HomeWritten Submission for the Standing Committee on Finance’s Pre-Budget Consultation

Written Submission for the Standing Committee on Finance’s Pre-Budget Consultation

Recommendations

  1. Physiotherapists stand ready to help address Canada’s greatest health challenges, including the urgent need to support the country’s aging population and those living with chronic pain, to assist Canadians living with Long COVID, and to increase non-pharmacological pain management care.

    As such, the Canadian Physiotherapy Association recommends that the Federal government convene an inter-ministerial task force consisting of representatives from the Federal Ministry of Health, the Ministry of Seniors, the Ministry of Mental Health & Addictions, and the physiotherapy profession to explore innovative care delivery solutions that optimize the use of physiotherapy expertise and increase access to physiotherapy services.

  2. Canada is not currently graduating enough physiotherapists to support the country’s needs.

    As such, the Canadian Physiotherapy Association strongly recommends that the Canada Student Financial Assistance Program (CSFA) be expanded to physiotherapists. This would reduce the financial burden on physiotherapy graduates, entice new entrants into the system, and provide upstream solutions to the health human resource shortage.

The Future of Canada’s Health Care System

The COVID-19 pandemic, compounded by delayed health care access, has exacerbated pre-existing societal inequities, impacted the ease of labour mobility, and intensified the health human resource crisis. It has also required us to find innovative ways to optimize the use of professional services and expertise from across the health care spectrum. The physiotherapy sector is poised to support the federal government in alleviating our country’s current health care crisis.

Canada’s health care system is under severe strain, with no end in sight. Physiotherapy professionals can help reduce this strain by supporting innovative solutions that can be integrated immediately.

Canada’s health system must be transformed if it is to continue to offer the level of care needed to support the high quality of life expected by Canadians. Physiotherapy professionals are well-positioned to support the recovery from the pandemic and its lingering effects. Physiotherapy can lead and support care focused on aging and chronic disease complexities, Long COVID, and non-pharmacological pain management.

Since physiotherapy is already embedded into the Canada Health Act, physiotherapists are in a unique position to do more — right now. Optimizing the use of their expertise by better incorporating their distinct skills through innovative care delivery solutions is an expedient way to help improve system capacity across Canada[i].

Physiotherapy professionals can help reduce strain on health care delivery and increase system capacity now.

Our specific recommendations for the federal government stem from the position that the easier it is to access physiotherapy, the stronger our health care system will be, now and in the future.

Physiotherapy Can Support The Evolving Health Needs Of Canada’s Population

Over the next twenty years, the number of Canadians aged sixty-five and older is expected to grow by sixty-eight percent, to 10.4 million[ii]. Additionally, projections estimate that by 2030, nine million Canadians may be living with chronic pain[iii]. Together, these factors will amplify the urgent need for health professionals from all disciplines to work together to treat and support the evolving needs of Canada’s population.

Quick Fact: There are 26,019 physiotherapists licensed to practice in Canada

A recent survey showed that 93% of seniors prefer to stay at home with additional care and support than move into long-term care institutions[iv]. Providing direct access to physiotherapists at the primary care level, including by enhancing access to in-home physiotherapy, prevents and delays long-term care placement, and allows Canadians to live longer in their homes and communities, and to continue to be active participants in the economy[v] [vi] [vii] [viii]. It also helps improve quality of life, lower total medical costs, and reduce hospitalization and hospital lengths of stay for those living with chronic pain[ix] [x] [xi] [xii].

At present, the practice of integrating physiotherapy services into inter-professional or family health teams (FHTs) in publicly funded settings is not common in Canada. This is considered a gap in care provision, one that Canadian family physicians also identify as a barrier to accessing publicly funded physiotherapy care[xiii]. But integrating physiotherapy care into new models of practice, such as FHTs, will depend on sufficient financial investments and support from political tables. The Canadian Physiotherapy Association encourages governments to work with us and other professional organizations and decision-makers to facilitate this needed change.

Long COVID

It is estimated that Long COVID may affect more than one million Canadians[xiv]. The WHO presumes that ten to twenty percent of people who acquire COVID-19 will experience mid-and long-term sustained and potentially episodic health-related challenges as they recover[xv].

Per the 2022 WHO guideline, physiotherapy is well-positioned to lead and support Long COVID rehabilitative care[xvi].

