Good afternoon. My name is Katya Masnyk Duvalko, and I am the newly minted CEO of the Canadian Alliance of Physiotherapy Regulators. I am just starting my third month with the organization, with still a great deal to learn, but what I have learned I am happy to share with you.
I am very pleased to be here to share my thoughts on the experiences we have had with the Canadian framework for success and with the framework's administering agency, the HRSDC.
The Canadian Alliance of Physiotherapy Regulators, also known as the alliance, is the umbrella organization, a national federation of provincial and territorial physiotherapy regulators committed to the development and improvement of regulatory standards of practice for physiotherapists. The alliance, on behalf of most of the physiotherapy regulators—the one exception is Quebec—administers the physiotherapy competency examination to determine a candidate's readiness for safe, effective, independent physiotherapy practice, and establishes whether the education and qualifications of internationally educated physiotherapists, IEPTs, are substantially equivalent to that of their Canadian counterparts.
Currently there are approximately 18,000 registered physiotherapists practising in Canada, the majority of them in Ontario and Quebec, followed by British Columbia and Alberta. The most recent statistics reported by CIHI, which include 2009 data, indicate that 12% to 15% of registered physiotherapists are educated outside of Canada. The top five countries for training in order of frequency are the U.K., India, the United States, Australia, and Poland. There have been a few changes in that rank ordering in the current report, but it's more or less the same.
The highest proportion, by province, of registered physiotherapists who were internationally trained are found in Ontario, where almost one-fifth of the registered physiotherapists were trained internationally; British Columbia, where 16% were internationally trained; and Alberta, where 15.5% were internationally trained.
As mentioned, the two main lines of business of the alliance within its evaluation services mandate are administering the physiotherapy competency exam and credentialling internationally trained applicants.
First I will provide a few words about our exam process. The physiotherapy competency exam is a national exam that includes both a written component and a clinical component. The written component is administered six times a year and it can be taken during the last term of education, while the clinical component is administered twice a year and must be taken after the completion of all physiotherapy training. Furthermore, a candidate cannot challenge the clinical component until they have passed the written component.
Each year, approximately 1,000 physiotherapy candidates challenge the exam. Of those taking the exam, 60% are Canadian educated and 40% are educated internationally. Overall, 85% of the candidates pass. However, the pass rates vary significantly between Canadian and internationally educated candidates. In recent years Canadian-educated candidates have passed the clinical component of the exam, on average, 96% of the time—so almost all of them—compared to only two-thirds, 68% of the internationally educated candidates. The disparity is even greater for the written component of the exam, where on average 94% of Canadian-educated candidates passed compared to only 53% of the internationally educated. There is quite a big difference.
The other main line of business of the alliance is the credentialling of all internationally educated physiotherapists to determine if their education and qualifications are substantially equivalent to their Canadian-educated counterparts and whether the candidate has the necessary knowledge and skills to challenge the exam. The physiotherapy profession is one of only a few health professions that has a coordinated pan-Canadian credentialling program. Pharmacy is another health profession that has a pan-Canadian approach, although others are moving in this direction.
Each year the alliance receives approximately 600 applications for credentialling from internationally educated physiotherapists, half of them from India. Other common source countries are the Philippines, Australia, the U.K., the U.S., Egypt, Iran, and Brazil.
Of all the credentialing applicants seen and completed in recent years, about 40% are eligible to move directly to challenging the competency exam. An additional 40% are eligible for what's called the prior learning assessment review, which takes a look at their work experience learned outside of education. They will eventually take the exam. Further research is needed to assess what percentage of candidates, and with which training and education characteristics, are successful in the exam and are successful in integrating into successful physiotherapy practice in Canada.
The alliance has been working diligently to research opportunities for improvements in its evaluation services processes, and HRSDC has been a valuable partner in this process. We have been able to count on their financial support for many years, starting with the first mutual recognition agreements process in 1999, designed to support compliance with labour mobility, and continuing to our current proposal for support, which is to develop an updated rubric for the assessment of credentials, a data analytics capacity, and a variable-pathway approach to credentialing.
The alliance is a small organization with only 12 staff and a member-funded budget of around $3 million. We could not have done nearly as much as we have without your support.
As a result of our initiatives, the alliance has seen improvements in its processes and in its communication with IEPTs. For example, with HRSDC funding, we've been able to revise our website and to review and update all of our documents to follow profession-specific and plain-language guidelines. We've been able to train our staff in cultural sensitivity and improved communication. This has led to increased effectiveness of our candidate support and increased satisfaction among our applicants.
In addition, the alliance completed an HRSDC-funded comprehensive review of the full spectrum of credentialing activities, resulting in numerous recommendations for updating policies, procedures, and strategies in credentialing. We are currently in the process of implementing these recommendations.
The alliance's experience with the granting and financing process administered by the HRSDC has been a positive one. Staff have been accessible and responsive, providing support in a timely fashion. This support and guidance allowed for the efficient and effective completion of funded projects, and efficient tracking of project progress, without undue administrative burden on our very small staff.
A few key challenges remain, especially as we move from addressing the structural and process challenges that have been our focus to date and we turn to dealing with challenges with outcomes. The alliance is mindful of the ever-changing national and international educational landscape for physiotherapists, and the need to update our credentialing framework to keep up with these changes.
Our biggest priority at this time is the development of an analytical plan that would link credentialing information with exam results, and then in turn with practice outcomes. We really need a clearer understanding of what barriers remain to the successful integration of IEPTs into the Canadian workforce, and we need to identify variables that predict success. This will allow us to develop further training and apprenticeship programs and continue to build on appropriate bridging programs to support those internationally educated candidates most at risk.