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10.01.2006

The statutory minimum insurance does not include physiotherapy - but the importance of the physiotherapist in Australia is higher than in Germany

To person:

Tina Lohner, 30 years old, resident in Sydney, Australia

“I did my physiotherapy training in Koblenz from 1993-1995, with a subsequent year of recognition. I went to Australia in 1998. After it became clear that I would be staying for a while and got a work visa (originally for another job), I started collecting information that would enable me to work as a physiotherapist here in my job as well. Anyone who wants to become a physiotherapist in Australia must have a good to very good high school graduation grade in order to receive a place at university. After successfully studying for four years at the university, one receives the academic degree \ "Bachelor of Applied Science \". The course itself is very demanding and many drop out. On the other hand, many Australian physiotherapists are still studying, doing their masters or studying medicine. There are certain standards here that Australians want to maintain and they make it difficult for foreigners who have learned from a different training system. I will come back to the recognition procedure later.

The health system in Australia guarantees a minimum statutory insurance for every citizen. However, this does not include any physiotherapy measures. If the patient is not insured privately or in connection with a work or car accident, he or she is usually not entitled to physiotherapy after discharge from rehab. Those who live as close as possible to one of the larger hospitals can possibly receive six weeks of outpatient therapy there, otherwise one pays on a private basis. A referral from the doctor is not necessary.

Since I have not worked in a German hospital for a long time, I cannot compare the hospital systems. In practice, however, in Germany I am always fascinated by the fact how spoiled people are, when it comes to the number of therapies and what expectations they have of the therapist.

However, the status of the physiotherapist in Australia is higher than in Germany. Here, scientific, analytical skills are increasingly expected from physiotherapists. The physical therapist in Australia is also allowed to prescribe certain prescriptions and referrals (e.g. wheelchairs or orthotics) and does not depend on the consent of the doctor. Australian physical therapists don't do massages.

There are many opportunities to work as a physiotherapist, e.g. also for insurance companies in a multidisciplinary team as a \ "consultant \". The earnings are accordingly higher than in Germany. Payment is based on work experience. There are mandatory rates that increase every year. In the private practice, the payment is negotiable and usually better paid than in the hospital. I don't know the current entry-level rate, but with a few years of work experience, this rate can be around $ 1,000 per week. (1 euro = approx. 1.4 Canadian dollars).

Multidisciplinary teams work in the hospitals, i.e. the team in a rehab ward consists of physiotherapists, occupational therapists, social workers, speech therapists, doctors and dietitians. The case conferences take place every week and are always very detailed. All aspects of the various disciplines and all "goals" are discussed for each patient. Everything is meticulously documented. Every explanation that I give the patient, as well as all tests and new findings after each treatment, must be documented. Legal disputes against the hospital or the therapist because of therapeutic steps are frequent.

Every physiotherapeutic measure has to be "evidence-based", (almost) everything you do has to be proven with studies and everything is standardized. Many Australian physiotherapists are involved in research projects. No statements or treatment approaches may be used that cannot be statistically proven or substantiated.

The discharge phase, in which home visits are made, is extremely well organized to see how the patient is doing at home, whether he is safe or, if necessary, needs a ramp for the wheelchair or modifications in the house, etc. There is also assistance in finding accommodation for handicapped-accessible accommodation if the patient can no longer be released into his own house.

\ "Inservices \" take place every week. Everyone in the team has to take an active part and present and discuss a new study or a specific clinical picture every few weeks. Every few months, each of us gives a lengthy presentation on subject-specific topics.

In Australia great importance is attached to the \ "Occupational Health and safety \" (OHS) standards. These are important for a safe and healthy work environment. I have to commit myself not to do anything (e.g. lifting) that puts me or the patient at risk. In general, I think it's good that there are certain standards, but in many ways they are also quite exaggerated. Every hospital has OHS managers and a committee who come up with new rules. A good example is that I am not allowed to hang up a pin board in my office because I could contort myself and would be unable to work!

