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

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.

Yes, Of course Physiotherapy is becoming a stronger profession as time goes on. Now people become very familiar to physiotherapy and other professionals are also giving importance to physiotherapy.But I don't think that it is independant still.

It is a stronger profession ever since but i have to say that training and practice differ from every region. And the strengthening multi disciplinary approach makes our profession more challenging not to be diluted by others - the margin between the other discpline is not so wide, there will always be overlap but i still believe the physical and personal (we listen to our patients) approach of our profession makes us different than the rest of our team members.

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Originally Posted by Dhidhak

...there will always be overlap but i still believe the physical and personal (we listen to our patients) approach of our profession makes us different than the rest of our team members.

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I agree with that somewhat; because we have such intimate and constant contact, good physiotherapists are able to develop quite a bond with patients. However, it does depend very much on the skill of the practitioner, not only their profession, as I have also met some wonderful doctors, nurses, speech paths, OT's and AHA's who have just as wonderful interpersonal skills as my fellow physio's.

Anyway... onto the poll. Physiotherapy is constantly undergoing some fantastic changes that pave the way for a smoother and more efficient health service. The level of evidence-based practice has changed dramatically, as has community-based knowledge of the profession and increased respect. As a 4th Year Physio student I have found that when I mention my course, people tend to react the same way. Their eyebrows lift, and a look (of what I hesitate to say) awe crosses their face. It is almost as if you are lifted up into higher echelons in their mind based on that - seemingly minor - piece of information.

As a nearly graduated student I am very excited to see where our wonderful profession will take us in the near future.

From my rather limited experience, I believe physiotherapy is at a crossroads.
It has the potential to become a well recognised and highly respected profession, but it is my opinion that we, as physios are too modest. We do not sell ourselves, nor the benefits of our interventions and advice, as highly as we should do.

For example, the rise of pilates has been enormous over the last few years. Why is this? - because it has been heavily endorsed and publicised.
...and what is pilates, if it is not a set of core stability exercises which are remarkably similar to those that have been taught in physiotherapy outpatient departments around the world.

If we do not stand up and take the credit we deserve soon, then the profession as a whole may eventually fade further into obscurity.

Physiotherapy, physical therapy, having two names for the same profession doesn't help either.....
In the old east european countries and even in west germany physio's do what the docter tells them. The medics in germany have slowly misvormed the profession because they will prescibe a certain therapy without knowing exactly what it is and have stopped prescribing others. The german connective tissue massage ( teilrich leube-dicke) is hardly ever used anymore because of this. You can be told to give lymf drainage without any real oedema.......On the other hand the countries professional organisation has not gone into protest about it.


In countries like holland, australia, canada and the usa we do what we think is right . At a yearly conference in holland in november last year a usa delegate warned us that the same is happening in some states of the usa.
doctors are buying practises with their own therapists and telling them what to do.
I agree with baby physio kieran that we have never really promoted ourselves enough. I used to think that it had something to do with the fact that many women are physios. (oeps... I am one you know...).

I think we have to stop acting like assistants and start reacting like professionals. In a lot of countries this is the normal practise but in a lot of others it isn't yet..... Good luck to you all#
esther

hi to all i think physio therapy and music therapy may have a good combination if we use them properly suggestion needed plz reply back

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! :)

dear colleague, which country would that be??

esther

ofcourse...physiotherapy is a stronger profession,,never diluted by thers...it has its own value in many countries,, especially in the european countries....

yup
i believe physiotherapy profession will increase....

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

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

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.

As for the comment about other services taking over like Pilates. I have to argue that point simply because retraining "core stability" is SO MUCH MORE than just having someone go through a set of exercises (particularly someone who has had an injury....i.e. our clientele). Doing exercise with good technique is important and enough for most but it's not enough for those folks with injuries.

While we and our professional associations are trying to market our profession to a larger community, as therapists we can do some pretty easy marketing by doing what we do. We have the knowledge to do a thorough assessment, to critically evaluate our findings, to plan a treatment plan etc. etc. and most importantly.....to EDUCATE our clients. Although some of them just want us to "fix them" most are really interested and reassured when we cite research, talk about a conference we were at, show them pictures in the anatomy text etc etc etc. We also need to know what everyone else (other members of our health care team) does so we can refer appropriately and bounce thoughts/ideas off each other. So basically, we need to market ourselves by taking the time to really apply all the knowledge we have!!!

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Originally Posted by trendytiger

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

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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 with ATTIreland in the need for better recognition and higher standards accepted for specialisation. Currently this is happening in a number of countries. In NZ we are currently going through a review of what a specialist physio means. Routes to specialisation can be well defined both through academic qualifications and through steps outlined by a body responsible for specialisation

Interestingly the move towards a Doctorate in Physiotherapy as an entry level qualification tugs us in the opposite direction – primarily being a better generalist. Here we are being expected to be better generalists and to be able to manage the challenges of primary practice.

So may be there will continue to be a place for a well qualified generalist. It seems to me that much of the different areas of physiotherapy have more in common. I good graduate physiotherapist should be able to apply their skills to just about any given area providing they take measures including (but not limited to):

* Acquaint themselves with the background knowledge of the area of practice:

* Know how to access and evaluate the best available evidence for the area of practice

* Know their limitations and seek help from specialist physios who they can consult with

Such a generalist is not an expert in the area of practice and should not be seen that way. However there are numerous jobs available where a generalist knowledge base is sought, not a specialist. Jobs where physios have to deal with a wide variety of patient conditions.

I think there is room for both but on both accounts the standard of practice is crucial

I 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.

