I had the opportunity to sit down with Rachel Onishi, a stellar physiotherapist who works on the physiotherapy end of our Orthopaedic Outpatient Clinic. Prior to starting at our workplace, Rachel had never heard of Physician Assistants, after working with myself and PA colleagues, she is one of our biggest advocates! I often overhear her explaining how multi-disciplinary the physiotherapy and Orthopaedic clinic is, and how the physiotherapists communicate with the PAs and physicians.
Here I interview Rachel who talks about physiotherapists, how physiotherapists interact with Physician Assistants, and the difference between a physiotherapist and a PA working in Orthopaedics or Physiatry Practice. We were amazed at a lot of the similarities in our patient assessments, special tests, and clinical reasoning, but there are a few places where physiotherapist and physician assistants differ.
We go through what Physiotherapists do, however you can jump right to the comparison of a PA versus Physiotherapists which is near the end of the post.
About Rachel Onishi, Canadian Physiotherapist
Rachel went to University of Waterloo for Health Studies. While completing her undergraduate degree she was considering medical school at the time. She decided to volunteer at the physiotherapy clinic in her 3rd year of undergraduate study, and from that experience she decided that physiotherapy was the career she wanted to follow. She successfully applied to Queen’s University with a Master’s in Physical Therapy. Following graduation, she worked in private practice and community clinics.
What do Physiotherapists Do?
I enjoy working in physiotherapy, as it is a very rewarding profession in terms of working with people and helping achieve their functional goals.
Physiotherapists are primary care providers – which means that patients can directly access physiotherapists without requiring a referral. Often patients receive a referral from a physician’s office; however, this is usually for insurance purposes to allow for coverage of the physiotherapy visit from the patient’s extended health care benefits.
- New Assessments and Follow-up Assessments (physio history, physical, can be trained additionally to interpret imaging results)
- Therapeutic Treatments may involve:
- Manual Therapy – hands on, mobilizations (moving a joint passively) and manipulations, soft tissue work
- Modalities – TENS machine, Interferential current, muscular stimulation, biofeedback, heat, ice, ultrasound therapy, taping, laser therapy, shockwave which help decrease pain and/or swelling, and improve healing
- Exercise Prescription
- Patient Education
Acupuncture, among treatment modalities, manual therapy and exercise prescriptions are ways physiotherapists help to improve patients’ physical function.
Physiotherapists are Regulated Health Care Professionals
Physiotherapists are regulated health care professionals, which means regulation sets out practice requirements and maintenance of their certificate of registration. Physiotherapy treatment you are receiving can be provided by a physiotherapist or working under a physiotherapist’s direction (e.g. a physiotherapy assistant). Only a registered physiotherapist can use the title ‘Physical Therapist’, ‘Physiotherapist’ or ‘PT’.
Physiotherapists are subjected to auditing by the College of Physiotherapists, which ensures physiotherapists are practicing according to the minimum standards.
Physiotherapists also have access to four controlled acts:
- Moving the joints of the spine beyond the individual’s usual physiological range of motion using a fast, low amplitude thrust.
- Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis.
- Performing a procedure on tissue below the dermis, below the surface of a mucous membrane, in or below the surface of the cornea, or in or below the surfaces of the teeth, including the scaling of teeth. (e.g. a Wound Care Physiotherapist)
- Internal assessment or internal rehabilitation of pelvic musculature (e.g. Physiotherapist with additional Pelvic Health Training)
Specialties and Areas of Focus in Physiotherapy
There are different areas a physiotherapist can work in:
- Physiotherapists in respiratory rehabilitation / pulmonary rehabilitation: these physiotherapists may work with patients who are suffering from issues such as COPD, emphysema and chronic bronchitis.
- Physiotherapists in cardiovascular rehabilitation may work with patients who are recovering from a heart attack, heart surgery or other heart conditions.
- Physiotherapists in neuro rehabilitation may work with patients in hospital and in the community who may be recovering from a stroke, spinal cord injury, acquired brain injury, or suffering from conditions such as Parkinson’s, Multiple Sclerosis and ALS.
