I agree that if the clinic is owned by a regulated health professional than that should be good enough. If you want to improve the quality of care the college needs to enforce Mandatory continuing education....people havent taken courses in 20 years and you cannot practice in a specific area of therapy without taking courses beyond basic knowledge from school.  Majority of all colleges hace CEU requirements except for PTs

I do not think that restricting physiotherapy clinic ownership to only physiotherapists is something the College should spend time fighting for as it is not right.  For example, there are Chiropractors, Massage therapists, OT's, even Osteopaths that own clinics with physiotherapy as a treatment offering.  As long as the owner is a Regulated Healthcare Professional and the physiotherapists are ensuring clinics are abiding by the CoPT regulations should be enough.  Perhaps there could be a specific certification for owners to learn about physio regulations and standards of practice for those that are not under the RHPA.

if college is not there to support physiotherapist .i think physio shouldn’t be involved in any decision making against themselves. Assignment of care to ” SUPPORT STUFF” is against both public and PT BENEFITS. if you believe SUPPORT STUFF can deliver the quality care. then close the college of physiotherapist and stop producing PT!!!!!

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Having worked in the US over the past few years, I found it shocking to find what is happening in Ontario. I expected the guidelines to be a lot stricter. The extent to which assignment of care can be transferred to “support staff” per college guidelines is endless. I think this in part contributes in a lot of fraudulent billing. With that said, I fully support PT ownership and more college regulation with individual clinics.

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I too enjoy this way of communication. I do believe, from reading the blog’s that physiotherapy is at a crossroads. OHIP funding is forcing clinics to minimize the physiotherapy by the therapist and maximize the therapy by the support staff. Insurance companies are putting pressure on evidence based practice.

We have to decide how we want the profession to move forward. Do we become technical robots or do we stay as caring individuals that assist the patient/client in their healing.

If you ask older nurses about their practice, they all tell you that the 15 minute “back rub” or as it was known “massage” that they applied on each patient in the hospital each day, as they listened to the patient’s “story”, was more healing than anything else they did that day. It has been removed from nursing practice because the “research” didn’t validate it. Maybe we are moving in the same direction.

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From college website.

question:

Who does the College deem appropriate to be able to work as a support personnel or PTA? Also, if the PTA or support personnel has years of experience, is it still necessary for me to be in the exact location to provide direct supervision?
Answer:

Support personnel/PTAs are not regulated in Ontario. Essentially anyone can work as a PTA but the PT must ensure that the PTA can carry out the assigned treatment competently. It is up to the PT to decide the appropriate supervision. The number of years of experience of the PTA may be one of several factors the PT would consider when deciding on the amount/type of supervision.

Word from Niagara region – Saint Elizabeth is implementing PTA model for home care ,starting April 28th. Physiotherapist does Initial assessment and re-assessments (2 visits). PTA’s actually Physiotherapy Aids carry over all treatments. Physiotherapist gets $2 for supervising PT aids. For $2 you are responsible for everything. First they killed nursing home jobs.Now they are coming after home care sector .100’s of PT’s going to lose their jobs across Ontario.

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Dear Shenda ,
Thank you so much for your support .You are our only hope. Our association is only good for getting professional liability insurance. I really hope college will regulate clinics as similar like regulators in USA.

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Although I cannot answer every question posted in the comments section, please know that I do read your comments and I’m most appreciative of you taking the time to share your thoughts and opinions on this blog. If you would like to further discuss your thoughts, please feel free to call or email me directly as I am always happy to chat.

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we should adopt above regulations in Ontario

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“I hope I can work in Texas. Physical therapist and patient’s in Texas are so lucky to have responsible regulators who regulate the profession in realistic manner unlike in Ontario”

From their website

Facility Registration in Texas
The Texas Occupational Therapy and Physical Therapy Practice Acts require that facilities providing occupational therapy or physical therapy must be registered, unless exempt by law (see Who Must Register?)

Every registered facility must have a Therapist in Charge form on file with the Board. If a facility offers both occupational therapy and physical therapy, there must be an OT in Charge and a PT in Charge.

Registration must be complete before OT or PT services may be provided in the facility. Therapists who work in facilities that are not exempt and not registered can be disciplined by the Board. Facilities that violate the law can be fined.

A registered facility is subject to random, on-site inspections by investigators of the Board.

A registered facility must display prominently the original Registration Certificate and a Consumer Information Sign to operate legally in Texas..

