Sitting in My Castle, Making Up the Rules…

Judging by some of the comments to some of my blogs, some of you must think I sit in my office, scheming to write rules that make the lives and jobs of physiotherapists harder than they need to be.

When I wrote the blog “My support person hurt someone. Am I in trouble?” one person responded that PT supervision of support personnel has always been adequate and “the College just wants to keep changing things for no reason.”

Several of you suggested the College had created a new rule to make PTs responsible for the actions or omissions of the support staff with whom they work.

When I wrote that it’s a PT’s professional responsibility to report colleagues with physical or mental conditions which may impair their ability to deliver safe and effective care, you responded saying this was a “witch hunt” and that physios don’t have the skills to decide whether a colleague has cognitive dysfunction.

In my last blog, when I wrote about the sensitivities of having personal relationships with patients, one of you said, “Thank you for making our social world even smaller and the bubble in which you prefer we live in even larger.”

I didn’t make any of those posts up. In fact, none of these blogs were about new rules—I was describing expectations that already exist.

The expectations are found in standards on our website and in the practice of your colleagues. I was just writing to remind you about them, or maybe to point out a rule where the evidence at the College suggests a certain percentage of PTs may be slipping a little (or sometimes a lot).

The fact is I have no authority to make up the rules. But you do.

If you feel that the College’s expectations are wrong or out of touch with reality, step up and take part in changing them.

Self-regulation means the rules about physios are set by physios. There are legal and governmental requirements sometimes, and legislation requires that any decisions about practice standards make patients’ needs the first priority—but the specific content of standards and regulations is determined by College Council.

Council considers all of the research before it makes any decisions. They might look at things like worldwide standards for physiotherapy, the expectations for other professions, trends in regulation and the viability of enforcement and costs of implementation.

Once they have an idea of how they might want to proceed, they consult with members of the profession and the public in Ontario to determine whether there is an Ontario-specific expectation.

Council’s responsibility is to capture in writing the expectations of the majority of the profession so everyone practicing physiotherapy in Ontario shares the same understanding of right and proper professional behaviour.

Since Council is required to put the patients’ needs at the centre of every decision, the decisions do not always create the easiest path for physiotherapists, but they do ensure that the integrity of the profession is maintained.

Based on some of your feedback, there are physiotherapists who think that the College is getting it wrong.

If we are, then we want to do better.

We have begun reviewing every one of our standards to update them and make sure they capture the realities of modern practice: that’s one of the College’s strategic goals.

You can be as involved as you want to be. Watch the website and your email for opportunities to contribute your opinion. Your perspective will always be considered by Council, and I promise that we will report back in Perspectives or on the website about how Council responds to the feedback it receives.

In the meantime, keep the comments coming to the blog—although we don’t respond individually, we read every one and take them into account when we are deciding about what to focus on, preparing materials for our website or updating our standards. Even when you don’t like us, we’re listening.


College Standards 


17 thoughts on “Sitting in My Castle, Making Up the Rules…

  1. Great blog. I read each of your blogs and find them very helpful, and sometimes I comment. Thanks for the information this month.


  2. My comment probably covers more than one issue we face. I am a PT who owns more than one clinic in the GTA. I have been interviewing PT candidates for a couple of positions within my organization. Here is what I have come across.
    1. Interviewed a young lady with approximately a year’s experience & not much in terms of clinical skills, no CE done. She wanted $50 plus per hour. When I asked her how she justifies that number, her answer blew my socks off. She said her current employer (non-PT??) pays her that much, he bills the whole family of a patient to their isurance without them attending treatment. I asked her if she is ok with that, she said yes, as long as she was aware of it.
    2. I see a lot of bashing on this blog, of PTs who own clinics & are concerned about patient numbers. As long as the patient is the first priority, I don’t see why clinic owners should not be concerned about patient numbers. Who pay the PTs salaries & the rents? Are PTs okay to work for free? They certainly want their $40-$45 per hour but only want to see 1 or 1.5 patients per hour. In an interview I asked a candidate, can you guess the rent of this clinic? Answer: No idea.
    3. Another PT I interviewed took up a job at a Chiropractic clinic. He gets $50 per hour. Has to go in only 2 days a week to do assessments, rest of the week patients are billed for physiotherapy, treated by PTA or Chiro??
    4. New PT graduates – sign contracts & then renege on their committment. This has happened more than once.
    5. I have provided monitoring to many new grads over the years. After I hire them, teach them & coach them for 3-4 months, as soon as they pass the clinical exam, they are out the door looking for “better opportunities”.
    6. A few years ago a PTA in my clinic resigned her position with us “for better growth” to join a clinic that “lets PTAs do assessments”.

