Advertising is used by physicians to attract patients to their practice, or to help inform patients about the services, products or treatments they offer. Currently the General Regulation under the Medicine Act, 1991¹ (the Regulation) sets out physicians’ legal obligations when advertising.

The Advertising policy aims to help provide clarity around these rules and set out appropriate professional expectations where the rules of the Regulation are ambiguous or open to interpretation. This will assist physicians in advertising their services effectively, while assuring such advertising is appropriate and in the best interests of the public. Importantly, the policy captures both physicians’ legal obligations as set out the Regulation as well as additional expectations of the College. This is to assist physicians in understanding their obligations, by having all expectations contained in one document.

This companion Advice document provides further guidance around how the expectations in the Regulation and policy can be met.

What is considered advertising?

As the policy outlines, advertising means any communication that has as its primary purpose the promotion of a physician, or a clinic, facility or group with which the physician is associated. This can be both paid or unpaid and includes:

• print ads in newspapers, magazines, and brochures;
• newsletters and mail outs;
• business cards and stationery;
• logos and signage;
• TV or radio ads;
• websites;
• blogs and social media posts (e.g., Facebook, Twitter, Instagram);
• posters and billboards; and
• other information related to the physician’s practice, regardless of the form or the manner of distribution.

Under the Regulation, posters or pamphlets displayed in a physician’s office or clinic waiting area are also considered to be advertising.

What is not considered advertising?

While the term “advertising” covers a wide range of materials or activities, there are tools that physicians may use to inform patients that would not be considered “advertising” under the Regulation. Such tools would include materials that physicians use to inform patients about procedures in a clinical setting, for example, showing a patient images or pamphlets when discussing treatment with them during an appointment.

Fundraising efforts on behalf of a foundation or an organization are not generally considered advertising, as the primary purpose is to raise funds and not to attract patients to a particular physician or clinic. That said, there may be instances where the nature of the content is such that it is subject to the Regulation and so the requirements set out there and captured in the policy would apply. It will be important that physicians who choose to be associated with such campaigns use caution and ensure it is appropriate, based on the specific circumstances and content of the campaign.

What kind of advertising content would not be in “good taste”?

Advertising that is educational or informational in nature, is more likely to be found to be in “good taste” whereas advertising that is excessively commercial in tone is less likely to be in good taste.

Examples that may be considered to not be in good taste include advertising that uses incentives to entice the public to seek a medical service, such as offering medical treatments as prizes in contests or offering prospective patients products or gift certificates not related to the medical service to encourage them to undertake a procedure.

The setting and size of the advertisement may also inform whether something is in good taste or not. For example, content that may be considered acceptable on a clinic’s website, could be in bad taste if displayed on a billboard. Advertising content that is displayed for “shock value” may also be in bad taste. Careful consideration will need to be undertaken when using images that depict devices or images of patients.

What kind of advertising content would be misleading or deceptive?

Content that is false or not based in fact will be in breach of the expectations contained in the policy. However, what would be considered “misleading or deceptive” is broader than this. Thinking carefully about whether the wording of advertisements includes content that may lead the reader to an incorrect conclusion, create a false impression, or that leaves out key information or context, will help physicians meet the expectations contained in the policy.

What are the rules around testimonials on third party sites?

The Regulation prohibits physicians from using testimonials in their advertising.

Internet sites currently exist on which patients and the public can post ratings, reviews and feedback on a particular physician, practice or clinic. These can take the form of testimonials, but there is no prohibition against such sites where the public are freely posting their opinions on a service.

Physicians will need to be very careful in considering how they interact with such sites to avoid engaging in activities prohibited by the Regulation. Some behaviour by physicians relating to testimonials on third party sites could potentially be considered a breach of the prohibition against testimonials. For example, if a physician:

• linked to their reviews on these sites in their advertising,
• directed patients to post about them or their practice on such sites,
• posted on such sites themselves under other names, or
• paid to remove negative reviews from such sites.

In particular, asking patients to post on such sites could cause patients to feel that they may not receive the same quality of services if they refuse and could impact the relationship of trust between a physician and a patient.

What should I do with comments on social media posts?

