Part 1 - An Overview of the Canadian Model of Physiotherapy Practice

The Canadian Physiotherapy Model

The physiotherapy regulations and policies may be slightly different in each Canadian province or territory, but the model of physiotherapy practice is similar across the country. Physiotherapy, or physical therapy, and physiotherapist, or physical therapist, are all terms used to describe the discipline and practice of physiotherapy in Canada.The basic characteristics of this model may give you an idea of the responsibilities and daily experiences of work as a physiotherapist in Canada. These include:

Scope of Practice
The goals of Canadian physiotherapy practice include:
  • the promotion of physical activity and overall health and wellness,
  • the prevention of disease, injury, disability and mobility limitations,
  • the management of chronic conditions and activity limitations,
  • the restoration of function and rehabilitation of disease, injury, or disability with therapeutic exercise programs and other interventions,
  • the counselling and planning of maintenance and support programs to prevent re-occurrence, re-injury or functional decline.
Core areas of clinical practice in Canada focus on the neuromusculoskeletal, neurological and cardiopulmonary-vascular systems. Within these systems, physiotherapists practice in areas that include paediatrics, geriatrics, oncology, women’s health, pain, wound care, occupational health and sports medicine.
Primary Care and Direct Access
Canadian physiotherapists work as primary care, first contact clinicians with clients and families of all ages. Their work includes health promotion, disease, injury, and disability prevention, restoration and rehabilitation, and maintenance and support. In all provinces in Canada, clients may refer themselves to a physiotherapist without a physician’s referral. Physiotherapists are often the first-contact of clients to the health care system for their illness or condition. Physiotherapists are fully responsible for making clinical decisions and managing care within their scope of practice. They may identify conditions that require consultation or referral to specialists or other health professionals. Most Canadian physiotherapists work either in the publically-funded setting of hospitals and homecare, private practice settings and/or educational institutions such as universities or colleges.
Continuity of Care
Practice settings include hospital emergency departments, inpatient acute or critical care, rehabilitation centres, and out-patient departments, and community based practice in nursing homes, with home care services and in private practices. Physiotherapists work with clients who range in age from infants to elderly populations. Physiotherapy service is common across Canada on all 7 days of the week, with extended hours into the evening, depending upon the setting and needs of the client population being served.
Informed Choice
Canadian physiotherapists support the client and family’s right to make informed choices about their care. Physiotherapists believe that the client and family are the primary decision-maker. Physiotherapists offer their professional knowledge and recommendations in a manner that is empowering and non-authoritarian. This helps the client and family to understand all the health care options available to them, including the risks and benefits of each option.

Physiotherapy Work and Lifestyle

Work in the Canadian physiotherapy model is very rewarding and enjoyable, but it also has its challenges and demands. It is very important to consider the following questions:

