The Canadian Alliance of Physiotherapy Regulators (CAPR)—the governing body that administers and oversees the national Physiotherapy Competency Exam (PCE)—recently made the news when it cancelled its online exam shortly after students began writing the exam due to significant technical difficulties.

The PCE must be successfully completed by eligible candidates before applying for an independent licence to practice physiotherapy in Canada. This is the fourth time since the pandemic took hold in Canada in March 2020 that the CAPR has cancelled the PCE.

This has left a group of would-be physiotherapists waiting to start their healthcare careers, a hiring shortage in the industry, and ultimately decreased access to physiotherapy care for some patients in Canada.

At Propel Physiotherapy, we regularly have physiotherapy students completing their clinical placements with us. We asked one of our current students, Sandra Al Ali as well as our two physiotherapy residents on staff Nick Li and Reggie Ragos to share how this situation has impacted them personally and professionally.

1. How has the delay of the PCE affected you professionally?

Nick: It has affected my ability to practice independently which I’ve been waiting for over a year to do. Requiring supervision can become distressing because it makes me doubt my skills at times, almost as if imposter syndrome is persistently there.

It has prevented me from advancing my career and pursuing professional endeavours, such as potentially mentoring physiotherapy students and participating in clinical teaching sessions in academia. This also prevents me from moving back home to BC in order to start a business of my own or even consider it.

Reggie: I have had to continue dedicating time to preparing for this exam for over a year – instead of using this time to learn new skills, delve into the existing research and learning to apply it to my clients.

There is continued uncertainty regarding the exam date makes it difficult to plan ahead. For example, I would like to study for an exam under a reduced caseload to focus on my studies. This would require co-ordination with other therapists to ensure continuity of care. This may be difficult if we are given no updates to the potential exam dates. 

Also, some clients prefer to see a Registered PT, even after providing them information that we are still able to provide assessments/treatments. 

Sandra: As a soon-to-be grad, it has impacted plans for my career once I graduate. First, the delay impacts the job prospects. Some hospitals and clinics prefer to hire fully licensed physiotherapists. With the delay of the exam, there is a host of jobs that new grads will not be able to apply for until we have successfully completed the practical exam, which seems likely to be a long time from now. Even the courses that I want to take when I graduate (i.e.: pelvic health) seem hard to plan or even think about because we do not know when the exam is and I don’t want the course(s) to overlap with exam.

2. How has this affected you personally?

Nick: Because of the pandemic, it’s been more than a year of waiting and it feels as if I can’t move forward with my life. I was waiting to complete the clinical exam before going home to Vancouver to visit my family, but the delayed exams have continued to place my life in limbo.

Because of the stress and anxiety of having the exams cancelled over three times this past year, I actually sought counseling to manage my mental health. Although a lot of candidates, myself included, are more than ready to take the exam, the Regulators have not provided an alternative to the clinical exam. Their inflexibility has been the most frustrating part. We’re ready to take this exam – we just need an exam to take.

Reggie: Continued preparation for this exam has taken away time that could have been spent with my family or pursuing other personal interests like exercise and sport. I am also unable to access courses such as acupuncture that require a registered license to enroll.

Prior to cancellation of November 2020 exam, the CAPR warned examinees that they may have to travel to different provinces to take the exam. If that applied to me, I would have to quarantine for 2 weeks before writing the exam limiting my preparation time and adding the financial strain of a 2 week stay in another province 

Sandra: I feel like it’s definitely ramped up my stress levels in an already stressful time. There is so much uncertainty. We don’t know when the exam is going to be, whether it will be in-person or online, or how different it will be from previous years.

It feels like we’re the only profession struggling this much to pivot examinations online. There has been so much backlash in the news, via petitions and emails but nothing about the process seems to be changing nor does there seem to be a willingness to change. The way it’s being handled makes it hard to be excited to start a career as a PT. There is this huge obstacle in the way and it seems we can’t get over it.

