Feedback and Suggestions Regards to Physiotherapy Council Physiotherapist This document contains the feedback and suggestions supported by relevant references on ALLIED AND HEALTHCARE PROFESSIONAL CENTRAL COUNCIL BILL 2015 uploaded by ministry of health & family welfare for Comments/Feedback from stakeholders on the bill.
ALLIED AND HEALTHCARE PROFESSIONAL CENTRAL COUNCIL BILL 2015 uploaded by ministry of health & family welfare for Comments/Feedback from stakeholders on the bill.
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Feedback and Suggestions Regards to Physiotherapy Council
Physiotherapist
This document contains the feedback and suggestions supported by relevant references on
ALLIED AND HEALTHCARE PROFESSIONAL CENTRAL COUNCIL BILL 2015 uploaded by ministry of
health & family welfare for Comments/Feedback from stakeholders on the bill.
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Date 22/10/2015
To,
The Secretary
Ministry of Health and Family Welfare Nirman Bhawan, New Delhi
Sub: - Resentment with respect to proposal for the formation of Physiotherapy Council in present
form and Seeking Comments/Feedback from stakeholders on the same, October 25th, 2015)
Respected sir/madam,
With regard to the aforesaid subject, I would like to place before you certain enlightening facts
pertaining to Physiotherapy Profession in our country for your kind perusal and just action in the favor
of Independent Physiotherapy Council. As informed, I do citizen do offer suggestions for the rest of
the professionals, annexed as Annexure -1
Historical facts and background of Physiotherapy profession suffering in Union of
India.
I would like to bring to your kind notice that the Government of India had already decided to have an
independent Council for Physiotherapists under the Ministry of Health and Family Welfare with separate
cells for Occupational T h e r a p i s t a n d Physiotherapists way back in the year 1988 and budgetary
allocation of 5 lakhs rupees was also sanctioned between the years 1989-90 for the same.
Physiotherapy has been defined and categorized more than half dozen by MoHFW in
years 1994(independent council), 1995(paramedical along with lab technician),
1998(rehabilitation professional), 1999(paramedical along with lab technician),
2002(physiotherapy & paramedical), 2012(allied health), 2014(allied health) and
2015(along with physician assistant & dietician) in a very contradictory manner to
implicate physiotherapists with paramedical /allied health/physician assistant &
dietician (non-direct form of health discipline) profession in influence of physician
especially PMR.
Some important dates and incidents are mentioned below: (1998-2007)1
1988 The Government of India decided to have an independent Council under the Ministry of Health
and Family Welfare with separate cells for Occupational Therapist and Physiotherapists
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1989 Budgetary allocation of 5 lakhs rupees for Physiotherapy and occupational therapy council bill.
1994 The MoHFW defined the term Physiotherapy as independent professional and prepared the
bill.
1995 The MoHFW on the recommendation of Law ministry conducted the state health secretary
meeting which decided the paramedical bill to be legislated
1997 Files pertaining to Paramedical and Physiotherapy, reported to be misplaced by them and
later on the noting portion was received from the office of DGHS.
1998 MoHFW itself recorded the need of dominance between PMR and Physiotherapy
1998 Government notified Physiotherapy in rehabilitation council of India (RCI) and categorized as
rehab professional.
1999 The Government de - notified Physiotherapy from RCI.
2001 Despite the aforesaid need of dominance observations, MoHFW constituted an expert
committee consisting of a PMR doctor, pathologists and Radiologists, without any expert
from the Physiotherapy profession to define the term “Physiotherapy”. The committee inserted
the term “Medically directed” in defining Physiotherapy in above said meeting.
2002 The paramedical bill was sent to the Ministry of Law for vetting. The Ministry of law pointed out
that” they are not paramedical and don’t come under the purview of paramedical” and the same
was accepted by MoHFW.
2002-7 The term ‘medically directed’ was strongly opposed by physios; it was rejected by MoHFW in
view of expert opinion, where PMR professionals were members.