Many governments and citizens are understandably exhausted by pandemic life and would like to put COVID behind them. However, governments need to consider the effects of Long COVID on our population, health systems, and economies and begin to integrate the diagnosis and treatment of Long COVID into our existing health, research, and social structures.

This means recognizing Long COVID as a disability and providing a support system for those who suffer from Long COVID and cannot work. Canadians need enhanced investments in research to better understand and treat Long COVID so that those who experience it can access timely, quality care. A harmonized national framework for standardized education, clinical care, and data collection would help to support robust Long COVID intervention[xvii].

Finally, the government should provide targeted funding to increase access to physiotherapy care[xviii] [xix] to support rehabilitation for those living with Long COVID. Working with physiotherapy professionals to create a national framework for Long COVID rehabilitative care and delivery that is person-centred, evidence-informed, localized, timely, and accessible for Canadians in need of care will help prevent, address, and mitigate disability and enhance health outcomes.

Pain Management

Canada is in the midst of a national opioid crisis that is affecting families and communities across the nation, highlighting the urgent need to bolster non-pharmacological pain management in Canada. Now more than ever, Canadians need evidence-informed support to navigate the complexities of pain. Subsidizing greater access to physiotherapy care can help address this need.

Quick Fact: pain-related disability[xx] is the leading type of disability according to Statistics Canada[xxi]  — it is a costly public health emergency affecting nearly eight million people across the country.

Chronic pain disproportionately affects the poor in Canada, who are not able to afford therapy or cannot access it with ease close to home. Canadians must have “access to pain management without discrimination”[xxii]. Leadership across all levels of government is required to support appropriate, consistent, and equitable pain care in Canada.

Physiotherapists are best positioned to answer the calls to action included in the Canadian Pain Task Force Report, as they offer the best evidence of non-pharmacological, compassionate, and person-centred chronic pain care.

Student Assistance

Simply put, Canada is not graduating enough physiotherapists to support the evolving health needs of Canada’s population. Currently, the Government of Canada Job Bank estimates that from 2019 to 2028, there will be 13,600 new job openings for physiotherapists[xxiii], paired with only 11,300 new job seekers (arising from school leavers, immigration, and mobility). Unfortunately, there will not be a sufficient supply of physiotherapists to satisfy the dramatic rise in demand[xxiv].

While the opportunities for physiotherapists in both public and private practice are fulfilling, there needs to be more attention paid to enticing new entrants into the health system. That begins with providing support for the extensive education and training physiotherapy students undertake to be professionally certified.

The CPA welcomes discussions of the Canada Student Financial Assistance (CSFA) program being expanded to additional professionals in the coming year[xxv]. Physiotherapy is a natural choice for expansion, as it would reduce the financial burden on physiotherapy graduates, entice new entrants into the system, and provide upstream solutions to the health human resource shortage.

It would also help support better access to care in rural and remote areas of the country, and in turn, advance the Canadian rural and economic development strategy[xxvi]. Physiotherapy care in rural and remote areas remains largely inaccessible[xxvii]. Expanding the CFSA program to include physiotherapists would provide Canadians with greater access to timely, high-quality, preventative physiotherapy care no matter where they live.

Expanding the CFSA to incorporate physiotherapy students should be the next step in evolving the program, and there would be no better time to announce this than the 2023–24 Federal Budget.

Conclusion

Physiotherapy professionals have multi-dimensional expertise that can be optimized to help relieve the current health care crisis and support the sustainability of our health care system.

Especially for underserviced and underprivileged populations who experience major obstacles to care, physiotherapy has the potential to alleviate pain, increase mobility, and ultimately provide a better
quality of life.

With the health care system under significant strain, now is the time to deploy innovative solutions and care models that will support Canadians’ immediate health needs. The physiotherapy sector can help maximize system capacity and act as a solution-oriented partner to lead and support Canada’s equitable pandemic recovery.

About The Canadian Physiotherapy Association

The Canadian Physiotherapy Association (CPA) represents physiotherapy professionals, including registered physiotherapists, physiotherapist assistants, physiotherapy technologists and students across Canada. Physiotherapy professionals provide essential rehabilitative care and treatment, enabling Canadians to live well and actively participate in all facets of their lives.

