Is Physiotherapy becoming a stronger profession or is it being diluted by others?

[physiobob]

This question is a simple poll to ask for a view on whether you feel physiotherapy is becoming more independent and stronger as a unique and valued therapy, or whether your feel that it is being slowly diluted and made less independent by the advancement/encroachment of other professional groups.

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[gcoe]

In Australia and New Zealand we have good public health systems although far from perfect and you are right about the politics. Most of Western Europe seem to have excellent systems. Look at the trouble Obama has has introducing a fairer public health system in the USA.

I have observed over the years that one of the hardest jobs for a minister in government is governing Health. However I have known excellent health ministers with real vision who under their governance can achieve fantastic improvements in health care.

In my opinion an effective health system private enterprise can never be the main player. A business model for core health services doesn't work - Effective and fair Health services where everyone has access to will always be a liability. Care costs more than the profits that can be made. If you look at the World Health Organisation statistics on the countries that enjoy the best health that is spread across the whole population- without exception all countries have sound public health systems and many of the top countries have almost exclusive public health systems.

That doesn't mean private health care doesn't have a role. Many countries have very good partnerships between public and private providers. However the countries in the world that have fair equitable and effective health care all have at least core services that are provided by the public purse.

I suppose I will be accused of being a red :=(

[Christopher.pl]

I agree with you. There has to be a compromise and somehow the public system here must find its way out of its hole.

I think people here can't even really imagine what it means to have decent ongoing health care, for the large amount of money that they and employers give toward the public purse. They deserve better.

[chris.metcalfe]

I know in Canada there has been a big push to have physiotherapy more visible to the public. Recently the CPA launched its first ever national television AD campaign.

[bensynergy]

the development of physio profession in malaysia also doesnt seems like growing well, its mushrooming after ppl (educators who making money) keep going organising physio program without controlling n thinking of the disadvantages of overwhelming and poor quality of student physio..

to increase visibility of physio in public, v need to think and act out of the box.. donot always look for patients only (outpatients or ppl with sickness), we should n must, n its our obligation to create and educate public bout health, heart, lung, back, neck, shoulder, etc before they are in sick (pid, shoulder impinged, pelvic floor weak, OA, etc)

im a junior physio, but i hope i can do something diff to enhance our profession's standpoint in public and other professions such as doctors (as i dun think docs are very great too)..

stand up, physio guys and gals.. think positive to achieve positive, as wat we always tell our patients to be positive..

sorry for my misleading statement, if any...

[Dr Damien]

TO ATTIRELAND

Thank you for your post and I agree that specialization is valuable for your above mentioned reasons....however,only when the problem is specific.

Most patients are not clearcut and are complex especially the elderly group who have rich PMHs. With regards specialization, where does that leave the Community therapists who see these patients?

As a respiratory physio, will you wait for an MSK/ortho physio to help you assess for a walking aid for your COPD who you are progressing his/her function simply because this is not technically in your field? or as a neuro physio, your newly diagnosed stroke patient has had a fall and suffered a mnor injured knee, will you refer to MSk services for another 6-8 weeks before you continue your rehabilitation knowing that time spent and intensity is crucial for this client to regain her function?

lay too much emphasis on specialization and lose the ability to manage a patient holistically. When the problem is clear and straightforeward to a field, then a specialist physio in that field can address that problem.

The other point you made was that the emergence of professions has made physiotherapy sit up and sharpen up old practices. I believe the reason why they were considered old was because the were old in the first place. What my take on the whole is, yes physiotherapy is diluted however the profession is dynamic and will continue to evolve as research into its practices and new therapies emerge.

An example is the bobath concept that is changing constantly. acupuncture was never considered a physio tool before but its now part of the practice of many therapists and has been considered one of the major alternatives to back pain management.

The truth is we cannot stay purists and restrict ourslves to what we have always done. As research developes in many areas so would we and physiotherapy now would not be the same tomorrow.

Back to the whole concept of specialization, I have been a physiotherapist for close to a decade now, my core background is MSK, worked in outpatients for many years but I also have experience managing neurological cases. What does that make me? A neuromuscular physiotherapist? who is to say I shouldnt be seeing a stroke patient if I am confident, have the knowledge base and experience in managing these cases.

Specialization is all about your CPD, your ability to pick an interest area and develope on it. Having a masters in sports medicine means you are a sports physiotherapist (because you are developing yourself in that field) you may not just be an experienced one.

You may have only had a diploma in physiotherapy yet you have a wealth of experience in sports, can anyone say you are not a sports physio?

Because we Rehabilitate patients, we need to manage them holistically whether they are an aged gentleman who suffered back trouble while golfing, had a knee replacement eightmonths ago, is diabetic and also suffered a stroke four years ago... or a fit football player who has no real PMH. Which one of these patients do you think a specialist physio will be able to manage?

cheers

[Barbara25]

I think that physiotherapy is becoming stronger. It is really important! It gives the strength and support. I experienced it all after the accident happened to me(I had fallen down the stairs).

[nikole957]

I have enormous respect for the physiotherapy profession but I have to say I think this post shows up many of its flaws. I'll outline why below but firstly I just wish to apologise in advance if it turns out that I'm just mis-interpreting your english.

