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.