Can we get beyond ‘allied’?: The critical role of physiotherapists on Ontario’s primary care system
Just say their name: physiotherapists.
I was struck recently when the one-year milestone of Ontario’s Primary Care Action Plan was announced. The Ontario government noted progress in attaching patients to a primary care provider and how much work there is left to do in expanding the definition of ‘primary care’ and the role of ‘allied health professionals’ in inter-professional care teams and beyond. While I applaud the progress made to date, the use of the word ‘allied’ is a source of increasing frustration for me. It obscures the potential contribution of each of the health professionals who are referred to in this group.
Let me explain.
Physiotherapists are regulated health professionals. Patients don’t need a referral to access a physiotherapist, and where one is requested, it is usually the requirement of an insurance company. Physiotherapists work across the health system, in communities, hospitals, primary care, homecare and long-term care, providing evidence-informed care to treat a wide range of musculoskeletal (MSK), cardiorespiratory and neurological conditions.
They are patient-centric professionals dedicated to restoring movement and function, alleviating pain and improving quality of life for those recovering from an injury, managing a chronic condition, requiring pre and post-surgical care or seeking to improve physical health and well-being.
For many seniors access to physiotherapy by regulated physiotherapists impacts mobility, overall function and the ability to live independently. For MSK conditions, physiotherapists are often the first point of contact and they assess, diagnose, and manage these conditions each and every day. They work both independently and as a member of an interprofessional care team, in a myriad of settings.
Enable full scope of practice in Ontario
In fact, if the scope of practice changes already approved in Ontario legislation in 2009 are enabled in 2026, physiotherapists would be able to order diagnostic tests. This would increase timely access to care and provide a more seamless patient experience.
Enabling physiotherapists to practice at their full scope will:
- reduce the number of contact points needed within the health system
- reduce inappropriate utilization of walk-in clinics or emergency departments for imaging referrals
Patients would get appropriate and comprehensive care where and when they need it. Truly integrated care means that a qualified professional can act in the patients’ interest to provide care without artificial barriers or any additional gatekeeping. With a patient-centered lens, this could mean potential earlier return to function for patients, including care of self, family and earlier return to work. There would be potential savings for employers with improved time to return-to-work, reduced expenses related to travel and to eliminated healthcare visits. After all, this is about patients.
Important role of PTs in ordering diagnostic imaging
Recently a newspaper article published by two physician authors questioned the role of physiotherapists in ordering diagnostic imaging suggesting that this would cause new problems and delay access to MRIs. Their statements were not based in evidence and drew a robust factual response from OPA member physiotherapists citing the evidence. Published studies demonstrate that first contact physiotherapists order less imaging and reduce the need for prescription pain relief. It is unfortunate that Ontario has not followed the lead and the evidence from other jurisdictions (the U.K., Australia, Quebec, Alberta and P.E.I.) where this authority exists. Although, we remain hopeful that before the second anniversary of the Primary Care Action Team this will finally have advanced.
Our health system continues to buckle under the demands; whether that’s population growth, population distribution in the province, our aging population or the complexity in navigating our health system of systems. We need more physiotherapists working to full scope of practice to meet these grown demands. We would prefer to have ‘allies’ enacting system change who understand the value and impact that access to physiotherapy across the continuum of care has for patients in our province. Finally, let us name and respect the contribution of all of those “allied” health professionals that make a tremendous impact of the health and well-being of Ontarians.
Sarah Hutchison, MHSc., LL.M, ICD.D, is the chief executive officer of the Ontario Physiotherapy Association.