REP 22 - No room for complacency
This post was originally published in Physiotherapy Practice (Volume 6, Issue 6) on November 8, 2016 and can be accessed here.
This issue of Physiotherapy Practice focuses on the current state and future evolution of the physiotherapy and rehabilitation market. For many of you, this is not a subject at the top of your list of interesting things to talk about.
After all, providing good health care is a ‘here and now’ business: your clients’ needs are immediate and typically acute.
Yet one of CPA’s most important responsibilities is to assess demand for physiotherapy services within a rapidly changing health care system. Demand is shaped by the irresistible forces of demographic and cultural change, and the seemingly endless cycle of health care system reform.
Members who understand their impact are prepared to respond to change in the coming years. Physiotherapy jobs of the future won’t be the same as today, just as today’s work force looks much different than it did 30 years ago.
As a profession we are used to change, perhaps more than any other health profession in Canada. Education, practice, regulation, gender mix, workplaces and remuneration are significantly different.
Will this pace of change continue? There is evidence and arguments throughout this magazine that say ‘yes’. The Conference Board of Canada report confirms some important trends.
Physiotherapy services have increased by roughly 3.8% annually. Services continue to shift to the private sector as a result of direct access and delisting. Physiotherapy employment is essentially full.
The report also identifies a host of other health service providers that occupy a portion of the mobility and rehabilitation services spectrum.
We can draw some basic conclusions: demand will grow at an increased rate based on increased demand from an older population with expectations of ‘healthy aging’. Unemployment will remain very low for several more years. Services will continue to shift to more open markets, typically privately paid, autonomous physiotherapists working in teams.
These are promising trends for the profession, but there are challenges that must be acknowledged and addressed.
In the very short term, we need to manage high demand without compromising care or suffering caretaker burnout. We must guard against high-margin, low-quality services designed to reduce wait lists at the expense of good outcomes.
We need to manage the ‘dehospitalization’1 of our health care system, where services are shifting from large hospitals to community and home-based care. We must ensure that patients have full access to necessary rehabilitation services within these new models of care.
Another, longer term responsibility is planning for increased competition. Markets constantly correct imbalances. When demand for services goes unmet, other providers and alternate services emerge.
In addition, public and private payers constantly strive to reduce service costs. Timely, quality service at lower cost: that is our ongoing reality. We are well-equipped to compete in this environment, but we will fail if we are complacent.
Today, chiropractors, massage therapists, athletic therapists, and kinesiologists claim to offer similar services to physiotherapy, and even use the word in jurisdictions where the practice term is not protected by regulation.
Notwithstanding the frustration we rightly feel when our hard-earned reputation is borrowed by others, the more important question is how best to manage our competitive position in the mobility services market.
In one sense we are at a disadvantage. Physiotherapists are licensed, therefore our labour force is restricted. This drives up our unit cost of labour.
Kinesiologists and athletic therapists are, for now, mostly unlicensed, therefore their services are generally less expensive.
It is difficult to clearly identify their specific areas of expertise since national qualification standards don’t currently exist. Yet payers and clients are attracted to these providers due to lower cost and no restriction on the claims they can make of the value of their services.
Physiotherapy would appear to be at a disadvantage in competing on the open market for the self-directed client seeking exercise advice.
Physiotherapy’s strength is the extensive understanding of mobility impairment due to a pathological condition. No one else in Canada is as thoroughly trained to assess mobility impairment and prescribe therapeutic exercise.
Is there an opportunity to build consensus around this? Could we engage with athletic therapists, kinesiologists and others to define the optimal referral model?
Today, the non-licensed fitness community is not sufficiently organized across Canada to achieve this goal.
However, we see licensing models emerging in Ontario, and being contemplated in other provinces. This may be the optimal time to proactively lead the establishment of a referral model by consensus, rather than arbitration within the health regulation bureaucracy.
These trends create considerable pressure on our profession, but there are several resulting opportunities for physiotherapy.
Our ability to diagnose and our understanding of pathology mean we are well placed to lead mobility and rehabilitation teams. As noted in Fred Horne’s article, we anticipate that Canadians will demand access to a full slate of services provided by care teams that focus squarely on patient needs, use electronic health records to facilitate transitions between providers, and measure outcomes in order to demonstrate effectiveness.
‘Bundled care’-style payment is becoming more prominent, where the dollars follow the patient. The old fee-for-service models are changing. More and more patients will pay for an outcome, rather than a service. Physiotherapists who understand these trends will be well-placed to respond with clear outcomes at reasonable cost.
Rather than compete interprofessionally, we can anticipate collaborative work consulting with family physicians, referring to other exercise specialists, and supporting treatment of complex care patients.
This team approach, where the patient receives care from the right provider based on their needs, is becoming more entrenched across all areas of health care.
Will it also apply to private orthopaedic physiotherapy?
The trend may take several years to significantly change our traditional private practice model, but we would do well to pay close attention, and increase our capacity to adapt.
1 A term used by the Canadian Medical Association to define prioritization of primary health care above hospital-based services.
Shared from Physiotherapy Practice Fall 2016
Over to you
- Do you agree, disagree with the above ideas? What’s your take?
- What are some additional concerns you‘ve noticed in the physiotherapy profession?
- What opportunities do you see for your profession?
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