The following changes must be reported to the Board in writing (email or fax) within 30 days of the date the change occurred:

Therapist in Charge change
Facility address or name changes
Changes to managing partners or officers in the business entity that owns the facility
Sale or closure of a registered facility

http://www.ptot.texas.gov/page/facility-registration

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[…] you for all your input on the issue of whether the College ought to regulate clinics. We left the blog post up for longer than usual because new comments kept coming […]

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You are right… I hope that all the comments that have been posted here (more than 160 and counting) will have a TRUE resonance-/-Impact-/-repercussion within the college and with our profession in Ontario in general. It would be very sad if after having this blog open for comments for two months NOTHING end up happening/changing. There are two good points that still need to be answered:

– Why is it necessary to have our registration numbers openly shown at the college website? This make us vulnerable to fraudsters. Isn’t showing just our names and where we work enough information to be published.

– Will the college REALLY end up regulating ALL clinics providing physiotherapy services in Ontario? (This sounds just TOO GOOD to be truth; I honestly don’t think that non-physio owners and/or other health practitioners owners would allow this to happen, but: lets see!)

Keeping my fingers crossed and wishing that this blog will have a great outcome and will be effective.

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When can we anticipate a response from the College on this matter?. This Blog has been running for two months now.

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Good luck- keep wishing!!

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I hope someone will organize physiotherapist working in private sector to protect our fundamental constitutional rights ,better wages,job security and prevent employers,college,insurance companies abusing us. Here is the example from Toyota Canada workers.

http://www.thestar.com/business/2014/03/31/union_seeks_right_to_represent_toyota_plants_in_canada.html

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We need only to look at the Dental profession in Ontario for some help – only a dentist can own a dental clinic/practice. They seem to have managed this for years. I am in agreement with only physiotherapists being able to own PT clinics. Accountability would certainly be higher if this were the case. The dilema would be what to do with the current clinics that are not PT-owned?

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If clinics are regulated , clinic A would not be able to open clinic B that easily. I am assuming closing down comes with hefty fines, possible criminal investigation etc, also his name must be black listed in college data base that will prevent him own any clinic under his name.If college routinely audit/inspect clinics. .I can guarantee that 90% problems will be solved reg physio abuse. Reg big companies owning clinics. Pharmacies in ontario are regulated still shoppers, Walmart etc run pharmacies.they have to give ownership to pharmacist. Right now physiotherapist are treated like slaves
Regulating clinics will bring dignity and respect to physiotherapist and whole profession

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This is a travesty, and a clear indication that the College needs step in and either a) regulate PTA’s, b) regulate PT agencies/clinics or c) mandate that PTA’s can only work under the direct onsite supervision of a PT. How else can this rampant abuse of the system be prevented? Leaving the PT alone accountable is not only unjust, but impractical. No one will file a complaint with the College to prevent such things from happening; not the PT or PTA who’s income depends their employment with the Agency/Clinic, not the LTC facility, since they merely assume the agency or PT/PTA will conduct themselves appropriately (and lets face it, as long as their getting their funding and residents/families don’t complain, they don’t care) and not the residents or the residents’ families (because they don’t know any better)

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Here is the Ottawa area, we have a clinic which runs newspaper ads that claims that they offer FREE OHIP physiotherapy with absolutely no details about qualification. Why is this allowed?

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There is no clear definition for PTA supervision. The college doesn’t not mandate PT to supervise PTA’s onsite. Its says..from the college website.

1) ASSESS COMPETENCE- In real life clinic owners hire PTA’s, PT’s don’t have any role in hiring

2) CONSIDER THE FACTORS AND ASSIGN PATENT CARE- In real life middle man/supervisor/clinic owners decide PTA’s role. the trend is PT’s are for assessments and re-assessments,PTA’s deliver treatments

3) CONSIDER THE FACTORS AND ENSURE ADEQUATE SUPERVISION- How can you supervise PTA if you are not onsite??.

Clinics should be regulated ASAP. Regulate PTA’s or mandate onsite PT supervision for PTA’s while PTA’s treating patients.

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There is no clear definition for PTA supervision. The college doesn’t not mandate PT to supervise PTA’s onsite. Its says..from the college website.

1) ASSESS COMPETENCE- In real life clinic owners hire PTA’s, PT’s don’t have any role in hiring

2) CONSIDER THE FACTORS AND ASSIGN PATENT CARE- In real life middle man/supervisor/clinic owners decide PTA’s role. the trend is PT’s are for assessments and re-assessments,PTA’s deliver treatments

3) CONSIDER THE FACTORS AND ENSURE ADEQUATE SUPERVISION- How can you supervise PTA if you are not onsite??.