Once an "amputee" patient slipped while walking in the hallway because he was in a hurry to get to the toilet. I was not allowed to help him up, not even with the help of another person. So the poor guy had to sit on the floor until the "lifter" on the ward was free and we could lift him into the toilet chair. The \ "no-lift rules \" make sense, but in that case I would have loved to help him up so he could still make it to the toilet. The rules are also taken very seriously here and there would be many more examples.

\ "Quality Management \" is just as important. New projects are constantly being developed that improve quality, e.g. through the creation of quality plans. Each department works throughout the year on various projects to improve the quality of work and treatment. In addition, there are regular “performance reviews” (retrospective) for all employees and departments, and the “policies and procedures” of the hospitals are regularly checked and evaluated for performance and effectiveness. The \ "Australian Quality Improvement Program \" includes the constant evaluation of current statistics. The new quality programs are then standardized.

At the moment I am working more in a \ "consultant \" role as a physiotherapist for paraplegic patients. We work in a multidisciplinary team, with nurses, physical and occupational therapists, social workers and a medical rehabilitation specialist. We take on paraplegic patients who have just been discharged from rehabilitation and have to find their way back first. The first contact with the patient occurs shortly before discharge from rehabilitation. First, the main problems are crystallized out during the detailed, multidisciplinary diagnosis, e.g. finding one's way in the \ "community \", the social worker would be more responsible for this, the nurse for bladder problems and the physiotherapist for creating exercise programs or using the wheelchair.

As a physiotherapist, I do my findings in the patient's home, advise the patient, create a \ "home exercise program \", check whether he can cope with his wheelchair indoors and outdoors and do training sessions with the nursing staff who look after him takes care of and can perform the stretching program. I often take one or the other to the gym and create a program with them, trying to get them excited about wheelchair sports or hand cycling. Or I refer him to other physiotherapists for further therapy. We also give training in other rehabilitation hospitals and have to attend training courses and conferences on a regular basis.

The recognition process

It is best to contact ACOPRA (Australian Council of Physiotherapy Regulating Authorities) and AECOP (Australian Examination Committee for overseas Physiotherapists) for the latest information on the exam process. The procedure begins with a Medical English Test (written, spoken, listening). This is followed by the written or screening exam. This takes two days and is a multiple choice exam in all relevant subjects. The questions go into great detail. This exam can also be taken in Germany. As preparation material, I was given a long list of book recommendations, \ "Study Guides \", a date and of course the invoice (that was several hundred dollars per exam at that time). The failure rate on the first attempt is 50 - 60 percent! (according to AECOP). The screening test can be done twice a year, with a total of three attempts. Many things were asked about that I had not learned from my training (according to the old training system). For example the interpretation of X-rays and the analysis of blood values.

If that is done, it is recommended to do a clinical internship (placement) in one of the teaching hospitals, preferably one month in each of the respective areas. But you have to organize that yourself.

Last but not least, you can do a \ "clinical exam \", i.e. one hour at a time in front of three examiners on the patient, diagnosing, treating and re-diagnosing. The whole thing in three main areas: neurology, cardiovascular and musculoskeletal system.

After about four to six weeks you will receive the result in writing (as with the previous exams). Since the exam dates are only twice a year and the chance of failing is high, the whole thing can easily drag on for two years. With the certificate you can register as a practicing physiotherapist with the Physiotherapy Registration Board. The registration must be renewed every year and the application is submitted together with the evidence of advanced training. If you miss the annual application, there may be difficulties in re-enrolling.

The recognition procedure is independent of a work permit! If you want information on this, the best thing to do is to contact the Australian embassy in Germany.

If you want more information, it is best to go to the websites of the responsible organizations:

www.acopra.com.au/index_ht

www.acopra.com.au/eligibility (exam information)

www.physiotherapy.asn.au (Australian Physiotherapy Association)

The rules may have loosened a little by now, as many Australian physiotherapists go abroad. More physiotherapists are needed at the moment!

I hope my report gives a little insight into the "Australian world of physiotherapists."

Tina Lohner from Sydney / Australia

Editor's note: If you have any further questions or suggestions about working as a physiotherapist in Australia or in other countries, please contact the Education, Training and Further Education department at the ZVK. Get in touch with your membership number and your national association at [email protected]