Grant: Operating Grant - Priority Announcement: Ethics

Physiotherapists are specialists in the musculoskeletal system. Many therapists' caseloads include patients who are on workers' compensation. The frequency of physiotherapy sessions has recently been questioned by health insurers, other third party payers, by the media and the Order of physiotherapists in Quebec. Of concern is that the workers' compensation system - and the expectations and pressures by third party payers - may create powerful incentives that can unduly influence decision-making by health professionals regarding service provision. Delays in receiving services as well as frequency of treatments may be related to the source of payment, raising concerns about equity and appropriate access to health services in both public and private settings. Yet, professional codes of ethics for physiotherapists in Quebec include only minimal guidelines on the subject. In this project, we will explore the ethics challenges raised by this situation in Canada and propose some ways forward. It is imperative for health professionals to be conscious of ethical issues in their clinical practice. This project has three components. We will analyze policies of different provincial and national agencies (orders, association, worker compensation board) across Canada. We will conduct a survey with physiotherapists across Canada using clinical vignettes to examine differences in delays and treatment frequency between patients who are or are not covered by workers compensation insurance. We will then explore physiotherapists' perspectives on this subject through individual in-depth interviews. We aim to develop ethics guidelines and policies for physiotherapists concerning conflicts of interest and equity in the distribution of health services. This work is extremely important in view of the limited number of physiotherapists in Canada and the increased need for rehabilitation services that is forecasted due to the aging of the population.