“Physiotherapists are leaving the profession”

Simone von der Linden (28) from Wijchen, Gelderland, is about to go on a walking holiday to the Czech Republic. She says she has a passion for sport, exercise and health. She loves football, running, swimming and cycling, and is fascinated by the human body. Biology used to be one of her favourite subjects. She worked as a physiotherapist for three years, 34 hours a week. “It suited me. I enjoy getting up and having my feet in the mud, to be able to help people right away. Very valuable.”

However, von der Linden is no longer a physiotherapist, but an intern in the province of North Brabant. She is seconded to municipalities and is involved, for example, in services and higher politics. She says that working as a physiotherapist is a tough job. “It can be physically difficult, but also mentally. You see people all day long, you hear a lot of dramas. It's not very flexible: you can't go to the dentist during your lunch break, for example, you have to be back on time because there are already people waiting for you.

Another drawback: her income was lower than that of her friends who had also completed higher vocational education, and this income barely increased. “I was able to make ends meet, but it caused a lot of turmoil: Can I buy a house? What if I want children? She paid for the extra training herself, on top of her pension.

So she asked herself: Do I want to do this for the rest of my life? The answer was: No.

“As an intern, which is a convincing training course, I get a thirteenth month and earn three hundred euros more than I earn as a trainee physiotherapist with three years of experience. This is crazy.”

Von der Linden is not the only physiotherapist to resign. In 2023, one in ten physical therapists will leave the profession – that's more than four thousand people. In addition, seven in ten are considering doing something else, and the number of new physiotherapy students has continued to fall every year since 2020. This is demonstrated by a large representative survey among physiotherapists conducted by physiotherapist FDV, which will be released on Monday. .

“Physiotherapists are running out of practice,” concludes Bob van Ravensburg, chairman of the FDV board. “We are heading towards the collapse of our profession.” These are the front-line physiotherapists, who practice “in the corner” and should be available to everyone.

Younger physiotherapists in particular are quickly put off. “They enthusiastically complete a four-year HBO course, often a three-year master’s degree after that, and only then do they realize they’re not earning much more than an MBO salary,” says Van Ravensburg.

FDV research also shows why physiotherapists are leaving: low salary, insufficient career prospects, poor working conditions. There is no collective agreement. Since 2004, physiotherapy has only been included in the basic package to a limited extent; you have to take out additional insurance for this. Free rates apply for this.

The research agency Gupta reported in a 2020 study commissioned by the government, health insurers and physiotherapists that the treatment rate should be around €34 per half hour to cover all costs. Adjusted for inflation, this is now around €45. But in practice, health insurers pay between €36 and €40, the study shows. At the same time, housing, energy and staff costs for employers have risen sharply. “The rates are very low,” says Charlotte van Laar, a specialist in the medical professions sector at ABN Amro. The result: employers look first at their high costs, and their physiotherapy is “the bottom line,” says Marieje Bosboom, secretary of the FDV. “Some physiotherapists haven’t had a pay rise for years. They’ve been on the payroll since 2003.” Last year, that resulted in an average gross salary of €3,600 per month for a 40-hour work week, slightly above the average (€3,300).

Physios also refers to working conditions. Many of them, both self-employed and employed, pay the costs of mandatory training and registration themselves, and often also pay for their vacation days and pensions – although sometimes a small part of this is paid by their employer. Meetings, training and management take place at a time that suits you. “I receive emails and phone calls every week from physical therapists who can no longer afford to pay their mortgage and groceries, or have not gone on vacation for years,” Van Ravensburg says.

The research shows that the difference with second-line physiotherapists – a collective labor agreement, better working conditions, and a 55 to 70 percent higher salary – is significant. It ensures that physiotherapists not only leave the profession, but also move to the “second line”: hospitals, rehabilitation centers, and nursing homes.

Flowers and reading materials

Paul Claver (62) sold his Nardin therapy practice in April 2023 after almost forty years. Now he allows himself to work as a self-employed person in his “old” practice because it is “a wonderful profession.” “You want attention, and enjoy working with people.” Claver says he has an optimistic attitude and doesn't want to complain too much, but he's also had to watch his money for years: Sometimes he pays himself less than the physical therapists he's hired, asks for a rent cut during the coronavirus, works twelve hours a day, and has no… Flowers or reading material in the waiting room. “All the frills had to be removed. You have to keep costs as low as possible, because there is nothing to be gained on the income side. What also helped him was that his wife earns a good income – a comment many physiotherapists have heard.

Eighteen months ago, Claver took action with his practice. He hung a sign and gave clients sponges afterward. The message: Physical therapy is like a sponge. Eventually it gets all squeezed out and nothing comes out.

More than four million people use physiotherapy each year, according to figures from the professional association KNGF. Problems with rates have been going on for years. The last collective labor agreement dates back to 2003, and a new agreement in principle was not reached until early 2023. The majority of physiotherapists agreed.

Most employers also support collective bargaining, but they are concerned about affordability. “Practitioners are concerned that they will lose out on higher staff costs if the rates charged by health insurers don’t also go up,” says Charlotte van Laar. Rates are already rising, but less than inflation. “Health insurers are concerned about very high costs, when they should be paying attention,” says van Laar.

A spokesman for Zilveren Kruis says the insurer “is not against salary increases. We certainly don't want to get the most out of it. But we pay from the premium payer's wallet, and many people already have difficulty paying the premium. We always have to look carefully at what we spend on “Our money.”

Everyone looks at each other, “but nothing happens,” says FDV's Van Ravensburg. This is worrying, especially now that physiotherapists have been assigned a key role in the Integrated Care Agreement IZA (Rutte's fourth plan to arm the Netherlands against an aging population and rising healthcare costs). Physiotherapists can reduce the burden on general practitioners and prevent complaints from becoming so serious that people end up seeing a more expensive specialist.

In May, National Security Council MP Danielle Jansen expressed concern during the weekly question time in the House of Representatives that “patients will soon face a closed door due to the shrinking professional group”. Outgoing Minister Dijkstra (Healthcare, D66) acknowledged the problem: “Allied health care is given an important role within the IZA, but this does not always go well”. According to her, the reason lies partly with the physiotherapists themselves. “Small providers do not have good talks with the insurance companies. They should negotiate together, then they will be much stronger.”

Physical fitness in physical therapy

Van Laar of ABN Amro points to other possibilities. For example, physiotherapists could offer lifestyle programmes (at higher prices) and do more occupational physiotherapy. They could improve their efficiency by increasing their volume (think of chains like FysioHolland or TopzorgGroep). Physios could also combine its business with, for example, fitness. “After treatment in the clinic, you can continue fitness with it, but at your own expense. This makes physiotherapists less dependent on the insurance company. But according to FDV, this does not necessarily suit physiotherapists; they are mainly there to provide care.

Paul Claver points to another solution. His fellow creators have come up with an alternative. Cuperto (Pay extra for cutlery in the restaurant). They ask their clients to pay a contribution for each treatment. Claver: “The patients understood, but the health insurance company immediately blew the whistle on them.”

At the FDV trade union, they now have a bleak outlook. “Many people have gone to the physiotherapist in their area,” says Van Ravensberghe. “They think that the physiotherapist is there now, and will always be there. But the question is whether the physiotherapist will still be there in five years.”

To participate




Email the editor