Hi gcoe,

Interesting to hear about the move towards specialisation in New Zealand. I think there is some movement on this issue in Ireland but the general public is not really aware of it as unlike a doctor who specialises and is called something else (oncologist, psychiatrist, etc) a physio remains a physio even after specialisation.

I do know physio's who have done a MSc in Sports Injuries often call themselves 'sports physio's' but there’s nothing to stop any physio calling him/herself that aswell which comes back to my point of self-regulation. If the physio associations only allowed those members that could prove they met certain criteria to call themselves sports physios then the 'sports/athletic therapy' professions would not have been needed or been able to establish themselves. While they may or may not measure up to an experienced specialised sports physio (an argument for another day) what they do offer the public is a certain level of certainty when it comes to professional ability.


Just a point on this: "the move towards a Doctorate in Physiotherapy as an entry level qualification tugs us in the opposite direction – primarily being a better generalist"

- I'm not sure I'd agree with you there. Again the comparison with medical doctors who must 'specialise' in general practice after they graduate. A doctorate in physiotherapy would increase the knowledge and skill level of graduates but would not necessarily lead to generalisation. That is of course unless you think that the years of study required to achieve a doctorate would leave the average physiotherapy graduate jaded and disinterested in further study (i.e. subsequent specialisation). With the level of interest I see in the physio community here in Ireland for CPD I doubt that would be an issue.

I would however agree with you on the need for generalists as not all patients require specialist attention. The big problem is how to operate a proper inter-physio referral system in a country like Ireland where MSK treatment is largely private and therefore each physio will try and retain as many patients as possible in order to make money/a living. There is no financial incentive to make the system more efficient or professional.

Anyway just some thoughts.......:)

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Originally Posted by aprillove20

I 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.

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Hi April Love,

May I ask why all of your posts are either random quotes or else a partial copy of something someone else has already posted? Not exactly contributing to the discussion......

Hi ATT,
I understand where your coming from regarding the situation in ireland. There's too much striation in our own profession - between the clinical interest groups, public/private and between those dealing with sports people as a whole. With sports you either have (not solely) 1) those working full-time hospital -week-ends with teams for extra money
2) those in privat practice interested in how many patients they see a day, 3) those who commit to a team/club and continue to try to improve their service to sports people.

A huge problem in ireland is the lack of chartered physios willing to work in sports due to the long and unsociable hours that go with it. this has left the door wide open for other "therapists" to clean up as the "PHYSIO" for clubs both locally and provincially. So much so the public don't even know the difference.

As has been said in this thread earlier - Promotion is vital.Currently workin inAustralia i can see the public have a greater understanding of the role of the physio and benefits to them, what they can and can't do and as such is a more stand-alone profession.

However unless the clinical interest groups start recognising eachothers specialities and referring on accordingly - the public will continue to think that every physio is the same, and when a less experienced physio can't help, the patient writes the profession off as a whole and heads for the alternatives (literally)

I agree a basic life support/spinal care cert should be manditory, but it think that regardless whether a physio - massseuse- NMT etc. What i think WE should do is give our new grads etc a boost, a basic course ensuring accurate diagnosis/injury management, along with other practacilities you don't learn in college. with a clear strategy for professional development. The accreditation is a big step - have many other countries begun this?

I think as a profession we have not realised half of our potential overall, and i have no doubt we can - however we need to do it soon before other "professions" start picking bits and pieces of the profession for their own and we lose what hope we had of independence (sorry if this is a rant)

First, I think the physiotherapy is def becoming stronger ( sorry if i miss spell words all my physiotherapy studies have been in spanish, I will do my best), for example alot of your opinions are really helpful and this whole forum discussions are making us stronger as we go..... I think to make the profession stronger .. schools have to provide students with the right curriculum.... I have looked at some curriculums in the USA and they go to school for about 7 years to become a Physio but the first two years they take classes that arent really related to PT it self ..... It seems more like a business to me to keep students 7 years in school for PT .... in Chile for example it last 5 years with 1000 supervised clinical hours and a year of each area ( neuro, Trauma and respiratory) to me this seems good enough so this way they can do an specialization after...it makes me mad how americans are making up this doctorate degree of physical therapy when its the same degree that pt´s use to get in america 5 years ago .... the point I´m trying to make is that as long as the schools curriculums are made the right way things will keep growing for pts.

Another thing that I think its wrong about PT is that too many people are going into this career to make money and not to help people and those graduates that are into it for money become bad proffesionals and they make the rest of pts look bad...

I also think that physiotherapy is becoming stronger. Just after my accident I noticed how important it is. It gave me strength and hope and it was a big support during the long way of healing after all medical treatments in the hospital was over. I experienced it as something very personal and a mixture between physical help but also having someone to talk to.

I don't think the situation in Poland is healthy.

The country doesn't have any private health care. Hospitals are drastically underfunded and the government medical scheme doesn't support long term rehabilitation, which means many who can't afford to pay from their pockets, just don't bother with physiotherapy.

Many doctors don't see the need for physiotherapy-there are very few who actually have a referral system going with physiotherapists in clinics.

The government medical fund limits patients to 10 treatments over 3 months. Physiotherapists in many clinics just do what the doctor 'prescribed' without re-evaluating the patient, which leads to poor results and an unimpressed patient.

that is a bit depressing, Christopher.

Do you think things may improve as the European Union tries to harmonise health services, including allied health?

I hope so.

I think that Poland needs private health care. There is too much politics in public health care and we all know it.

I think that it will change. Not very quickly though.

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 :=(

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.

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.

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...

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

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).

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Originally Posted by ATTIreland

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

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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.

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Originally Posted by estherderu

dear colleague, which country would that be??

esther

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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!

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Originally Posted by trendytiger

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

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

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.

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

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

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

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Originally Posted by pdoan01

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

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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