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 Table of Contents  
LETTER TO THE EDITOR
Year : 2017  |  Volume : 11  |  Issue : 1  |  Page : 34-36

Physiotherapy - The state of the profession in India: An analysis


Professor & Principal, JSS College of Physiotherapy; Deputy Director, JSS Physical Medicine and Rehabilitation Centre, JSS Hospital, Mysuru, Karnataka, India

Date of Web Publication18-Aug-2017

Correspondence Address:
Kavitha Raja
JSS College of Physiotherapy, MG Road, Mysuru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/PJIAP.PJIAP_17_17

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How to cite this article:
Raja K. Physiotherapy - The state of the profession in India: An analysis. Physiother - J Indian Assoc Physiother 2017;11:34-6

How to cite this URL:
Raja K. Physiotherapy - The state of the profession in India: An analysis. Physiother - J Indian Assoc Physiother [serial online] 2017 [cited 2019 Aug 20];11:34-6. Available from: http://www.pjiap.org/text.asp?2017/11/1/34/213275



Sir,

Physiotherapy is a science which incorporates a firm understanding of anatomy, physiology, disease and dysfunction, to provide intervention strategies for a variety of conditions notably, but not restricted to disabilities, pain, movement dysfunction, and health and wellness.

In India, the course of study is intense with a large amount of science and humanities subjects and is 4.5 years in duration. At the end of this grueling course, a physiotherapist is capable of working independently/autonomously/as part of an interdisciplinary team depending on the area she/he chooses to work in.

The discipline is well established globally with over 60 reputed journals solely dealing with advances in the discipline. Physiotherapy has made significant and giant strides in the past three decades in terms of knowledge base, autonomy, and visibility.

A large number of practicing physiotherapists in the western nations have had their physiotherapy education in India. They are known for their knowledge and competence and are considered crucial members of rehabilitation teams, frequently heading the teams. However, in the country of their origin and education, the scenario is far from rosy.

Although physiotherapy education has more than half a century of history in India, the acceptance and respectability are inadequate. All educational institutions have been offering a degree program for the past 30 years. However, the salary structure and designation remain at “technician” level, i.e., someone who holds a 2-year diploma. The average earning potential of a graduate physiotherapist ranges from 9000 to 25,000 in the government sector, and that of a postgraduate is no better. The number of academicians with a doctorate is on the rise, but unfortunately, their plight is also the same.

Over the past three decades, the discipline has taken over the attributes of a profession in education and scope of practice. This is not reflected in policy. Due to this lethargy on the part of the core professionals and the patronizing attitude of the orthopedicians and physiatrists who are more often than not, the chair persons of curriculum committees in the universities which have formulated the basic curriculum advances in the field are not reflected adequately.

The core subjects that a physiotherapist in India learns are far from current global standards. Over 50% of the curriculum is dedicated to “medical” subjects taught by various doctors whose refrain of “this is not important for you” has changed little over the past 3 decades. This state of affairs is compounded by a general apathy on the part of government authorities who tend to laugh off our concerns voiced time and again to various authorities. Some of the purportedly “crucial” skills that are tested in examinations are the methods to suspend a limb!! Clinical reasoning and analytical skills are rarely examined; but a great deal of importance is given to irrational and unnecessary procedures. This is a continuation of the requirements mandated by prescribers, of technical staff and has no place in the curriculum of a reflective practitioner which is the current role of a physiotherapist.

There is no firm leadership, and this may be a cause for the inadequate salary and the lack of a central body. The association is plagued by disagreements based on ego and personal gain, and this has firmly entrenched the profession is a seemingly bottomless morass. Voices of reason rise from time to time only to be drowned in the louder voices of detractors.

Young professionals are forced to flee the country due to the lack of opportunity and recognition. Central institutions engaging in interdisciplinary research often overtly/covertly bar physiotherapists from their institutions. This is a policy flaw and is discriminatory.