Clinics should be regulated ASAP. Regulate PTA’s or mandate onsite PT supervision for PTA’s while PTA’s treating patients.

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FYI: http://www.fsco.gov.on.ca/en/service-providers/Pages/2014-march-newsletter4.aspx

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What about now?. Under new funding model PTA’s are working with out onsite supervision as well. Actually PTA’s got more hours than PT’s under new funding model. This new funding model created high demand for PTA’s while PT’s are struggling to get full time job.

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It is for this reason that I chose not to apply for public funding for our clinic under the new model. It promotes lesser quality, high volume care provided by unregulated, less qualified support personnel. It just didn’t make business sense to pay a PT to provide quality treatment for $300 per incident. At our usual rates ($80 Ax, $50 Tx), that would be fewer than 6 visits with the PT. Regardless of how fantastic a physio is and how compliant a patients is with a home program, it’s difficult to properly rehab post-operative patients (total knees, cuff/ACL reconstructions) adequately in only 6 visits. I know the model doesn’t limit the number of visits but the funding does. In the end, the clinic is still a business, not a charity. I certainly didn’t want to create a two-tiered system at our clinic where some patients got great, high-quality one-on-one care from a PT and those with public funding/OHIP got lower grade care and less PT interaction. PS I don’t own a $100,000 Mercedes and I’m not in an urban centre.

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In response to Working as a PT in Ontario
The model of PTs doing Initial assessments, re assessments and discharge with PTA’s carrying out all treatments is the model used by the DPCs. Patients and the government were told that this is what physiotherapy is.

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i love this idea

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did anyone talk about the OHIP agencies…there is a LTC home where one PT works for 350 residents….hilarious. previously 2 PTS used to be there. due to new funding changes..one was taken off. the agency wants to make money out of it. the college should focus on issues like this first. why only foreign trained therapists are working for 90 percent of LTCS….simple…they were trapped to make money by agencies.. [This comment has been edited by the moderator to maintain compliance with blog guidelines.]

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if PTA model running in home care ,I will be very surprise. Any case like post op (THR,TKR) physio home visit limited 6 to 8 visit? Each visit should be reassess as these are acute cases which close monitoring of patients’ progress are critical , otherwise the best mobilization peroid pass become more difficult to gain the ROM. How can PTA alone responsible for these type of patient. Also in OHIP funded clinic , lot of ACL reconstruction, rotator cuff repair, post spinal surgery …..cases, all these should be closely monitor by well-trained physiotherapist like you and me to make sure patient get proper post-op rehab. If PT only do the initial assessment and discharge assessment according to new ohip funded module, I am afraid those patients’ progress will be much slower as no close monitoring during the episode of care.(Assume PTA only hook up the modalities during course of treatment as they are not able to assess/reassess the patient )
If those patient follow up with the surgeon with unsatisfactory result, do you think the physiotherapist should be blame because of poor monitoring? Remember, more and more hospital physio outpatient closed, so OHIP funded clinic will take more post op case than a year ago.Most clinic owner just think about maximize their profit, OPA should set more rules in the use of PTA

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FYI. CCAC is expanding PTA model to patients home ( other than retirement homes). PTS get 3 visits .Initial assessments, re assessments and discharge. PTA’S carry out all treatments. This model is already running in the retirement homes. Now it’s coming to community. Unregulated professionals delivering treatments..but still PTS are responsible for everything. This is called modern form of slavery
Working as a PT in ontario

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There is a PTA FUNDING MODEL already running in CCAC and PT gets only 2 to 3 visits for assessment or reassessment over the period of 3 to 6 months ,this is spported by none other than OPA and MOHLTC. Eventhough PTs work for home care agencies and PTAs are hired by agencies, PTs are responsible for PTAs actions ,being an independent contractor-strange thing. hope Shenda read all these feedbacks and take necessary steps .

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I agree!! It’s about time the college step up and protect the Physiotherapists. Overegulating the Physio inadvertently protects the owners of the private clinics that rely on the Physio license for income. Stop persecuting the Physio and start looking deeper into the actual problems Physios encounter daily. Regulating clinics and protecting our title would be a start. This should happen ASAP.

