Responding to the Study of Canada’s Health Workforce - Canadian Physiotherapy Association

Executive Summary:

Recommendation # 1: the government effectively integrate physiotherapists into Canada’s wider Federal health policy planning framework as a critical health system partner. This can help address current health human resource challenges caused by COVID-19 and help design a more effective and efficient interprofessional patient care solution.

Recommendation # 2: the government design a targeted and comprehensive strategy for investments in rural, remote, and northern areas to increase access to physiotherapy for underserviced communities and people.

Recommendation #3: the government adopt a targeted and focused approach to improve access to physiotherapy services, including:

Incentivizing physiotherapists to be recruited and retained in rural and remote areas of Canada by extending the Canada Student Loan forgiveness to physiotherapy practitioners. This will allow more qualified physiotherapists to join rural and remote labour markets and actively participate in those local economies while improving access to services for the local population.
Making permanent the temporary removal of the referral requirement for coverage of physiotherapy services from the Public Service Health Care Plan (PSHCP). This will increase access to physiotherapy services as we recover from the pressures of the COVID-19 outbreak without placing additional administrative burdens on the health care system.
Making strategic investments to broaden Tele-rehabilitation services in disconnected Indigenous communities and improve access and coordination of rehabilitation services for those residing in Canada’s rural, remote, and northern areas. This will allow timely and equitable access to in-demand electronic health technologies and improve patient and healthcare outcomes for disproportionately impacted populations – such as our Northern and rural Indigenous communities.

Introduction:

The Canadian Physiotherapy Association (CPA) represents 17,000 physiotherapy professionals and students across Canada. The CPA’s members are rehabilitation professionals dedicated to Canadians’ health, mobility, and fitness. In partnership with provincial and territorial Branches and practice Divisions, the CPA enables members to learn, share knowledge, and enhance practice. In addition, the CPA provides resources, education, ideas, and advocacy to enable our professional community to serve Canadians better.
The CPA is pleased to provide these recommendations to the House of Commons Standing Committee as it prepares recommendations to the Federal government on building a strong, accessible, and resilient public healthcare system and workforce that will be better prepared for risks from COVID-19 and future health pandemics.
This submission will focus on why it is important to integrate physiotherapists into the wider Federal Health Policy Framework as a critical health system partner – and the key steps the government should take to improve access to physiotherapy care services and increase recruitment and retention of physiotherapists across Canada.

Canada’s Physiotherapists and the COVID-19 Challenge:

Physiotherapists are highly trained, regulated health care practitioners with expertise in movement and play a significant role in health promotion and treatment of injury and disease. There are approximately 26,000[1] registered physiotherapists working in Canada in private clinics, general and rehabilitation hospitals, community health centers, residential care, assisted-living facilities, long-term care (LTC) facilities, home visit care agencies, workplaces, and schools. Through evidence-informed practice, physiotherapists prevent, assess, and treat the impacts that injury, pain, disease, and/or disorders have on clients’ movement, function, and health status.
Physiotherapists play a vital part in optimizing health system performance through an increased focus on upstream solutions and redirecting patients away from costly acute health care and emergency departments toward timely, accessible, and affordable community services.
During the COVID-19 pandemic, physiotherapists safely provided care across the health system in compliance with all required infection prevention and control measures. In addition, physiotherapy care can be adapted using alternate delivery approaches, such as tele-rehabilitation/virtual rehabilitation, to manage exposure risks during pandemic restrictions and ensure patients can safely continue treatment.
The COVID-19 pandemic continues to present the profession with significant challenges, including:
1. professional burnout due to systematic stress from COVID-19,
2. labour mobility issues due to barriers to accessing independent licensure; arising from the unavailability of the national Physiotherapy Competency Examination (PCE) clinical component for over two years, followed by the slow adoption and varied application of interim alternative processes by provincial regulators to grant independent licenses to practitioners, a situation which has the potential to be remedied by the application of a reciprocal national licensure framework; and
3. limited incentives to service high demand and high priority areas in rural and northern communities.
4. prolonged licensure delays due to COVID-19, which included the slow adoption and inconsistent application of interim/alternative processes to license practitioners.

