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Member Spotlight – Expanding Horizons: A Physiotherapist’s Role in Ontario’s Emergency Departments

Highlighting the Full Scope of Physiotherapy Practice with Andrew Tri, Emergency Department Physiotherapist

Andrew Tri, smiling Physiotherapist at an emergency department at Toronto General Hospital

In the ever-evolving landscape of Ontario’s healthcare system, physiotherapists are stepping into new roles and settings with significant impact. Andrew Tri, a physiotherapist working in the emergency department at Toronto General Hospital, shares his journey, insights, and hopes for the future of the profession.

A Dynamic Career Path

From his early days working in private neurological rehabilitation and high-performance sport clinics, to supporting elite athletes at the Toronto Lakeshore Skating School and national teams such as Swimming Canada, Skate Canada, and Rowing Canada, Andrew Tri’s career has always been dynamic. Diverse education and a shifting healthcare landscape allowed him to move between roles in inpatient surgical units, sports organizations, and even a health tech company, which eventually led him to become a trailblazer in the emergency department.

“My path has always included both public and private settings,” Andrew explains. “That hybrid approach kept my skills sharp and my perspective broad.”

After earning his FCAMPT (Fellow of the Canadian Academy of Manipulative Physiotherapy) designation in 2018, Andrew pursued further education through the Master of Clinical Science in Advanced Health Care Practice (Sport and Exercise Medicine) at Western University (AHCP-SEM). This interdisciplinary program was a steppingstone to a new opportunity to work at Trillium Health Partners – Credit Valley Hospital, which eventually led Andrew to University Health Network, where he is helping define and expand the role of physiotherapists in the emergency department.

Emergency Care

Andrew credits his wealth of postgraduate training and wide-ranging clinical experience for preparing him for the unpredictable nature of the emergency department. “The emergency department is one of the most unpredictable areas of the hospital” Andrew explains. “The AHCP – SEM program at Western is designed so that you’re in a mixed cohort of PTs and Physicians…I had the privilege of learning from some brilliant physicians, some of whom practice in the emergency department.”

In the emergency department at Trillium Health Partners – Credit Valley Hospital, Andrew worked under medical directives that allowed qualified physiotherapists to order imaging, administer analgesia, and manually reduce dislocated joints:

“If a shoulder dislocation comes into the emergency department, we are the first ones to assess, order imaging, and initiate the reduction process.”

This proactive, team-based approach helps streamline emergency operations and improves patient outcomes. Andrew has noticed that this model “allows individuals to receive appropriate care in a time-effective model that better utilizes resources and distributes work amongst team members.”

Physiotherapists as System Changers

Andrew is part of a small but growing group of physiotherapists working to their full scope of practice in collaborative teams. “Having the experience of working in a role that allows for basic medical imaging and administering analgesia allows me to experience first-hand what a full scope of practice in Ontario could look like,” Andrew says.

Andrew believes that high-quality roles where physiotherapists practice to full scope are powerful advocacy tools: “I believe doing the role, and doing it well, helps push the boundaries as we continue to serve as a strong representation of what PTs can do, or look to do once trained to do so.”

Over time, Andrew has seen growing awareness of the value that physiotherapists bring to the emergency department: “There is a lot more understanding of what PTs can do and the value that can be provided in the emergency department.” From assessment and early management to discharge planning and education, physiotherapists play an integral role in improving patient care.

Serving Underserved Populations

Musculoskeletal conditions, which are frequently underserved in traditional emergency department models, are an area where PTs shine.

“These musculoskeletal populations are in our wheelhouse as PTs,” says Andrew. “Our impact is in providing early, effective education and starting someone’s journey on a higher trajectory…This reduces the likelihood of those fear avoidant behaviours and maladaptive patterns.”

He also highlights the PT’s role in managing chronic conditions and geriatric syndromes, both of which are areas where timely intervention can prevent unnecessary hospitalizations and future emergency department visits.

In a system battling hallway medicine and capacity issues, Andrew believes physiotherapists are key allies. “We’re constantly assessing and developing management and discharge plans to ensure those who are in need of active emergency medicine, have the space to receive the appropriate care…”.

Advocacy, Collaboration, and Moving Forward

Andrew believes that adding more physiotherapist roles in emergency departments is not only possible but essential: “We are trained to provide value beyond mobility and discharge planning, [and] we are well-positioned to contribute more to assessment and management”.

