Together We Are Stronger
How physical therapy in Canada parallels the opportunities and threats experienced by therapists and clinic owners in the United States.
By Darryl Yardley, PT
Canada comprises one of the world’s largest landmasses while having one of its smallest population densities. As a result, Canadians and their health care providers must find creative and innovative solutions to complex health problems across a broad set of contexts. For almost 100 years, physical therapists have been an integral part of the Canadian health care system as expert guides in the promotion, restoration, and rehabilitation of physical function and mobility. Many professionals, experts, and futurists agree that the changing world is driven largely by a growing and diversifying population with shifting demands, and an explosion of new technologies. As physical therapists, we need to take a long hard look in the mirror and ask ourselves how we are going to continue to fit within the health care environment of tomorrow. Physical therapy in Canada parallels the opportunities and threats experienced by therapists and clinic owners in the United States. Three common traits can describe the current state of the nation north of the border.
Service Confusion
There is poor understanding and no consensus among the general public on “who we are and what we do” as physical therapists. We spend a great deal of time debating this among ourselves as a profession but fail to communicate well to the general public. We also need to stop criticizing each other, the sectors we work in, the practice models we employ, and what other health disciplines are doing around us. It is blatantly obvious that other regulated and nonregulated health providers are encroaching on our space. The profession requires strong alignment for brand awareness and a reduction in practice variability. Physical therapists of the future will need to be more business focused. Business acumen will be added to the list of necessary skills required to effectively build partnerships and alliances, to compete effectively against new and existing competitors, and to market our services in innovative ways. If done well, this identity will create clarity and truly launch us into the primary care role we desire.
Professional Engagement
The mantra is that private practice owners are often overworked, underpaid, and simply do not have the time to explore new opportunities while trying to keep their clinic afloat and balance their work with a personal life. In my opinion, it speaks to a general engagement problem. Of course, this does not apply to all physical therapists; today I am preaching to the choir. We can appreciate that accepting the status quo will likely lead to our slow but steady extinction Eventually we could be overtaken by less expensive and less well-trained providers. It is often not until a crisis occurs that physical therapists become engaged enough to mobilize as a group. I do not mean to be pessimistic. We as a profession have yet to come close to our full potential. There are so many opportunities in the profession, some staring us right in the face, others to create and incubate, but we should only worry when we stop innovating. There has never been a better time to be in physical therapy, as long as we are willing to put in the work, to change and adapt, and let go of old ways of thinking in favor of new approaches. We will continue to not only survive but thrive into an uncertain future.
System Fragmentation
Health care consumes $0.42 of every dollar spent on provincial programs in Canada. Without a change of course, health spending will grow to 70 percent of provincial budgets within 12 years.1 One of the major causes of these fiscal constraints is the amount of fragmentation and poor coordination of care that exists. We all know physical therapists are optimally positioned to address the mandate of the Institute for Healthcare Improvement’s Triple Aim: better health for populations, improved experience of care for patients, and lower costs. Thus, there is a strong need to re-invigorate primary care and insert the physical therapy skill set to improve access to the right person, in the right place, at the right time. This calls for more than tinkering with delivery changes; it calls for real transformational change in the way we collect, manage, and share health care data. Outdated payment models have triggered funding reform that requires a shift from a system based on transactional payments-per-visit to a system that pays for performance and incentivizes practitioners. The investment of physical therapy in primary care (currently $4.2 million in Ontario) is key to unifying a compartmentalized health care system by mitigating gaps in service delivery, eradicating inefficiencies, and improving the quality of care Canadians receive.
The Time Is Now
We need to encourage physical therapists to rethink our identity and how we differentiate ourselves to become pioneers of change. As Canada’s population grows and diversifies, new technologies emerge, and health care environments change, physical therapists must similarly evolve to meet the needs of those they serve. To be viewed as leaders in the field, innovations and opportunities over the next 5 to 10 years need to be harnessed now to ensure our continued health and even survival as a profession. If we hold back, it may be too late to change course in the near future. I believe we are stronger together. Let’s join our North American collective powers and voices to take our profession out from the sidelines and into primary care in the promotion, restoration, and rehabilitation of physical function and mobility.
Darryl Yardley, PT, FCAMPT, is chair of the Private Practice Division of the Canadian Physiotherapy Association. He can be reached at darryl.yardley@gmail.com.