Recommendation # 1: the government better integrate physiotherapists into the wider Federal health policy planning framework as a critical health system partner. This can help address current health human resource challenges caused by COVID-19 and help design a more effective and efficient inter-professional patient care solution.

The extraordinary demands placed on the Canadian healthcare system by the COVID-19 pandemic has had a severe impact on physiotherapists who, just like many others in the healthcare community, have had to deal with severe emotional and financial burnout as they respond to an increase in patient caseloads, backlogs, and system volume pressures. However, according to a CIHI report, as many as 6,000 physiotherapists and occupational therapists recently returned to their practices to help respond to the pandemic with many supporting testing and administration of much-needed vaccines across Canada – as the healthcare community banded together to resolve the ongoing and unprecedented healthcare crisis.[2]
As vaccination rates increase across the country and infection rates continue to decline, many hospitals have resumed non-urgent surgeries and procedures, including hip and knee replacements. This provides physiotherapists with another opportunity to support pre-and post-surgical care and patient recovery, enabling return to home function.
Physiotherapists continue to be key in providing support to Canadians during the recovery phase of the COVID-19 pandemic. As healthcare professionals who provide essential care and treatment to Canadians enabling them to stay mobile, healthy, and active, physiotherapy professionals will see greater demand for services as Canadians recover from COVID-19 and as the impacts of delayed surgeries/treatments, reduced physical activity due to quarantine, isolation and physical restrictions are realized.[3]

Physiotherapists and Long COVID

Physiotherapists working in the home and the community sector, including those who work as part of team-based interprofessional care services, are well-positioned to manage the symptoms of both COVID-19 and recovery and rehabilitation from variations like Long COVID. In particular, physiotherapy during COVID-19 recovery is helpful for patients, especially when weaning patients off the ventilator and physical rehabilitation.
Given the critical and essential role physiotherapists continue to play in the management of COVID-19 and post-pandemic symptoms, we are calling on the government to allocate targeted funding envelopes for research and design policy frameworks that incorporate integrated, interprofessional care services to better manage systems of new and emerging conditions such as long COVID-19 that are on the rise across all jurisdictions in Canada.
Our healthcare system is facing a growing human resource crisis with shortages[4] in critical health professions such as physiotherapy. This is especially concerning at a time when Canadians need access to physical rehabilitation services to address many ongoing issues, including the growing impact of delayed surgeries and procedures, increased general pain or discomfort and management of symptoms arising from Long COVID, as well as those who may experience long-term disability and require recovery support from Long-COVID[5].
Currently, there is no clear or consistent national approach in place for physiotherapy graduates to achieve independent licensure to practice. With the discontinuation of the clinical component of the physiotherapy competency examination, physiotherapy regulators across the country have responded with a variation of interim solutions that have left some candidates with no path to achieving an independent license – causing entry to practice delays, escalating labour shortages and mobility bottlenecks and reducing the flow of skilled and necessary healthcare workforce personnel to rural and northern parts of the country where they are needed most.[6]
As a priority, there is an urgent need to explore and implement a national approach to licensure that promotes standardization, transparency and accountability and removes the burdensome requirement of separate provincial and territorial licenses to facilitate better and more accessible delivery of physiotherapy. In addition, such an approach should seek to uphold and enable Chapter 7 provisions of the Canadian Free Trade Agreement (CFTA) and ensure a forward-looking process that commits to facilitating ‘the movement of physiotherapists among all Canadian jurisdictions.’[7]

Recommendation # 2: the government design a targeted and comprehensive strategy for investments in rural, remote, and northern areas to increase access to physiotherapy in underserviced communities and people.