For fellow health professionals, he emphasizes the need for collaboration:

“PTs can provide a lot of value to a healthcare system that is currently overloaded and understaffed. The deterioration that typically happens in the care areas of musculoskeletal, cardiorespiratory, neurological, and complex care systems often end up presenting to the emergency department in the form of falls, physical fragility, loss of function and independence, and generally failure to thrive.”

As the healthcare system evolves, Andrew outlines a roadmap for progress: use data to demonstrate impact, build public and political awareness, advocate for new physiotherapist roles, and form task forces to address broader healthcare trends.

He also urges physiotherapists to challenge the status quo and continue to grow: “We are in a profession of continued, life-long learning [and] times have changed. The stresses and demands on the health care system have changed. We must continue to advocate for the appropriate change in our scope of practice to better serve and support these new demands.”

A Vision for Physiotherapists in Emergency Care

Andrew’s story is a case study of the untapped potential of physiotherapists within Ontario’s healthcare system. His work exemplifies how the profession, when supported to work to full scope, can transform emergency care and support system-wide goals.

As Ontario’s healthcare landscape continues to shift, stories like Andrew’s are a powerful reminder of what is possible when physiotherapists are empowered to lead, innovate, and care at the highest level.

Are You our Next Member Spotlight?

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Scope of Practice Update

Thank you to everyone who has been engaged with the recent announcement about pending scope of practice implementation for physiotherapists in Ontario. We are equally excited about these next steps and want to assure our community that we will share additional information as soon as it becomes available to us.

Following the Announcement, the Government of Ontario opened a public consultation on the scope of practice for a number of regulated health professions and specifically included the authority for physiotherapists to order diagnostic imaging.

What’s Been Completed

Scope of practice expansion began under the Physiotherapy Act, 1991 in 2009. Specifically, members will recall that the Physiotherapy Act was amended to:

Expand the legislative description of the scope of practice of physiotherapy in section 3 of the Act;

Authorize physiotherapists to “communicate a diagnosis”;

Perform several procedures relating to wound care;

These changes have been in place for some time. Combined with the earlier extension of authority to “administer a substance by inhalation” that was extended prior, the scope changes arguably represent the most extensive granted to any profession that was regulated by the Health Professions Regulations Act when it came into force and effect in 1993. With the pending addition of diagnostic imaging, the only outstanding authority is the ability to order of lab tests.

In the fall of 2024, OPA collaborated with the College of Physiotherapists of Ontario to update past submissions to the Ontario Government on scope of practice implementation. This included the results of a 2024 updated survey of Ontario physiotherapists to understand the current landscape. A comprehensive submission has already been made to the Ministry in advance of this announcement. OPA has been committed to advocacy in this area dating back to 2009. View the timeline of OPA activities related to scope changes.

What Needs to Happen for Scope of Practice Changes to Advance

It is important to know that few of the health professions that are seeking scope expansion are at the same point in terms of the necessary enabling legislation. In this regard, the physiotherapy profession is among the furthest advanced. In our case, the necessary statutory amendments have already been made and have been proclaimed.

Once this current consultation period has ended, the following amendments to regulations need to occur. The changes to regulations are under the authority of the Minister of Health, subject to approval by Cabinet. Implementation of the physiotherapy scope of practice changes require:

A regulation under section 6(2) of the Healing Arts Radiation Protection Act to add prescribing of X-rays by physiotherapists.

Amendment to the Exemptions section of O. Reg 107/96 “Controlled Acts” under the Regulated Health Professions Act, 1991 is required to give physiotherapists the authorization to order the following “ prescribed forms of energy”:
o MRIs, under Sections 3.1 and 7.4,
o Diagnostic Ultrasound, under Section 7.1(2), by including “a member of the College” as a “member with ordering authority.”

Physiotherapists are also seeking the ability to order laboratory tests, but the announcement did not reference this request. The following regulation changes would be required:

Amendment to O. Regs. 45 /22 Sections 17 & 18, under the Laboratory and Specimen Collection Act to permit physiotherapists to order laboratory tests (9.1(a)) as appropriate.

Amendment to O. Reg. 207/94 General, Section 12 under the Medical Laboratory Technology Act, 1991 to permit taking blood samples when ordered by a physiotherapist.

