Physiotherapists as Clinician-Scientists: An Insufficiently Supported Advanced-Practice Physiotherapy Role in Canada

Physiotherapist clinician-scientists (PTCSs) play an advanced-practice role in the physiotherapy profession that can improve quality of care, drive innovation, and move the profession forward.^1–5 We contend that PTCSs are strategically positioned to conduct clinically relevant research, help bridge the gap between clinicians and academics, and meaningfully translate research into practice – all with the goal of improving patient care. Yet, contrary to clinician-scientists in parallel health care fields (e.g., physician clinician-scientists), in physiotherapy this advanced-practice role is currently underdeveloped, poorly established, and insufficiently supported.^1–3,6

In this editorial, we call for universities, employers, funding agencies, policy-makers, and other influential stakeholders in the physiotherapy profession to provide more tailored support for PTCSs so that they can thrive in Canada and help improve patient care.

Physiotherapist Clinician-Scientist Advantage

PTCSs have specialized training as both clinicians and researchers.^1–3 This hybrid perspective offers several advantages that strategically position PTCSs to judge the real-world relevance and applicability of research findings,^1–5 act as champions for evidence-based practice in the clinical setting,^5,7 and better incorporate clinical experience into the conduct of research as a valid source of knowledge and innovation (i.e., practice-based research).^8,9

However, PTCSs’ true value probably resides in their meta-identity as brokers (i.e., bridges) between the clinical and academic worlds. Clinician-scientists bring additional value beyond having two sets of professional skills; they have developed boundary-crossing professional competencies and insights.^1–3,5,6,10 In other words, the whole is greater than the sum of its parts. This has been described as the broker’s “vision advantage” or “the ability to select and synthesize different viewpoints and approaches from different unlinked groups on either side.”^10(p.5)

Thus, this broker vision advantage can help drive innovation through unique competencies and insights, but also by fostering collaboration.^1–3,5,6,10 This leaves PTCSs well positioned to establish collaborative and fruitful relationships between clinicians and researchers by facilitating a better understanding of each other’s perspectives, priorities, and constraints.⁴ These close collaborations may improve how innovative practices are incorporated into patient care and facilitate carrying out clinically meaningful research.^1–5,10

Challenging Reality of Physiotherapy Clinician-Scientists in Canada

In allied health, clinician-scientists are rare, and the role remains underdeveloped, especially in non-physician professions such as physiotherapy.^1–3,5,6 Despite the unique benefits provided by these advanced-practice professionals, this role lacks structure and is poorly established as a formal position.^1,2,6 Many clinician-scientists suffer from a lack of support, funding, recognition, and regulation in academia, in part because there is no clear career pathway for them.^1,2,6

A panel of experts discussed the role of PTCSs in the physiotherapy profession at the Canadian Physiotherapy Association’s 2018 annual congress,⁶ and they provided some insight into the professional landscape and the difficulties faced by current and past PTCSs. Broadly speaking, the panel discussed the short life expectancy of PTCS careers, touching on the challenges of job security and securing remuneration beyond a contractual agreement, juggling multiple roles (e.g., educator, clinician, researcher),⁶ and dealing with the uncertainty of the ever-restructuring health care system and, perhaps most important, the difficulty of remaining competitive for research funding and university promotions compared with full-time academics.⁶

Because funding and university promotions are typically awarded on the basis of academic metrics (e.g., publications), researchers who maintain a clinical foothold are not usually adequately rewarded or recognized for their clinical activities, and they may be at a disadvantage compared with their peers who focus solely on traditional academic activities.^6,11 Unfortunately, the current landscape leaves PTCSs in need of stronger recognition, established jobs, and support.

Strategic Support to Help Physiotherapy Clinician-Scientists Thrive

Experts suggest that the best sources of support for clinician-scientists are tailored training, mentorship, and job positions, as well as formal funding and salary structures.^1–3,6 First, an established training programme is needed. Although hybrid training tailored to aspiring clinician-scientists is starting to appear at Canadian universities (e.g., the combined MPT and PhD),^12,13 these initiatives are still at an early stage of development.

Second, formal postgraduate mentorship has been shown to improve career success, promote a unified sense of professional identity, and foster the well-being of novice clinician-scientists in parallel health care fields.^1–3,14 Similarly, prioritizing the development of formal mentoring opportunities tailored specifically to PTCSs (e.g., mentorship programmes, establishing a Canadian network of PTCSs) could better support those who decide to follow this career path.

Still, tailored training and mentorship opportunities are not enough. Universities, employers, funding agencies, and policy-makers need to better support PTCSs by offering tailored career options and funding. Formal dual appointments for PTCSs with appropriate salary and employment benefits should become more common in Canadian universities and research centres, with the possibility that they will lead to permanent employment.^1–3,6

With respect to funding and salary structure, it is important to consider the three main roles of a clinician-scientist: clinician, researcher, and broker. First, there is a need to systematize protected time and recognition for each of these roles. Because clinician-scientists are essentially working part time in each role, a need exists to adjust the expectations for productivity outputs compared with those of a full-time researcher.^1–3,6 Similarly, universities and clinical institution committees should carefully examine their promotion and reward systems. Funding agencies should also consider an adapted point system and continue to fund differential competitions for clinician-scientists in which ranking is balanced and reflective of merit on all fronts, not based predominantly on traditional research metrics.

There needs to be formal recognition of and reward for the attributes of the PTCS, such as clinical practice-based knowledge production, engagement with patients and clinicians, and knowledge-brokering activities, all of which help improve research quality and clinical care.^1–3,5,6

Call to Action

Although this hybrid career path is recognized as being particularly demanding for the individuals who undertake it,^2,3,6 PTCSs are a truly valuable asset to the physiotherapy profession, for the patients physiotherapists care for, and for the health care system.^1–3,5,6,10 For this reason, we call for universities, employers, funding agencies, policy-makers, and other influential stakeholders in the physiotherapy profession to (1) recognize the vital role that PTCSs can play in elevating both clinical and research practice in physiotherapy and (2) take concrete actions to more commonly provide PTCSs with a unified and supportive employment structure that includes a realistic set of productivity expectations for each role and specifically tailored funding and salary incentives.^1–3,6

Clearly positioning PTCSs in the profession as playing a recognized advanced-practice physiotherapy role and providing them with adequate support at the individual, institutional or organizational, and systemic levels will help PTCSs to thrive rather than cope. These actions will help move the profession forward and, most important, improve patient care.