The Advanced Clinician Practitioner in Arthritis Care (ACPAC) program is a novel, competency-based, rigorously evaluated advanced clinical and academic educational program created in 2005 and hosted by St. Michael's Hospital and The Hospital for Sick Children, Toronto, Ontario. The program is offered to experienced physical and occupational therapists selected to engage in expanded scope of practice roles with the aim to provide optimal, timely and appropriate delivery of healthcare to patients with arthritis in academic, non-academic and remote community healthcare settings. The ACPAC program is offered at a critical time in the context of rapidly changing healthcare delivery, producing highly skilled advanced practitioners across Ontario central to the development of innovative models of chronic disease management in arthritis care. The processes driving change and the risks assumed thereof, as well as a description of the successes, challenges and shortcomings of the ACPAC program, are intended to be instructive to other healthcare facilities considering similar initiatives.