Why is the College such a lousy advocate for PTs?

Hi Everyone—the headline is a trick question. We aren’t advocates for physiotherapy or physiotherapists at all. We aren’t even allowed to be.

The legislation that creates the College of Physiotherapists (and all the other health colleges in Ontario) gives us our power but also limits our power. It creates the College for the purpose of regulating physiotherapists in the public interest. There is nothing in there about assisting the profession to ensure that more patients receive public funding, nothing about assisting PTs to obtain a broader scope of practice, and there isn’t anything that says that we can stop other health professionals from delivering physiotherapy.

It’s understandable that people get confused about the role of the College. Historically, when people began to train to deliver specialized skills, they established guilds. The point of the guilds was to set standards to keep quacks out because quacks stole business from the real professionals. The best way to protect the business was to make sure that the real members of the guild met entry standards to get into the guild and then met performance standards in their work. A person who needed a bricklayer, for example, could count on a guild member to build a house that would not fall down and squish the babies in their sleep.

In a way, we are not so far from that today—the College still sets entry requirements and ensures ongoing quality—but the promotional aspects of the guild (that is, the advocacy part) have been separated from the rule-making activities and now belong to the Association.

There is sometimes overlap in our activities. A recent example is the work we did together to provide webinars about the practical application of the funding revisions. From the College’s perspective, we needed to educate physiotherapists about the rules and expectations surrounding the delivery of care under the new model. From the Association’s perspective, they wanted to offer support and education so that PTs could make the most of the new model.

So does the College do anything to help the profession? We think that we do. First, we collect information from you to establish what you expect of your peers. From this information, we set out standards and guidelines for all PTs. We educate and advise about the standards and, in worst case scenarios, we investigate and prosecute their violation. And what does that do for you? It ensures that a patient who needs a physio can count on a College registrant to offer safe ethical care. And that preserves and promotes the profession. But that’s as far as we can go.

Sometimes some of you make comments on the blog, or e-mail me (thank you, I am always happy to hear from you) and you are disappointed because we do such a lousy job of advocating for you. I’m sorry about that—sometimes I wish that we could do more because I believe so strongly in the value of the profession—but that’s not our job.

23 thoughts on “Why is the College such a lousy advocate for PTs?

  1. Thanks for the reminder on the role of the CPO vs. CPA/OPA. Diana Hopkins-Rosseel did a great job of delineating these differences in our Professional Practice course at Queen’s but, as the years go by, it’s something that one forgets.

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  2. What is the use of such blog, if college does no changes to its ‘system’ and physiotherapists inspite of doing a good job and being so passionate about patient care are pushed into corner by other non-professionals who can use all tactics for ads, endorsements etc. to promote their practice.
    After so many comments from so many physiotherapist giving suggestions has college taken any concrete steps. for example ‘allowing testimonials’.
    I am sure after a decade we will have so many over lapping practices who will give ‘physiotherapy’ that we so called the protected, the regulated ‘physiotherapist’ will struggle to exist!
    you say that ‘We educate and advise about the standards and, in worst case scenarios, we investigate and prosecute their violation. ‘
    Whom do u investigate??? A chiro or a non-professional …..NO…..!
    and i think the % of PTs doing wrong things are pretty low. Its mostly other clinic owners who do all sorts of unethical practices and sometimes the poor PT working there does not even know if his/her boss is feeding someone with money to get the patients in.

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  3. The College is not a lousy advocate for PTs, the College is rather lousy at making the rules for its own profession compared to other health professional colleges. What is the point of setting entry requirements and ensuring ongoing quality if those requirements and quality can be delivered by other health professionals? What kind of an image is that to send to the public? So that you are a regulated health professional but the health care you are providing is not regulated? If the College can’t stop other health professionals (such as chiros) from delivering physiotherapy, should physiotherapists be allowed to provide chiropractic care then?

    If the College is looking into regulating the clinics, the “clinic regulation” part should come after a revised profession regulation. In order to do that, the College should look into the rules and regulations and find a way to establish a specific and unique role for physiotherapy in the continuum of care.

    It saddens me to have patients tell me that they are getting “physiotherapy treatments” from a chiropractor for an elbow injury and they think that we are interchangeable. By establishing a unique role in the continuum of care, each profession should have their own expertise. If a physiotherapist is a regulated health professional, what exactly is regulated? Is it the title of reg. physio or is it what a physio can do? Why there are “health clinics” or “rehab centres” that would provide chiropractic and physio treatments to the same patient for the same condition within the same course of treatment using the same techniques? If the profession as a whole is strictly regulated, the definition of physiotherapy will be clearly defined and only physiotherapists (or personnel under the supervision of a physio) can provide physiotherapy. It’s like when you want to hire someone to fix the roof of your house, you’d want somebody who’s actually a roofer, not a plumber who happens to know how to fix the roof. After all, physiotherapists should be the “experts” in physiotherapy itself, and chiropractors should be the experts in chiro, but before we can call ourselves experts, we should clearly define what exactly we are an expert in. This is where the College would help if it starts looking into the rules and regulations to: (1) clearly define what physiotherapy is and what it’s not, (2) differentiate physiotherapy from other health professions, and most importantly (3) establish a unique role for physiotherapy in the continuum of care in the outpatient setting. The public should also have sufficient sources to know what they should expect during the course of physiotherapy treatment vs chiropractic treatment. It should then be up to the patient to make an educated decision in terms of what kind of health care s/he should get. It’s good to have multidisciplinary clinics (RMTs, Kins, trainers) as long as they all have a specific role and provide a specific medically-oriented treatment that would progress the patient towards the goals, but if you mix two very similar ingredients like physio and chiro into the system at the same time, without even going into the business side of it, from a patient’s perspective, it’s like mixing meds like taking pain killer and anti-inflammatory at the same time in an attempt to fix a migraine headache. If physiotherapy clinics are to be regulated so only registered physiotherapists can own and operate one, will a physio be able to hire a chiro to provide chiropractic at all? If no, there will be physio-owned physiotherapy clinics and chiro-owned chiropractic clinics, but what if the chiro is still able to provide physiotherapy at that point?

