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REP 30 - The cool down

Thank you for being part of #30Reps 2017. Sometimes, these kinds of conversations can be difficult. The functions of professional associations are to provide leadership, opportunities for education and to assess a changing landscape that may affect the profession.

The decision to engage the membership in a discussion about risks to the reputation of physiotherapy was based on regular member inquiries related to areas of risk, changes in the insurance industry that are increasingly focused on fraud, abuse and waste, and media reports that identify practices that could negatively impact the professional as a whole.

We recognize that CPA’s role is to advance the profession of physiotherapy in order to improve the health of Canadians. We believe that part of that role includes asking tough questions. By doing this, we understand that we have touched a nerve. Some of you have commented on “yellow” and “red” reps saying that these examples were upsetting to read about. Many of you have never found yourselves in situations like those that were presented. That’s great. Unfortunately, some have...

Our profession’s commitment to ethics and professionalism is what makes us strong. Over the last 30 days, we have been reminded on a daily basis how passionate and committed the physiotherapy community is to upholding a positive reputation that is built on solid clinical reasoning and evidence-informed practice.

You have demonstrated this through your unprecedented engagement that took place below almost every rep. Thank you for joining the conversation and adding your points of view.

As the last post in #30Reps, we are concluding with a collection of tools to support you, and an additional opportunity to engage with colleagues in a conversation about ethics and professionalism:
 

  • Ethics and professionalism toolkit: We recognize that some members seek support to make good decisions in bad situations. This toolkit helps you work through six steps in order to take action. There are extra readings and resources included under each step.
     
  • Tweetchat: Log in to Twitter, Tweetdeck, TweetChat or Hootsuite to join the conversation using #30reps on March 31st from 12-1 EST.

New to tweetchats? Here are some tips from #physiotalk.
 

Here are the questions to be covered:

  1. How do you demonstrate ethics and professionalism in your practice?
  2. Can you describe how you have engaged or mentored colleagues about ethics and professionalism in health care?
  3. Which reflection and decision-making tools and techniques do you use when confronted with a challenging issue?
  4. What safeguards do you have in place to prevent fraud, abuse and waste?

The next step will help CPA better meet the needs of our members and the profession as a whole. We encourage all participants of #30Reps to answer a short survey. Your answers will be kept confidential. The aggregated information will help CPA to plan future education and advocacy activities.

 

If you prefer to contact us directly, send us an email to manderson@physiotherapy.caclauzon@physiotherapy.ca or koconnor@physiotherapy.ca

 

Thank you for participating in this “workout” with us. We’ll only be stronger for it. 

 

 

#30REPS 2017 is brought to you by:

 

 

Read more #30REPS

Comments

I have really enjoyed reading all of these.  I was shocked at some of them though.

Well done and thank you.

 

Thanks to CPA for these very interesting and sometimes provocative #30REPS. They were very good reading, as were the many comments that followd each one.

While several comments suggested CPA shouls not be doing this type of "being aware" campaign, I disagree. Yes, the regulatory bodies in Canada are the ones who "police" us if we do wrong. Their mandate, however, is to protect the public, and often we feel they do not look out for us - their registrants. But they do look after us by making sure we practice ethically and appropriately. What CPA has done with these #30REPS is to simply reminded us of the need to be aware of our own practices and behaviours, and to always practice ethically and professionally so we don't get in to trouble with our Colleges.

Personally I am confident that our profession is NOT "behaving badly" overall, even though there are some sketchy things going on out there. Thanks to CPA for making us take a second sober look at our profession and how it operates.

I found these reps stimulating,& thought provoking and look forward to the next time the reps appear.Just another value added reason to be a member of this professional association

I think it was REP27 that really got me thinking. It was one with a new grad describing their interaction with the clinic manager about profits and expectations. I myself am a clinic manager now with alot of support through my upper management to run a small town clinic that has stuggled in the past.  I can say now that financially we are in a good spot but it wasn't easy.  I remember being a new grad working at this clinic and I too struggled with the expectations of the 'metrics' we tried to achieve. I graduated from McMaster and I can honestly say it did nothing to help me navigate the vast 'outpatient ortho' clinic landscape from the business side of things. I recall we had 1 class about creating a business plan for a new start up but it was combined with OT's and generally useless. My final project requires a business plan and my expenses were 10 items. I had no clue what owning/ running a clinic required. Now my financial sheets I see have over 100 items.  The bigger problem is that without a proper knowledge of the business side of physiotherapy we are naive to how the world works because every business needs to make a profit for the doors to stay open and PT is no different. The problem with a PT clinic is that the way it makes profit is usually from seeing patients and providing care.  Ultimately we have to strike a balance between seeing enough patients in a day/week/month/year to cover the costs. And unfortunately the costs are continually going up (rent, utilities, internet, wages) but the amount we charge for PT is decreasing; WSIB changing from a fee for service to 8 week POC, MVA adding the MIG, and the general cutting of paramedical health benefits /TP benefits. These changes are making it harder and harder to make a viable PT business work and I'm sure other PT's feel the same way.  I think there is a stigma of new grads entering the workforce about the business side of their profession which hinders us as a whole. It allows unethical people to take advantage of the uninformed new grad because they have entered the 'grey area' due to financial pressures. If we were more informed in school we can make better choices.  I dont think there is anything wrong with graduating with the tools needed to understand the business of physiotherapy and that confidence could go a long way to ensuring we can identify shady deals and run a clinic within the ethical boundaries of our profession.  I think the addition of a private practice division in the CPA is a start but the tone and messaging from the CPA is still negative towards making profit in physiotherapy.

