2024-02-17 09:03:31
This text is part of the special section Professions and careers
Better access to health care according to patients’ needs, saving time and efficiency for doctors; physiotherapists, chiropractors and physician assistants provide their skills to alleviate the shortage of doctors.
Primary physiotherapy
For several years, physiotherapists have had direct access to patients in private clinics. “But not all people have the financial resources or insurance to consult,” notes François Desmeules, professor at the School of Rehabilitation at the University of Montreal.
Good news: for several years, these specialists in musculoskeletal disorders have been found in family medicine groups (GMF) and emergencies. Around sixty physiotherapists provide services in GMF at the moment, and around 90 are in emergency rooms in Quebec. These physical therapists can complete a university-based advanced practice program, although this training is not required. “The development of these practices is still heterogeneous,” explains Mr. Desmeules, who is also responsible for the in-depth professional studies diploma program in advanced physiotherapy in neuro-musculoskeletal at the University of Montreal.
A patient with back pain, for example, and who presents to one of these GMFs, will see a physiotherapist, free of charge, without going through a doctor. “They have an autonomous role and advanced practice, and take care of the patient in a comprehensive manner,” continues Mr. Desmeules. In emergencies, physiotherapists can replace doctors or work collaboratively. “Obviously, if a patient presents with an open fracture, it is not the physiotherapist who will see them. But a person with a sprain or lower back pain will immediately be seen by a physiotherapist,” observes Mr. Desmeules.
Inspired by experiences elsewhere in Canada and around the world, this new advanced practice allows everyone’s skills to be put to good use, as well as better access to care. “The care pathway for the patient is simplified, collaboration and communication between doctors and the physiotherapist are easier, and for the physiotherapist, the practice is interesting and autonomous,” summarizes Mr. Desmeules.
Have a finger in the pie
Chiropractors would also like to participate in improving access to care. The Association of Chiropractors of Quebec (ACQ) is demanding from the provincial government that chiropractors be included in front-line care trajectories. “Patients come to the emergency room for neck or back pain, but ultimately need manipulative care more than being taken care of by a doctor. It overloads emergency rooms and outpatient clinics,” illustrates Dr. Guillaume Corbin, chiropractor and president of the ACQ. The latter would like these patients to be referred to chiropractors, like those who go through the First Line Access Counter (GAP).
In addition, chiropractors would like to be able to refer their patients to a specialist doctor in their field of expertise, rather than having to refer them to their family doctors. “Pre-triage by chiropractors is very effective,” argues Mr. Corbin. The ACQ also wants chiropractors to be able to take care of accident victims, and estimates the savings in salary compensation at nearly $12 million. “Across Canada, patients have direct access to a chiropractor during work and road accidents,” says Mr. Corbin. In Quebec, you must first go to a doctor.
Focusing on collaboration and complementarity of professions, chiropractors wish to participate in improving the health system. “We can relieve doctors in our field of expertise,” says Mr. Corbin, who emphasizes that chiropractors are governed by a professional order, and follow an undergraduate doctoral program in chiropractic (in Quebec, this is the University of Quebec at Trois-Rivières which offers the program).
Support doctors
Although the profession of physician assistant appeared in the United States in the 1960s, it remains largely unknown in Quebec. “The physician assistant appeared among the military to fill a shortage of advanced qualified health professionals,” says Guillaume Couture, physician assistant and deputy director of the Quebec region of the Canadian Association of Physician Assistants.
There are four university programs in Canada (bachelor’s and master’s), and nearly 1,000 physician assistants working in public health systems. The training, which is shorter than that in medicine, attracts people in career change or foreign doctors, who would otherwise have to repeat their studies to practice. In Quebec, this profession is not yet recognized, and physician assistants who practice in the province do so on military bases.
“We work in collaboration with a doctor. It’s teamwork,” emphasizes Mr. Couture. If the physician assistant shares certain administrative tasks, his scope of practice reflects that of the doctor who supervises him. “I’m not the one who will do the entire knee replacement surgery,” specifies the one who specializes in orthopedics. However, he can perform a physical examination of the patient, make a diagnosis, make a treatment plan, and provide treatments.
Dr. Michel Leroux, orthopedic surgeon, with whom Guillaume Couture practices, is convinced that the physician assistant has his place in improving health care in Quebec. “We increase productivity by more than 30% during the day,” he estimates. The College of Physicians is also supportive. “The contribution of physician assistants is a possible solution to consider, but which must be the subject of an analysis involving in particular the College of Physicians […] », nuance Leslie Labranche, senior media relations advisor for the College of Physicians. A pilot project is underway, in collaboration with the Cree Health and Social Services Council of James Bay. “This pilot project will certainly contribute to the reflection of the various stakeholders involved regarding the place that physician assistants could potentially occupy in the health network in Quebec,” adds Ms. Labranche.
If the physician assistant allows doctors to be relieved, the profession, like many others, makes its contribution. “We are all about teamwork and complementarity. The patient wins, and so does the care team,” concludes Mr. Couture.
This content was produced by the Special Publications team at Duty, relating to marketing. The writing of the Duty did not take part.
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