Many physicians choose to maintain a social media presence for themselves or their practice. Social media is a rapidly evolving space and is being used by physicians in a range of ways.

It may be that members of the public post comments on the social media accounts of physicians or their practices. When considering such comments and how they should be handled, physicians will need to use their professional judgment and act in compliance with the College’s Social Media – Appropriate Use by Physicians statement.

While social media comments by third parties may not on their own be considered advertising, a physician taking an active role in managing social media comments could change the way such comments are perceived. For example, if a physician was to delete negative comments and not positive comments, this could be viewed as a breach of the Regulation and the Advertising policy as it relates to testimonials. This does not include the deletion of discriminatory or unprofessional comments, which would likely be permitted.

Why can’t I reference specific drugs, appliances or equipment in my advertising?

The Regulation prohibits physicians from referencing specific drugs, appliances or equipment in advertising. The purpose of this prohibition is to prevent physicians from endorsing a specific brand of drug, appliance, or equipment, or by marketing their medical practice to patients through an association with a specific brand of drug, appliance, or equipment. Physicians will need to ensure the focus of their advertising is on the medical services and treatments they offer (e.g. I offer this medical procedure), rather than the brands or trademarked equipment or drugs they use (e.g. I use this Trademarked Device).

This provision may allow for physicians to reference in their advertising a drug, appliance or equipment used for treatment, where the drug, appliance or equipment is not identified by a specific commercial or brand name (e.g. “I offer fillers,” rather than “I offer this Trademarked Filler”).

When can I use before and after photos or videos in my advertising?

As stated in the policy, physicians cannot display before and after photos or videos in advertising where any member of the public may then see them unsolicited, without seeking them out. For example, advertising that is published in magazines or newspapers, tv advertisements, or paid for sponsored or promoted posts on social media that appear in the feeds of users who do not follow that physician or practice on social media.

Physicians are permitted to use before and after photos and videos in formats where prospective patients may seek them out, for example on their websites or on their social media pages generally (with no targeting or promotion of the posts), provided of course those photos or videos comply with the requirements of the policy.

Careful consideration will need to be given before posting photos or videos to social media, as the terms of use for social media sites can change and evolve, with potentially unforeseen consequences.

What constitutes “permitting” myself to be associated with an advertisement?

All advertising produced by a clinic or practice where a physician provides services, could be associated with that physician. It is important that physicians maintain awareness of any advertising or promotional material published or put out by an organization with which they have a direct connection, and whether that advertising is in compliance with advertising obligations.  

Why can’t I associate myself with products and services other than my own medical services?

The Regulation specifically prohibits physicians from associating themselves with products or services other then their own medical services. This prohibition is intended to ensure that physicians are not misusing their credentials to advertise and promote products or services to the public that may not be relevant or appropriate. The following examples are likely to be viewed as problematic and violating the prohibition in the Regulation:

• A physician marketing and selling commercial health products and/or supplements they created;
• A physician attaching their name to facilities where they do not practice or provide medical services;
• A physician appearing in advertising to use their credentials to endorse a product or service marketed to the public;
• A physician including in their advertising references to brand-name medications or devices to promote the benefits of these products.

What is the purpose of the prohibitions on directing and targeting prospective patients?

The Regulation prohibits physicians from:

• Participating, directly or indirectly, in a system in which someone else (e.g., a person or a company), steers or recommends patients to them for professional services, and
• contacting or communicating with, or attempting to contact or communicate with, any person known to need medical services to solicit or invite professional patronage.

The intention of the Regulation is to prevent physicians from attempting to generate business and income for themselves in a way that might not be in the best interests of prospective patients, or encouraging patients to seek a medical service for commercial reasons, rather than for medical reasons. Examples of where these prohibitions might be enforced include physicians offering services through group discount companies, or physicians giving “kickbacks” to a person or company in exchange for patient referrals.

This would not prevent physicians from doing such things as making referrals as part of their normal course of practice where there is no conflict of interest, recommending another particular physician, practice or clinic if asked by a patient to do so, or contacting existing regular patients about their services. 

