Transcript of recent YouTube video

Here is an almost word-for-word transcript of the youtube post you can find at https://youtu.be/4kZRVw4HsiY

Hello internet and welcome to what I believe is the 10th video update from the physio moves Canada project.

After 7 weeks on the road that saw us drive 12,000 kms, visit 21 clinical sites, engage with over 30 clients and 80 clinicians, I am now back here I Casa di Walton in London Ontario.  While the formal road trip part of the project is over, I still have several sites here in Southern Ontario to visit over the next 6 weeks or so, at least 2 more focus sessions and several more clients to interview.  So the project is far from over, but I did want to offer some summarized reflections from the completed part of this ambitious project.

First off, many have asked when the results will become available.  Truth be told I have countless hours of data to pour over and probably 8 or 9 scientific papers to come out of it that will take me well into 2018 to fully disseminate.  However, you all will more likely hear the results first either at one of the conference presentations I already have booked, including CPA’s upcoming leadership forum or PTAlberta’s annual conference.  There will be a talk at CPA Congress in Montreal next year as well I’m sure, and others.  I will also continue to disseminate reflections and findings in smaller chunks here on our YouTube channel so go ahead and subscribe, also on the physiomovescanada.com website, and through our Twitter, Facebook and Instagram accounts.  So plenty of ways to stay informed.

Now to a few broad reflections from this project so far.  First of all, what an adventure it has been.  You know a project is good when you come out the other end a changed person, and that has most definitely happened for me.  I am pleased to say that I have had some of my own biases challenged and I like to think improved, and most certainly will be approaching my own research questions going forward with a very different worldview.  So right there the project has been a success for me, but this has never been about my own personal gain.  The value is what I will be able to share with all of you, the physiotherapy stakeholders.  And let’s be clear, I’ve learned a lot, not all of which is going to be easy to swallow.  There are some very clear and very real threats facing the current practice of physiotherapy in Canada and likely many are applicable internationally.  I think it’s safe to say that if we become comfortable with the status quo then we will slowly but surely see our sphere of influence in the greater pantheon of healthcare erode.  However, for every threat there is an opportunity, and indeed this profession is also rife with opportunity if we’re willing to see them coming and prepared to adapt to fully leverage them as they come up.  And there are several we can create ourselves, we needn’t wait for the rest of the world to change and then sort out how we fit into it.  Why can’t we lead the change? 

I’ve also heard a lot about things we should consider about our current training programs and how they should be revised or reformed to better prepare the next generations of physios for the realities of clinical practice today and into the future.  And while I don’t want to risk over-politicizing this message, one of the consistent messages I’ve heard across the country is the importance of cultural literacy, including the creation of culturally aware, sensitive and safe spaces for our clients.  Recent international events have driven the need for cultural awareness and safety training home quite hard, and I’ll be engaging with leaders in that field to identify mechanisms through which that type of training can become a more integrated component of physiotherapy education.

So I’ll leave it at that for now.  I realizing I’m being somewhat vague but remember that the project is still ongoing and I am trying to maintain engagement while avoid biasing information I get from future participants.  Do keep an eye on our various information dissemination platforms and if you have your own thoughts on the future of PT please reach out to me on email, our website, or any other platform of your choosing.

Cheers

Physiotherapy in Canada may have an engagement problem

Bit of a touchy subject this one, and I will do my best to avoid hyperbole while writing it.  First, a story: I have heard several times through this Physio Moves Canada journey that as a profession, PT in Canada is struggling to demonstrate its value to policy and decision makers.  A statement that is probably true, through there are certainly examples in history of our success in doing so.  Nonetheless, many of the clinicians with whom we’ve engaged have quite correctly stated that it would be great if only we had a large national database of PT outcomes that we could mine to demonstrate the value of the services we provide.  I would agree that this is also true, it would be great to have such a database.  When I then bring up ‘what about FOTO?’ the most common response is ‘what is that?’.  So far there have been far more quizzical shrugs than there have been nods of recognition, and only a single clinician that we’ve visited is in fact using FOTO on a routine basis.  And for what it’s worth, while speaking with that clinician’s clients, one specifically identified ‘the ability to provide me with a very concrete predicted outcome and how long it would take to achieve that’ (which is a tremendous function of FOTO through it’s advanced machine learning algorithms) as what ultimately made her choose and stick with her PT provider rather than any number of other options in the community.  Interestingly, CPA has been subsidizing the use of FOTO (Focus on Therapeutic Outcomes) for I want to say 2 years now, with the specific intention of building a national database of physiotherapy outcomes that could be mined for purposes of advocacy to decision makers.  So far, as far as I know, uptake has been relatively dismal despite what appears to be a general appetite for such data.

