Responding to the Study of Labour Shortages, Working Conditions, and the Care Economy

Submission to the House of Commons Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities

Summary

Over the next ten years, the growth in demand for physiotherapists in Canada will outstrip the number of new job seekers entering the profession. The labour shortage in the industry will continue to persist at a national level, and the aging population, coupled with longer life expectancy, means the demand for health professionals, including physiotherapists, physiotherapy technologists and physiotherapist assistants will sharply increase. This will result in a reduced availability of physiotherapy services, for a profession that is already experiencing burnout and exhaustion. Unfortunately, this experience for those working in the industry has been compounded by the impact of COVID-19 on the Canadian healthcare system.

The Canadian Physiotherapy Association (CPA) recommends the following:

  1. Design a targeted and comprehensive strategy for investments in rural, remote, and northern areas to increase access to physiotherapy in underserviced communities and people.
     
  2. Adopt a targeted and focused approach to improve access to physiotherapy services, including:
    • Incentivising physiotherapists to be recruited and retained in rural and remote areas of Canada by extending Canada Student Loan forgiveness to physiotherapy practitioners.
    • Making permanent the temporary removal of the referral requirement for coverage of physiotherapy services from the Public Service Health Care Plan (PSHCP).
    • 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.
       
  3. ​Better integrate physiotherapists into the broader 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.

About

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 treatment of injury and disease. In partnership with provincial and territorial Branches and practice Divisions, the CPA enables members to learn, share knowledge and enhance practice. The CPA provides resources, education, ideas, and advocacy to enable our professional community to serve Canadians better.

Recommendations

As part of the CPA’s mission to ensure equitable access to physiotherapy in Canada and support our members, we are committed to working with the government to address these issues in our sector. We ask the committee to consider the following recommendations.

  1. 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.1 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.2

    • Indigenous communities, especially those based in remote northern areas, have experienced a staggering increase in the burden and severity of COVID-19 illness; and continue to simultaneously contend with disruptions in health care services, including physiotherapy.3 While telehealth and telerehabilitation 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 telerehabilitation services.4
       
  2. Adopt a targeted and focused approach to improving access to physiotherapy services, including:
     
    • Incentivising physiotherapists to be recruited and retained in rural and remote areas of Canada by extending Canada Student Loan forgiveness to physiotherapy candidates. 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.5
    • Making strategic investments to broaden telerehabilitation services in disconnected Indigenous communities and improve access and coordination of rehabilitation services for those residing in Canada's rural, remote, and northern areas.6
       
  3. Better integrate physiotherapists into the broader 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.
     
    • Physiotherapists continue to be vital 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.7
    • 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 shortages8 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.9
    • Currently, no clear or consistent national approach exists 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.10
    • 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.’11

We believe it is critically important that these issues and our recommended solutions be considered, not just for the physiotherapy industry in Canada but also for Canadians’ well-being and to strengthen the current healthcare system.

The CPA is pleased to provide these recommendations to the Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities (HUMA) as it prepares recommendations to the federal government on building a robust and accessible workforce that will be better prepared for risks from COVID-19, future pandemics and supporting the care economy professionals. We look forward to continuing engagement with HUMA on these key concerns.

 

 

1. Conference Board of Canada. (2017, March). The Market Profile of Physiotherapists in Canada. Retrieved online: https://physiotherapy.ca/sites/default/files/8695_profile-of-physiothera..., p. 39.
2. Ibid.
3. CPA. (2020, December). Magnifying Inequities: Reflections on Indigenous Health and Physiotherapy in the Context of COVID-19. https://physiotherapy.ca/blog/magnifying-inequities-reflections-indigeno...
4. Ibid.
5. CPA. (2022, March). Responding to the Study of Canada’s Health Workforce – Submission to the House of Commons Standing Committee on Health. Retrieved online: https://www.ourcommons.ca/Content/Committee/441/HESA/Brief/BR11673677/br... p. 7
6. CPA. (2020, December). Magnifying Inequities: Reflections on Indigenous Health and Physiotherapy in the Context of COVID-19. https://physiotherapy.ca/blog/magnifying-inequities-reflections-indigeno...
7. CPA. (2020, August). CPA HESA Submission. Retrieved online: https://physiotherapy.ca/sites/default/files/hesa_aug31_final.pdf
8. Government of Canada. (2022). Job Bank: Physiotherapist in Canada. Retrieved online: https://www.jobbank.gc.ca/marketreport/outlook-occupation/18214/ca
9. 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...
10. 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-profe...
11. 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-Suppor...