    If the College can’t stop other health professionals from delivering physio now, is there a way to better educate the patients so they would choose wisely? If the advocacy part belongs to the Association, the College and the Association should overlap the activities once again. The association should look into a better model of advocating for PTs and physiotherapy as a profession while the College starts looking into the rules and regulation to better protect the PTs and physiotherapy as a profession. I’m always seeing TV commercials from the College of chiros on how chiropractic can help but I rarely see one for physiotherapy. Educating patients to choose wisely would in turn make shady clinics go out of business on their own, and by that time, it will be much easier to regulate the clinics and the profession as a whole. If the legislation creates the College for the purpose of regulating physiotherapists in the public interest, isn’t that in the best interest of the public to have the most effective physiotherapy care, delivered in the most professional way, by a registered physiotherapist?

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    • Well said with several great suggestions on definitions, protection and action that should be taken. It’s interesting to me that OHIP PT was reformed because the Ministry – supported by the OPA – deemed that small group physiotherapy sessions were not actually physiotherapy. Now I regularly hear restorative aides in LTC say that they do “physiotherapy” and the retirement homes list the new group exercise classes as “physiotherapy” – it gives the perception that the retirement homes provide physiotherapy services to their clients when, in fact, they don’t. I agree that the old OHIP system needed reform but at least with the old model a Registered Physiotherapist and a supervised PTA were somehow involved in the process. Is there no way to protect the term “physiotherapy”. Can we more aggressively promote the concept that someone saying they do physiotherapy certainly doesn’t mean he/she has the skills, training and expertise of a physiotherapist?

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  4. The name “College” implies that this institution represents the profession and those in it. By your explanation the name should be changed to THE PHYSIOTHERAPY REGULATORY BOARD OF ONTARIO. This would remove any confusion as the role and obligationof this institution.

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  5. How very unfortunate it is to read such negative comments. Perhaps these people need to review the history of physiotherapy in this province. Go back to the days before self-regulation. Without self-regulation and the standards set out by our College we would not be recognized as a profession. We would still be required to practice only with a physician’s referral. Extended health plans would not pay for our services. It is a privilege to be self-regulated professionals!!

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    • —to the above poster—
      I generally agree with the June 12, 6:29pm reply (well said!).
      Of course the College has been instrumental in the forward momentum of our profession. Most people would agree that self-regulation has been aided by the standards (usually) enforced by the CPO. History doesn’t lie.
      However the past is the past. Times change and our healthcare industry as fast as any other segment. The College needs to adapt to these changes in order to maintain relevancy, and to truly serve patients in Ontario. The profession of physiotherapy is being “down-graded”, becoming more obsolete , let alone advanced, or even maintaining status quo. Like a business that refuses to update their Operating Systems and keeps on using Windows 95. Like my father who still record shows on his VCR, then later complains that he can’t find the show he’s looking for.
      Funny? Not really. It’s our livelihoods at stake.

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    • What cave have you been practicing in? I provide OHIP based physiotherapy…I must have a doctors’ referral to see the patient. The College is supposed to be looking after the best interest of the public-how is needing a medical referral in that “best interest”? A few years ago the College was quite happy to brag how legislation was coming into place in regards to physiotherapists being allowed to do diagnostic testing i.e. ultra-sounds, CT-scans etc. This was cancelled without barely a peep from the College (coincidentally with settlement of the Province and OMA on the new doctors contract). it strikes me that if you are going to advocate for the public, you actually should do it.

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    • yes, college has done and should continue to do more for the public/physiotherapist. after all aren’t we paying over 600.00 each year to them?

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  6. I like the regulation and all the rules we think day and night about how to regulate this profession , but the real harm is done by the non professionals and other professional who openly say that they can practice physiotherapy eg chiropractors.

    I sometimes wonder is this “”self regulation or self destruction.””
    If we go in this blind path of self-praise that we are amazing. our grand kids will read in wikipedia that physiotherapist were a extinct profession who had to study almost like MD and were paid less than auto mechanic or electrician, soon they become extinct.!!!