What the Government Announcement Means

This announcement is consistent with the government’s commitment to advance scope of practice expansion. The public consultation is a forum for the government to share its intent and to receive input on the benefits and risks of implementing scope of practice changes for multiple regulated health professionals including physiotherapists. We remain optimistic that following the completion of the consultation on November 3, 2025 the government will move quickly with the needed regulation changes to expand the scope of practice for physiotherapists.

What Information We Do Not Have Yet

Specific timelines for the drafting and approval of the necessary enabling regulation changes. We are hopeful that the regulations pertaining to physiotherapy could be in place as early as mid-year 2026.

Timeline from approval of regulation changes to clinical implementation including confirmation of the College of Physiotherapists processes for rostering that will be adapted to support this new authority. We understand that the College is preparing for implementation so that once the government has made the final regulatory changes, they will be ready to move forward. We will continue to work with CPO on implementation related considerations.

Government of Ontario Consultation

Thanks to all who provided thoughts to inform OPA’s feedback. This feedback closed October 8, 2025.

The Government of Ontario has released a consultation on the proposed changes to scope of practice closing on November 3, 2025.

Continue with your letter writing advocacy in support of scope expansion for physiotherapists.

Respond directly to the government’s consultation.

We are actively collecting feedback from the physiotherapy community to include in our response to this consultation, which closes on November 3, 2025.

In addition to a summary of the existing PT competencies and scope of practice already passed in legislation, OPA will ensure the following points are clearly articulated with supporting evidence.

Continued access to diagnostic imaging must to be publicly-funded.

Implementing the authority for physiotherapists to order diagnostic imaging will:

Increase access to the right health care at the right time for many people in Ontario

Improve efficiencies and reduce costs in the healthcare system by eliminating redundancies and red tape

Require additional education and ongoing learning by PTs to ensure best practices

Be implemented safely and effectively by the College of Physiotherapist of Ontario’s robust and proven rostering process and quality assurance

OPA will share our submission with members prior to the government’s consultation closing.

We strongly encourage all PTs to provide their support through any of the two remaining pathways with comments directly to the Government’s consultation or continue with our letter writing campaign. Our voices are stronger together!

Questions? Contact OPA at physiomail@opa.on.ca

Courtney Bean, OPA’s President Message, September 2025

OPA President, Courtney Bean, shares a message upon the recent Government of Ontario announcement about pending scope of practice implementation for physiotherapists in Ontario. Courtney also welcomes new students to the physiotherapy community.

Scope of Practice Expansion Announcement

We are pleased to share that today the Government of Ontario announced proposed changes to expand scope of practice for physiotherapists.

For physiotherapists, proposed scope expansion enables ordering of diagnostic imaging further enabling our ability to diagnose. OPA has long advocated for these changes so that people in Ontario have timely access to care. We are pleased to see this progress and OPA is committed to continue to advocate to take scope expansion across the finish line.

The government has recognized that scope expansion provides more timely access to care for people when they need it most. Supporting and enabling physiotherapists to work to the full extent of their training and expertise will further contribute to the optimal use of Ontario’s health human resources. The regulation changes for physiotherapists are straightforward and within the Ministry’s authority under current legislation, and we look forward to working with the Government to complete this important work this fall.

Sarah Hutchison
Chief Executive Officer
Ontario Physiotherapy Association

Read Ministry News Release

Meeting with Premier Doug Ford & Minister of Health Sylvia Jones

May 8, 2025

On May 8, President Courtney Bean joined Isaac Taylor, Physiotherapist to meet with Premier Ford and Minister of Health, Sylvia Jones, advocating and engaging on issues that really matter to the profession. This meeting provided the opportunity to talk about how physiotherapists can make an impact on ER wait times, the role of first contact physiotherapists in expanding access to primary care, integrated community care and transitions between hospital and home, and of course of critical importance – expanding scope of practice for physiotherapists across Ontario.

Minister Jones heard and understood the priority of the profession in advancing Scope of Practice in Ontario and we remain optimistic that this will progress to implementation over the course of the summer. We want to thank Minister Jones for acknowledging National Physiotherapy Month and thanking PTs for their contributions to the Ontario health system.

At OPA, this opportunity is core to our mission and our commitment to influence and shape decisions that affect the profession and the patients you treat across the province.

