Good Practice: What is the Role of the College?

  •   March 26, 2021
  •  Leanne Loranger, PT

Physiotherapy Alberta frequently hears from our regulated members, physiotherapists from other jurisdictions, members of the public and other stakeholders with questions regarding our name and role as a dual mandate organization. This Good Practice article will highlight the organization’s history, mandate, strategic partnerships, and upcoming changes to the work that we do. The intent is to address common questions and misconceptions about the role of the organization.

How Physiotherapy Alberta – College + Association was formed

Physiotherapy first became a regulated health profession in 1985 with the formation of the College of Physical Therapists of Alberta. Prior to 1985 leaders in the profession worked for many years to gain physiotherapists the privilege of self-regulation.

The Alberta Physiotherapy Association pre-existed the College and was a branch of the Canadian Physiotherapy Association at that time. The two organizations always had a good relationship, but at the time they operated as two separate organizations.

However, as time passed the Alberta association began to struggle and eventually concluded that it was no longer financially viable. The association chose to cease operations, and at that point approached the College to see if it would take on some of the association’s functions. Some of the functions of the Alberta Physiotherapy Association could not be taken on by the College; however, the College did take on specific tasks that were compatible with our mandate and Physiotherapy Alberta – College and Association was formed. Common misconceptions about our history are that the two organizations merged, or that the College engaged in a hostile takeover of the Association. Neither of which are true. The College did not seek out this dual mandate.

From the very beginning, Physiotherapy Alberta has sought to be clear to all parties, our regulated members, members of the public, external stakeholders, and national physiotherapy organizations, that our first consideration in all operational activities is to address the mandate given to us by the Government of Alberta - to protect the public interest. Although we agreed to take on some association functions, when the interests of the public and those of the profession were not aligned our focus will always be to serve the public interest.

What is the public interest?

The most challenging task of all is defining what, exactly, is the public interest. Simply put, there is no clear and agreed upon definition; however, Physiotherapy Alberta takes guidance from this Walter Lippmann quote:

The public interest may be presumed to be what [people] would choose if they saw clearly, thought rationally, and acted disinterestedly and benevolently.

Let’s look at some of the core functions of health profession regulatory bodies as established in the Health Professions Act: Registration, Competence, and Conduct, to illustrate how the public interest plays out in Physiotherapy Alberta’s daily activities.

Registration and renewal

Top of mind these days, in the face of ongoing challenges with the clinical component of the PCE, are Physiotherapy Alberta’s registration policies. Both registration and renewal policies are in place to serve the public interest by ensuring that only duly qualified and competent individuals are afforded the title of physiotherapist and the right to practice the profession of physiotherapy within the province of Alberta.

Registration requirements are in place to confirm that those entering the profession have met a specified minimum standard of entry-to-practice education, competence, and good character and reputation. The public interest is served through the development and enforcement of these requirements as they assure that when members of the public seek physiotherapy services, they will receive care from someone who is competent and capable to provide those services.

Registration and renewal requirements, like conduct and Continuing Competence Program requirements are established in Physiotherapy Alberta’s governing legislation and are a core component of what it means to be a member of a self-regulated profession. The Government of Alberta has granted physiotherapists the privilege and responsibility to regulate ourselves and has trusted that we will put self-interest aside in favor of promoting the public interest, protecting public safety, and maintaining public trust.

Each and every regulated member is responsible for this privilege and expected to assist in the task of self regulation, even when this is difficult. Historically, the vast majority of PCE candidates have been able to successfully complete both components of the physiotherapy competence examination. The point of the examination is to identify those candidates who cannot demonstrate their competence and ensure that the public is protected from these practitioners.

Individuals working outside of the regulatory world may not be aware that the pace of change of governing legislation is very slow. While this can be frustrating and may limit the ability of regulators to be nimble in the face of challenges, it also means that registration and other requirements cannot change without sober consideration and the opportunity for second thought.

While in the current context, the challenge posed by not being able to quickly change registration requirements for physiotherapist interns waiting to complete the clinical component of the PCE is frustrating for many individuals, the same slow pace of change proves beneficial when it means that new regulatory requirements are not imposed without due warning and preparation.

Competence

Physiotherapy Alberta has long known that the vast majority of physiotherapists engage in continuing professional development and life-long learning without being told to do so by their regulator. However, in those cases where a member of the profession is not intrinsically motivated to engage in continuing professional development, the patients who access that physiotherapist’s services are at risk of receiving low quality, ineffective, or potentially unsafe care.

A mandatory Continuing Competence Program is established in Physiotherapy Alberta’s governing legislation and reflects the fact that it is in the public interest for all physiotherapists to demonstrate ongoing professional development relevant to their area of practice each year, keeping abreast of current evidence and best practices.

Conduct

The College establishes Standards of Practice to ensure that all physiotherapy services meet a minimum set of expectations. Included in each standard is a global statement of what the patient can expect when receiving care from a regulated member of Physiotherapy Alberta. Conduct processes exist so that patients and members of the public can bring forward issues of concern when they believe that the standards were not met or that wrongdoing occurred.