Perhaps the most important reason for this state of the profession is the lack of articulate representation to the highest policy makers. There are four notable central institutions for locomotor disabilities. There are two for speech and hearing disabilities that are trend setters. In the centers for locomotor disabilities, physiotherapists are relegated to a subsidiary level whereas they should logically be heading the institutions as is the case in the centers for speech and hearing disabilities. Central institutes have required positions for physiotherapists in their clinics on a contractual basis, where sometimes, the salary is less than that of a Class IV employee. The state of physiotherapists in the private sector is no different. Institutions which have set the standard in physical rehabilitation have conveniently and through policy restricted the access of their physiotherapists to leadership roles and higher education.

States which have been pioneers in physiotherapy education have had hierarchies dominated by orthopedicians and physiatrists who have virtually shackled the therapists to their fate as lowly technicians afraid of their shadow. Those who dare to escape this plight and move to other states carry the baggage of their oppression with them. They set up systems where they oppress their subordinates and students and continue the vicious cycle. It is a well-known fact that those who are oppressed become oppressors in turn. Nowhere is this truism more evident than in the physiotherapy educational system in India. The oppressed also begin to believe that they are somehow the cause of their own misfortune. Physiotherapists are well-known proponents of this self-defeating attitude where we name ourselves for our lack of status constantly berating each other and ourselves for our state.

It is an interesting fact that interview committees for physiotherapists in government institutions are headed invariably by orthopedicians and not physiotherapists. It appears to be a well-accepted fact that they are more knowledgeable in physiotherapy than physiotherapists themselves! This is a refrain that several well-known orthopedicians have voiced time and again. Hence, their insistence that we follow orders. This is possibly a fact only in the southern states where the status of the physiotherapist is even more marginalized than in the northern and western counterparts.

Another interesting fact is that a couple of years ago at a regional conference of orthopedicians in a southern state, one of the agenda items was how to “control” the menace of physiotherapists practicing independently!!! Laughable is it not? But rather than laughing at the sheer idiocy of it, the physiotherapists immediately started to worry and blame each other. Talk about the lack of perspective and confidence. There was an immediate knee jerk reaction among the physiotherapists to avoid courting controversy by engaging in self-blame in front of orthopedicians afraid that they would lose patients.

One reason for this fear of authority in this case “doctors” may be the traditional gender roles. Most doctors were men and most physiotherapists were women. In India's patriarchal society it was easy to fall into subservient roles. Unfortunately, we have been unable to shake this off till date.

Add to this, is the fact that almost everyone with the ambition and ability leave India in search of greener pastures. Hence, the ones left behind are the ones who are either not good enough to leave or are left behind due to concepts of patriotism and/or family commitments. These individuals are either too philosophical to actually care about status and money or are too burdened by the effort of making a living to actually have the time or energy to think of the profession.

This institutionalized discrimination over decades has resulted in a group of marginalized professionals who have no ability or confidence to demand their rightful and obligatory place in the healthcare industry. Naturally, the fall out of this scenario is a group of professionals who are not fulfilling their roles in the health-care spectrum. This is a national waste of workforce especially in the current context of increasing burden of noncommunicable diseases where physiotherapists are crucial. We have definitely moved away from our traditional roles of electrotherapy applicators and crutch trainers!

It is high time that the relevant authorities take steps to correct this entrenched wrong. Discrimination and oppression have no place in a democratic nation. Rather than involving a convenient few to develop the national syllabus and to take an opinion, there must be a sustained and committed effort to hear the voices of all of us. Physiotherapists from across the country must be invited by public announcement to be part of a committee to address remedial steps needed to elevate the profession to its rightful place. Physiotherapy is neither subsidiary to medicine, nor is it an alternative form of medicine. It is an independent and autonomous profession within the larger health-care spectrum with a core knowledge that is unique. As a first step, perhaps all physiotherapists in India will join together, on September 8 not to spread awareness as we have until now but to take out silent marches with black ribbons as a sign of protest to draw public attention not only in Delhi but across the nation. It is time that we shake off our personal quarrels, our self-defeatist attitudes and come together as one for the betterment of all of us. Each for all and all for each…





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