Author : Dr. Vijay Gupta (MPT Msk USA) & Dr . Gajanan Bhalerao (MPT Neuro)
Physiotherapy, as practised in India, is still in its nascent stages of development in comparison to the field of Medicine. This is because statistics indicate that, at least, in the state of Maharashtra, the proportion of the number of seats in Medical colleges to that of those in Physiotherapy colleges is nearly five times!!!! This means that Maharashtra (and by extension, the whole country) perhaps produces approximately five times as many doctors as physiotherapists. Moreover, this also indicates that approximately five times the finances are pumped (by the state government and other private institutions) in the field of Medicine (in setting up Medical colleges) than in physiotherapy colleges. This is clearly because the return on investment from a Medical student is by far greater than that from a student of physiotherapy.
Who is responsible for this poor return on investment from students of physiotherapists, and physiotherapists? Is it because most of the colleges of physiotherapy are affiliated to medical colleges, and hence receive ‘step-child’ like treatment from the promoters of these colleges? Or is it because there is a lack of a robust professional body of affiliation for the physiotherapists, unlike the Medical Council of India (MCI)? Or is it simply because students of physiotherapy do not attempt to enhance their clinical skills in super-specialised fields such as paediatric Neuro-physiotherapy (much like a paediatric gastro-enterologist) or women’s health physiotherapist or an ergonomic specialist?
Let us explore each of these possible reasons individually.
All about the money!
Although there is almost equal number of Medical and Physiotherapy colleges in Maharashtra, what is of significance is the total intake of students by these colleges. According to the Perspective Plan 2017-2022 of the MUHS, the total intake of Medical colleges is approximately five times the total intake of physiotherapy colleges. Hence, it is clear that Maharashtra produces almost five times the number of doctors as physiotherapists; although, it is admissible that not every patient that needs a doctor will need a physiotherapist too. If such were the case, then it could be argued that the total intake of both these types of colleges should be equal.
Admittedly, a medical education costs much more than a physiotherapy education, and also a doctor (specialty doctor) charges much higher fees than her physiotherapy counterpart. Hence, most of the finances (by these institutions) will be deployed towards setting up medical colleges (since the ROI is much higher, be it in terms of social returns or financial returns) rather than physiotherapy colleges!
Lack of professionalism?
Unfortunately, a nation as big as ours, does not have a robust professional organization for affiliation of practicing physiotherapists modelled after the Canadian Physiotherapy Association (“Advancing the profession of physiotherapy in Canada”) or the Australian Physiotherapy Association (which is the peak body representing the interests of Australian physiotherapists and their patients.”) In contrast to these Associations, the IAP is merely a governing body, with a meagre 30,000 physiotherapist members, with memberships that are ‘one-size-fits-all’ versus those offered by the other Physiotherapy Associations (which offer different types of memberships catering to a variety of types of Physiotherapists, from the practicing ones, to the non-practicing ones (who work in Admin) and finally to student Physiotherapists. )
How these other Physiotherapy Associations are more efficient and effective than our association is a discussion for another blog post. However, one can easily assume that given the advancements made in physiotherapy profession in both Canada and Australia, their respective associations may have played a very significant role in its advancement. So, in order to develop super-specialities (in other words, in order to develop the profession of physiotherapy) in India, our association will have to be stronger, more robust and require active involvement of all the practicing and non-practicing physiotherapists.
Inadequate skill enhancement!
Most newly graduated physiotherapists and also many of those who have been in the profession for more than a decade, choose to participate in as many workshops as they can. In one way this is commendable since all these physiotherapists are trying to enhance their skills. However, there appears to be a lack of sense of focus for these physiotherapists. Perhaps due to the abundance of varieties of workshops available, these physiotherapists lose focus of their careers, and try to become jack-of-all-trades instead of master-of-one!
The super-specialist physiotherapists practicing in India could maybe counted on our fingers. And then again, almost all of these super-specialist physiotherapists are almost never involved actively in academia in order to seek their guidance and make a structured program, and thus train more and more physiotherapists like them.
None of the above three reasons are individually responsible for the lack of super-specialization in physiotherapy field in India. A play of all of these factors has led to our profession remaining on the fringes of Medical field, instead of becoming a cornerstone of it!
It would be best to start with the last reason first, since only when us physiotherapists become best at what we do (super-specialize), can we have better professional organizations, and better colleges.