How to Find the Best Physiotherapy in Toronto (or Anywhere Else)

Who offers the best physiotherapy in Toronto? Or anywhere else for that matter?

I know lots of therapists who are great at what they do (including my lovely wife), but I’ll never meet the best physiotherapist in Toronto (sorry Lindsay) – because the best physiotherapist for me and my needs right now is likely not the same as for you and yours.

But assuming the ‘best physiotherapist’ does exist, and I find them, that still doesn’t mean that I’m going to get the ‘best physiotherapy’ that I could, or even good physiotherapy for that matter.

Here’s why: a fantastically talented therapist can come across as a real dud if the clinic care model they operate within hinders how they deliver my care, or if I simply can’t make it in to the clinic to see them when I should.

So, finding ‘the best physiotherapist is neither possible nor necessarily a good idea, but making an educated choice of physiotherapy clinic is – and this can significantly increase the chance that you will have a great experience.

So without further ado, here are the 6 most important criteria for finding the best physiotherapy in Toronto (for you):

The 6 Criteria for Finding the Best Physiotherapy in Toronto (for You):

1. Does the clinic’s model of care prioritize face-time with your physiotherapist?

Since you are looking for physiotherapy, it goes without saying that you’re looking for the care and advice of a physiotherapist. But depending on where you go for physiotherapy this isn’t necessarily what you’re going to get, and here’s why: physiotherapists are expensive.

Clinics need to manage costs to ensure their profitability and thus their sustainability.

The easiest way to decrease costs is to use a clinic model of care that somehow reduces the amount of time each patient spends with their registered physiotherapist.

Many clinics, including the largest and most financially successful physiotherapy companies in Ontario, use one or more of these three popular cost-saving strategies designed to reduce the amount of physiotherapy each patient receives in each session:

  1. Double-booking physiotherapists so that they treat two (or more) patients at the same time by bouncing back and forth between them.
  2. Using support staff such as athletic therapists/kinesiologists/physiotherapy assistants or other staff to deliver care in place of the physiotherapist.
  3. Using shorter assessments and visits (such as 20 minute follow-ups), that are billed at rates that are proportionately greater than longer appointments.

Having less face-time with your physiotherapist means receiving less physiotherapy.

Is this ‘diluted-care’ approach to physiotherapy necessarily a bad thing for patients? No. Reducing face-time can be more cost-effective for the patient as well, assuming the rates they are charged are correspondingly less, that they respond well to the therapy they do receive, and that they wouldn’t have had better results or a faster rehabilitation (resulting in less visits) if they were treated at a clinic that offers exclusively 1-on-1 physiotherapy.

There are also some rehabilitation activities that do not require the expertise of a physiotherapist 100% of the time, and so could be delivered more cost-effectively by less-trained support staff. The best example is observing a patient perform an exercise therapy routine that they have been prescribed (although arguably this could be delivered even more economically to the patient in the form of a home-exercise program that they can do on their own).

This diluted-care model of physiotherapy has also made coverage more cost-effective for the Workplace Safety and Insurance Board (WSIB) and OHIP, which does still cover physiotherapy care under certain conditions.

Both WSIB and OHIP insurance schemes reimburse for physiotherapy at rates that are far below the industry average, but which the diluted-care model can (somehow) still find profit in.

This presumably results in more people having at least some coverage, which is a good thing. But this is a double-edged sword. In doing so, these companies are perpetuating a second-tier physiotherapy offering for WSIB and OHIP claimants, a market that only these same companies can service. Is this beneficial for patients?

When making your decision between physiotherapy providers, keep in mind that the amount of face-time with your physiotherapist is one area where clinics can differ considerably, and this may have an impact on your care.

Since you’re looking for the best physiotherapy for you, how much face-time you may want with your therapist is also up to you. If cost-savings is a high-priority for you (like it is for most people), keep in mind that physiotherapy should be delivered to you on YOUR terms – talk to your physiotherapist about your financial and other constraints so that they can create a rehabilitation program that works for you. This should include home-exercise programming and other education and advice that you can take with you to continue your rehabilitation on your own, for free.