2007 Department related standing committee on Health and family welfare in its report on
paramedical and physiotherapy bill 2007 pointed out that the word ‘Medically directed’ in
the definition of Physiotherapy has been deliberately used defeating the very basis of defining
a profession in para9.47 and also observed the discrimination of physiotherapy by the
MoHFW .The same committee also observe the rivalry between medical profession and
physiotherapist in 9.452
2008 Bill Lapsed
2012 MOH&Fw released a report ‘Paramedical to allied health’, and presented to the MoHFW. The
role of private body PHFI which has members from MoHFW at the cost of public exchequer
of Rs 64 lakh is dubious. The report has presented the profession in a derogatory manner and the
experts have dissociated from the report3.
2014 Physiotherapy service was defined with restriction under the Clinical Establishment Act Rule
with PMR as chairman of committee, as allied health professional services4.
2015 syllabus hosted in the portal for the Ministry of Health and Family welfare, seeking comments
from stake holders also hosted in the portal for the Ministry of Health and Family welfare,
described physiotherapy scope of practice with limited scope of practice and term diagnosis or
method of treatment/system of treatment is missing from the definition.
It is very sad to point out that office of physician especially of PMR Rather engaged in using derogatory,
unconstitutional and medically vested term like “medically directed therapy” and “have to render the
duty under prescription of PMR /Physician” its rule ,circular, order and reports in direct violation of
fundamental right “right to practice”.5
The uploaded draft right away speaks to subsume the Delhi council of physiotherapy, which define
the physiotherapy as method of treatment and provides professional freedom to serve the patients as
autonomous profession. On the other hand, the draft defines the health and allied as …………
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“Prescribed as under rule of government of India “. I am afraid the above mentioned rules and
reports, which are direct violation of fundament; do not fall in the description of ………… “Prescribed
as under rule of government of India “. If it so, in that case, I wonder, rule will precede the act and
subsume more ethical act of Physiotherapy?
Deteriorating condition of Physiotherapists in India in comparison of developed Nations:
It is humbly informed that the Government of India does not know the number of Physiotherapists6 due
to lack of Physiotherapy council and Due to the same, there is rampant irregularities in recruitment of
physiotherapist e.g.; at Safadarjung Hospital alone since 2008, in 5 different recruitment have been done
with five different recruitment age criteria, Despite complain and resentment no action has been taken.
year 2008- prescribed age for the recruitment -27
year 2011-prescribed age for the recruitment -25
year 2012-prescribed age for the recruitment 27
Year 2013- prescribed age for the recruitment 25 and age of the candidate will be counted
from closing date of previous advertisement.
Year 2015- prescribed age was 35.
Despite complaint and resentment by Indian Association of Physiotherapists that rules have been
violated in year 2010 and 2013.
It has been claimed that “there is acute shortage of allied health professionals” which is contrary to the
truth in the case of Physiotherapy profession. Rather Physiotherapy professionals are available in
abundance and there are approximately 240 unregulated colleges of Physiotherapy which have already
mushroomed in our country. They are offering Graduate, Post Graduate, and also Doctoral courses due
the absence of a National Council for Physiotherapy.
The condition of Physiotherapists has worsened over period of time due to Absence of independent
regulatory mechanism as described in a study conducted in Tamil Nadu in fig. 27 , in dark contrast to
perception in developed Nation e.g. Australia, a study conducted by turner, describes the perception of
Physiotherapist(fig.1) in Australia8
It is humbly informed that the Physiotherapist’s pathetic condition is more or less the same in each state
of Union of India. In Delhi state, in year 2008, at Safdarjung Hospital, to recruit one Physiotherapist,
51 Physiotherapists have been examined. In same hospital at sports injury center, in years 2015, more
than 200 post graduate in sports injury have interviewed for recruitment of 8 physiotherapists. It is
important point out that the examination lasted for three days and most of Physiotherapists who had
already been working on contractual basis in Sports Injury center, were selected. As a matter of fact
rather than selecting Physiotherapists on the basis of merit, Physician experts at the examination
must have enjoyed the derogatory condition of Physiotherapists for all along three day. Not to mention,
the age criteria as usual has been changed to prefix the candidate. The kind of abuse, derogation,
unemployment and irregularities in recruitment are unprecedented and are the true status of
Physiotherapy in India, for all these poor status of Physiotherapy in Union of India, MOH&FW is fully
responsible at the behest of physician especially of PMR.
