5 years of autonomous physiotherapy in Poland

Let’s imagine Poland is one of the last European countries with lack of professional regulations regarding physiotherapy. Further attempts to introduce the Act on the Profession of Physiotherapy is being abandoned by physicians. The only person responsible for the rehabilitation treatments is a doctor. He orders the procedures. Physiotherapists do not have the right to change implicated therapies or choose the appropriate ones on their own. They are not proceeding manual therapy, because other medical staff are not keen on that.

Physicians require mainly laser, electro- and hydrotherapies due to misunderstanding. Even if a doctor refers to the wrong side of the body physiotherapeutic procedures, we are not allowed to change the physiotherapeutic procedures. The patient must return for the correct referral. Physiotherapists must not order medical devices nor assess or diagnose. What for? These are among rehabilitation doctors’ competencies. Besides, according to the submitted project, they soon will have to hire a rehabilitation doctor in every physiotherapeutic private practice. No idea how to ca. 2500 medical rehabilitation doctors will be able to practice in tens of thousands of private clinics. After all, they would also be entities with the National Health Fund (NHF) contracts. Medical rehabilitation doctors have been consulting within the NHF in Poland for a long time now, even though they already had difficulties in supplying patients. I wonder what wages they would have demanded for working in our privacy practices.

„The Act on the Profession of Physicians and Dentists explicitly states who is responsible for the treatment of the patient in Poland. Now, a physiotherapist would have the same capabilities as a doctor because he would be able to decide on the treatment method?” – Stated one of the rehabilitation physicians leaders, who strongly believed only medical rehabilitation doctors should decide about the rehabilitation process.

The independence postulated by physiotherapists arouses fear and reluctance in doctors. “National Trade Union of Doctors (OZZL), together with the Medical Self-Government – believes that the above-mentioned project [re. The parliamentary draft that was the base of the Act on the Physiotherapy Profession, September the 25th, 2015] contains so many doubts and controversies, especially when it comes to the mutual relations between physiotherapists and doctors that work on it should be suspended until these doubts are resolved. Incorrect, hastily adopted solutions may only make it difficult or even impossible for doctors and physiotherapists to cooperate for many years. It will result in another permanent conflict in health care and worsening a patient’s situation.” [position of OZZL 20th of July, 2015.] There is no question of changing the physiotherapeutic reimbursement valuation: after all, executors of medical orders do not need to earn more. Besides, doctors will not ask for a raise on behalf of physiotherapists. Let’s presume further on there is no insurance dedicated to physiotherapists, nor any verification of their competencies. Anyone can act as a physiotherapist. There are also no contributions because there is no self-government, providing an occupational registry, reporting to the prosecutor’s office against people who pretend to be physiotherapists. In a pandemic, rehabilitation service is being opened at the same time as tattoo parlours, because there is nobody to fight and explain that rehabilitation is not a spa, but a necessary medical profession. During a pandemic, dedicated support or social assistance for physiotherapists in the most difficult financial situation is a pipe dream: after all, they are not a partner for doctors or the government to discuss…

The above sounds scary, right.? It could be the case if it were not for the Act on the Profession of Physiotherapists introduced in Poland on 25th of September, 2015. Due to the Act, The Polish Chamber of Physiotherapists has established and hence also professional rights and obligations. We curse our financial contributions due to the registry, but it is thanks to the charge we have the opportunity to fight for our rights. Another benefit is that we are able to do a precise calculation in Poland regarding the number of professionals, services provided, patients contributions in the system. Therefore, we collected arguments for discussion, research, analyzes, and legal expertise. We are no longer at the whim of those who think to know physiotherapy better. The conflict with other medical staff decreased or vanished, and in many places, cooperation is closer than ever.

If we avoid valuing ourselves and the Chamber achievements, do not expect others to respect us either. We act like shooting ourselves in the foot. After all that has been done, some of us still feel unsatisfied, hungry for more, compared with others. Those others are numerous local governments with long traditions and roots. Who have their representation in the Parliament or political parties. I agree that it is still the beginning of the road. However, first, most difficult steps point us in the right direction.

Today we celebrate the 5 years since The Act on the Profession of Physiotherapists was first introduced in the system. It was 5 years of hard work in the tremendous rush. When the first enthusiasm cooled down, we set our shoulders to the wheel. First 5 years have passed very quickly. The next elections are approaching. I bet on those who build a community, strengthening our profession. On people who have the experience and understanding of working realities in the local government.  People who do not use populist arguments such as abandoning the self-government and its required fee only to gain some cheap applause.

I would like to thank all those who take the trouble to build the prestige of our profession. Those who are not afraid of challenges, responsibility or reflection. I would like to thank those whose efforts raised the Polish physiotherapy on a world-class level.

I wish us many reasons to be happy and to act forward. It is necessary to subsidize physiotherapy. We will not let go on the matter. I hope that the stakeholders will reach decisions about the funds. Our rates must be realistic and reflect the contribution of physiotherapy in the health care system. We will fight for specialization as well. Physiotherapists – strength and hope in you!.

Prof. Maciej Krawczyk PT, PhD
President of The Polish Council of Physiotherapists