German Physiotherapist ---> Master/working in english speaking country?

[Fyzzio]

Hi,
let me give you estimates for what would happen here in NZ. I know that Australia is fairly similar:
There is a huge difference between medical problems and accident related problems. We do not have compulsory health insurance (as I heard you have got in Germany), but compulsory accident insurance and a free of charge public system.

In private practice, we therefore mainly see accident related cases paid for by insurance, e.g. musculoskeletal/ orthopaedic/ sports symptoms. The insurance has guidelines as to the expected amount of total treatment sessions and usually, you are able to stay well within. There are also a few clinics who see private respiratory and private neurological clients. Treatment duration is anything between 20 and 60 minutes and patients come 1 - 4x per week. Goal setting is a major and all clients are expected to do a thorough home exercise programme in order to maintain achieved progress. I presume that is the same all over the world.
E.g. (I made this up) a client comes in with thoracic pain and inability to move after twisting his back; you might see him for an hour initially to get history and mobilise/ manipulate and tell him to come back next day; you would see him then for a check and a home exercise programme (30 min) and again for a review after a week (30 min).
Someone with a mobility problem after an ankle fracture might need to come 3x weekly for 30 min each for a fortnight and might then reduce to once weekly 20min for 3 weeks.

Neurological cases, such as Strokes, are generally cared for in hospitals on acute wards, stroke units and rehab wards and later on at home/ community. Treatment duration in hospital is anything between 20 minutes to 2x 60min per day. It depends on what you have analysed as neccessary and on what the patient is able to tolerate. In the community = at home, people get seen for 30 to 60 minutes, according to who pays (public = 30 min; insurance = 60 min). For private long term neuro clients it depends entirely on the contract you have made with them and the goals they have set to achieve. If you can no longer justify why your intervention is beneficial or can no longer show the achievement of progress, no-one is happy to pay. Neither the public system, nor the insurance, nor the patient. ;-) And it is part of our documentation to each provider to justify our intervention and demonstrate achievement....

Now this is all terribly generalised and it feels quite awkward to write it down, but there you go.
everyone - please feel free to also make comments!!!!

Cheers,
Andrea

[physiogirl76]

Hi there,

well, I think, I need to reply to this thread as well since I`m a German physio. I did my first training in Germany, but continued for another year in the Netherlands to get my bachelor degree (since most physio degrees in Germanys are not academic...even though it`s slowly changing towards a university taught degree). I have worked in Germany, NZ and Australia (that`s where I am at the moment).

Fyzzio has pretty much summed it up very clearly: Most patients you would see in private practice here in Australia have private health insurance which contributes (depending on your specific cover) to the cost of physio treatment. You get a certain amount per year to spend on certain services (in this case: physiotherapy) - when you exceed this amount, you have to pay the full amount for the treatment yourself.
Since physiotherapists work independently in Australia (as well as NZ and most other English speaking countries), you don`t need a doctor`s referral to see a physio (unless in an outpatients department in a public hospital where physio treatments are free). Some doctors though will give the patient a letter (to hand it over to the physio) where the past medical history is outlined and then asks the physiotherapist for an assessment/treatment. Never ever would a doctor here determine the frequency/duration or sort of treatment (like it`s the case in Germany). It´s entirely up to the treating physio to use his/her clinical judgement, set goals with the client, assess and treat appropriately and then discharge the client when the goals are met. It`s VERY different from the "German" way of thinking Even though, most experienced physios in Germany would do exactly the same, but it`s not really well educated in physio schools. It usually develops with your post grad courses (e.g. manual therapy).

Medical gymnastics is the result i get when looking up "Krankengymnastik" in a dictionairy.

Well, you can`t really translate the term, as this is very specific to the German system. Physiotherapy is the term, I`d prefer to use and this is the international term.

As you implied (i assume) in germany we are not allowed to think for ourselves but only do what is prescribed.

Really??? Well, I don`t know about you, but as far as I´m concerned, I always use my brain (i.e. think) when I see patients, no matter, where in the world I´m treating these patients. Even when I worked in Germany, where the patient needs a referral and the doctor needs to come up with the diagnosis (something like "lumbar syndrome" or "shoulder-arm-syndrome"....great! what a useful "diagnosis") and the treatment modality (e.g. manual therapy combined with electrotherapy), I have ALWAYS assessed the patients and then treated accordingly. I always considered the prescription more like a document for billing purposes (as insurances pay different rates depending on treatment modalities), rather than a guide for treatment or worse: a substitute for my own clinical judgement. In my past jobs in Germany, we always had the freedom to adjust treatments. I would hope that you do the same.

Anyway, enough of my rant. My point is: Physios here enjoy greater autonomy than in Germany which also means greater responsibility. But it´s so much better After working in NZ and AUS, I went back to Germany for a year, but I had a real hard time to adjust professionally: I felt it was very rigid (prescriptions) and I couldn`t stand the snobbishness of most doctors who considered themselves "superior" (whereas here, everybody works in a team and there are little hierachies).
So I returned to Australia

Cheers, Melanie

[it's raining]

Really??? Well, I don`t know about you, but as far as I´m concerned, I always use my brain (i.e. think) when I see patients, no matter, where in the world I´m treating these patients. Even when I worked in Germany, where the patient needs a referral and the doctor needs to come up with the diagnosis (something like "lumbar syndrome" or "shoulder-arm-syndrome"....great! what a useful "diagnosis") and the treatment modality (e.g. manual therapy combined with electrotherapy), I have ALWAYS assessed the patients and then treated accordingly. I always considered the prescription more like a document for billing purposes (as insurances pay different rates depending on treatment modalities), rather than a guide for treatment or worse: a substitute for my own clinical judgement. In my past jobs in Germany, we always had the freedom to adjust treatments. I would hope that you do the same.

Anyway, enough of my rant. My point is: Physios here enjoy greater autonomy than in Germany which also means greater responsibility. But it´s so much better After working in NZ and AUS, I went back to Germany for a year, but I had a real hard time to adjust professionally: I felt it was very rigid (prescriptions) and I couldn`t stand the snobbishness of most doctors who considered themselves "superior" (whereas here, everybody works in a team and there are little hierachies).
So I returned to Australia

First of all, thanks to both of you. Very helpful.

@Physiogirl
What you said in the lower quoted part + I don't like the attitude to see the prescription as a document for billing purposes (which i see in most Physios i have met so far). I can see no reason to bend the law in order to provide better service to a broken system. Neither do i want to provide inferior/useless treatment to my patients. So obviously not working in germany is the logical choice.

Going over all the things that bother me would take too long and wouldn't be very productive as well so nevermind.