I currently have a student intern from Europe and part of his four month student internship, initiated from his university, is to do a business project that will or could actually be implemented. Interesting and valuable I believe.

I will admit that I read the reps every day and shared some of the days reps with staff and collegues. Having said that, I will toot our own horn and say that the majority of the reps ( 25/30) were relevant to our profession but seemed like "no brainers".

We have a great profession which should be held to a high(er) standard. Thanks for you work.

I agree with the 'no brainer' comment. This is not the usual high standard of communications coming from CPA. It is assisting in dumbing down the profession of physiotherapy which has had a very high public profile for a long time. It is presenting the profession in a bad light and furthermore putting the idea into our heads to 'suspect' that our clients are trying to de-fraud (i.e. REP 4: organized crime in rehab). I would suspect that this is a very rare situation. Do you have any statistics on this? Where did the idea for all of this come from? maybe the third party payers who are trying hard not to pay for physiotherapy services for their genuinely entitled clients?

If you want to do this again next year, I suggest you reduce the number of REPS drastically (i.e. to 4: once a week for 4 weeks) and put a lot more thought into what you are sharing. You are at risk of losing your longstanding membership base.

For addressing the ethical issues, I suggest you consult with an ethicist so that you are actually providing the membership with accurate information. Many public healthcare organizations have Ethical Frameworks that they follow and Ethics Services that they can consult with to work though these difficulty situations with the help from knowledgeable professionals. Possibly promoting Ethical Decision-Making Continuing Education courses would be an idea.

I appreciate that you have put effort into this campaign however for me it has turned me off CPA, and I don't believe that was your purpose.

 

I have appreciated reading the reps. Even if we haven't found ourselves in those situations, we need to know that these things are going on. We should all want to be a part of improving the ethics of our profession, and that includes helping to correct those who step out of bounds. Thank you for the work you put into this. 

This has been a great series. Lots of food for thought and discussion!

The second "season"  of  30 Reps has been thought provoking.  Thank you so much for bringing all this valuable information to the membership.

The one thing I have found interesting through all these blogs is that there was a lot of discussion about our profession maybe looking a bit beyond the "bottom line," and remembering that in order to have a good business, you have to give your clients good experiences (REP 25).  There was discussion about how we will have to be be "carefully creative" in how we can generate and bill clients, yet my concern was there was too much talk about farming out our own skills to other health professionals (Rep 22) who may cost less in order to do this.  I'd like to see our associations (and ourselves as professionals) step up and advocate more, so that instead of losing our status within the health care model, we improve it.  My understanding is that in Australia, the physios are the next step down from physicians - and are paid accordingly.  Rightly so, as we have a unique skillset that transcends many areas - cardioresp, neuro, MSK, pediatrics, etc, etc - plus the ability to assess, DIAGNOSE and apply appropriate evidence based treatment programs.  We shouldn't be selling ourselves short by giving these skills to other professionals to perform at a cheaper rate.  While it may be a boon to business models, it does nothing for our own profession.  I would like to see our associations step up and promote the client centred formula - which it seemed many of the commentors followed, versus the big-box style health care delivery that seemingly CPA is backing (see Physiotherapy Practice Vol 6, No 6, Holiday 2016).  I'd like to see more support for the independent owner-operated clinics whose focus is generating an income from giving good care and achieving patient satisfaction, versus providing outcomes that make the bottom line look good, but may not include patient satisfaction (which when you think about it, is what will drive your bottom line).  At the very least CPA should not be in a position to back a certain style of physiotherapy clinic ownership/management as was indicated in that Practice edition.

As a busy clinic owner who also maintains a large caseload I skipped over these emails until this weekend, when I finally read them all through in one long sit...Wow!  Very worthwhile, obviously provoked much discussion, if not all of it positive, but that was the most interesting part.  We are spread over this vast land, and many of us do not attend provincial or national meetings, Congress etc...but here we all had a voice, and thanks to anonimity, spoke freely and candidly.  No travel required!  We all face similar issues.  Thank you, CPA, for stimulating this engagement, this wide communication.  How can that be a bad thing?  And for some, perhaps the discomfort felt at reading some of the Reps came from a hard look in the mirror.  If we want to rise above the rest of the players looking for a piece of the health care pie, this discussion needs to happen.  Can;t wait for the next one...and can one access the first one somehow?  Seems I did not notice that one!

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