Elizabeth Benny’s journey as a physiotherapist began in India, where she completed her Bachelor of Physiotherapy in 2007. She started her career in a quaternary care hospital, working for four years within a multidisciplinary rehabilitation team.

“This setting provided me a strong clinical foundation and exposure to complex inpatient and outpatient populations across orthopaedics, neurology, cardiopulmonary care, oncology, medical and cardiothoracic ICUs, neonatal and neurosurgical ICUs, and organ transplant services,” says Elizabeth.

She later joined a university hospital under the Bahrain Defence Force, where she helped develop an orthopaedic triage unit. Reflecting on this phase, Elizabeth explains that the role strengthened her clinical reasoning, assessment, and diagnostic skills and introduced her to an early model of first-contact physiotherapy.

After immigrating to Canada and completing the licensing process, Elizabeth began working at a Community Health Centre (CHC). At the time, she says she had only a limited understanding of what a CHC truly represented. “The transition from a fast-paced corporate healthcare system to one characterized by long waitlists and patients facing profound medical and social complexity was challenging” she says. “Yet the work felt deeply familiar, echoing my upbringing in a village in Kerala, India.”

Discovering Primary Care

At the CHC, Elizabeth encountered patients living with chronic pain complicated by psychosocial stressors, trauma, economic hardship, and marginalization. “I quickly realized that physiotherapy alone was insufficient; meaningful care required addressing the social determinants of health,” she says.

This realization shaped her professional direction and led her to pursue a Master’s Degree in Physiotherapy. Her research focused on chronic pain management and resulted in a peer-reviewed publication, Ontario Musculoskeletal Physiotherapists’ attitudes and beliefs about managing chronic low back pain (Physiotherapy Canada, 2020). Over the following decade, Elizabeth’s role expanded to more than hands-on treatment.

“My role expanded beyond clinical treatment to include conducting programs, patient education, self-management strategies, behaviour change, outcome measurement, referral coordination, interprofessional collaboration, and case management when needed,” she explains. “For me, the question shifted from why I came to primary care to why I stayed.”

For Elizabeth, working in a CHC is about purpose. “While I may not always eliminate pain, I can consistently offer support, continuity, and compassionate care, and that has proven deeply meaningful,” she says.

Physiotherapy in a Primary Care Setting

Elizabeth currently works full-time as a physiotherapist at CommunitiCare Health. She primarily sees adult patients with musculoskeletal conditions, many of whom live with chronic pain, and she is also trained in vestibular rehabilitation.

Elizabeth explains that primary care physiotherapy relies heavily on a biopsychosocial model. “Many patients have experienced significant adversity, including displacement from war-torn regions, interpersonal violence, discrimination, substance use challenges, or systemic inequities,” Elizabeth says. “These lived experiences profoundly influence pain, recovery, and function.”

She recalls a patient with persistent knee pain who did not improve despite appropriate rehabilitation. Further discussion revealed the patient was climbing eight flights of stairs multiple times a day because she feared using her building’s elevator due to Islamophobic abuse. With support from a social worker and police, the patient was able to safely use the elevator, fully participate in rehabilitation, and experience gradual pain reduction.

In another case, an elderly patient disclosed he slept in a chair because he did not own a bed. “A referral to a community health worker addressed this basic need, making rehabilitation possible,” Elizabeth explains. These experiences reinforce a central principle of primary care: “Pain and function cannot be separated from lived experience,” she says. “Physiotherapy extends beyond exercise prescription to advocacy, collaboration, and addressing root causes.”

Elizabeth works within a robust interprofessional team that includes physicians, nurse practitioners, occupational therapists, kinesiologists, psychotherapists, social workers, chiropodists, dietitians, and community health workers. Care is delivered through both individual appointments and group-based programs.

“This is only possible through cohesive teamwork,” she notes.

First-Contact Physiotherapy in Action

Elizabeth played a key role in implementing first-contact physiotherapy within her team. She explains that success depended heavily on interprofessional collaboration. “I advocated for direct access to allow all team members to book patients directly into my schedule and reduce a growing waitlist,” she says. This included the reception staff who were trained to book patients presenting with MSK issues directly into the physiotherapist’s schedule.

As the model developed, waitlists were gradually eliminated and administrative burden decreased, allowing more time for patient care. Elizabeth notes that benefits to this model included timely access to musculoskeletal care, reduced burden on family physicians, early identification of red flags, improved patient flow, and early activation to prevent falls and injury.

Challenges such as role ambiguity and managing complex presentations were addressed through clear communication, standardized documentation, and close collaboration with physicians.

Expanding Scope of Practice

Elizabeth’s role pushes beyond traditional perceptions of physiotherapy in Ontario: “My role extends beyond addressing physical impairments to actively considering psychosocial factors such as stress, emotions, beliefs, and social context,” she says.“ Functioning as a first-contact provider, triage clinician, case manager, and patient advocate is essential within a primary care framework,” she explains.

Impact on Underserved Populations

Chronic pain management has been the most impactful area of Elizabeth’s practice: “My approach is grounded in the biopsychosocial model and often begins with motivational interviewing, sometimes starting with something as simple as encouraging a patient to return to their favourite coffee shop,” she says. Elizabeth is particularly focused on developing expertise in chronic pain and vestibular rehabilitation for underserved populations.

“For many patients, even the cost of public transportation is a barrier to care, making private vestibular rehabilitation inaccessible,” Elizabeth explains. “Everyone deserves the right care.” She adds, “I deeply empathize with individuals living in constant fear of pain, dizziness, imbalance, and falls, all of which are conditions that significantly restrict participation and quality of life.”

Improving Access and System Efficiency

When Elizabeth joined her CHC, the physiotherapy waitlist was nearly two months long. Limited discharge capacity meant only a small number of initial assessments could be completed each month.

By pursuing additional education in chronic pain management and implementing group-based programs, the team transformed service delivery. As a result, patients were discharged sooner with improved outcome measures, assessment capacity increased, and the waitlist was reduced to under 48 hours. Twenty-four-hour urgent appointments were also introduced for post-surgical, post-fracture, and prenatal patients.

Through a first contact model, Elizabeth explains, patients were often seen by physiotherapists faster than by family physicians for musculoskeletal concerns. “Physiotherapists functioned as a triage service, escalating care when red flags were identified and initiating treatment when appropriate,” she says. This approach preserved physician capacity and contributed to reduced emergency department utilization.

Strengthening Attachment to Primary Care

Elizabeth describes the Community Health Centre as a patient’s healthcare home: “This model ensures that no patient in need is denied access to physiotherapy and strengthens attachment to primary care teams,” she explains.

Rather than focusing solely on a diagnosis, the team considers the full context of each patient’s life. “This is what a CHC represents,” she adds. “Healthcare delivered under one roof, with dignity, continuity, and compassion.”

Looking Ahead

Elizabeth believes that focused advocacy is required to expand primary care physiotherapy roles in Ontario: “Primary care physiotherapy is a niche that requires maturity, accountability, empathy, ongoing skill development, and strong ethical grounding,” she says.

Despite their impact, many roles remain vacant due to low remuneration and high turnover. Elizabeth emphasizes the need for appropriate compensation, recognition of advanced scope, sustainable funding models, and education about primary care physiotherapy.

Reflecting on lessons learned, she highlights the importance of leadership, strong networks, standardized practices, ongoing evaluation, and continuing education aligned with community needs. “Above all, a strong support system is critical,” Elizabeth says. “Managing complex care in primary care settings can be emotionally demanding, and having a trusted team for guidance and encouragement is indispensable.”

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