The CPTA's College Conversations

Changes are coming to how Physiotherapy Alberta regulates the performance of pelvic health internal examinations by physiotherapists in Alberta. Although pelvic health internal examinations have always been a restricted activity, Physiotherapy Alberta is now transitioning to an authorization process for this activity that is similar to those used for authorizing the performance of spinal manipulation and the use of needles in practice.

In this episode we discuss the terminology Physiotherapy Alberta uses to describe this area of physiotherapy practice and what the plans to transition to individual authorization entail. We also address common questions from registrants, such as:

• What do these changes mean for physiotherapists currently working in this area of practice and wishing to continue to do so?
• How will these changes affect physiotherapist interns on the Provisional Register?
• What type of supervision is required for physiotherapist interns when they perform the restricted activity? What supervision is required for physiotherapists on the General Register who are in the process of learning how to perform internal examinations?

Legacy providers of these services should know that there are options open for them to apply for and obtain authorization to perform pelvic health internal examinations. We talk about that process in detail toward the end of the episode.

Resources:

• Restricted Activities – Pelvic Health (Internal Examinations) https://www.physiotherapyalberta.ca/physiotherapists/what_you_need_to_know_to_practice_in_alberta/restricted_activities#pelvic_health_internal_examinations
• Good Practice: Pelvic Health Update https://www.physiotherapyalberta.ca/physiotherapists/news/good_practice_pelvic_health_update?
• Pelvic Health (Internal Examinations) Resource Guide https://www.physiotherapyalberta.ca/physiotherapists/resources_to_help_you_meet_practice_standards/pelvic_health_internal_examinations_resource_guide

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From time to time, conflicts and challenging situations may arise between physiotherapists and their patients, which may lead the physiotherapist to consider declining to continue to provide services to the patient. These situations exist on a continuum from the slightly challenging to the potentially dangerous. Although there are circumstances where a physiotherapist may decide to discontinue treatment, when opting to decline services the physiotherapist also has several duties to fulfill.

In this episode, Jody and Leanne discuss the situations where it is or is not OK to decline services and the duties and obligations a physiotherapist must fulfill.

The onus is always on the physiotherapist to address conflicts appropriately, but how should we go about doing so? At the seven-minute mark we highlight a process for working through and addressing challenging situations and discuss key considerations, such as when it is important to involve a manager or clinic owner in a discussion with a patient.

When is it ok for a physiotherapist to decline services to a patient? Listen to this episode to find out.

Resources:

• https://www.physiotherapyalberta.ca/physiotherapists/resources_to_help_you_meet_practice_standards/managing_challenging_situations

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Advertising is a challenging topic within physiotherapy regulation, due in part to the tension between the need to promote the services offered and the need to conduct ourselves professionally. In this episode Jody and Leanne talk about common advertising problems including the use of the title 'doctor,' comparative and superlative statements, and misleading advertising.

Along the way we talk about the need to avoid a race to the bottom when it comes to advertising, and the importance of making sure that the advertisements for your business are consistent with the Standards and Code of Ethical Conduct, even when (especially when) you hire advertising professionals for help.

The key point here is that physiotherapist advertisements promote a health professional's services. The purpose is to inform members of the public about services that are available in their community, not to engage in unseemly aspects of advertising, such as bait and switch tactics, in order to get business in the door.

Resources:

• https://www.physiotherapyalberta.ca/physiotherapists/what_you_need_to_know_to_practice_in_alberta/standards_of_practice/advertising
• https://www.physiotherapyalberta.ca/physiotherapists/what_you_need_to_know_to_practice_in_alberta/code_of_ethical_conduct

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Physiotherapy Alberta has always fielded questions regarding Physiotherapist Interns and the Provisional Register, with questions relating to everything from the requirements for becoming a Physiotherapist Intern to the ins and outs of supervision and the performance of restricted activities. In the latter half of 2020 the number of questions received increased, presumably due to the delays to the completion of the clinical component of the Physiotherapy Competency Examination due to the ongoing impact of COVID-19.

