Profession Creep in Physiotherapy

Change is Occurring at the Top and at the Bottom of our Professions

The Coming Healthcare Revolution

Healthcare is changing. The technological and information revolution which has blown through retailing, taxis, hotels and music is now blowing through healthcare. Demand is always quoted as the driver for these changes, but there are other drivers which may be more important.

Medicine is at the top of our particular pyramid. They diagnose and treat us and have the ultimate responsibility for our health. As science and technology progress, they can do more and more and their specialities become narrower.

Now the medical profession has a problem. By constantly acquiring new skills and techniques at the top end of their abilities, their field is continually widening and filling up with new treatments. Profession creep for the doctors means more complexity and the cutting edge.

They can treat conditions that were previously not treatable or can treat them better with new techniques. The pool of potential patients increases and looks like it will continue to do so. This process shows no sign of stopping or slowing and will likely accelerate with our ageing populations.

Medicine has dealt with this with varying success. As there is nothing “above” the medical profession it’s interesting to note what’s happening “below” medicine. Doctors are being forced to give up some of their functions to continue on their path.

Demand means that they can’t hold on to everything they have been doing. The stresses on the system have steadily increased as patients complain they can’t get to see their doctor and waiting lists rise. And that’s not considering the stress, burn out and early retirement of many doctors, a result of impossible demands.

At medicine’s cutting edge, technology and research move inexorably forward, forcing increased specialisation. Something has to give.

Profession Creep – Advancing the Profession

Nurses and physiotherapists are taking over the lower levels of doctors’ roles. Advanced practitioners exist in many medical areas and carry out procedures that doctors would normally do, such as inserting a central line or running a spinal clinic. This process is now in full swing and will continue to accelerate.

The Rise of Physiotherapy

The greatest profession creep in physiotherapy is occurring in the musculoskeletal (MSK) field. GPs have a huge and varied caseload, and MSK diagnosis and treatment is not generally one of their fortes. 15 to 30% of the patients they see have an MSK problem and as spending on this group of patients continues to rise, results are not keeping pace.

Physiotherapists, already skilled in assessing, handling and managing MSK patients, are the natural group to take over this workload. Many have taken post-graduate qualifications and become highly-skilled diagnostic clinicians in this field.

NHS managers have realised that they can provide safe and less costly services by having non-medical personnel trained to do specific jobs. Whether this work is effective is a subject for another post, but it is likely no less effective than when performed by doctors.

Physiotherapists are now diagnosing, requesting imaging, listing for surgery, prescribing and giving injections. They are moving into the screening and treating roles for the large number of conditions which are more routine and don’t demand advanced medical judgement.

What happens to other Professions….

Profession creep is not just happening to the doctors, it’s also happening to physiotherapy. Non-physiotherapists are routinely employed (Band 3 or 4 in NHS lingo) to do the jobs that don’t demand skilled assessment or handling by a qualified therapist.

The NHS now employs large numbers of trained and skilled people who can do the more routine work of physiotherapy, such as mobilising patients after operation or injury. This leaves the physiotherapist free to assess and treat more complex cases.

These challenges will increase, particularly for medicine. The rise of machine learning and eventually AI will heavily encroach first on the interpretation of imaging and then on diagnosis. Physiotherapy, with its emphasis on direct handling of people, is more insulated from being replaced by an algorithm.