Every day in Ontario, people end up in the ER for conditions that a physiotherapist could have treated months earlier.
“Patients are coming to the emergency department every day with pain that should have been managed weeks earlier by a physiotherapist in the community setting,” said Makaila Koshurba, a physiotherapist working in a Toronto-area emergency department.
The Canadian Institute for Health Information’s latest report confirms what Koshurba is describing. Emergency room visits across Canada have climbed to 16.1 million annually, and Ontario is no exception to that trend. CIHI is explicit: the factors driving longer wait times originate outside emergency departments, including a lack of access to primary care and community-based programs.
For the one in three people living in Ontario without private insurance, or for those who cannot afford to pay out of pocket, the public system is the only option.
“Every time I come to ask for treatment on aging issues, I am told that the waiting period is about four to six months,” wrote Joe, one of nearly 2,000 people living in Ontario who have signed our petition. “Treatment is needed right away. Otherwise, the issue becomes more severe,” he added.
Without that access, seniors whose mobility is declining end up in emergency departments rather than community clinics – often for falls and joint pain that community physiotherapy is specifically designed to prevent.
CPCs Prevent an Estimated 70,000 ER Visits
Ontario has the infrastructure to address this. The Community Physiotherapy Clinic Program operates through over 200 clinics across the province, preventing an estimated 70,000 emergency department visits in Ontario annually. Each dollar invested saves four dollars in downstream health care costs, reducing falls, surgeries, specialist consultations and visits to primary care.
The program hasn’t kept pace. According to OPA’s analysis of Ministry of Health data, since 2013 Ontario’s senior population has grown by 45 per cent, the cost of living has risen by more than 40 per cent, yet referral capacity has grown by just 14 per cent. Clinics that are paid a fixed lump sum regardless of how many sessions they provide are capping services and shifting toward private clients. In some communities, when a clinic exhausts its funded referrals, the nearest alternative is hours away.
Expand Access to Community Physiotherapy
One solution to the pressure on Ontario’s ERs already aligns with commitments this government has made: no hallway medicine, aging at home, and connected care for all. Expanding access to community physiotherapy is not a new direction. It is the most direct path to delivering on the ones already announced. Ontario’s primary care strategy is also expanding team-based care, but physiotherapists are rarely part of those teams – a gap that compounds the pressure on emergency departments every day.
The evidence is clear, the infrastructure exists, and the return on investment is proven. Physiotherapists across Ontario are ready to keep people out of emergency departments. What’s needed is specific: fund the 195,000 referrals people living in Ontario require, not the 140,000 the current model covers. The program that prevents 70,000 ER visits a year cannot be allowed to collapse for want of investment. Patients like Joe cannot wait months for conditions that will only get worse. Neither can the hospitals treating them.
Sarah Hutchison, MHSc., LL.M, ICD.D
Chief Executive Officer, Ontario Physiotherapy Association
As one of only two physiotherapists currently working within a Nurse Practitioner-Led Clinic (NPLC) in Ontario, Andrea Harrison-Hercun is demonstrating the value of physiotherapy in team-based primary care.
Working three days per week at the Georgina Nurse Practitioner-Led Clinic (GNPLC), Andrea provides physiotherapy services to patients who might otherwise face significant barriers to accessing care. Patients are typically referred by the clinic’s nurse practitioners (NPs), usually when they do not have extended health benefits or have exhausted publicly funded post-surgical or other OHIP rehabilitation services.
“I am the only physiotherapist at our clinic” Andrea explains. “If one of the nurse practitioners has a patient who they feel requires physiotherapy, they refer them to me if they do not have extended health benefits.”
The clinic has also built flexibility into its referral process to ensure patients with urgent needs can be seen quickly. Andrea maintains dedicated urgent appointment slots for conditions such as vertigo, paediatric concerns, and patients at high risk of falls.
A Natural Fit for Team-Based Care
Andrea’s path to primary care physiotherapy was shaped by years of experience across multiple practice settings. She has worked in:
hospital outpatient services,
the neonatal intensive care unit (NICU),
school-based care through the Children’s Treatment Network,
and private practice.
Her interest in primary care grew through her work alongside physicians and through conversations about the challenges many patients face when trying to access physiotherapy services.
Andrea reflected on conversations with the many physicians she has worked with over her career, including even her own family physician:
“We would have [conversations] about his frustration with recommending physio and some patients not being able to access physio if they didn’t have benefits and didn’t qualify for OHIP,” she says. “It made so much sense to me that physiotherapists should be part of a primary care team!”
