The recent Physio Update article about physiotherapists being invited to apply for a new four-year “Healthcare Entry Medicine MBBS” at King’s College London raises a fundamental question: Is this really where we want our profession to go? While the programme promises to help healthcare professionals “take the next step in their medical careers,” we need to ask ourselves whether we’re advancing physiotherapy or abandoning what makes it unique.
The “Next Step” Assumption
The King’s College programme positions medical training as the “next step” for healthcare professionals who are “already making a difference in patient care.” But this framing reveals a troubling assumption: that our current roles are somehow incomplete or insufficient.
This connects to a broader identity crisis where our profession seems increasingly drawn to medical procedures and technology as markers of advancement, rather than celebrating what makes us uniquely valuable. Are we trying to become cheap doctors, or are we confident in the unique value of expert physiotherapy?
A Profession at a Crossroads
This identity crisis isn’t going unnoticed by other thoughtful voices in our profession. Sue Julians recently articulated this divide perfectly, observing that physiotherapy faces a choice between algorithm-thinking practitioners who “speak rather than listen” and dispense “generic information,” versus those who learn from experience, adapt to individual patients, and understand that “execution should be different because everyone is different.”
Julians warns that the algorithmic approach—with its biomedical mindset, flow charts, and rigid programmes—risks being “replaced by AI within 5 to 10 years.” In contrast, she advocates for embracing “our traditional skills whilst updating our knowledge to make these truly personalised and robust,” offering what AI cannot: “Hands on. Supervised adaptable rehab. Health coaching to the individual need.”
This concern has reached the CSP’s own publications. Sara Conroy and Tamsin Baird recently wrote in Frontline that as physiotherapy expands into prescribing, injections, and investigations, “we, as a profession, [are] moving in two different directions.” They identify one path broadening scope into roles that “may distance us from our core strengths of exercise and rehab,” while private practice maintains focus on “hands-on treatment and targeted rehab.”
Their fundamental question mirrors our own: “Will we keep our profession whole, or let it split into two divergent paths?”
The “Old School Physio” Fallacy
This splitting is perfectly captured in recent social media posts—ironically from a private practitioner—claiming “The Days of ‘Old School Physio’ Are Over” and dismissing traditional physiotherapy skills in favour of ultrasound scanning, blood tests, and injectable treatments.
What’s being dismissed as “old school”:
- Expert movement analysis and clinical reasoning
- Comprehensive manual therapy and joint mobilisation
- Evidence-based exercise prescription and progression
- Patient education and behavioural change strategies
- Skilled communication and therapeutic relationships
What’s being promoted as “gold standard”:
- Ultrasound scanning for “precise diagnosis”
- Blood testing and medication prescribing
- Injection therapies and medical procedures
- Force plates and data-driven exercise over clinical judgement
This trend risks suggesting that traditional physiotherapy skills aren’t enough. But here’s the question: If patients need ultrasound scanning, blood tests, and injections, shouldn’t they see doctors who are properly trained in these areas? And more importantly, do we ALL need these skills to be valuable practitioners? Apparently, knowing how to help someone move better is now considered out of touch—who knew?
While there’s certainly a place for physiotherapists who choose to develop these additional competencies, the danger lies in implying that excellence requires them. Why are we suggesting that every physiotherapist must acquire medical procedures to be considered high-value, instead of celebrating the profound impact of therapeutic relationships, skilled movement therapy, manual treatment, and rehabilitation expertise?
What Physiotherapy Actually Offers
There’s nothing “plain” about quality physiotherapy. Our profession brings unique strengths across the full spectrum of healthcare:
- Movement and exercise expertise spanning musculoskeletal, neurological, respiratory, cardiac, pelvic health, women’s health, paediatrics, mental health, and elderly care
- Therapeutic relationships that enable lasting behavioural change
- Holistic assessment of function across multiple body systems
- Manual therapy skills developed through extensive training
- Patient education that empowers self-management
- Cross-setting expertise – from intensive care to elite sport, community clinics to specialist centres, and domiciliary care meeting patients where they are
As I responded to one “old school” post: “Modern physio is about integration—using tools where appropriate, also recognising the power of education, behaviour change, and functional rehab. What matters most is not how many devices are used, but whether care is effective, ethical, and meets the needs of the person in front of us.”
Another colleague Helen Preston noted: “It takes a high level of skill to consistently deliver meaningful care without relying on technology… I do not see physiotherapy having to brand itself as high value only if it uses the next gadget in the market.”
And as I commented: “People are not one tissue, one structure, or one data point. They are whole stories—and the goals they set often tell me more than any scan or machine can.”
Technology should support, not replace, clinical reasoning. Comprehensive assessment, clear communication, and outcomes that matter to patients aren’t “old school”—they’re the hallmarks of excellence.