3. How do you think this delay in physiotherapy graduates has affected patient care?

Nick: With the ongoing delay, there has already been a backlog of candidates waiting to do this exam. Delayed exam administration means a delay in licensing physiotherapists and a continued shortage of frontline workers in urban and rural communities.

We have already seen a backlog of clients awaiting to be seen in outpatient clinics. If patients are waiting longer to be seen by a physiotherapist, it can increase their risk of preventable disability.

Reggie: Physiotherapy residents are not able to perform rostered acts such as tracheal suctioning and pelvic physiotherapy leading to decreased access or longer waiting times to these speciality services.

If this continues, we might see a case where students are hesitant to join the profession, leading to a decrease in physiotherapists in the future. Some schools in Ontario have already decreased their program intake due to a lack of clinical placement opportunities.

Sandra: In general, we know the sooner a person sees a healthcare professional the better their health outcomes. But right now, with the delay in graduates, some clinics and hospitals are not able to fulfill PT positions. In turn, wait times to see a physiotherapist will increase.

Physiotherapy helps Canadians recover from illness, improve the flexibility, strength, and balance that older adults need to remain independent and mobile and plays a key role in healthy aging. Access to physiotherapy becomes increasingly important in an aging population.

At Propel Physiotherapy we believe in delivering the highest quality of care by passionate and dedicated professionals.  We are committed to providing education to students, new therapists and are invested in lifelong learning.  We support and stand with our all our physiotherapy colleagues including students and physiotherapy residents as they work to find the best solution to ensure timely and equitable physiotherapy access for all clients.

Fast Forward Two Years: Residents to Registered Physiotherapists

More than two years into the pandemic, the Canadian Alliance of Physiotherapy Regulators (CAPR)—the governing body that administers and oversees the national Physiotherapy Competency Exam (PCE)—has not fixed the technical issues that caused four exams to be cancelled. The industry still has not recovered. There continues to be a shortage of physiotherapists to fill the demands of clinics and hospitals in Ontario.

We spoke to Nick, Reggie and Sandra about their long journeys to obtaining a licence to practice in Ontario, and what they think the physiotherapy licensing process should look like going forward in this follow up article Residents to Registered Physiotherapists.

About Nick Li

Nick Li registered physiotherapist Propel Physiotherapy Etobicoke 359x370

Nick Li is passionate about helping his clients find the right motivation to help them reach above and beyond their goals. His approachable personality allows clients to feel comfortable expressing concerns regarding their conditions. He coaches his clients towards self-management by empowering them with knowledge.

Nick joined Propel Physiotherapy’s Etobicoke clinic fresh off his graduation in fall 2019 as a physiotherapy resident. He was one of thousands of students across Canada who attempted to write the exam in March. His story was shared on CityNews recently. Nick plans to take the next exam in the fall of 2021.

About Reggie Ragos

Reggie Ragos registered physiotherapist Pickering Propel Physiotherapy Pickering 370x370Rehginald (Reggie) Ragos believes that improving your physical function also improves your mental health. He is passionate about helping clients accomplish their rehab goals. Seeing their self-efficacy and confidence grow, as they learn new skills and become stronger, is what he loves most about his work.

Reggie completed his clinical placement at our Pickering clinic. Upon graduating in the fall of 2020, he joined our team full-time as a physiotherapy resident. He has attempted to take the exam twice, is planning to take the exam this fall.

About Sandra Al Ali

Sandra Al Ali student intern Propel Physiotherapy

Sandra is a second-year physiotherapy student at the University of Toronto and is currently completing a placement at Propel Physiotherapy in business leadership.

Sandra will be graduating in October 2021, and is planning on taking the clinical exam in November 2021.

Written by

Kathy Mileski
Kathy MileskiRegistered Physiotherapist and Mindfulness Trainer
Kathy Mileski loves the idea of helping others be as mobile and active as they possibly can. She believes that every person has the potential to do amazing things. That belief bolstered by her training and experience has helped her clients to achieve success in their rehab goals no matter where they are in terms of their recovery.

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