To be responsive and demonstrate our commitment to the public interest, all formal complaints received by the College are investigated, and the College has developed resources to support the public’s understanding of the complaints process.

Historically, one of the biggest arguments against self-regulation of the professions is that from the public’s perspective they are “old boys’ networks,” in which the public has no voice and little chance of success if they raise a complaint. To address this perception, the Government of Alberta has legislated that effective April 1, 2021, all hearing tribunals and complaint review committees must be composed of no less than 50% public members.

Both the Conduct and Competence aspects of Physiotherapy Alberta’s work serve to address the minority of regulated members, those who do not engage in ongoing professional development and those who engage in practice which is not consistent with the Standards. The privilege of self-regulation comes with the cost that all regulated members must demonstrate a commitment to meeting the expectations and requirements articulated in legislation and standards, and their competence to practice both at registration and on an ongoing basis.

When challenges arise

There are times when the public interest and that of the profession are aligned. For example, it is in the interest of both groups that continuing physiotherapy education provide high-quality, current, evidence-informed instruction that is relevant to the practice of physiotherapy. The interest of the profession is served by physiotherapists enhancing their clinical knowledge and skills. High-quality education and a commitment to continuing professional development also enhances the credibility of the profession. The public interest is served when the skills of physiotherapists are enhanced, resulting in more effective, quality, and safe physiotherapy care being delivered, and less wasted time and money spent pursuing ineffective or low-value care.

At other times, the interests of the public and those of the profession diverge. An example is the fees that physiotherapists charge. It is clearly in the interest of the profession that fees for service increase over time, reflecting both the skills and knowledge of the physiotherapist providing the service, and the costs of providing that service. However, fee increases are not generally seen to be in the public interest, as the recipients of physiotherapy services are typically also payers, whether they are paying out of pocket, or through the public purse in the form of taxation. This is one reason why Physiotherapy Alberta is legislatively barred from engaging in fee negotiations – keeping the interest of the public at the forefront of such conversations is difficult and engaging in fee negotiations reasonably presents a conflict of interest if those engaged in the negotiations are also clinicians who stand to directly benefit from fee increases.

There are times when individuals tie themselves in knots trying to argue that a specific action is in the public interest. When trying to determine if a course of action is in the public interest, some questions to consider include:

  • What is the primary motivator for the course of the action?
  • Is the patient interest clearly and solely the motivator for action?
  • If not, who else stands to benefit?
  • Is it a case where the profession’s interests are advanced and the benefits to the patient occur indirectly, inconsistently, or by extension?

The more steps one must take and the more inferences or explanations needed to demonstrate that an action is in the interest of the public, the more likely it is not truly a public interest action.

Physiotherapy Alberta’s strategic relationships

Physiotherapy Alberta receives many questions from registrants regarding our relationships and partnerships with other organizations at the national and local level.

As a provincial physiotherapy regulator, Physiotherapy Alberta is a member of the Canadian Alliance of Physiotherapy Regulators (CAPR). CAPR members work together on shared issues of importance for the regulation of physiotherapy practice. This includes work to enable cross-border physiotherapy service delivery, harmonization of registration requirements, the development and revision of the Physiotherapy Competence Profile and Entry-to-Practice Milestones, the development and endorsement of the Core Standards of Practice, and policy development on topics of national concern.

Physiotherapy Alberta works with Physiotherapy Education Accreditation Canada (PEAC) and has a close working relationship with the Physical Therapy Program at the University of Alberta. Our work with these two groups is to support and collaborate with the academic programs when needed, and to provide support of PEAC’s work of accrediting university programs.

Physiotherapy Alberta is also a member of the Alberta Federation of Regulated Health Professions, where we work with local regulatory partners on issues of shared local concern, such as the development of resources to respond to amendments to the Health Professions Act.

Physiotherapy Alberta’s relationship with the Canadian Physiotherapy Association

When it existed, the Alberta Physiotherapy Association, was a branch of the CPA. However, the mandate of the College is incompatible with that of the CPA. Although Physiotherapy Alberta maintains a collaborative working relationship with the CPA, we are not, nor have we ever been, a branch of the CPA.

From the day that we agreed to take on a limited and narrowly defined set of member service activities from the Alberta Physiotherapy Association, we have been clear that we are a College first and that our government mandate to serve the public interest will always be our top priority.

Dividing the College and Association

In December of 2020, the Government of Alberta passed amendments to the Health Professions Act. There are many changes included in the amendments, but one of the most significant changes for Physiotherapy Alberta is that we will no longer operate as a dual mandate organization. The government has mandated that regulatory Colleges discontinue association-related activities and cease to hold themselves out as associations.

What that means in terms of the future activities of the College is still being evaluated. Certainly, any activity that is specified in legislation – such as registration, competence and conduct will continue, but other activities are being reviewed to ensure they are aligned with our public interest mandate. Council is also in the process of determining what Physiotherapy Alberta’s role will be in supporting the formation of a new Association.

Physiotherapists who are interested in being involved in the formation of a new physiotherapy association within the province of Alberta are advised to monitor Physiotherapy Alberta’s website for further information in the coming months.