Scope of Practice & Labour Mobility

May 7, 2025

OPA applauds MPP France Gélinas (Nickel Belt) for her strong comments in the Ontario Legislative Assembly on April 30, 2025, in support of implementing outstanding scope of practice elements for physiotherapists. As a physiotherapist herself, Mme Gélinas knows the beneficial impacts of PTs gaining the authority to order diagnostic imaging and laboratory tests.

Mme Gélinas said:

“Back in December of 2009, we voted in this House in favour of changes to the scope of practice of physiotherapists. Why? Because the scope of practice in other provinces had changed. It was time for Ontario to do the same … we are in 2025 and those changes have not been implemented.”

Her comments were in response to Bill 2, the Ontario Free Trade and Mobility Act, 2025, which would allow workers registered in other Canadian jurisdictions to work ‘as of right.’ Currently, only certain healthcare professionals (physicians, nurses, respiratory therapists, and medical lab technologists) are included; Bill 2 proposes adding physiotherapists to this list.

OPA’s submission on Bill 2 supports improved ease of PTs across Canadian jurisdictions, while also highlighting how the implementation of outstanding scope of practice changes, specifically the authority for PTs to order diagnostic imaging and laboratory tests, must be completed to prevent a drain of PTs from Ontario to other jurisdictions with fewer limitations in scope.

Mme Gélinas raised the same concerns as OPA and spoke powerfully on the risks of PTs moving to other provinces and territories if scope of practice is not harmonized across Canada. She spoke to the competencies of physiotherapists in relation to ordering diagnostic tests, to the success of other jurisdictions that have streamlined the process, the benefits to patients, and the improved access, especially for people without a primary care physician or NP.

For the full text of France Gélinas’ comments, see the Hansard transcript of the OLA for April 30, 2025, pages 238-240.

Read OPA’s Submission

National Physiotherapy Month – Members on Scope of Practice – Helen Razmjou

April 30, 2024

For National Physiotherapy Month 2024, Ontario Physiotherapy Association members shared the impact of physiotherapists’ scope of practice on their communities.

Helen Razmjou, PT, PhD:

“The Advanced Practice Provider (APP) role was developed in Ontario to maximize health human resources with the goal of streamlining access to care for patients with shoulder conditions, and hip and knee arthritis. Extensive responsibilities of the APPs include triaging of the referrals, clinical examination, ordering diagnostic imaging, using complex decision-making tools, and providing post-operative care. Our APPs at Sunnybrook have shown continuous leadership in clinical and research activities, which contributes to ongoing practice changes.

APPs in our centre have been authorized by medical directive to order diagnostic imaging investigations. We have seen the growth and success of the APP model of care over the past 18 years in Ontario, and I am positive that by final approval of the Bill 179 and expanding the scope of practice to all eligible Ontario physiotherapists, we can further facilitate timely and effective access to diagnostic imaging.

Our team at Sunnybrook Health Science Centre’s Holland Bone and Joint Program is leading the way in optimizing patient care. Through extensive research, we have shown that physiotherapists and occupational therapists working to their full scope and beyond, can significantly reduce unnecessary investigations and consultations, ultimately improving the patient experience. I have specifically written a book about the radiological examination of the shoulder joint, that is available via University of Toronto to all physiotherapists who wish to enrich their training for ordering and interpreting diagnostic imaging of the shoulder.

I would like to celebrate National Physiotherapy Month with all my fellow colleagues who reach for their full potential and strive for excellence every single day.”

National Physiotherapy Month – Members on Scope of Practice – Pamela Houghton

May 6, 2024

For National Physiotherapy Month 2024, Ontario Physiotherapy Association members shared the impact of physiotherapists’ scope of practice on their communities.

Pamela Houghton, Physiotherapist:

“I am a retired physiotherapist as of 2022. I was registered with the College in Ontario (CPO) for 29 years. I worked as a full professor teaching and doing research that supported the important role of physical therapists in wound care in Canada.

For many years physiotherapists in Ontario have been able to “work below the dermis” which includes many of the skills needed to provide wound care. Skin health and wound care is an emerging field of practice aimed at improving the outcomes of people who are at risk of, or those who are living with chronic wounds. This includes a huge number of Canadians since chronic wounds are a common complication of many health conditions including diabetes, cardiovascular disease, and neurological conditions such as MS, SCI, stroke. Problems with skin integrity and delayed healing also affect a significant proportion of elderly people with limited mobility and people with critical illnesses such as acute trauma, complex surgery, and cancer.