    This is the state of the profession. Sorry for my rant but I had to put it out there to see if the College has an inkling about what is going on.


    • Hearsay is what I have to say….I just think that PT owners AND clinic owners should also show some respect to other PT’s. Who started contract jobs? We have to cover evening and weekend shifts for a pathetic part time work, so that you can enjoy your family time; get out of the city and either move, commute or drive to work – who pays for our rent or mileage? We also have to upgrade while paying off debts. e; get out of the city and either move, commute or drive to work – who pays for our rent or mileage? Some owners opted to get PTA students or volunteers whom “they train” and make other poor PT’s supervise them while faced with four (or more) patients an hour. I had to hear from owners that he cares about what the accountant or lawyer has to say – has to make sure they see you carry insurance policy and pay for rental of the clinic (which can go up to $300/mo btw or you get 30% split). No job securities at all. I would be a fool to leave an employer who is generous, considerate and respectful of this profession. Anyways, WGACA says J.T.


    • That’s why college is planning to regulate clinics. Unfortunately OPA is silent on this issue. New graduates are vulnerable and non PT owners/chiropractor are abusing them


  3. Shenda, I had to say that _all_ businesses should run like CPO. I just had my new car to the dealership 3X in a month and complained to the head office re: mechanic and business incompetence. I want to know which of their dealership has been in the business for certain years as my safety is at stake. I was told they have no records of this and also implied that they cannot share infos that are private. Take note that I already complained to the head office before and they advised me repeatedly to just try to resolve this issue with the dealership as they cannot intervene. My health and life is an issue and here I am as a PT paying expensive college dues to have my profile viewed by everyone. What are the odds that one gets killed by a PT versus a non-driveable, malfunctioning car? Advise to PT students out there: There is still time to change courses. Try a business on car dealership?


  4. First of all, we need to change regulations regarding maintaining documentation. These regulations do not match with current practice. It seems like these regulations were made when physiotherapy was a full time profession. Now a days, most physiotherapists work at more than one practice sites (although some of their college registration suggests that they are working only for one company because they are employed through that company to more than one practice sites). Most jobs are part time but expectations of keeping up to date assessment, care plan, insurance records etc. increases. Only one person is responsible for all of these… A Physiotherapist. In order to stay out of trouble from the College, the ministry, the insurance companies and so many other bodies, physiotherapists have to be perfect in their documentation. This is changing a physiotherapist’s role from a care giver to a clerical worker. Writing same assessments (most times not needed) and care plans over and over again in long term care practices because ministry wants an assessment done every quarter should not be acceptable as best practice. It is good to have a re-assessment done every quarter but the chain of paper work which follows that assessment, takes most of our time. After gaining a six year University level education, do we have to perform clerical work? All we are doing is to diagnose and suggest treatments. TRY ANSWERING THIS QUESTION: HOW A PERSON GRADUATED FROM ONE OR TWO YEARS OF COLLEGE COURSE CAN PERFORM AS GOOD A TREATMENT AS A PHYSIOTHERAPIST FROM SIX YEARS OF UNIVERSITY COURSE (No matter how good and clear a treatment plan written)? If the answer to this question is: yes. A PTA can follow our treatment plans as perfect as we want them to… than IT IS PROBABLY A TIME TO REVISE OUR CURRICULUM AND TO REDUCE OUR COURSE DURATION TO SIMILAR AS PTAs. WE DO NOT NEED TO STUDY SO MUCH. WE ARE WASTING OUR TIME AND MONEY BEHIND SIX YEARS OF UNIVERSITY PROGRAM. But we have very easily accepted, due to pressure of above mentioned bodies, that we have to spend most of our valuable time to write unnecessary things than to provide first hand patient care because properly written paper work is saving us from all possible legal troubles.


  5. I just watched a college you tube video. Practice adviser was keep saying that there is no definitive answer for how much supervision needed for PTA’s. But PT’s are ultimate responsible for PTA’s. College created this PTA model and now we PT’s are pressured by employers to do just assessments and pass it all treatments to PTA’s who went to 6 months programs. Please close this lope hole. Please regulate PTA’s and their programs. Please give us definitive answer about supervision.


  6. I think college in this form waste of money .It is not meeting public interest at this point. Like our OPA president mentioned on previous blog. Why do we need so many colleges ?.


  7. Is there any plan from college to regulate the PTAs, test their cometency, and have yearly renewal? It would greatly help the profession.


  8. Shenda, why does the CPO care about my driving record? I think a lot of PTs simply feel we are being over-regulated. Nurses don’t have to self-report speeding tickets. Dentists don’t. Lawyers? Nope. It’s too much. Do you want to know if I have some outstanding library books?
    If the CPO wants new regulation proposals to be accepted by PTs, some of the over-reaching regulations currently in place need to be scaled back. A lot.