Are you confident working independently as a primary care provider?
Physiotherapists in Canada often manage client care within an interprofessional team. Other members of the health care team, including physicians, may be involved in working together with you to manage the care of the client. However, you will be responsible for designing and delivering the physiotherapy care for your client. This also may include handing down tasks to a support staff member or physiotherapy assistant. This will require good communication and supervision skills.Many times you will work independently, with no other health care team members involved with the client and family. You will be expected to make clinical decisions during assessment, treatment implementation and reassessment. This means working without supervision or direction from other health care professionals. You can find information related to primary health care in Canada here:
  • The Alberta Physiotherapy association document entitled Primary Health Care: A Resource Guide for Physical Therapists www.physiotherapyalberta.ca/
Physiotherapy practice is simliar across Canada. However, there are differences from province to province depending upon provincial healthcare legislation.
Do you understand your professional responsibility to maintain client confidentiality?
During assessment and treatment, physiotherapists will often learn personal information about a client and/or their families. The physiotherapist must keep that information secure and private. You may only share the information as needed. For example, you may need to discuss information learned about a client with a colleague who is a health professionals working with that client. However, you CANNOT share information about a client with your family and friends.
Are you familiar with informed choice as well as client and family-centred practice? Are you comfortable with this model?
Client and family-centred physiotherapy practice requires that you know the client and their family. You must know their concerns and what they need to manage their health. It also involves sharing information, offering choices about treatment options to help the client and family make decisions for themselves. This requires a conversation style and client education method that is interactive and empowering rather than didactic or directive. It allows for a collaborative relationship with the client and family.
Can you manage a 7-day work schedule, including some evenings?
Physiotherapy practice in many hospital settings across Canada is a 7-day practice model. Saturday and Sundays are regular work days with other days of the week taken off as ’rest’ days. In addition, evening hours for physiotherapy services in Canada are not uncommon both in the private and public health care settings. There are some clinical areas where the physiotherapist may be "on call", or available to come in to work as needed. Expect busy practices both in public and private settings. There are times when you will have to manage your time expertly in order to complete priority care.
Are you able to manage your time well and prioritize tasks?
The workload, both in the public and private health sectors, is often very busy. You must manage a number of tasks at the same time and be able to prioritize those tasks. The most important ones must be completed, while others may not be completed by the end of the day. Canadian physiotherapists face the daily challenge of an increased demand on their limited resources. You must decide what activity in your workday needs to be done today, and what can wait until tomorrow. You often will be asked to explain to colleagues and team members why you gave priority to certain tasks. This requires strong communication skills.
Are you able to develop collaborative working relationships with health care colleagues?
Physiotherapy is a well established profession in Canada. Collaborative work or teamwork is very common. Physiotherapists work closely with other professions in almost all practice settings. However, sometimes, you may be working in an interprofessional environment where your colleagues do not understand your role as well as expected. Heavy workload demands may create stress and conflict. Because professional interactions are challenging, you must use diplomacy and respectful communication skills in collaborative team relationships. You must understand and respect each other’s role and scope of practice to serve the genuine interest in the client. You must put your own professional pride aside for the sake of the client’s wellbeing.
Are you able to contribute to the development of the physiotherapy profession?
Many physiotherapists in Canada help to builds their profession in addition to their clinical practice, For example, physiotherapists may teach or mentor students, develop policy, do research, participate on hospital and community committees, and speak to the public. You will be expected to take part in some of these tasks.

Self-Reflection

As you work through the self-assessment tool, it is important to consider your professional and personal ability to:

  • Work in partnership with the client. This is called client centred practice.
  • Apply current research evidence to your practice so that your client receives the most appropriate care. This is called evidence based practice.
  • Balance your work schedule with other life responsibilities such as family, work, leisure, etc.
  • Be able to set priorities for your professional duties.
  • Consider all aspects of a client including their physical, cognitive and affective wellbeing.
  • Provide culturally sensitive care. Clients will not always share your religious, political and personal values.
  • Communicate effectively with clients. Be sure that your language, vocabulary, non-verbal cues, tone and volume are correct for your particular client. Accommodate different language abilities, hearing or vision difficulties as well as any cognitive impairment.
  • Work collaboratively with other members of the health care team.
  • Be assertive with other health care providers.
  • Work as an independent health care provider. Although it is important to work collaboratively with other members of your team, you will not be told how to treat a client. You must assess a client’s problems, make a diagnosis and decide which physiotherapy treatment plan is needed.
  • Evaluate your own practice for its strengths and weaknesses. Participate in professional development to improve your practice.
  • Delegate or transfer some of your workload to assistants and supervise physiotherapy support personnel.
  • Document your interactions with clients. Include subjective and objective client information, assessment findings, treatment recommendations and your rehabilitation plan.
  • Make sure that you obtain client consent at every step in the rehabilitation process.
  • Be able to provide responsible decision making, sound clinical reasoning and professional judgment.
  • Use professional language, not jargon or slang.
  • Understand the Canadian health care system and how it will affect your practice.
  • Understand the regulations, standards, policies and ethical frameworks which control physiotherapy practice.
  • Make sure your practice is ethical. Follow the Code of Ethics, respond appropriately to ethical situations in practice, protect client confidentiality and privacy, and maintain appropriate client boundaries.
  • Understand the legal aspects which govern physiotherapy practice such as the need to obtain consent, provide informed choice, ensure confidentiality, and maintain records etc.
  • Understand and apply infection control procedures such as hand washing. These are known as universal precautions.

If or when you apply for physiotherapy licensure in Canada, you must take part in a formal assessment to make sure that your knowledge and skills meet Canadian licensing standards. This process includes language tests, written and oral or clinical examinations.

To learn more about becoming a physiotherapist in Canada, please refer to the Canadian Information Centre for International Credentials: http://www.cicic.ca or the Canadian Alliance of Physiotherapist Regulators website: http://www.alliancept.org