The Reality of Professional Roles
This isn’t about undermining advanced clinical roles—we should celebrate colleagues who’ve developed these specialised pathways. The crucial difference is:
Advanced/Consultant Physiotherapists: Remain fundamentally physiotherapists with enhanced skills, serving complex cases requiring additional expertise.
Medical-Model Roles: Risk transforming physiotherapists into diagnosticians, prescribers, or gatekeepers—roles that may dilute our professional identity.
The reality: While advanced roles serve important functions, the vast majority of patients don’t need interventional procedures—they need skilled, personalised physiotherapy delivered with adequate time and in a timely manner.
Are we creating a false hierarchy where only medicalised roles are seen as advancement, while physiotherapists doing essential work with the majority of patients are somehow inferior?
The Evidence from Practice
The FCP experience offers important lessons. While FCPs have fulfilled their intended brief—saving the NHS money because physiotherapists are cheaper than doctors and order fewer scans and medications—the evidence shows quality of life measures show no improvement following FCP consultations. FCPs have achieved their cost-saving purpose, but outcomes are no better for patients. FCP is a role, not physiotherapy—it’s healthcare triage that happens to be delivered by people with physiotherapy training, but it doesn’t utilise physiotherapy skills to improve patient outcomes.
Private practice demonstrates the alternative. Our sector shows that when physiotherapists are confident in their professional identity, patients value comprehensive care and excellent outcomes follow. We already have significant clinical autonomy and deliver outstanding results with it. The irony is that FCPs have actually increased demand for private physiotherapy—patients seek real treatment after assessment-only services fail to help them.
What True Advancement Looks Like
Instead of four-year programmes to become doctors, shouldn’t we be advocating for:
- Recognition of physiotherapy expertise in movement and function across all specialities
- Adequate funding for comprehensive physiotherapy services
- Time and resources to deliver quality care
- Celebration of our existing professional autonomy and the outcomes it delivers
- Public understanding of physiotherapy’s unique value
The Choice Before Us
Do we want to be doctors, or do we want to be excellent physiotherapists? The question isn’t whether physiotherapists can train as doctors—it’s whether we should want to.
What message does it send if we need medical training to be taken seriously? Are we solving the right problem—lack of physiotherapy capacity versus lack of medical roles? Are we creating a profession where only medicalised roles are valued while dismissing those who serve the majority of patients who need skilled rehabilitation, not medical procedures?
The danger isn’t just that medical-model approaches often don’t work effectively—it’s that they risk transforming physiotherapy into something it was never meant to be. We have a unique and valuable profession that patients need and want when they can access it properly.
Maybe the answer isn’t becoming doctors—maybe it’s having the confidence to be excellent physiotherapists who deliver the comprehensive, person-centred care that creates real change in people’s lives.
What are your thoughts? Should we be fighting for better recognition and resources for physiotherapy, rather than trying to become something else entirely?
[Read the full Physio Update article about the King’s College Healthcare Entry Medicine MBBS programme here: [Read]
References
- Goodwin R, Moffatt F, Hendrick P, Stynes S, Bishop A, Logan P. Evaluation of the First Contact Physiotherapy (FCP) model of primary care: a qualitative insight. Physiotherapy. 2021 Dec;113:209-216. doi: 10.1016/j.physio.2021.08.003. PMID: 34583834.
- Stynes S, Jordan KP, Hill JC, Wynne-Jones G, Cottrell E, Foster NE, Goodwin R, Bishop A. Evaluation of the First Contact Physiotherapy (FCP) model of primary care: patient characteristics and outcomes. Physiotherapy. 2021 Dec;113:199-208. doi: 10.1016/j.physio.2021.08.002. PMID: 34656297.
- Wood L, Bishop A, Goodwin R, Stynes S. Patient satisfaction with the first contact physiotherapy service: Results from the national evaluation survey. Musculoskeletal Care. 2022 Jun;20(2):363-370. doi: 10.1002/msc.1599. PMID: 34709711.
- Budtz CR, Rønn-Smidt H, Thomsen JNL, Hansen RP, Christiansen DH. Primary care physiotherapists ability to make correct management decisions – is there room for improvement? A mixed method study. BMC Fam Pract. 2021 Oct 6;22(1):196. doi: 10.1186/s12875-021-01546-1. PMID: 34615482.
- NHS England. NHS Long Term Plan. 2019. Available from: https://www.longtermplan.nhs.uk/ [Accessed December 2024].
- Conroy S, Baird T. Physiotherapy at a crossroads. CSP Frontline. Available from:
https://www.csp.org.uk/frontline/article/physiotherapy-crossroads [Accessed December 2024].
Disclaimer: This is an opinion piece reflecting on current trends in physiotherapy practice and professional development. The views expressed are those of the author and do not necessarily represent the official position of Physio First. The discussion is intended to stimulate debate about the future direction of our profession, and diverse perspectives are welcomed and encouraged. Comments and discussion are invited from all members of the physiotherapy community.
We welcome discussion and different viewpoints on these important professional issues. Please share your thoughts and experiences.