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This Blog has clearly unearthed enough concern that should trigger a formal CPO response on the use of unsupervised PTA’s and the associated risks to the consumer and the PT proper. Furthermore, there is a prevailing ruse being used by the usual suspects (former DPC’s) that use the professional reference to physiotherapy to take advantage of unsuspecting seniors who think that they are paying for private physiotherapy based on what should be an episode of care but in reality they are receiving limited care delivered by an unsupervised PTA. Is the CPO waiting to get drawn into litigation before is intervenes?

DG
Pickering

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Honestly, when I read or hear about what goes on in Physiotherapy private practice, I get depressed about having gone into this field.

There seems to be not enough regulation where it counts, and too much regulation where it doesn’t.

Clinics need to be regulated, otherwise, the PT’s working in them (be they new grads, foreign trained, financially strained, etc.) will be at the mercy of the whim of the clinic owner, who will remain unaccountable.

I addition, it only makes sense to bring the term “Physiotherapy” as it pertains to “Physiotherapy Clinic” under the protection of the College. The lay public cannot be expected to know the difference between a real “Physiotherapy Clinic” vs. one owned by a chiropractor, kinesiologist, athletic therapist, etc.

Public information campaigns can only go so far, since public memory is short-lived and people are apathetic unless it concerns a person directly. Regulating the term “Physiotherapy” as it relates to clinics and clinic names is imperative to protecting the public from others who would deliberately mislead the public for personal gain.

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Have you tried opening a clinic in the GTA? It’s saturated with non-physio owned clinics, the owners of which are accountable to no-one. Unless you have deep pockets to begin with, good luck getting doctors to refer patients to you. It’s known that in the GTA, there are well entrenched “referral networks”.

The only hope of getting around this is to mandate that clinics are owned by physiotherapists. Then, the clinic itself will come under the jurisdiction and regulation of the College.

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I agree. Allowing off-site supervision opens the system right up for abuse of billing privileges

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I found this post interesting. I agree that majority of the clinics are owned by non regulated PTs and it would not be a surprise to me if most of the fraudulent billing practices occur in the cities mentioned in this post. I am surprised that the stakeholders (Insurers, Employers or other benefit coordinators, and organisations that serve to protect public interest) have not done enough to curb down these fraudulent billing practices or investigate clinics in these cities with more caution or detail. Many of the insured employees are informed about the total dollar value of their benefits. Totalling up all the benefits the family of the employee may have thousands of dollars in benefit. The total dollar value is billed to the insurer, and the profits are shared by the employee themselves, the clinic owner, and the referral source. The clinic owner needs a PT only for his/her billing number. In return the PT is paid 7 – 10 hours a week. The situation is so bad that the employee now thinks it is their right to use benefits this way.

Regardless of the patient being able to speak English well or not, the patient has the right to receive quality care, and the PT regardless of them being a new graduate / internationally educated, deserves to be employed in a decent and ethical environment. As mentioned in another post, this will work only if more PTs are willing to come forward and take the responsibilities of ownership of their own practice, and willing to negate unethical profit margins. Be courageous to bill a decent amount per visit and be ethical to provide quality ‘hands on’ care, rather than enticing the patient with a low fee and just treat them with modalities. This creates in the mind of the public a loss of hope in approaching our profession with trust.

With regards to the College regulating a Clinic – it sounds good in theory. But let me put this scenario. E.g Clinic A is regulated. (Note: The clinic is regulated by CPTO and it’s owners are non regulated members of the Public) In the event of the College revoking its license, Clinic A can always close down and open itself in another location as Clinic B. In this scenario is it any worth in the CPTO regulating a clinic.
On the other hand if we are discussing about PTs working for only PT owned clinics, then it has a lot of practical implications, and unforeseen consequences, especially if we consider that majority of the PTs are now given steady and stable employment in large brand name clinics that are not owned by PTs (sometimes even traded publicly in the stock market). In theory its a good idea and may be the direction we need to work into, but how many PTs would be willing or be able to afford to buy ownerships? Great discussion Thanks to Shenda and the CPTO for initiating this, and to all those who are providing their inputs to make this a vibrant one.

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About the LTC home. PTs have lesser hours in LTC home and PTAs have more hours because of the so called “Middle man”. If the funds/budget were used to directly hire Physiotherapists and PTAs then we could maximize the Physiotherapy program for the residents. Meaning, more staff (PT and PTA), more hours, more quality care for the residents. PTAs should not be left unsupervised. If they are, then we should all start thinking about regulating PTAs!

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