When an opportunity became available at the Georgina Nurse Practitioner-Led Clinic, Andrea knew it was the right fit – “I jumped at the chance to apply!”
Expanding Access to Care
One of the most significant advantages of having physiotherapy embedded within primary care is improved access for patients who may otherwise go without treatment. Andrea sees firsthand how physiotherapy services within an NPLC can bridge gaps in care, particularly for patients with chronic musculoskeletal conditions, mobility challenges, arthritis, balance concerns, and those recovering from surgery.
John Holbrook, GNPLC Clinic Director
According to Nurse Practitioner and Clinic Director John Holbrook, the addition of a physiotherapist has strengthened the clinic’s ability to serve patients with complex needs:
“Adding a physiotherapist has enhanced our ability to accept and retain patients with complex musculoskeletal and mobility-related needs,” John says.
“Having a physiotherapist available within the clinic increases confidence that we can provide comprehensive care without relying solely on external referrals, making attachment more sustainable and improving the overall patient experience.”
The impact extends beyond access alone. John notes that the clinic has observed:
faster access to assessment and treatment,
earlier intervention for musculoskeletal concerns,
improved patient function and mobility,
more appropriate use of diagnostic imaging and specialist referrals,
and increased patient satisfaction through coordinated team-based care.
Collaboration in Action
Perhaps the most distinctive feature of Andrea’s role is the close collaboration she shares with nurse practitioners and other healthcare professionals. “Our team is great at working together,” Andrea says.
As a valued member of the team, Andrea is frequently consulted by nurse practitioners when assessing musculoskeletal concerns, reviewing imaging results, or determining whether physiotherapy may be an appropriate treatment option. Likewise, Andrea can connect patients directly with other team members when concerns arise outside her scope of practice.
“If I see a patient and they start talking about their stress at home and I am concerned about them, I can talk to our social worker and get them seen; or if a patient has questions about wanting to lose weight or eat better to manage their blood pressure, we can book them with our dietitian.”
This collaborative environment allows patients to receive timely support from multiple providers without navigating separate referral pathways or lengthy waitlists.
John notes that Andrea “has become a key clinical partner in managing musculoskeletal conditions.” He adds that “as a nurse practitioner, I can focus on diagnosis, medical management, and complex chronic disease care while collaborating with the physiotherapist on rehabilitation, exercise prescription, mobility assessments, and functional improvement plans.”
Redefining Physiotherapy in Primary Care
Working directly alongside primary care providers has also changed how Andrea delivers care. In traditional practice settings, communication with physicians often involved writing reports and waiting for responses, whereas within the NPLC model, those conversations happen in real time.
“If I think they need imaging, all I have to do is ask and they order it” Andrea explains, “and if I think cortisone could be a good idea, it usually gets done.”
The ability to collaborate directly with nurse practitioners allows concerns related to pain management, medication, inflammation, imaging, or specialist referrals to be addressed quickly and efficiently. This integrated approach supports earlier intervention and helps patients access the right care at the right time.
Beyond Individual Patient Care
Andrea’s role extends beyond one-on-one treatment. She contributes to a variety of health promotion and education initiatives offered through the clinic.
The team currently runs the GLA:D® program for arthritis management and has offered educational sessions for parents on topics such as tummy time, safe sleep, infant feeding, and infant CPR. The clinic also hosts summer cooking camps and other community-focused programming. The clinic also collaborates with nearby Family Health Teams on educational initiatives, highlighting the unique role physiotherapy plays within the NPLC model.
Rewards and Challenges
For Andrea, the greatest reward is knowing that she is helping people who might otherwise be unable to access physiotherapy services. At the same time, being the clinic’s sole physiotherapist can occasionally present challenges, such as not having intra-professional colleagues with whom she can brainstorm and learn from.
Advice for Physiotherapists Considering Primary Care
For physiotherapists interested in working in collaborative healthcare settings, Andrea’s advice is simple: “Do it! Primary care is an amazing setting to work in, and being able to work directly with doctors and nurse practitioners is such a refreshing change.” Andrea adds that “working with a team of social workers, dietitians, and occupational therapists is rewarding when you can offer team-based care.”
As one of only two physiotherapists currently embedded within Ontario’s Nurse Practitioner-Led Clinics, Andrea’s experience and contributions highlight the important role physiotherapists play in improving access, enhancing collaboration, and strengthening primary care for patients and communities alike.
Check out Andrea highlighting physiotherapy at GNPLC during National Physiotherapy Month on Instagram.
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