Thank you very much. It's a pleasure to be here this afternoon.
On behalf of the Canadian Physiotherapy Association, I'd like to thank you for this opportunity to speak to best practices and federal barriers related to the scope of practice of Canadian health care professionals. I think this is an extremely important topic, as there are many different health professionals looking to work through interprofessional collaboration, and it's not always possible. There are a lot of local innovations that aren't necessarily spread throughout the system.
One of the most important changes to improve efficiency in health care today is the integration of this interprofessional collaboration in a variety of different primary health care settings. The benefits of interdisciplinary team-based care have been clearly demonstrated in research, with very positive outcomes, including better access to services, shorter wait times, better coordination of care, and more comprehensive care than from a single health care provider alone.
Physiotherapists are among health professionals who have the qualifications and skills to share responsibility for the provision of care with the family physician and with other health care providers. They have advanced knowledge in the assessment and diagnosis of conditions and injuries, and it's all within their scope of practice.
Today I'd like to focus my comments on three specific areas where the federal government can play more of a leadership role: first, to align federal health programs and permit health professionals to work to their maximum scope of practice; second, to support best practice through collaboration and communication with health professionals in areas of federal health programs; and third, to support skills training for physiotherapists and other health professionals who are working in rural and remote areas.
To begin, aligning federal health programs with recognized scope of practice is a bit of a challenge, and we do recognize this, because many health professionals are regulated by provincial bodies. It's a bit of a patchwork quilt to be able to match the provincial regulatory bodies and regulations and the scope of practice with what is happening federally. However, we do see that there's an opportunity where there can be better alignment with provinces and regions, particularly because within federal programs there are a lot of regional offices that do oversee the health provisions under the programs.
I'll use the NIHB program, the non-insured health benefits program, as an example of where there are barriers to working to full scope of practice. I'd like to reiterate Dr. Guitard's comments around the challenges of access to care. Really, the barriers to appropriate care in this program do include these gaps in access to the right professionals, who can deliver the right care at the right time to improve health outcomes and quality of life. Evidence shows that there are significant opportunities for cost savings when there is a focus on prevention and promotion of health, but more important, there's an immediate need to curb epidemics of obesity, diabetes, and asthma, and to focus on injury prevention and ending addictions.
When Minister Ambrose announced the review of the non-insured health benefits program in 2014, we took that opportunity to reach out to our members to find out what their challenges are with the NIHB program. We really wanted to better understand what physiotherapists are doing and how they're working within the program and to possibly help inform a better direction for the future.
What we learned is that while there are regional variations in the program and the regulation of physiotherapy, the federal program is not consistent and does not recognize or support current scopes of practice of physiotherapists. One of the biggest challenges we see as physiotherapists is not just that they're not quite aligned with the scope of practice, but that their scope within the federal program is actually quite minimal, where they're only allowed to prescribe or order assisted devices and supports for individuals, for example, rather than actually working to fully use their knowledge and competencies to improve the health and well-being of the individual.
In practice, what this really means is that physiotherapists are regulated, so if you're working in northern Alberta, you're regulated within the Province of Alberta to work to your full scope of practice, but as soon as you step onto a reserve to provide care or services, that scope is no longer recognized. There's a great variation in the ability—and the inability—to really work to full capacity under the NIHB program.
The recommendation for this is really to look at the evidence. There's strong evidence in favour of positive patient outcomes at a lower price if governments are willing to invest in interdisciplinary models of care to maximize health outcomes.
We call on the federal government to actually look at how to maximize scopes of practice within federal programs, such as the NIHB program, and invest in interdisciplinary models of care that truly reflect these models.
To go back to one of Dr. Guitard's points, if a physiotherapist, for example, were to work under the NIHB program, they would not only have to look at suppliers but call the doctor to ask for the doctor to sign off on what they would be prescribing as an appropriate device, when the doctor has never seen this patient. The physiotherapist actually does have the scope to order it on their own, but under the program, they aren't able to actually follow through with their full scope of competencies.
The second point I'll make is around supporting best practice through collaboration and communication with health professionals. Evidence has shown that direct access to physiotherapy services decreases total health care costs. This is because patients require fewer visits with their general practitioners and they require fewer prescriptions. Patients require less referrals for radiographs, less referrals for secondary care, and a decreased need for invasive treatments. An example of cost treatment per episode is with patients with musculoskeletal conditions. It is much less when patients are treated by physiotherapists, making additional health care dollars available for other more critical medical services.
To fully achieve these interprofessional models of care within the federal health programs, we have to look at examples of communication and collaboration at the systems level rather than looking at the local level for how to improve care. Without this change, we'll continue to have local-level efficiencies but with very little system-wide change. If we reverse it so that there's better communication at the systems level, we can actually improve the efficiency at all levels under the larger umbrella.
Our second recommendation is to reinstate the federal health care partnership program. The federal health care partnership program, if you're not aware, was created to achieve economies of scale while enhancing the provision of care. Under the program, federal departments responsible for the delivery of health services would meet regularly with health professional groups to identify gaps and concerns and provide strategic leadership. While there are still some ongoing agreements between various departments and associations, the program on the whole has been disbanded. CPA would like to see this program reinstated, as we see it as a best practice model. We believe if it were to be reinstated, it could facilitate strategic partnerships with key stakeholders in support of better programs, interdisciplinary care, and evidence-based policy development.
The third area I'll focus on is federal support for skills training. Physiotherapists are health care professionals who have demonstrated advanced knowledge and scope of practice and a unique value to solve problems within Canada's health systems. However, there's a disconnect between physiotherapy education programs that provide this advanced skills education and training for health professionals and the recruitment and retention of physiotherapists in rural and remote areas. I know that physiotherapists aren't alone in this challenge. It's across the board. Rural and remote areas struggle to recruit and retain the best of the best, because they're often going to urban areas. However, of significant concern to CPA is the challenge of filling vacancies or getting access to physiotherapy in many regions across Canada.
For example, in 2014 the Physiotherapy Association of British Columbia reported that vacancies across B.C. reached 267 positions, which was last audited at the end of 2013. These 267 vacancies represented a substantial gap between the nearly 3,000 practising physiotherapists in the province and the need for a least 10% more physical therapists to fill the immediate need, not to mention the need in the future. At this time the physical therapy community of B.C. has urged the Ministry of Advanced Education to immediately expand the UBC physical therapy department to 132 seats through a distributive model that would better address challenges for Fraser Health in northern B.C.
Now, I understand that this a provincial issue, but it does reflect on federal responsibility as well, because we do see evidence to suggest that models of distributive education across the country actually do enhance recruitment and retention in rural areas. We would like to see this opportunity extended to physiotherapy programs and other programs that would allow for a more stable health care workforce that will meet the urgent need in various regions.
B.C. is not alone in its challenge in filling vacancies in rural and remote regions. We also see, through the Manitoba Physiotherapy Association, that there's a top priority to improve access to physiotherapy in rural and remote parts of the province because there's only a handful of publicly funded physiotherapists outside of the Winnipeg region. Nova Scotia is also fearful of the impact of vacancies. because what happens in Nova Scotia is that if a vacancy is left open for too long, the vacancy disappears rather than having it filled.
We see that the solution is more about health human resource planning as opposed to provincial jurisdiction over education.
So the third recommendation is about expanding the—