Medical Employment Agency New Zealand & United Kingdom, Medical Staffing International

2011 NZSP/Medical Staffing International Achievement Award for Physiotherapy

What does advanced practice mean for physical therapy and patient care?

Advanced practice is vital for the development of Physiotherapy but what this actually means is confusing. There is a lack of understanding from both the profession and the public and a lack of consensus internationally on what advanced practice means. Consequently this proved a very interesting topic for a panel discussion at the recent World Confederation of Physical Therapy (WCPT) Congress held in Amsterdam in June.

The degree of confusion was first highlighted at the policy summit on ‘advanced scope of practice and direct access in physical therapy’ held in Washington DC in 2009. At this summit I presented a paper on ‘Advancing the scope of practice, the New Zealand experience’ and it was obvious that although we have similar terminology to some countries advanced practice is not interpreted the same way across all countries.

The objectives of the panel discussion were; to investigate a common understanding of the term advanced practitioner; to highlight what skills are gained and or lost in this role; to illuminate what the implications are or might be for the profession; to discuss the implications for healthcare in general and for education and training.

The panel members represented leaders in the profession from countries that had well established career pathways and those without. The panel members were Dr Alice Aitken (current President of the Canadian Physiotherapy Association); Peter Fazey (Specialist physiotherapist and chair of the Australian College of Physiotherapy); Sue Greenhalgh (Consultant physiotherapist and Fellow of the Chartered Society of Physiotherapy); Dr Haejung Lee (Director of International Affairs in Korean Physical Therapy Association); Bhanu Ramaswamy (Independent Physiotherapy Consultant in the UK). I was privileged to chair this discussion and to see if we could bring some clarity to this subject.

Nomenclature is the area of most confusion in this area so initially the panelists described what advanced practice means in their respective countries. In some countries advanced practice meant additional education and training in specific areas within the general scope of practice and in others countries it refers to areas outside scope (e.g. intra-articular injections, diagnostic ultrasound). The term extended scope is generally applied to the therapist working outside their general scope of practice. Confused, well there are of course a large number of countries within the WCPT that do not have a scope of practice and are unregulated so their use of advanced practice differs again.

This did lead to the comment ‘If you think we are confused about the nomenclature, then I don’t know what the public think. When people are told they are going to an extended scope practitioner, they think they are going to have something stuck down their throats!”

For example in the UK Sue Greenhalgh works as a consultant physical therapist. The term consultant in this case relates to her job position and is not a title she could use if she left that post. She runs a musculoskeletal service with a team of non-medical prescribers who do not work under medical direction. She detailed that the interventions by this service has resulted in less surgery and greater satisfaction from the patients due to the earlier treatment and care that they receive. This was just one good example of how advanced practice can benefit the patient. Both Sue and Bhanu highlighted that advanced practice is regional rather than nationally based and is usually facility dependent.

Advanced practice does also mean specialisation in different countries and the pros and cons of this were discussed. This debate has already occurred in New Zealand with the proposed specialisation process. Specialisation in Canada is evolving along similar lines to New Zealand while other countries have a specific course with exam as a requirement, like Australia. As with all these areas it is important for countries to do what is most appropriate for the local conditions. There was also general discussion on the need for greater use of assistants as the profession becomes more specialised.

Other areas that were discussed were: the cost to the profession and public with advanced practice and the corresponding risks; the importance of a critical mass of any scheme to ensure its sustainability; finally the barriers to advanced practice which included legislative, political, cultural and again cost.

In summary this subject was so vast it was impossible to explore it in too much depth. It did highlight that as a profession it is important to provide a career pathway with advanced practice that is recognised both nationally and internationally and by the profession and public alike. This will enable the profession to further develop the ‘brand’ of physiotherapy and its value to the public.

I would like to thank and acknowledge Physiotherapy New Zealand and Medical Staffing International for the PNZ/Medical Staffing International Achievement Award for Physiotherapy which helped towards the costs of this conference.

Jon Warren

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