Imagining an Encompassing Physiotherapy
This is the second of two blog posts which reproduce articles from the Canadian Physiotherapy Association's excellent recent "Diversity in Practice" issue of their news magazine Physiotherapy Practice. A huge thank you again to the authors and the CPA for permission to post this here.
NB: While this article contains a lot of detail specific to Canada, I am sure that the content will resonate for many physiotherapists across the globe.
IEPT: Imagining an Encompassing PhysioTherapy
Jeffrey J.D. Andrion, PT, BScPT, MA, PhD(c), CPA Member since 2004. An emerging social justice researcher, Andrion's areas of interest are in health policy and equity. He is currently completing his PhD in Health at York University. A physiotherapist at the Sunnybrook Holland Centre, he is also a faculty of the Ontario Internationally Educated Physiotherapists Bridging Program and the Chair of the Philippine Working Group – International Centre for Disability and Rehabilitation, both at the University of Toronto. Jeffrey can be reached at jeffrey.andrion@utoronto.ca
© Canadian Physiotherapy Association, Physiotherapy Practice, Diversity in Practice, Volume 7, No. 2, 2017.
The number of internationally educated physiotherapists (IEPTs) in Canada is growing. In Ontario, 23% of physiotherapists who registered in the 2014-2015 fiscal year were educated outside of the country (1). Other than the fact that they were educated or have practiced elsewhere prior to their migration to the Great White North, the Canadian physiotherapy profession in general knows very little about them. As a result, IEPTs have become the silent minority within the profession. However, the profession’s limited knowledge on IEPTs can also become a fertile ground to plant the seed of hope: hope that the international training and education of IEPTs will be fully recognized as critical elements in advancing the Canadian physiotherapy profession. And using the concept of sociological imagination—using the power of the imagination—can perhaps be an important step towards realizing some of the IEPT aspirations. And as we begin to imagine, we might also begin to realize that instead of getting answers, we end up asking more questions. To me, that is a sign not only of a curious mind; it is a sign of a critical mind.
In 1959, the American sociologist C. Wright Mills introduced the concept of a sociological imagination (2) to encourage thinking outside of the box and to find alternative ways of how we view the world. As an IEPT myself, I would like to imagine a profession where diversity is not only acknowledged but also recognized and included. Within Canada (and beyond), I also would like to imagine an equitable profession where some colleagues do not appear to be more privileged than others. As well, I would like to imagine a profession where members from the minority and racialized groups are given the chance to lead and help shape an otherwise Eurocentric profession. I would like to imagine a profession where IEPTs are courageous to speak when the world is silent about them.
I would like to imagine a profession where global citizenship is of utmost importance to physiotherapists to help change the world. And I would like to imagine a physiotherapy profession where a person’s colour is reflective neither of privilege nor oppression. Indeed, using the concept of sociological imagination allows one to critically reflect on the direction that a growing profession should take. Sociological imagination is also about realizing that as we continue in our professional journey, there are few heavy items that we have accumulated through the years that we need to unpack. Some of these items are called assumptions while some are called biases. And as we begin to critically reflect, we might also realize that throughout our professional journey, history has become a good teacher who enlightened and challenged us when the conversations led to uncomfortable issues that are often not talked about in our profession such as racism, power, privilege, or oppression.
Unlike in the past, a substantial number of our internationally educated colleagues are now coming from low- and middle- income source countries where English or French may not be their first language. Most of these countries also have health systems where the practice of physiotherapy may be entirely different from Canada’s. Indeed, the changing face of the physiotherapy workforce in this country is an opportunity for us to imagine in what shape or form privilege may appear in our profession. At the same time, given that the skin colour or accent of IEPTs may be viewed as ‘different’ from the mainstream, how might one imagine not distinguishing between us and them?
By using Mills’ sociological imagination, what are some of the ways in which our profession should reflect on the IEPT identity? For instance, do we openly discuss racism within our ranks (or do we acknowledge that racism exists in our profession)? Do we encourage and support our IEPT colleagues to speak up when they feel that they are being discriminated? Or do IEPTs themselves feel that their accent, international training, and way of dressing prevent them from gaining upward career mobility? And what would be the best way for the profession to call this cohort? Internationally educated? Foreign trained? Overseas-trained? Or most importantly, what is the value of labeling them as such?
One of the (little) things that we know about IEPTs is that their pass rate in the licensure examinations is lower compared to the Canadian-educated. Imagine a profession that fully supports the academic needs of IEPTs. Imagine a profession that creates a cohesive and supportive network for its internationally educated colleagues where mentors are eager to support them. The IEPT challenges are real and life-changing. As we think about them, imagine what life is like for IEPTs who are the breadwinners of their families. Because putting food on the table may be far more important than saving for the credentialing or licensure fees, their dream of practicing in Canada is put to the side, hoping that someday things will be financially better. Imagine a profession that raises funds to support the integration of IEPTs. And when they become successful, we celebrate with them. But have we started imagining how to support an internationally educated colleague when his or her licensure examination attempts have been fully exhausted? As a profession, how do we console them?
What does the IEPT experience look like? Literature suggests that the ‘Canadian experience’ has become one of the most important barriers towards the integration of immigrants to the workforce. I would like to imagine that the ‘Canadian experience’ requirement does not apply to our profession. But if it does, what impact does it have in our goal of creating an inclusive profession? And have we ever wondered how IEPTs survive their immigration journey? What does it feel like to live in a country whose culture, weather, and people may be entirely different from their home countries? And how do we address IEPT inclusion? For instance, does the Canadian physiotherapy profession invite IEPTs when developing policies about them?
Without a doubt, the Canadian physiotherapy profession has exponentially grown in the last 100 years. However, what does the growing presence of IEPTs in the profession teach us? Instead of us just being satisfied with the little things that we know about them, perhaps the IEPT presence in our profession is an opportunity to imagine how this cohort can further contribute to the growth of our profession in the next century and beyond. Imagining allows us to be creative to create a vision of how we want the Canadian physiotherapy profession to look or the direction we would like it to take. Can we imagine the visibility of IEPT leaders in our profession? Or how can we better imagine a profession where our colleague’s skin colour, accent, or way of dressing is celebrated? I invite you to imagine how the Canadian physiotherapy profession will look in the next 100 years. How will our individual identities blend? (I would like to make a start: that’s me wearing the traditional costume of the Philippines.)
Using the concept of sociological imagination to situate IEPTs within the Canadian physiotherapy profession opens the door of imagination to think about how things could be and how things should be. Imagining allows us to look at things from a different angle and, depending on the lens that we use, that imagination might take us to breath-taking views that we never thought existed. Let’s keep imagining what the IEPT landscape might look like and how it might blend with the Canadian physiotherapy profession panorama. I suspect that a masterpiece is waiting to be discovered.
References
1. College of Physiotherapists of Ontario. (2015). 2014-2015 annual report of the College of Physiotherapists of Ontario. Retrieved from http://www.collegept.org/Assets/annual_reports/CPO_2014-2015AnnualReport_150722.pdf
2. Mills, C. W. (1959). The Sociological Imagination. Oxford: Oxford University Press. https://global.oup.com/academic/product/the-sociological-imagination-9780195133738?cc=ca&lang=en&
© Canadian Physiotherapy Association, Physiotherapy Practice, Diversity in Practice, Volume 7, No. 2, 2017.