"as we know our multidiciplinary approach is the strength we got which no other professionals got...........we physiotherapist can understand and go ahead all fields"
- What I think you mean is that only physiotherapists have educational domains from varied fields that allow them to deal with a wide variety of conditions.

I would agree that physiotherapy has a broad scope of practice/education base that allows practitioners to work with patients of widely varying conditions however I would argue that a Doctor has a similarly broad (if different) education upon which they subsequently specialise.

My problem with physiotherapy/physiotherapists is that specialisation is needed as there is far too much information in each domain area for a practitioner to be expert in them all and while they may indeed specialise (sports, neuro, ortho, pulmonary, etc) this specialisation is not properly structured and more importantly is next to immpossible for the public to identify. This leads to situations where a physio working all his/her life in a stroke rehab unit can start working with a sports team at the weekend because 'I'm a physio' and yet cannot differentiate between an ACL rupture and an meniscal tear because its been 15 years since he/she did a lachmans/mcmurrays!

My point is that the reason professions such as athletic training (USA, Taiwan, South Africa), athletic therapy (Canada), sports rehabilitation & sports therapy (UK) have emerged is because physios took the view that once you're a qualified physio you can do everything regardless of what domain your work experience, post grad training and study has been in. This has led to many members of the public becoming cynical about physios as they have been treated by physios who did not have the correct post grad training/experience to meet their needs. Therefore while these other professions will never be able to compete in fields such as stroke rehab, the public has confidence in them when it comes to the area of sports injuries.

I really think that Physio as a profession needs to tighten its internal controls on who is allowed do what. Its not my place to say how this should be done but at a minimum in my own area of sports medicine I would like to see it manditory that anyone working pitchside have a certain certified level of emergency care (CPR/AED/Spinal Care/etc).

I will say that I think that the emergence of these other professions has been a positive development in that it has made the Physiotherapy profession sit up, take notice and begin to sharpen up practices that may have been overlooked in the past, which is great both for the area of sports medicine and the physiotherapy community in general.

Anyway apologies for the length of the post and any comments on the physiotherapy profession and its workings are drawn solely from my experiences here in Ireland and things may differ throughout the world.

Feel free to respond with your opinions

I agree that some of the views that physiotherapy is being "diluted" is based on the promotion of our profession. We need to sell what we do. With the strong emphasis on evidence-based practice, we have a lot of research at our hands to ensure that other health professionals recognize our knowledge base. BUT...they don't read our research (and we don't read much of theirs!). So we have to market ourselves to them. Although a doctor's referral is not required for treatment in Canada (and in many other countries), doctors are still my main referral source. So we need to ensure docs know exactly what we do. However, related to that, maybe the docs wouldn't be our main referral source and clients would self-refer if they knew what we did.

[nikole957]

dear colleague, which country would that be??

esther

I believe verry strongly, that PT is goin up the stairs and very quickly ans drastically!
in my country, its been voted no 8 among the most successful professions in the world. Not remarkable....but we are getting somewhere!

[safira218]

yeh physiotherapy is becoming stronger
as we know our multidiciplinary approach is the strength we got which no other professionals got.

for example; a doctor in master of neurosurgery could deal his own subjects and he he has his own boundaries and a diabetoligst has his own boundaries

but we physiotherapist can understand and go ahead all fields.
and this makes as so proud

As long as the education physio students stays at a high standards, imrpovements should continue!

[yelufem]

YES, i believe physio has made and still making tremendious progress across the nations of the world.This however remains uneven in our various countries due to some factors.
Education- countries that pioneered physio training with curriculum and policies that make physio a subjugate or extention of doctors precriptions may suffer tremendiously from represive tendencies Doctors empire.So education remains a major key to giving physio a voice and relivance along healthcare chain.
University edu produces aggresive and sophisticated clinical physios who know their onions and by extention create an image and relivance for the profession.
Many countries of the world run sub-vasity physio programme and produce technician masqurading as physios.
Generaly speaking physio progress is on the rise and continuos curriculum review and upgrading is sinq qua non to getting to the promise land.yelufem.

[mahfujalmizan]

Yes, Physiotherapy becoming a stronger profession bcoz, Physiotherapists are primary care professionals, meaning you can go directly to them without a doctor’s referral.

[mysingy]

A view from the side line is, Physiotherapy over recent years has ring fenced low back pain as their own in the UK, with many patients going to them before their GP and perhaps to their detriment, as statistics now show a rise in the prevelence of LBP, from 3.9% in 1992 -to 10.2% in 2006 resulting in the rush to adopt Cognitive Therapy. Regards Mysingy

[pdoan01]

no the government does not recognize physios as primary care, we are secondary care even if patients come without referall

[mysingy]

no the government does not recognize physios as primary care, we are secondary care even if patients come without referall

Thanks for that, in terms of the poll, every one seems satisfied the profession is progressing, how do you feel about NICE diverting £24 Million from hospital care to Acupuncture in the treatment of Non-specific Low Back Pain, is this what is meant by being diluted by others? Regards Mysingy