This episode provides answers to the most common questions Physiotherapy Alberta receives about this group of Registrants. We discuss the Swiss Cheese Model of safety, and Physiotherapy Alberta's perspective that the Physiotherapy Competency Examination is one layer within a system designed to make sure that only competent and qualified physiotherapists are providing physiotherapy services.

As time spent in supervised practice passes, most Physiotherapist Interns will progress in terms of the nature and intensity of supervision that they require to practice safely, but what exactly does that mean? We discuss the differences between direct and indirect supervision and the instances where direct supervision is mandatory at the 6-minute mark of the episode.

We close with a discussion of restricted activities and the rules related to their practice by Physiotherapist Interns.

Resources:

• https://www.physiotherapyalberta.ca/physiotherapists/what_you_need_to_know_to_practice_in_alberta/standards_of_practice/supervision
• https://www.physiotherapyalberta.ca/physiotherapists/resources_to_help_you_meet_practice_standards/supervision_guide
• https://www.physiotherapyalberta.ca/files/supervision_agreement.pdf

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Provision of services rules are in place to guide the processes by which Physiotherapy Alberta approves practice settings where physiotherapy services are provided. In this episode Jody and Leanne talk about the evolution of regulation of physiotherapy practice settings in Alberta and the provision of services rules currently in place. We discuss when these rules apply and the application requirements for different types of physiotherapy practices.

Have you ever wondered what Physiotherapy Alberta means when we talk about the "most responsible physiotherapist" or why there are different application requirements depending on who owns a practice setting? Check out this episode to find the answers to these questions and more!

Resources:

• https://www.physiotherapyalberta.ca/employers/provision_of_professional_services

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September. The start of fall is a time of fresh starts for many. Some would even argue that with return to school and resumption of fall activities it's the real start to each year. It's also the month when regulated members of Physiotherapy Alberta submit their annual renewal documents. In this episode Jody and Leanne walk listeners through the renewal requirements, address some common questions, and discuss the importance of keeping your member profile up to date.

The deadline for on time renewal for regulated members of Physiotherapy Alberta is September 15th, but why wait? Listen to this episode and get started on your renewal today!

Resources:

• https://www.physiotherapyalberta.ca/physiotherapists/how_to_maintain_your_registration/annual_renewal

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Bitter divorces are not inevitable when physiotherapists decide to change employers. However, from time to time that is how things can play out. Physiotherapy Alberta typically only hears about the situations that are really problematic with both the clinician and the employer calling Physiotherapy Alberta to cast the other party as the 'bad guy' - not the transitions that go smoothly.

In this episode Jody and Leanne discuss:

• The root causes of conflict during these transitions.
• Some common issues that physiotherapists and business owners grapple with.
• Our best tips for avoiding trouble.

If leaving a practice can end up feeling like a bitter divorce, the best prevention is a good pre-nup agreement. With that in mind, this episode also covers topics that physiotherapists and physiotherapy business owners should proactively include in their employment agreements.

Most importantly, all parties need to internalize the mantra that no one owns the patient. We explain what we mean by that at the 3-minute mark of the episode.

Resources:

• https://www.physiotherapyalberta.ca/files/practice_guideline_leaving_or_relocating.pdf

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In this episode, Jody and Leanne discuss one of the Standards of Practice that typically gets little attention, the Legislative Responsibilities Standard. The episode starts with a brief review of some relevant legislation encompassed in the Standard, including:

• The Radiation Protection Act; and
• The Protection for Persons in Care Act.

The second half of the episode provides a more detailed discussion of the Occupational Health and Safety Act, which has recently garnered attention in the physiotherapy community because of the announcement that the Government of Alberta plans to send Occupational Health and Safety (OHS) officers to inspect physiotherapy businesses.

The discussion of the OHS Act focusses on:

• The application of OHS legislation to physiotherapy practice.
• The key aims of the legislation and its requirements.
• The roles of both employers and workers.