To be clear, the purpose of this post is not to suggest you all ought to be using FOTO in your routine practice, that’s an individual decision that includes a cost:benefit analysis unique to each setting (and, full disclosure, FOTO does fund a very small part of my research program but I personally receive no income from them).  The point goes back to those quizzical shrugs or eyebrow raises I get when I mention the name to clinicians.  In my opinion, CPA has done as good a job as they likely could have endorsing the platform through email and social media, with additional dedicated talks at national and provincial conferences, webinars, and even in-person talks to students in PT programs.  So why the lack of recognition?  To be fair there are likely several reasons, not the least of which is that PTs are often overworked and arguably underpaid and simply don’t have the time to explore new opportunities while trying to keep their clinic afloat and balance that with a satisfying personal life.  In my mind, this all speaks to a general engagement problem where it is near impossible to connect with all Canadian PTs.  We’ve seen it as well with the PMC project – while some of our clinician focus sessions have been ‘sold out’, we’ve struggled to get even 3 or 4 community clinicians out to our evening focus sessions even in some large urban centres.  CPA and the provincial branches have been supportive in pushing our sessions out through their own networks (and for that we are very thankful) yet I still get almost daily emails or social media messages of the kind stating ‘I didn’t know you were coming’.   Apparently people haven't seen the emails or social media posts.  The issue could be easily argued as being relatively minor when we’re talking about FOTO or our own PMC project, but what about when larger issues come up, either provincially or nationally?  How many clinicians outside of Manitoba are aware that the Winnipeg Region Health Authority announced just 2 weeks ago that as part of a larger cost-savings strategy, they were discontinuing public funding for adult outpatient physio services?  How many outside of New Brunswick were aware that 4 weeks ago the provincial government introduced a gender pay equity rebalancing initiative for public employees from which PTs were excluded?  Does every PT in Canada know that every Manitoban gets 7 visits to a chiropractor a year covered through taxpayer dollars but now no public PT?  And perhaps you think this isn’t your problem.  Maybe you’re in Ontario, where adult outpatient physio services have been delisted from public funding for 12 years now, so Manitobans had it lucky until now.  But all of these occurrences are yet another chunk out of our sphere of influence, out of our scope of practice that have traditionally been met by a collective ‘meh’ from not only the public, but in some cases by our own colleagues.

In a recent YouTube post I posed the question of what should be the rallying cry of Canadian PTs?  What will it take to get us largely engaged and mobilized towards a common cause?  Many have (quite rightly I suspect) said that it’s often not until a crisis occurs that people are finally engaged enough to mobilize as a group.  Maybe that’s true, but isn’t that also more than a little frightening?  Wouldn’t it be great if we could spot the crises coming and act proactively, as a group, to avoid them?

But here’s what scares me even more: that a crisis will never occur.  Rather, that our practice, our reputation, our scope or sphere of influence will continue to be slowly chipped away.  Not in any single grand fell swoop, but in bits and pieces.  A delisting of services here, a choice to fund an alternative service provider there, a loss of a position over there.  And like the frog in the pot of water who can survive albeit naively while the temperature slowly increases from lukewarm to boiling, by the time we finally raise our collective heads and look at what’s left of our PT landscape, it may be too late to mobilize. 

I hope I’m wrong, and also realize I'm painting the profession with a very broad brush that isn't applicable to everyone.  In fact, we've met with some outstanding clinicians who are truly engaged and pushing the boundaries of the profession forward often on their own time and dollar, but I suspect those are the exceptions.  I don’t know what the reasons for disengagement are and of course I haven’t been able to ask those who are disengaged – that’s kind of the definition of being disengaged.  I also don’t want to be accused of screaming the sky is falling when perhaps it’s all perfectly fine.  But I will say that this trip across the country, engaging clinicians in deep conversation has given me what I suspect is a somewhat unique perspective on the state and future of our profession, and there appears to be an engagement problem that needs to be sorted before we can effectively advocate for our value.  So if it will take a crisis, all I hope is that the crisis comes before it is too late and that it is not catastrophic for the profession.

Would love to hear your comments.

Privatization of adult outpatient physio in Manitoba the latest symptom of a bigger problem

As the Physio Moves Canada team prepares for the long drive from Ottawa up around the Great Lakes and into Winnipeg this weekend, we are learning about the Winnipeg Region Health Authority's decision to remove public funding for outpatient adult physiotherapy services, effectively meaning that the largest segment of the population who requires these services for their livelihood (working age adults) will very often find these services inaccessible.  I'm referring in particular to the middle class, those who will not pass the 'means test' on income because they are not in the lowest income brackets, yet also struggle to get by on a monthly basis leaving very little left over for 1 or 2 physio visits per week at, say, $45-$90/visit (or up) depending on where you go and the level of service needed.  This has been touted by WRHA as a cost saving measure, possibly saving the authority somewhere in the range of $1.5 - $3 million in the first year (of an apparent $83 million reduction target mandated by the province).  This is bad, this is bad not only for the profession but for the Canadians that rely on physiotherapists for their pain and mobility management needs.

