Over the past couple of weeks, CMTBC has received an increasing volume of questions about the return to RMT practice: what it will look like, when it might happen, what RMTs will need to consider to prepare themselves and their practice environment, and what is being done at the College to prepare. 

These questions are realistic, and are especially relevant with the release May 6, 2020 of BC’s Restart Plan. RMTs are concerned about the well-being of their patients, and wish to return to their profession and ability to earn a living in their chosen profession. However, RMTs also remain understandably concerned about the risk of transmission of the SARS-CoV-2 virus.

So: how do RMTs return to practice, safely, for themselves and their patients?

CMTBC is hard at work on this difficult question. We engaged a medical consultant to advise and lead a working group of RMTs who are tasked to develop an effective and practical return to practice protocol which is now under development. The draft protocol will be submitted to BC’s Provincial Health Officer (PHO) for approval, prior to release. Ultimately, return to practice will occur under the guidance of the PHO.

More details will be forthcoming when the full PHO-approved protocol is released, but here are a few early indicators and factors for RMTs to consider:

• PPE: The College has received many questions about personal protective equipment (PPE). However, PPE is unlikely to play a significant role in RMTs’ return to practice. BC’s Ministry of Health (MOH) presented an image of an “inverted pyramid” of the hierarchy of controls, which places PPE at the bottom in terms of importance. (See the Hierarchy of Controls on page 25 of the MOH’s COVID-19 Going Forward presentation.) All other factors matter more: physical distancing being the most important for all in-clinic non-treatment interactions, followed by regular handwashing and cleaning of contact surfaces. Screening, trust, communication and consent will also be critically important elements. Cloth masks may be indicated for portions of the treatment – details will be provided at a later date – but PPE is otherwise unlikely to play a significant role.
• Practice environment: In keeping with the importance of physical distancing, RMTs should consider how they can modify their practice environments to promote 6’ separation at all times and for all interactions other than actual treatment. Examples to consider and experiment with include – and are not limited to – one-way traffic flow in hallways and through doors (where possible), tape or other physical markers on floors, signage on walls, figuring out what to do about blind corners and washrooms (areas of inadvertent close contact), different ways to safely open and close doors, and contactless payment (including electronic payment either before or after treatment).
• Screening, consent, and communication: RMTs will be screening patients both at the time of booking and again on the day of the appointment to ensure that there are no current symptoms. Nonetheless, return to practice in advance of either a vaccine or an effective treatment for COVID-19 will involve some added risk, and requires both intelligent risk mitigation and consideration of one’s own – and one’s patients’ — risk tolerance. RMTs should consider how to manage consent discussions with their patients, taking into account the reality of COVID-19, and the potential risk of viral transmission. RMTs who have not yet taken CMTBC’s Boundaries and Consent online course are strongly encouraged to do so before returning to practice – it is currently free, thanks to joint funding by CMTBC and the RMTBC.

Return to practice is likely to be a gradual process, subject to limits and restrictions that may vary as conditions continue to change. 

CMTBC made a strong recommendation for RMTs to cease practice on March 24, 2020, supported by the PHO’s letter of March 23, 2020 (PDF), but did not order RMTs to stop. Similarly, CMTBC will not “order” RMTs back to work. The expectation will be that RMTs who return to practice will adhere to guidance and protocols released by CMTBC and by the PHO. However, some RMTs may assess the risk as unacceptable, and may choose not to return to practice until conditions have further improved.

The decision to return to practice will be a matter of individual judgment. Unfortunately, CMTBC cannot comment on if, when, and how the decision to return to practice will impact CERB and other government financial benefits – these are factors that each individual RMT will have to assess in terms of the impacts on them personally. Similarly, insurance considerations must be considered by each RMT, both in terms of coverage for any potential COVID-19-related claims and – where applicable – the impact of home-based practice on coverage.

CMTBC remains committed to working with its counterpart health regulators, as well as with the Ministry of Health and the Provincial Health Office to enable a safe return to practice for RMTs. Please continue to check CMTBC’s website, including the COVID-19 Information for Registrants page, for updates and new information.