We also talk about the rationale for the increase in OHS inspections, link to tools to help you prepare for an inspection and direct you to additional workplace safety program resources.

If you are surprised that this legislation applies to you and your practice, you may want to check out the episode!

Resources:

• Physiotherapy Alberta. Standard of Practice – Legislative Responsibilities. https://www.physiotherapyalberta.ca/physiotherapists/what_you_need_to_know_to_practice_in_alberta/standards_of_practice/legislative_responsibilities
• Physiotherapy Alberta. Legislation Related to Practice. https://www.physiotherapyalberta.ca/physiotherapists/resources_to_help_you_meet_practice_standards/legislation_related_to_practice
• Government of Alberta. Occupational Health and Safety. https://www.alberta.ca/occupational-health-safety.aspx
• Government of Alberta. OHS Work Site Inspections: What to Expect. https://open.alberta.ca/dataset/c99544f0-57e8-4666-9175-19a90c869339/resource/54010109-ed5a-4eb8-ab9e-11d9dcc71866/download/lbr-ohs-work-site-inspections.pdf
• Government of Alberta. Occupational Health and Safety Starter Kit. https://open.alberta.ca/publications/9781460144473
• Physiotherapy Alberta. Occupational Health and Safety Online Course. https://www.physiotherapyalberta.ca/xchange/continuing_professional_development/elearning_center/occupational_health_and_safety/?course_type%3Alist=Online+Course

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Hosts: Jody Prohar, Registrar, Physiotherapy Alberta; Leanne Loranger, Manager Policy + Practice, Physiotherapy Alberta

In this episode, we talk about infection prevention and control and some of the lasting effects that COVID-19 may have on physiotherapy practice. Fundamentally, the pandemic has changed clinical practice. Some of the changes seen will remain, even as the first wave of the pandemic wanes and will affect how we address the predicted second wave of COVID-19 as well as other infectious diseases, such as annual influenza outbreaks.

In this episode we discuss:

• The hierarchy of controls and other measures to limit the spread of infectious diseases. Although there has been a lot of focus on personal protective equipment, and specifically mask use lately, PPE is situated at the bottom of the hierarchy of controls to prevent the spread of infectious diseases.
• When, how and why to complete a Point of Care Risk Assessment. The likelihood of needing additional measures to protect against the spread of infectious diseases will depend on the practice setting and patient population served. For this reason, physiotherapists need to conduct a Point of Care Risk Assessment that considers the risks posed by the patient, the task to be completed, and the practice environment.
• Changing workplace sick culture. We close the episode with a discussion of one of the most challenging aspects of COVID-19 response, the need to change workplace sick culture. How do we recalibrate our collective understanding of what constitutes illness? How do we move away from a culture of needing to be nearly dead before taking a sick day, to one where staying home when ill is the right thing to do?

Resources:

• Alberta Health Services. Point of Care Risk Assessment https://www.albertahealthservices.ca/assets/healthinfo/ipc/hi-ipc-acute-care-pcra.pdf
• Alberta Health. CMOH Order 16-2020 (Direction on Continuous Masking). https://open.alberta.ca/dataset/2a615f78-aa9e-48d9-a323-9f2c08b07667/resource/fcca7551-9a32-4ec0-9545-aa5163f8a284/download/health-cmoh-record-of-decision-cmoh-16-2020.pdf
• Alberta Health Services. Aerosol-Generating Medical Procedure Guidance Tool. https://www.albertahealthservices.ca/topics/Page17091.aspx

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In this episode, Jody Prohar, Registrar and Executive Director of Physiotherapy Alberta is in the hotseat, answering common physiotherapist questions and discussing overlooked legislative responsibilities including:

• Can physiotherapists offer discounts to patients?
• What about cancellation fees?
• Do I have to release patient records when they are requested?
• How can I stay up to date with information from Physiotherapy Alberta?

In this rapid-fire episode we cover many of the most common questions Physiotherapy Alberta receives from our registrants. Want to be in the know? Then listen to this episode!

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