Physiotherapists are medically-trained rehabilitation experts for issues of mobility and non-pharmacological pain management.  If we start with the second of those, non-pharm pain management, it is gob-smackingly shocking in our current opioid climate that WRHA should be restricting access to an alternative pain management approach.  It would be over-reaching to say that we should expect to see an increase in opioid abuse as a result (far far over-reaching) BUT when the rest of the world is looking at ways to increase access to opioid alternatives, Manitoba appears to be heading in the wrong direction.  

The mobility piece however may be the even more concerning issue but one that isn't currently as sexy as pain.  If there's anything I've learned as we near half way through the Physio Moves Canada project, it's that mobility forms a critical component of the identity of Canadians.  If your mobility is impaired, you may have difficulty working (and earning an income, so that you can now pay for physiotherapy... ugh), you may have difficulty looking after your family, maintaining your home, or living without depending on other people.  All of these things have the potential to increase costs borne by the tax base, possibly through greater reliance on social support services, disability or unemployment insurance benefits, mental health services (I've become convinced of the intimate tie between independent mobility and mental well-being), and in what should be the most ironic twist in all of this - greater burden on public health services!  We've already seen this in Ontario, where adult outpatient physiotherapy has been delisted from from the Ontario Health Insurance Plan (OHIP) since 2005.  For those unable to access appropriate physiotherapy care, their only options are to look for less expensive (and less trained) alternative providers often meaning they are off work or otherwise disabled longer, or go to medical clinics and emergency departments for help and advice.  So while the delisting from WRHA may indeed save let's say $2.5 million in the first years of their budget, it will very likely end up costing the authority overall much much more in chronic disease management, orthopedic surgeries, psychological and social counseling services, and primary care visits (to speak nothing of the burden on social assistance systems), all of which can be ameliorated by timely access to good quality physiotherapy care.  Of course it's not as though the WRHA will see that link, and suddenly reinstate adult outpatient physio - it will be lost to the sands of time, and 5 years from now they will note that costs were not in fact reduced as expected, and some other service will be changed, cut, 'optimized' or even added, all of which could likely have been avoided in the first place.

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And now we come to the title of this post.  I'm continuing to hear from clinicians and clients that physiotherapy has a branding problem, and we also appear to have a problem supporting our national advocacy body.  Now I'm not saying for sure that these are the driving forces behind this decision (the driving force can be more easily described as dollars and cents).  But, why physio and OT are being cut, why not orthopedic surgery?  I know right, that sounds insane.  But why does it sound insane?  There's an increasing tide of evidence to suggest that many common surgical procedures, especially for knees, backs, and shoulders, have no better outcomes than a good course of physiotherapy while being far more costly and risky.  Yet can you imagine the outcry, from the Canadian Medical Association, consumer advocacy groups and the general public if something as hallowed as orthopedic surgery was suddenly something Manitoban's had to pay for?  One wonders what would have to happen for physio and OT to trigger the same level of emotional response in the public as this bonkers idea of delisting orthopedic surgery.  My suspicion, based on nothing more than my experiences engaging clinicians (and as a 20 year member of the profession myself) is that there are not enough members of the public, or even our colleagues in other professions, let alone health care administrators and policy makers, that adequately understand the value that physiotherapy brings.  I keep saying this, and perhaps at some point I'll try it: if I were to ask members of the general public walking down the street what an orthopedic surgeon does and when you should see one, chances are most could provide a reasonable answer fairly easily.  What a chiropractor does and when you should see one, again I suspect the answer would come easily (whether or not it's entirely accurate) because chiropractors as a profession have done a superb job claiming a key piece of the public mindshare.  What about what a physiotherapist does, and when you should see one?  I expect this to be a more difficult answer especially for those who have never engaged physio services.  I could point to several reasons for this, and am hearing about many more from clinicians in Canada, but regardless of the mechanism(s), we appear to be suffering an identity crisis.  Even within our own profession there appears to be far too much infighting - one only need to spend a half day on Twitter to see evidence of that.  So when a group like the Winnipeg Regional Health Authority is looking for a professional body to cut from its funding model, which one is likely to cause the least outrage?  How about this one over here that can't seem to even sort its own self out as to what it's meant to be?  

Which brings me to the last point of this lengthy post, and that is this: only through strong and healthy national and provincial advocacy bodies can we earn back some of this highly valuable stakeholder mindshare.  In Canada that means the Canadian and provincial Physiotherapy Association(s).  Full disclosure here is needed: most of these bodies are providing some part of the funding for the Physio Moves Canada project, though are doing so at an arm's length meaning they have no control over the findings and publications.  So take what I'm saying with the appropriate skepticism you should be giving to all such online 'talking forums' - but rest assured I am saying this from a position of someone who wants to retire in 25 years as a physiotherapist, meaning that there will need to be a physiotherapy from which to retire at that time: we need ALL Canadian physios to participate in the advancement of our profession, and currently the best way to do so (in my mind) is through supporting the CPA and its provincial branches.  These are the people that are advocating and fighting on our behalf.  Winnipeg is simply the latest consequence of a professional voice and brand that needs to be clearer, louder, and prouder - we need to come together.