    I praise shenda for opening this dialogue to have honest discussion, but OPA must have done this long time back what OPA has done is driving out lot of their members .by their confusing advocacy of supporting government position where physiotherapist lose their jobs in public sector,

    I hope that physiotherapist get up from their hibernation and fight for their rights rather than allowing the fate to dictate their destiny by putting more and more standards with no realistic outcome.

    I cannot understand the scope of the college is only protecting the public from physiotherapist . It looks like “”this drug will work only for benign tumour not the malignant tumor””
    so if the public gets physiotherapy from other professionals eg chiropractors or non-professional run clinic who will protect them?

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  7. I think protecting the public must involve prosecuting non-registered pretenders and Chiropractors who “hold themselves out” to be physiotherapists or say that they are providing physiotherapy. The term “physiotherapy” has or ought to be, defined as what a physiotherapist does, not just the application of “physical modalities” such as ultrasound, IFC and thermal agents…which we all know amount to very little effect. Protect the public? Start by stopping chiropractors, athletic therapists, and other quacks from saying they offer “physiotherapy”

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  8. Wow. I have been a physio for 26 years and agree with pretty much everything said starting with Shenda, but I definitely agree with the comments re the profession has changed, and the College needs to step-up – even in its role of protecting the public. We have seen so much anger and distress in previous columns about the term “physiotherapy”. Even CPA and OPA and legislation can’t get it straight. Promotion of PT’s so often uses “physiotherapy” or “physiotherapy services”.
    So the College needs to step up – to protect the public, “physiotherapy” needs to be a protected term.

    And they need to step up on following up with their own regulations. There needs to be a simple, anonymous process just to report breaches. Yesterday I was waiting for an elevator in a medical building and there was a poster for a physiotherapy clinic “specializing in …” How is that in the interest of the public if it is against our own regulations? A simple photo, and a cease and desist letter should suffice, without delving into huge processes and hearings.

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  9. Shenda,
    Curious. Have you ever contributed to any of the topics you’ve initiated?
    Or are you simply a moderator trying to stimulate discussion?

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  10. There is a lot of physiotherapist that I know of that simply refuse to pay CPA membership. CPA(OPA) should wonder why?

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  11. I’ve read the comments by various ‘Anonymous’ writers, and agree that CPO could do a better job of protecting our ‘role’ not just our ‘title’. That issue has been raging for the nearly 30 years that I’ve been a PT. From the first time I called the College and noted that the Yellow Pages listing said PHYSIOTHERAPISTS instead of PHYSIOTHERAPY when listing various clinics which had no PTs working for them, until now. At least the listing now uses “Physiotherapy”. I challenge those of you who are at the dawn of your careers to learn from those who do a better job at ‘marketing themselves’.

    That being said, I feel that I should challenge the headline’s claim that the “College does a lousy job of advocating for us”. I am well aware of the role of CPO as a defender of our title and protecting the public from ‘quacks’ as a guild might do. However, there is a DIFFERENT kind of advocacy that they provide which I was privy to. The College supported me at a time in my career when I became ill. Let’s name the illness to be clear- Clinical Depression. I was unable to provide the quality care I had previously delivered. I received good advice on how to proceed with issues at my workplace, although CPO was not able (or allowed) to advocate for me. They held my hand through the entire process of being reported for having “practice issues” with my workplace, and were in touch with my medical team regularly. After 2 years, they signed off and wished me well and I’m happy to say “so far so good”.

    In the end, advocacy is really something that we have to do for ourselves, with the support of our colleagues who “watch our backs”. It is the role of each of us who know our team members well to identify when one of us is in trouble and act quickly and decisively.

    Fellow Colleagues, if you see one of your team looking a bit off, and not behaving the way he/ she usually does, blow the whistle kindly and ask for help. And in a situation (as was my case) where you find yourself in a strange place with team members who don’t know you, get a professional advocate. Whether that help came from our professional association (CPA/ OPA), a union, or a lawyer depends on the level of help you need. No comment on who ended up being my advocate in the end.

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  12. What about the PT’s who billed OHIP to no end and where paid based on how many seniors they saw of their PTA’s saw? Why is this not a CPO issue?

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  13. Anonymous of July 7, 2014…Do you mean “What about the PT’s who billed OHIP to no end and WERE paid based on how many seniors they saw OR their PTA’s saw?” Sorry about grammar corrections, but I just wanted to be clear. And YES, I AGREE WITH YOU THAT this should have been a CPO issue. What if CPO had addressed such billing issues? I am assuming that someone had reported it, or the Ministry of Health and Long Term Care (MOHLTC) would not have been aware of the discrepancies. And therein lies the complaint I have and what you are definitely alluding to, I’m sure. How can the MOHLTC ‘negotiate’ with an organization which does not have 100% representation of PTs who are licensed with CPO? Why did they not fine or prosecute the clinics who billed inappropriately, and ‘claw back’ the portion that was “over-billed”?

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    • It is my understanding that the MOHLTC conducted random chart and billing audits of “the big players” and money was clawed back.

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  14. Most of the out patient clinics in GTA are run by Chiropractor and business men. Good part is college is moving forward with regulating clinics.

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