Even underdeveloped neighbor countries has better human resource standards9 and perception10 among
Physiotherapy profession.
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Figure: 1
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Figure 2: Physiotherapy Profession in India (Tamilnadu)
1. Poor understanding of PT role 2. Unaccepted nature of therapy 3. Poor awareness 4. Orthopedicians fear of losing
patients 5. Rural absence of physiotherapists 6. Poor affordability
Low Demand of Physiotherapy Service
1. Insufficient educational syllabuses 2. Poor acquired knowledge & low self- confidence 3. Un-prioritized continuing education 4. Unskilled and immoral teachers 5. Lack of evidence based practice
Knowledge deficit
1. Poor salary & struggling life 2. Hard work and no fruits 3. Poor employment opportunities
De-motivating rewards and worst career
opportunities
1. Profit concerned colleges 2. Fraudulent private colleges 3. Frightening strategies 4. Standard not a concern 5. Mismatch production & job
availability
Un-regulated educational Institutions
1. Unfavorable tradition of consultation
2. Denied independency 3. Doctors envy and upper hand 4. Nil regulations for authority 5. Forced misconduct
Powerless Physiotherapy Professionals
1. Worried about people perception 2. Unhappy to be known as
physiotherapists 3. Much relied on modalities
Low self-esteem of Physiotherapists
1. Fall in college admission
2. High discontinuation of profession
3. Harmful and less effective services
4. Asymmetry of information and immoral activities
5. Unhappy and frustrated professionals
Worsening Profession
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3. Jurisprudence in developed Nations and Indian states
A. American – Define physiotherapy as method of treatment / system of treatment.
AMERICAN JURISPRUDENCE, 1981 EDITION, HAS BEEN UTILIZED BY MINISTRY OF LAW
TO VET THE TERM OF PHYSIOTHERAPY11
B. Australian & NZ – The PBNZ has published the following description of the general scope of
practice for physiotherapists in Aotearoa New Zealand.12
Physiotherapy provides services to individuals and
populations to develop, maintain, restore and optimize health
and function throughout the lifespan. This includes providing
services to people compromised by ageing, injury, disease or
environmental factors. Physiotherapy identifies and maximizes
quality of life and movement potential by using the principles
of promotion, prevention, treatment/intervention, habilitation
and rehabilitation. This encompasses physical, psychological,
emotional, and social wellbeing.
Physiotherapy involves the interaction between
physiotherapists, patients/clients, other health
professionals, families/whanau, care givers, and
communities. This is a people-centered process where
needs are assessed and goals are agreed using the knowledge
and skills of physiotherapists. Physiotherapists are registered
health practitioners who are educated to practice
autonomously by applying scientific knowledge and clinical
reasoning to assess, diagnose and manage human function.
The practice of physiotherapy is not confined to clinical
practice, and encompasses all roles that a physiotherapist may
assume such as patient/client care, health management,
research, policy making, educating and consulting, wherever
there may be an issue of public health and safety.
The Physio BA has published a definition of “practice”. The following description is based on
that definition:
Physiotherapy practice is any role, whether remunerated or not, in which
the individual uses their skills and knowledge as a physiotherapist ...
practice is not restricted to the provision of direct clinical care. It also
includes using professional knowledge in a direct non-clinical
relationship with patients or clients, working in management,
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administration, education, research, advisory, regulatory or policy
development roles and any other roles that have an impact on safe,
effective delivery of health services in physiotherapy.
