, or may need to be entirely redone. Various cardiologists across Ontario that read ECGs for a specific chain of private clinics place the repeat rate for that test at 75%. Based on the number of branches of this clinic and the rate at which ECGs are performed, this amounts to approximately $86,000 a day or $22.5 million a year in additional labour costs only for ECGs performed out of this private clinic. These extra labour costs from repeat testing add to overtime costs associated with offloading RCT duties onto NPs, as well as delays in treatment that lead to more expensive interventions being required.

The issue of regulation of Cardiology Technology is also one of equity. Since RCTs are not regulated, there is no standard wage, leading to rural areas having difficulty attracting and retaining RCTs. These areas tend to have populations that are older and with lower annual incomes compared to urban and suburban areas. As older adults are more likely to be in need of cardiac tests, a situation is created in which the areas with the greatest demand for RCTs services are the least likely to receive them.

We, the undersigned, call on the Ontario Legislative Assembly and the Ministry of Health to aid Registered Cardiology Technologists in their pursuit of oversight and regulation. Upon the Health and Supportive Care Providers Oversight Authority Act, 2021 coming into effect in January 2024, we recommend a prioritization of the application made by OSCT at this time, given the history and future risk of harm done to patients by insufficiently-trained personnel. Providing further regulation for RCTs in Ontario is the path forward to reduce unnecessary harm to patients and costs associated with labour inefficiencies, and make high-quality healthcare accessible throughout the province.