Physiotherapy graduates say their careers have been stalled by industry's failure to offer COVID-safe exam

Almost one year after completing his master's degree in physiotherapy, Jeremy Lynn was prepared to finally take his clinical exam in November to become a fully licensed physiotherapist.

And then the exam was cancelled — again.

Lynn and other physiotherapy graduates are growing increasingly frustrated by their profession's licensing exam provider — the Canadian Alliance of Physiotherapy Regulators (CAPR) — which they say has failed to adapt to a COVID-19 compliant examination procedure seven months into the global pandemic.

They say the inability to sit the clinical portion of their exam is costing them money, clients and the development of their careers.

"They [CAPR] have been negligent toward our careers, our livelihoods and how we're able to help the public," Lynn said. 

Like many other physiotherapist hopefuls, Lynn was set to take the clinical component of his exam in June, but it was cancelled in March over safety concerns in light of the pandemic.

Lynn says he and his classmates understood that CAPR needed time to develop alternative administration options.

But at the end of September, CAPR cancelled the November exam dates.

In a notice to candidates, CAPR also revealed it was working on a "pandemic-proof alternative way to test clinical skills" — leaving many wondering why that hadn't already been done.

"We expressed our concerns right after the first [exam] was cancelled that we wanted a plan in place," said Lynn.

In a statement, CAPR said that in preparation for the November clinical exam, it began adapting the delivery of the exam to lower risk and maintain physical distancing while maintaining the validity of the exam.

It said the November exam was cancelled because, as cases of COVID-19 continued to grow, contracted sites and standardized patient programs were choosing to close their doors.

Similar regulatory and licensing bodies like the Canadian Chiropractic Examining Board and the College of Massage Therapists of British Columbia have developed and administered safe clinical exams during the pandemic.

CAPR says it's committed to offering the exam in March 2021.

Practising with an interim license

In Canada, except Quebec, candidates must first pass a written exam followed by the clinical exam. If they successfully complete the written exam, they can practise as an interim physiotherapist while they wait to take the clinical portion.

But Lynn, who is currently practising in Victoria as an interim physiotherapist, says this designation has several drawbacks.

Interim physiotherapists aren't allowed to specialize or learn specialty skills. Lynn, for example, wants to offer dry needling, a technique used to treat muscular pain that resembles acupuncture.

Lynn says many potential patients are put off by the "interim" title, which a physiotherapist must legally advertise. 

"It's a deterrent that will push them away from me to a physio that they perceive as more experienced, despite the fact that I have the same education," he said.

Normally, interim licenses only last 15 months, but CAPR says it confirmed with all physiotherapy regulators across the country that the time limits on interim licenses will be waived due to restrictions on exam delivery.

Careers in limbo

Meanwhile, those waiting to retake their clinical exam after failing first time haven't been able to work at all.

In B.C. and Ontario, a candidate who fails the clinical portion of the exam is not allowed to practice with an interim licence. The CAPR says the exam has a passing rate of 68 per cent over the past three years.

Lisa O'Grady, who was a practising physiotherapist in New Zealand before she moved to B.C. with her husband and baby, had taken a year off to care for her daughter before she decided to become licensed in Canada.

But she failed the clinical exam and now her career is in limbo.

"We're stuck waiting for this exam to proceed and meanwhile I'm unable to practise and maintain my skill set, which I trained really hard for," said O'Grady, who lives in Nelson, B.C.

O'Grady has spent money and time taking months-long refresher courses — while also paying for childcare — only to see exams cancelled.

"The financial constraint is huge. The courses that you have to take [to prepare for the exam] are not cheap, either. ... It's so difficult to maintain that peak book knowledge," said O'Grady, who added that the clinical exam boils down a Canadian master's program into a test.

"I don't think they [CAPR] understand the impact it has on people."

An online petition is now asking for public support to ensure provincial colleges offer safe, fair, equitable and timely certification by having alternative evaluation methods in place by November 2020.

CAPR said it relies on outside organizations and facilities to host the exams and staff them with standardized patients, something it says was difficult due to the recent resurgence of COVID-19 across Canada.

"We acknowledge that this is a very difficult and frustrating time for candidates awaiting access," it said in a statement, describing physiotherapy as a "high‑touch profession." 

"Making the clinical component a no-touch exam while ensuring it adequately tests a candidate's competence at an entry-to-practice level is no simple task."