C. United Kingdom- Human Medicine Regulation 2012 act, allow Physiotherapist serve as
independent/ supplementary prescriber of medicine. Due to such change only Musculoskeletal
(MSK) physiotherapy practitioners at four primary practices in North West Wales have saved
nearly 700 GP appointments over three months13.
D. CANADA -Physiotherapy Definition14
Physiotherapy is a primary care, autonomous, client-focused health
profession dedicated to improving quality of life by:
Promoting optimal mobility, physical activity and overall health and
wellness;
Preventing disease, injury, and disability; Managing acute and chronic
conditions, activity limitations, and participation restrictions;
Improving and maintaining optimal functional independence and
physical performance; Rehabilitating injury and the effects of disease
or disability with therapeutic exercise programs and other interventions;
and Educating and planning maintenance and support programs to
prevent re-occurrence, re-injury or functional decline.
Physiotherapy is anchored in movement sciences and aims to enhance
or restore function of multiple body systems. The profession is committed
to health, lifestyle and quality of life. This holistic approach incorporates
a broad range of physical and physiological therapeutic interventions
and aids.
Physiotherapy services are those that are performed by physiotherapists
or any other trained individuals working under a physiotherapist’s
direction and supervision.
Primary Functions
Physiotherapists utilize diagnostic and assessment procedures and
tools in order to develop and implement preventive and therapeutic
courses of intervention. They apply a collaborative and reasoned
approach to help clients achieve their health goals, in particular
focusing on the musculoskeletal, neurological, cardiorespiratory and
multi-systems. Within these systems, physiotherapists practice in areas
that include pediatrics, geriatrics, oncology, women’s health, pain,
critical care, wound care, occupational health and sports medicine.
Physiotherapists analyze the impact of injury, disease, disorders, or
lifestyle on movement and function. Their unique contribution to health
care is to promote, restore and prolong physical independence by
enhancing a client’s functional capacity. Physiotherapists encourage
clients to assume responsibility for their health and participate in team
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approaches to health service delivery.
E. Delhi, Maharashtra & Gujarat council – describe Physiotherapy as method/system of
treatment15.
4. Description of physiotherapy:
The description i t s e l f justifies the prolong demand of independent Physiotherapy council
a) Assessment/examination method –like any other system of treatment, Physiotherapists use
scientific methods which includes, examination of joint integrity and mobility, gait and balance,
muscle performance, motor function, cardio respiratory function, pain, neuro-motor and sensory
motor development, posture, cardiovascular and work capacity, cognition and mental status,
skin condition, accessibility and environmental review.
b) Diagnosis – like any other method of treatment Physiotherapist do utilize scientific methods/ Lab
/equipment which include a process that arises from examination and evaluation and represents
the outcome of the process of clinical reasoning; may be expressed in terms of movement
dysfunction or may encompass categories of impairments, functional limitations,
abilities/disabilities, or syndromes; diagnosis is both process and a label.
The diagnostic process performed by the Physiotherapist includes integrating and evaluating
data that are obtained during the examination to describe the patient/ client condition in terms
that will guide the prognosis, the plan of care, and intervention strategies. Physiotherapists use
diagnostic labels that identify the impact of a condition on function at the level of the system
(especially the movement system) and at the level of the whole person.
There is ample evidence that the Indian university in 4-1/2 curriculum of Physiotherapy do impart
radio diagnosis orientation16. In India condition the term “diagnosis” means mechanical
examination of human body, which Physiotherapist are used to performing since long time, as
SD curve from electrical stimulation, as in form of E.M.G biofeedback and Isokinetic test in
diagnosis and prognosis. Now a day Physiotherapist in devolved Nation especially in sports
setting use real-time ultrasound to detect muscle injury which is less time consuming, cost
effective and as effective as MRI and without radiation etc.17
c) Physiotherapy Interventions
Physiotherapy interventions include, but are by no means limited to, the following broad
categories:
Education, consultation, health promotion and prevention services.