References

[i] Conference Board of Canada. (March 2017). The Role of Physiotherapy in Canada, p. iii Retrieved online:
[ii] Canadian Institute for Health Information. (2022). Canada’s Seniors Population Outlook. Retrieved online: https://www.cihi.ca/en/infographic-canadas-seniors-population-outlook-uncharted-territory#:~:text=Over%20the%20next%2020%20years,sits%20at%20about%206.2%20million.
[iii] Canadian Pain Task Force Report: March 2021. Chronic pain is taking a massive economic toll. Retrieved online https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2021.html
[iv] Campaign Research Inc. (2020). https://static1.squarespace.com/static/5ed5ba488f3def4cae17ed81/t/5f2c7b3ba3553d76af3a0b9a/1596750653006/Home
[v] Ibid.,
[vi] VenderBent S. (2019). Stronger Care at Home, Better Health Care for All Ontarians. Home Care Ontario.
[vii] Mitton G; Dionne F. (2012). Valuation of Physiotherapy Services in Canada; CPA report using MCDA analysis for determining the value of physiotherapy services.
[viii] Canadian Physiotherapy Association (2012). The Value of Physiotherapy: Home-Based Physiotherapy.
[ix] Riley, S. et al. (2016). Retrospective analysis of physical therapy utilization by the specificity of the diagnosis and order written on the referral. Physiotherapy Theory and Practice. 32(6): 461-467. Retrieved online
[x] Demont, A. et al. (2019). The impact of direct access physiotherapy compared to primary care physician led usual care for patients with musculoskeletal disorders: a systematic review of the literature, Disability and Rehabilitation, DOI: 10.1080/09638288.2019.1674388.
[xi] Bornhoft, L. et al. (2019). Health effects of direct triaging to physiotherapists in primary care for patients with musculoskeletal disorders: a pragmatic randomized controlled trial. In Ther Adv Musculoskel Dis. 11: 1–13. DOI: 10.1177/1759720X19827504
[xii] Cieza, A et al. (2020). Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systemic analysis for the Global Burden of Disease Study 2019, p. 1-2. Retrieved online: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32340-0/fulltext#%20
[xiii] Deslauriers, S., Toutant, M. E., Lacasse, M., Desmeules, F., & Perreault, K. (2017). Integrating Physiotherapists into Publicly Funded Primary Care: A Call to Action. In Physiotherapy Canada. Physiotherapie Canada, 69(4), 275–279. https://doi.org/10.3138/ptc.69.4.GEE
[xiv] CADTH. (June 1, 2022). https://www.cadth.ca/news/cadth-host-national-roundtable-models-care-long-covid
[xv]  World Health Organization. (December 2021). Retrieved online: https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-(covid-19)-post-covid-19-condition
[xvi] World Health Organization. (Sept 16, 2022). Clinical management of COVID-19 – Living Guideline. Retrieved online: https://www.who.int/teams/health-care-readiness/covid-1
[xvii]  Dr. Emilia Falcone, Canada Research Chair. (June 13). Retrieved online: https://www.ourcommons.ca/DocumentViewer/en/44-1/HESA/meeting-26/evidence 
[xviii] Ibid.
[xix] Decary S, Dugas M, Stefan T, Langlois L, Skidmore B, Bhéreur A, and LeBlanc A. (2021). Care Models for Long COVID – A Living Systematic Review. First Update – December 2021. SPOR Evidence Alliance, COVID-END Network.
[xx] Statistics Canada. (July 5, 2016). Canadian Survey on Disability, 2012, Pain-Related Disabilities Among Canadians Aged 15 years and older, 2012. Retrieved online: https://www150.statcan.gc.ca/n1/pub/89-654-x/89-654-x2016007-eng.htm
[xxi] Ibid.
[xxii] Ibid.
[xxiii] Ibid.
[xxiv] Conference Board of Canada. (March 2017). The Market Profile of Physiotherapists in Canada. Retrieved online: https://physiotherapy.ca/sites/default/files/8695_profile-of-physiotherapists-in-canada_br.pdf
[xxv] Government of Canada. (April 7, 2022). 2022 Budget: https://budget.gc.ca/2022/pdf/budget-2022-en.pdf
[xxvi] Prime Minister of Canada. (Dec. 16, 2021). Mandate Letter: Minister of Rural Economic Development. Retrieved online: https://pm.gc.ca/en/mandate-letters/2021/12/16/minister-rural-economic-development-mandate-letter
[xxvii] Canadian Physiotherapy Association. (January/February 2022). “A Look at Physiotherapists in Canada, 2020”. In Physiotherapy Practice, p. 16. Retrieved online