After reading a recent article in Macleans, I was inspired to write a blog about wait-times for physicians in the province of Ontario and how I believe we as physiotherapists may be able to help reduce them.
The article describes how the Harper government stated in 2006 that reducing wait-times was one of their top five priorities. They initially appeared to be following up on this promise by paying $612 million to each province to guarantee a reasonable wait for a sample procedure. The problem? The money ran out in 2010, and it only created a “whack-a-mole” phenomenon where the wait time for the procedure that received the most negative media was reduced, while all of the others were increased. The harsh reality is that Canada placed dead last among 11 prosperous countries when it came to how quickly we can access an appointment with our family doctor.
Here are two simple ideas as to how these wait times can be improved by better utilizing our physiotherapists:
First, many insurance continue to require patients to get a doctor’s referral prior to receiving physiotherapy. Physiotherapists in Ontario are primary care practitioners, meaning we don’t require a doctor’s referral, but many policies continue to backlog doctors offices by requiring the patient to first see a doctor. The number of policies not requiring a doctor’s referral has improved, yet many do continue to lag behind. The only reason that I can see, is that these companies want there to be a barrier in place for patients who want to use their benefits, and in turn they are contributing to Canada placing 11th out of 11 countries when it comes to wait times. If these companies were mandated to allow physiotherapists to truly be primary care practitioners, surely wait times would be reduced!
Secondly, in 2011 many changes were made to the physiotherapy act. Though many of these changes have already been implemented, one change, though passed, has yet to be put in place. This change will allow physiotherapists (with specific training) to order certain laboratory tests, X-rays, diagnostic ultrasounds, and MRI’s. Giving physios this responsibility would once again reduce wait times with family doctors, as current procedure often involves a physio assessing the patient, writing a note to the doctor suggesting these procedures be performed, then asking the patient to set up an appointment with the doctor in order to have the doctor order the testing.
One argument I have heard about giving physios this “power” is that perhaps we’re not qualified to make these decisions. However, a study by Moore et. al (2005) states otherwise. In the study, they compared the clinical diagnoses of orthopedic surgeons, physiotherapists, and non orthopedic providers (which were essentially general practitioners, nurse practitioners, physicians assistants etc.). The findings were that PT’s and orthopods had similar agreements between clinical and MRI diagnoses, while the other practitioners were much lower. The conclusion of the study was that physios show good clinical judgement on ordering diagnostics and these decisions can be made independent of doctor’s referral.
In summary, with Canada finishing last amongst prosperous countries with respect to wait times for family doctors, some simple changes could be implemented to reduce these times. One would be to force the hand of insurance companies still requiring a doctor’s referral. The second would be to allow physios with special training to order lab tests and diagnostics. These two changes are just the tip of the ice berg when it comes to reducing wait times, but we have to start somewhere!