Physiotherapist providing one-on-one care. Is the best Physiotherapy in Toronto one-on-one?

2. Who owns the clinic or business that is offering physiotherapy?

This is probably the least obvious of my six criteria, but it could be a profound one.

In my experience, Registered Physiotherapists are by and large an extremely professional and principled group of overachievers. As regulated health professionals, the actions of all physiotherapists, regardless of their place of work, is governed by the standards of the College of Physiotherapists of Ontario.

So why does it matter who owns the clinic that your physiotherapist works in?

It matters because the physiotherapist is not always in control of (or aware of) many clinic actions and policies that impact the patient – even though they are ultimately responsible for them per the standards set out by the College of Physiotherapy of Ontario.

Clinic actions and policies that can affect the delivery of physiotherapy include (but are not limited to):

  1. Patient care programs and internal referral practices – this includes ensuring that the patient is only recommended care that they actually need, whether this is with the physiotherapist or with another service provider working with the physiotherapist to deliver care.
  2. Billing practices – this includes keeping accurate billing records, allowing patients to opt-out of pre-paid care and packages, appropriate use of the physiotherapist’s billing number, etc.
  3. Patient personal information and health file management practices – the Health Information Custodian (the clinic) needs to maintain the patient file and clinic financial records for 10 years, while ensuring privacy, security, and easy accessibility for the patient.
  4. Advertising practices – this includes advertising only for services that physiotherapists are qualified to provide, maintaining truth in advertising (for example, the clinic can not call itself ‘the best physiotherapy clinic’), etc.
  5. Health and safety practices – this includes holding appropriate insurance, infection control practices, regular equipment maintenance, etc.

If the clinic is NOT a Physiotherapy Professional Corporation (or a physiotherapy sole-proprietorship), then it is NOT 100% physiotherapist owned. This means it is not required to abide by the standards set out by the College of Physiotherapists of Ontario.

In contrast, a Physiotherapy Professional Corporation is a regulated form of professional corporation that must be 100% owned by one or more registered physiotherapists who are themselves in good standing with the College. In the case of Toronto Physiotherapy, we are a professional corporation owned 100% by Lindsay Davey, PT.

Physiotherapy Professional Corporations are required to place the patients’ interests first. To hold the status of a professional corporation, the owner(s) of the company must: “ensure that the corporation does not breach any provision of the College’s Standards for Professional Practice or Code of Ethics”, as well as comply with the Health Professions Act, and renew their application each year to maintain their certificate of authorization.

In a nutshell, 100% physiotherapist-owned clinics are legally required to act in the best interest of their patients.

That’s all fine and good, but is it realistic to expect that non-physiotherapist owned clinics will NOT act in the best interests of their patients? I am sure that most physiotherapists do their best to look out for their patients, and that most non-physiotherapist owned clinics also have the best of intentions.

Perhaps one could imagine a scenario where a financially desperate clinic, or a clinic owned by a profit-driven non-health professional might bend some rules now and then, but surely this would be an exception? And certainly not a clinic owned by an Orthopaedic Surgeon or other regulated health professional, right?

Well… good intentions and fiduciary duty are not the same thing. There is a fascinating American study published last year that illustrates this distinction nicely.

The study looked at how different types of physiotherapy businesses delivered care to patients after total knee replacement surgery. Specifically, the authors compared post-surgery physiotherapy provided by clinics owned by the orthopaedic surgeons who performed the surgery, versus physiotherapy provided by independent clinics that the surgeons did not have a financial interest in (ref 1).

The results were striking:

Patients who received physiotherapy at a clinic owned by the orthopaedic surgeon that performed their surgery received on average twice as many physiotherapy visits as patients who were treated by an independent physiotherapy clinic.

I know what you’re thinking: clearly orthopedic surgeons have a vested interest in seeing their patients get better, so perhaps they are simply overly-enthusiastic about their patients’ post-surgery rehabilitation, and this explains the difference.