Urban areas comprise just 3.6 percent of Canada’s geography and about 82 percent of the population but employ almost 90 percent of all Canada’s physiotherapists. The remaining 10 percent service 90 percent of the country’s landmass, and recruiting physiotherapists to these non-urban centers poses a significant challenge. As a result, patients in these areas have reduced access to the resources necessary to meet their physical therapy needs. The trend has worsened in the wake of COVID-19, which has magnified access to care issues and existing labour shortages in rural and northern communities – particularly Indigenous populations – which have been disproportionately impacted by the ongoing pandemic.[8]
Indigenous communities, especially those based in remote northern areas, have experienced a staggering increase in burden and severity of COVID-19 illness; and continue to simultaneously contend with disruptions in health care services, including physiotherapy. While telehealth and tele-rehabilitation have been championed as one solution to the widening gap in access to physiotherapy services for Indigenous Peoples during COVID-19, there remain significant infrastructure barriers to efficiently delivering virtual care and persistent labour shortages, which continue to limit equitable access to tele-rehabilitation services.[9]

Recommendation # 3 the government should adopt a targeted and focused approach to improve access to physiotherapy services, including:

Incentivizing physiotherapists to be recruited and retained in rural and remote areas of Canada by extending Canada Student Loan forgiveness to physiotherapy practitioners. This will allow more qualified physiotherapists to join rural and remote labour markets and actively participate in those local economies while improving access to services for the local population.
Making permanent the temporary removal of the referral requirement for coverage of physiotherapy services from the Public Service Health Care Plan (PSHCP). This will increase access to physiotherapy services as we recover from the pressures of the COVID-19 outbreak without placing additional administrative burdens on the health care system.
Making strategic investments to broaden Tele-rehabilitation services in disconnected Indigenous communities and improve access and coordination of rehabilitation services for those residing in Canada’s rural, remote, and northern areas. This will allow for timely and equitable access to in-demand electronic health technologies and improve patient and healthcare outcomes for the disproportionately impacted populations – such as our Northern and rural Indigenous communities.

Contact:
The Canadian Physiotherapy Association
955 Green Valley Crescent, Suite 270
Ottawa, Ontario, K2C 3V4

[1] Canadian Institute for Health Information. (2021, August). Physiotherapists.Retrieved online: https://www.cihi.ca/en/physiotherapists
[2] CIHI. (2021, August). Building Health Workforce Capacity in Response to the Pandemic.Retrieved online: https://www.cihi.ca/en/health-workforce-in-canada-highlights-of-the-impact-of-covid-19/building-health-workforce-capacity
[3] CPA. (2020, August). CPA HESA Submission. Retrieved online: https://physiotherapy.ca/sites/default/files/hesa_aug31_final.pdf
[4] Government of Canada. (2022). Job Bank: Physiotherapist in Canada. Retrieved online: https://www.jobbank.gc.ca/marketreport/outlook-occupation/18214/ca
[5] Government of Canada (2022). A Vision to Transform Canada’s Public Health System. Retrieved online: https://www.canada.ca/en/public-health/corporate/publications/chief-publ…
[6] ACE. (2021, August). Impacts of the COVID-19 Pandemic on Physiotherapy Employers Across Canada. Retrieved online: https://physiotherapy.ca/impact-pce-delays-and-covid-physiotherapy-profession
[7] Canadian Alliance of Physiotherapy Regulators. (2019). Memorandum of Understanding to Support Physiotherapy Labour Mobility within Canada. Retrieved online: https://www.alliancept.org/wp-content/uploads/2020/11/2019-MOU-to-Support-Physiotherapy-Labour-Mobility-Dec-9-2019-Official_EN-amended-1.pdf
[8] The Conference Board of Canada. (2017, August). Stretched Too Thin: The Demand for Physiotherapy Services in Canada. https://www.conferenceboard.ca/e-library/abstract.aspx?did=8916
[9] CPA. (2020, December). Magnifying Inequities: Reflections on Indigenous Health and Physiotherapy in the Context of COVID-19. https://physiotherapy.ca/blog/magnifying-inequities-reflections-indigenous-health-and-physiotherapy-context-covid-19