- Physiotherapists in MSK / Orthopaedics / Sports Medicine see patients with a variety of conditions which may include such sprains, strains, soft tissue tears, arthritis, fractures, and post- operative conditions to name a few. They may also treat people with sports injuries, workplace injuries, or post motor vehicle accident injuries.
- Wound Care
- Women’s Health
- Critical Care
- Occupational Health
- Education and research
Continuing Education for Physiotherapists
Learning does not stop after physiotherapy school. There are many continuing education courses that physiotherapists can complete, and many different directions a physiotherapist can go in to focus their practice.
For example, these special skills workshops go beyond what is taught in physiotherapy school, some of these courses is just on a weekend, a few weeks, or some a few years. Here are a few examples of some special skills workshops:
- Manual therapy courses (i.e. Canadian Academy of Manipulative Physiotherapy: CAMPT manippt.org/)
- NDT for adults with stroke, brain injury and other neuromotor
- Pelvic Health (urinary incontinence, pelvic pain, post and pre-natal care)
- Vestibular Rehab (e.g. dizziness, vertigo)
- Active Release Therapy
- Concussion Rehab
- Golf Rehab
- Wound Care
Rachel providing supervision and direction to Yuki, a McMaster Physiotherapy student
How Physiotherapists Collaborate with Other Health Care Providers
I work with the physiotherapy assistant, massage therapist, physicians and physician assistants in our the clinic
- Physiotherapy Assistant (PTA): The physiotherapy assistant helps me complete the treatment plan by showing patient experiences, doing gentle range of motion. I delegate the treatment plan to them and they help me to carry out. I do not have to be present for delegated work, I have to be confident that they can carry this out competently, which I have evaluated.
- Registered Massage Therapists: I refer people to massage therapy for soft tissue work. I do speak with the RMT at our clinic before she sees our initial visit, and how the patient is progressing.
- Physician: We send progress notes to physicians, or call the office if it was urgent to ask for a response. We may also ask about surgical restrictions and post-op surgical protocols.
- Physician Assistants: I basically go to the PA first prior to going to ask the Orthopaedic Surgeons. I tend to consult PAs for imaging questions, exercise restrictions post-surgery, I have helped to facilitate referrals for imaging, we reviewed imaging as entry-level physiotherapists we are not trained to read x-rays (some advanced practice physiotherapists can). We have brought up concerns to the PA about potential infections, poor progression with physiotherapy, any new problems and change in health status. Some benefits of this PA/PT communication is that continuity of care is significantly faster since the PA is more accessible than the physician at our clinic, we would have to wait long or didn’t hear back.
As a physiotherapist, Rachel often collaborates on patient care with other health care providers. Here she is speaking to Steve, a physiotherapy assistant and Sylvia, a registered massage therapist.
Pros & Cons of Being a Physiotherapist
Pros to being a Physiotherapist:
- In private practice I have a lot of autonomy
- Some physiotherapists open their own independent clinics
- Schooling is 2 years (24-25 months) depending on the program, and then you go straight into practice
- Job security is good, many physiotherapists are usually hired from a pool of already employed physiotherapists
- I get to develop rapport with patients, 30 minutes 2-3 times per week for whatever duration, 6 months you get to know people really well.
For me, a reason I decided to go into physiotherapy (instead of medicine) was because of the length of schooling and that that physiotherapists are “drugless practitioners”, they prescribe exercise rather than medications.
Cons to Being a Physiotherapist:
- Not all of your patients are covered by OHIP – and often you come across patients that would benefit from physiotherapy but do not have third party insurance or extended benefits to cover
- You may work evening hours in a private practice setting
- The job can be physical and you need to take care of yourself
Rachel working on medical documentation after seeing & assessing a patient.
- Canadian Physiotherapy Association: https://physiotherapy.ca/
- Canadian Alliance of Physiotherapy Regulators: http://www.alliancept.org/becoming-credentialled/
- Canadian Academy of Manipulative Physiotherapy: http://manippt.org/
- College of Physiotherapists of Ontario https://www.collegept.org/
- Ontario Physiotherapy Association https://opa.on.ca/
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