Throughout my career I provided evidence based physical therapy treatments that are known to speed healing of many types of chronic wounds including rehabilitation programs that “take the pressure off” the skin and leg exercises that improve peripheral circulation. Additionally, many of the therapeutic modalities used in physiotherapy are known to promote faster and stronger wound closure including electrical stimulation therapy (E-Stim), ultrasound, and light therapies. I have had the opportunity to help many people living with spinal cord injuries (SCI) who have developed terrible sitting acquired pressure injuries. Pressure injuries (PrIs) or skin breakdown is known to be the second most common complication after SCI and the one that has the greatest impact on quality of life.

The implementation of self-management programs has allowed 100s of people with SCI and PrIs to treat their own wounds with E-Stim, to close long standing open PrIs, and to ultimately regain their mobility and independence. Not many PTs in Canada appreciate that wound care is part of their scope of practice. However, so many of our current practices can help this growing population of people affected by chronic non healing skin wounds.”

National Physiotherapy Month – Members on Scope of Practice – Wanda Chen

May 21, 2024

During National Physiotherapy Month 2024, Ontario Physiotherapy Association members share the impact of physiotherapists’ scope of practice on their communities.

Wanda Chen, PT:

“Being able to communicate a diagnosis increases patients’ understanding and trust in their therapy program and leads to better treatment outcomes. In addition to communicating a diagnosis, being able to order imaging studies in a private practice could further benefit Ontarians.

Working to full scope of practice will enable physiotherapists to:

order diagnostic imaging when indicated, which will allow for improved diagnoses, more targeted treatment options, and better discussions of prognosis

communicate prognosis with patients and escalate issues to physicians faster. It does not take away physicians’ involvement but saves patients’ and physician’s time in redundant assessments.

decrease wait times to see a physician in Ontario and will alleviate the burden from the general practitioner for musculoskeletal cases.

It will help patients gain an understanding of their pain and have resolutions sooner. It will improve the quality of life for Ontarians.”

National Physiotherapy Month – Members on Scope of Practice – Jennifer Howey

May 28, 2024

National Physiotherapy Month 2024, Ontario Physiotherapy Association members share the impact of physiotherapists’ scope of practice on their communities.

Jennifer Howey, PT:

“Movement is life and life is movement.” As physiotherapists, we are movement specialists, with the ability to diagnose and treat movement disorders and injury. Our scope of practice goes beyond the treatment room. It includes public education, injury prevention and promoting healthy activity throughout the spectrum of life. In today’s sedentary world, it is more important than ever to encourage movement with every generation.

At InsideOut Physiotherapy and Wellness Group, we found that Nordic Pole Walking (NPW) – walking with Nordic walking sticks- is fun, inexpensive, and people of any age or exercise ability can benefit. It can get us moving and keep us moving! NPW has been shown to help people rehabilitate post surgery, those with chronic conditions, diabetes, osteoporosis, Parkinson’s Disease and many more.

As a clinic, we have developed a significant NPW program with a great deal of community outreach. InsideOut has had a 6-year collaboration with the Hong Kong Physiotherapy Association and University of Hong Kong Physiotherapy program. Two InsideOut physiotherapists went to Hong Kong and trained 25 physiotherapists to be instructors and started to support research within the University on NPW and its benefits with patients with Parkinson’s Disease. In Hong Kong, physiotherapists now get funding for NPW programs within their rehabilitation and community settings. We are currently advocating to get similar approval in Ontario.

As a physiotherapist, one of my proudest moments was when we had a group of clients enter as Nordic Pole walkers in the Scotiabank 5km walk. These clients would not have thought they were capable of doing an event like this! One of the participants had come to us using a scooter for full-time ambulation seven months earlier. She was completely deconditioned, having suffered years of low back pain and multiple chronic problems. We worked with her, using our physiotherapy treatment and home program that included NPW. Seven months later she was one of the participants completing in this 5 km walk, using the poles. She was so proud of her accomplishment she signed up for two more that year.

It is the impact we can have on the lives of others that motivate me as a physiotherapist and clinic owner. Happy National Physiotherapy Month!”