The College does not interpret these obligations in the Regulation as prohibiting physicians from participating in services such as Health Care Connect or outreach programs seeking to improve access to healthcare for vulnerable or marginalized populations, as long as they are complying with their other professional obligations while doing so.

How should I refer to myself in advertising?

The Regulation contains specific rules for the way physicians can refer to themselves and their areas of practice in advertising. There are a number of terms that are protected and can only be used where physicians have, for example, appropriate certification.

According to the Regulation, when a physician is referred to in any advertising, the physician’s name must² be followed by either:

1. the term, title, or designation that the physician may use with respect to the specialty or subspecialty of the profession in which the member has been certified by the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC) or formally recognized in writing by the CPSO, or
2. the title “General Practitioner.”

Physicians can also have their designatory letters (indicating academic degrees, professional certification from the RCPSC, CFPC or formal recognition from the CPSO) follow their name.

Examples of Proper usage

• Joan Clark, Family Medicine
• Joan Clark, MD, CCFP, Family Medicine
• B. Ali, MBA, General Practitioner
• Rousseau, MD, CPSO Recognized Specialist (Anesthesia) 

Focused Practice

Physicians who have a focused practice, for example, a family physician with a focus on pediatrics, may have completed additional training in specific practice areas but are not certified specialists in those disciplines. In keeping with their professional obligations, physicians must ensure they have the suitable knowledge, skills and judgment to practise in the areas that they describe. If physicians wish to describe other areas of their practice, they may do so, provided physicians comply with certain requirements:

• The physician must still state their specialty or subspecialty or designation as a general practitioner as explained above; and
• The phrase “practising in” must precede any descriptive terms that are used.

This is intended to ensure consistency in advertising and promotional materials, and that descriptive terms are not mistaken for formal specialization or sub-specialization.

Examples of Proper usage

• Charles Gauthier, MD, CCFP, Family Medicine, practising in pediatrics
• B. Rodriques, MD, General Practitioner, practising in psychotherapy

Other Credentials

Physicians can also include their other credentials in their advertising, if they wish, but that information cannot come before the required speciality designation and practice descriptor, if any.

Example of Proper usage

• Stevens, MD, General Practitioner, practising in sleep medicine, Diplomate of the American Board of Sleep Medicine

Restricted Practice Description Terms

Some practice description terms are restricted. Physicians cannot use the terms ‘surgeon,’ ‘surgery,’ ‘plastic,’ ‘facial plastic,’ ‘oculoplastic’ and ‘ophthalmic plastic’ unless they satisfy the conditions in the regulation. Specifically:

• No physician can use the title “surgery” or the term “surgeon,” or a variation or abbreviation to describe their practice unless he/she is certified by the RCPSC in a surgical specialty or subspecialty or formally recognized in writing by the CPSO as a surgical specialist or subspecialist.
• No physician can use “plastic” to describe his or her practice unless the physician is certified by the RCPSC in plastic surgery or formally recognized in writing as a plastic surgeon by the CPSO.
• No physician can use “facial plastic” to describe his or her practice unless the physician is certified by the RCPSC as an otolaryngologist – head and neck surgeon or is formally recognized in writing by the CPSO as an otolaryngologist – head and neck surgeon. In keeping with the other requirements of the regulation, otolaryngologists – head and neck surgeons can only use “facial plastic” as a practice descriptor; it can’t replace the full name of their specialty.
• No physician can use “oculoplastic” or “ophthalmic plastic” to describe his or her practice unless he/she has been certified by the RCPSC as an ophthalmologist or is formally recognized in writing by the CPSO as an ophthalmologist. Ophthalmologists must only use these terms as a practice descriptor; they cannot use them instead of the full name of their specialty.

Examples of Proper usage

• Liu, MD, FRCSC, Otolaryngology-Head and Neck Surgery, practising in facial plastic surgery
• Bonnie Smith-Fox, MD, CCFP, Family Medicine, practising in cosmetic procedures

Endnotes

^1. O. Reg. 114/94: GENERAL under Medicine Act, 1991, S.O. 1991, c. 30.

^2. According to O. Reg. 114/94: GENERAL under Medicine Act, 1991, S.O. 1991, c. 30.