    • Agreed 100%. Regulations and more regulations!!! Regulations are good up to some limits. This is definite intrusion in privacy. But…….is there anyone listening to us in OPA/CPA?


  9. They have clearly defined rules for physiotherapy practice than us

    Frequently Asked Practice Questions

    General Practice Questions | Direct Access to Physical Therapy Treatment | Medication Reviews by PTs

    Introduction To Practice Questions

    As a newly licensed physical therapist or certified physical therapist assistant you may have questions about the practice of your profession. The following may help you answer some of the most common questions. This information is based upon the questions submitted to the State Board for Physical Therapy by licensed or certified professionals like you.

    The scopes of practice for the professions of physical therapy and physical therapist assistant are defined in the law. Does that mean that I can do everything that falls within the legal scope of practice of my profession?
    Part 29 of the Rules of the Board of Regents requires that licensees practice within the scope defined in law and within their personal scope of competence. If you are not competent to provide a service that you are legally allowed to provide, then you may not provide that service. As a licensed professional, it is your responsibility to practice within the scope of your abilities and expertise. If you practice outside your personal scope of competence, you can be charged with professional misconduct.

    How long must I maintain patient records?
    All patient records must be kept for six years. Records for children must be kept until the child is 22, even if that means keeping the records for more than six years.

    Must I wear an identification badge when I am providing physical therapy services in a healthcare setting?
    You must wear an identification badge indicating your name and your professional title if you are practicing as an employee of a hospital, clinic, group practice or multi-professional facility, or at a commercial establishment offering health services to the public.

    May I use an “Aide or “Assistant” to provide physical therapy services?
    New York State law restricts the practice of physical therapy to licensed physical therapists or certified physical therapist assistants. Individuals who are not licensed or certified may not provide physical therapy services. Aides may perform non-patient related activities such as secretarial, clerical and housekeeping tasks. Additionally, aides may act as an extra set of hands for the physical therapist or physical therapist assistant who is actually providing the treatment.

    May I provide physical therapy treatment to animals?
    New York State law restricts the practice of physical therapy to providing services to humans.

    Can I accept a referral for physical therapy treatment from a physician, dentist, podiatrist or nurse practitioner not licensed in New York?
    In general, out-of-state physicians, dentists, podiatrists or nurse practitioners who are not licensed in New York may not practice in New York and consequently may not issue prescriptions or referrals for physical therapy to be performed in New York by a New York licensed physical therapist. However, one exemption permits practice in New York by a physician who is licensed in a bordering state and who resides near the border of this state. The border vicinity is usually defined as less than 25 miles. Therefore, a physical therapist may accept a referral from such a physician.

    Can I accept a referral from a physician assistant for physical therapy treatment?
    A physician assistant may perform medical services when under the supervision of a physician. Medical services which may be performed by a physician assistant include a referral to a physical therapist for treatment. In making such a referral, the physician assistant is acting as the agent of the physician.

    As a physical therapist assistant may I work under the supervision of a physician?
    Only a physical therapist may supervise a physical therapist assistant.

    What kinds of supervision are required for physical therapist assistants?
    Supervision of a physical therapist assistant by a physical therapist must be on site, that is, in the same building, but not necessarily direct personal supervision, that is, in the same room. For patients on a maintenance care program in residential health care facilities or certain other sites defined by the mental hygiene law, supervision of the physical therapist assistant by the physical therapist must be continuous but not necessarily on site. Continuous but not necessarily on site supervision is also required in home care services settings and in schools.

    In general one physical therapist may supervise no more than four physical therapist assistants. In a home care services setting, a physical therapist may supervise no more than two physical therapist assistants.

    Without exception, the physical therapist is responsible for evaluating the patient, setting patient goals, establishing a plan of care, and determining whether it is appropriate for the patient to receive the services of a physical therapist assistant based on the competencies of the physical therapist assistant and the needs of the patient.

    As a physical therapist assistant do my notes need to be co-signed by my supervising physical therapist?
    A physical therapist assistant does not need to have notes co-signed by a physical therapist. Physical therapists may read the notes of physical therapist assistants as one facet of their supervisory role. However, a co-signature is not required.


  10. NY state like many US states don’t have separate physiotherapy colleges. Professional licencing board control all profession under the same umbrella ( save $$$ from registration fees ). But they have clearly defined role of physiotherapist. Physiotherapy assistance, on site supervision etc. But our college rules are so complicated,not defined clearly for us to follow.


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