Not so. Patients whose surgeons owned a rehab clinic but who elected to attend physiotherapy elsewhere,  (at an independent clinic), were once again treated with only half the number of visits as they would have at their surgeon’s clinic. And here’s the real kicker:

Physiotherapy provided by independent clinics was found to be more intensive, include more individualized therapeutic exercises, and is more likely to be delivered 1-on-1 with a physiotherapist,rather than in a group setting.

Overall, the authors concluded:

“Patients treated by therapists not involved in self-referral arrangements received therapy services that appear to be better suited to assist the patient to recover more rapidly.”

So, even consummate health professionals – who are invested in achieving the best health outcomes for their patients – can fall into providing physiotherapy in ways that do not actually support the best interests of their patients, but instead support the bottom-line of their businesses.

This is the reason why there are laws in place (both in Ontario and in the US) to help prevent the ownership of physiotherapy clinics by orthopaedic surgeons and other regulated health professionals who might benefit from self-referral arrangements.

Nevertheless, even here in Toronto this practice is still common – although the orthopedic surgeons and other professionals involved tend to obscure their financial conflicts of interest.

Perhaps most the time, and for most patients, it doesn’t matter who owns the clinic that they receive physiotherapy at. But if you’re seeking the best physiotherapy experience possible for you, choosing a clinic that is 100% physiotherapist-owned will give you the peace of mind that the clinic you’ve chosen is required to act in your best interests, and faces disciplinary action if they don’t.

3. Does the clinic’s model of care emphasize exercise therapy?

Having read countless clinical studies of physiotherapy interventions, for a multitude of conditions and injuries, I can report that by far the most effective physiotherapy intervention used (other than perhaps patient education) is exercise therapy.

Incorporating a personalized exercise program in your therapy, including exercises that you can do at home, is typically a critical component to ensuring that you receive the most effective rehabilitation possible. This might not always be seen as the best strategy to help the clinic’s bottom-line, but empowering patients to take ownership of their rehabilitation and giving them the tools to do so can help a clinic build a strong reputation in the community. Physiotherapy should be delivered as a partnership between therapist and patient.

Selecting a clinic that prioritizes this clinical intervention will increase the chances that you’ll receive the best physiotherapy that you can.

4. Does the clinic have the appropriate expertise to treat your condition?

If you own a Subaru like me, you probably wouldn’t take it to a mechanic that specializes in European cars. Of course you could, and they may do a great job, but choosing a service provider that has taken extra courses or received extra certification related to your specific area of need definitely increases the chances that you will have the best rehabilitation outcome possible.

5. Is the clinic convenient for you?

Location and hours. It goes without saying that the best predictor of how well you will respond to physiotherapy is how well you will follow your program of care. This includes attending sessions with your physiotherapist.

6. Patient reviews… but not the way you think

The value of consumer reviews for any product or service is questionable, and this includes physiotherapy. Any reviews or testimonials that appear on a clinic’s website should be disregarded entirely, while reviews that appear on third party websites should be taken with a hefty grain of salt.

Here’s why: good reviews are just too easy to get, and business owners can ALWAYS find satisfied customers to write them. So the best use of customer reviews is to identify which clinic NOT to go to, rather than to help you find a good one. Bad customer reviews can offer insight into the types of problems that could arise at the clinic, and how the therapist and owner(s) might deal with them.

In Conclusion

Searching for ‘the best’ physiotherapist or ‘the best’ physiotherapy clinic is futile, and could even be detrimental to your care. But with a little bit of effort and consideration, you can significantly increase your chances of finding the best physiotherapy in Toronto – for you.

References

  1. Mitchell J.M., Reschovsky J.D., Reicherter E.A. Use of Physical Therapy Following Total Knee Replacement Surgery: Implications of Orthopedic Surgeon’s Ownership of Physical Therapy Services. Health Serv Res. 2016 Oct;51(5):1838-57.

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