Ethical Challenges for Patient Access to Physical Therapy: Views of Staff Members from Three Publicly-Funded Outpatient Physical Therapy Departments.

Demographic change and changing population needs are important drivers of increased demand for rehabilitation. These developments place significant stress on access to physical therapy services, as current resources are insufficient to meet the growing demand. This situation presents ethical challenges for physical therapists and others involved in managing wait lists and prioritizing access to services. The purpose of this study is to explore how outpatient physical therapy department (OPD) staff experience ethical issues relating to access to physical therapy services. We conducted semi-structured interviews with 13 participants who were staff at three publicly-funded OPDs in Montreal, Quebec, Canada. Using interpretive description methodology, we developed four themes related to access to physical therapy services: 1) negotiating access to physical therapy services; 2) navigating a complex system with outside influences and constraints, such as professional regulation and third-party payers; 3) managing wait lists responsibly; and 4) striving to be a good professional in a non-ideal world. Across the four themes, two main sources of tension that influence the staff were identified in relation to the experience of wait list management: responsibility and power. This study highlights how difficult it is for OPD staff to balance competing interests and values, and to respond to outside influences, when making resource allocation decisions. Until resource limitations are addressed, wait lists may be an unavoidable feature of many OPDs in the Canadian public health care system. Improving fairness in the access to and distribution of services is thus important in ensuring that professionals are able to treat patients based on their clinical needs, and in a timely fashion.