Personalized therapeutic exercise including testing and conditioning, neuro-therapeutic
approaches to improve strength, range of motion, and function.
Soft tissue and manual therapy techniques; including massage, spinal and peripheral
joint mobilization and manipulation.
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Physical, electrotherapeutic and mechanical agents; and acupuncture.
Cardio respiratory techniques including airway clearance methods.
Skin and wound care.
Management of incontinence including pelvic floor re-education.
Functional activity and tolerance testing and training.
Work and occupational re-training and return to work
planning.
Prescription, fabrication and application of assistive, adaptive, supportive and
protective devices and equipment. Environmental change, focusing on removing barriers
to function.
d) Practice Settings
Physiotherapists work in private and public settings providing client and/or population health
interventions as well as management, educational, research and consultation services.
This broad range of settings may include but is not limited to the following:
Child-development centers Community health centers
Government/ health planning agencies
Health clubs/Fitness centers
Hospices
Hospitals
Individual homes/home care Insurance companies
Nursing Homes
Long term care facilities
Occupational health centers
Outpatient/ambulatory care clinics
Physiotherapy clinics/ practices/private offices
Prisons
Public settings for health promotion Rehabilitation Centers/ Research facilities/
Seniors centers/residences Schoo ls /universities/colleges
Sporting events/field settings Sports medicine clinics Work sites/companies
e) Alternative method:
Often used to describe independent healing approaches and Techniques used in place of
conventional treatments or mainstream medicine. In developed nation Physiotherapy Servesas
alternative method treatment e.g. musculoskeletal (MSK) physiotherapy practitioners at four
primary practices in north west Wales have saved nearly 700 GP appointments over three
months.
Physiotherapist serve as first contact practitioner in Australia, NZ, Canada and United State as
describe above.
Due to absence of regulatory mechanism, the Government of India do not know that how many
Physiotherapists live in India and what type of practice are they engaged complementary
or alternative?
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Above mentioned facts give rise to following startling questions
1. If the state health secretary meeting on the recommendation Law Ministry was that much
important, I wonder why Ministry throws the Physiotherapy profession from Ministry of Health
to Ministry of Social justice. Whether sanctity of that meeting and recommendation of Law
Ministry Remain Secured?
2. If Law Ministry recommendation was that much important that it force the government to conduct
the State Health Secretary meeting in 1995. I wonder, why it was not important in 2002,
when t h e Law Ministry pointed out on the basis 20 year old literature Physiotherapist are not
Paramedical even after its acceptance by MOH&FW?
3. Whether inclusion of Physiotherapy profession curriculum in RIPs &NIPs, does not amount
misplace fund in light of above mentioned facts and condition of physio?
4. Whether our policy can be based on lost files Note and misplace fund?
5. Whether any present decision of the Ministry of Health and Family welfare with respect to the
Physiotherapy Profession and that which is inconsistent with the prior decision, “decided to have
an independent Council under the Ministry of Health and Family Welfare” with long history of
biased and vested on the behest of Physicians especially of PMR who are occupying influential
positions in the Mohfw, is not a violation of the principle of promissory of estoppels?.
6. How long will such derogatory victimization will be continued by Moh&fw at the behest of
Physician especially PMR?
Demand
Therefore, in light of the above mentioned facts, the pathetic condition of physiotherapists and in
view of continued victimization, I humbly seek your urgent intervention and special attention in this
matter and request you:-
1. To immediately formulate measures for implementing the original decision of the Ministry of
Health and Family welfare to have an Independent council for Physiotherapists as decided in
the year 1988, on the similar line of any other method of treatment being regulated in India.
2. To take appropriate action with respect to explained facts, misplaced files & fund o f
Physiotherapy, irregularities in recruitment, conflict of interest and discrimination pointed out
at different paras of this representation.
3. To ban the Physiotherapy education and practice in India, if above request not feasible
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Reference;
1. Mohfw file NO-20816/1/97-PMS Volume i, volume ii&iii 31st