Physiotherapist: ‘Almost no profession with a technical higher professional education is so poorly rewarded’

Even after 10 hours, physiotherapist Urs Keizer lays his hand gently, is focused, empathetic and sensitive. Leo* is the 14th patient on this long working day in mid-September. The teenager has an inflamed bursa in his left knee. The stop-and-go movements in floorball have bothered him for a long time. Keizer treated the 13-year-old’s damaged joint with a shock wave device and recommended tape to stabilize it. He doesn’t rub it in his young patient’s face that this kind of pain can occur in growing teenagers. That is unnecessary and burdensome.

But first things first. Urs Keizer enters his practice in Sarnen OW at 6:30 am and runs it together with a partner. But how does a physiotherapist work? What does his daily work life look like? The reason for Watson’s visit is the planned rate adjustment for physiotherapists by the Federal Council.

The Federal Council states that the sector causes too high costs and is therefore complicit in rising health insurance premiums. Moreover, collective labor agreement negotiations between the Physioswiss association and the health insurers have been at a standstill for years. This has now prompted the Federal Council to intervene with a so-called determination procedure.

There is great anger and concern among physiotherapists about this. The sector already feels underfunded. “No other healthcare profession is so poorly paid.” In addition to Urs Keizer, Mirjam Stauffer, chairman of the umbrella organization Physioswiss, also shares this opinion. If the rate adjustment is implemented, even more physiotherapists will be forced to change careers or give up their practice for financial reasons.

After a short preparation, Keizer welcomes his first patient at 7 a.m. Stefan*, 47 years old and in top shape, had an accident at work. The roofer injured his shoulder while lifting a steel beam. Physiotherapist Keizer tries to improve his muscle control and orders exercises that Stefan can do at home. The next patient arrives at 7:30 am, a 54-year-old man who barely survived a tumor in his bone marrow. The disease caused fractures. Within six months the man lost 14 centimeters in height.

This happens in quick succession. By 12 noon Keizer will have treated nine patients. A young landscaper suffered a torn cruciate ligament and the wife of a former farmer suffered from ankylosing spondylitis. A man tore his Achilles tendon while exercising, a pensioner who uses crutches has problems with his ankle, which is why the woman is currently traveling with the dog and the four-legged friend is also in poor health. Hopefully “the whole family will be fit again soon,” says the 81-year-old and says a friendly goodbye. Keizer only has one half hour free this morning. In most cases he uses it for administrative tasks.

Urs Keizer has been working as a physiotherapist for 30 years. He and his business partner employ seven other physiotherapists in his practice. In addition to his professional activities, the 55-year-old is chairman of the cantonal association Physioswiss Central Switzerland. He is particularly bothered by a statement by Pius Zängerle, director of health insurer Curafutura. Zängerle accuses the industry of exhausting medically prescribed physiotherapy sessions, even though therapy is no longer necessary.

Keizer refers to the case of the roofer who injured his shoulder. Nine meetings were organized there. He estimates that four to five will be enough and then he will close the business. “In our industry, unnecessary treatments are rarely carried out systematically.” Keizer mentions the sometimes enormous waiting list in his practice. There would be 50 to 60 people waiting for an appointment. There is no point in unnecessarily prolonging therapy.

Physiotherapy accounts for 3.6 percent of total healthcare costs. A marginal share. However, these costs are constantly rising, this year by about ten percent. Keizer confirms that many more physiotherapy treatments are being performed. However, this increase in volume is easy to explain. He summarizes: “There are more elderly people, the principle of outpatient before admission applies, patients return home much sooner after operations and in these cases physiotherapy provides follow-up treatment.”

In addition, many more palliative treatments are performed nowadays. And physiotherapy sometimes replaces entire operations – for example in the case of a ligament injury. Which in turn saves costs.

“We act in the interests of the health insurers, but they do not notice this because they only take the direct case costs into account. But not the costs saved by efficient physiotherapy throughout the healthcare system.” It is “presumptuous” that physiotherapy is partly responsible for rising healthcare premiums.

Back to practice in Sarnen. A woman feels the consequences of back surgery. Eight screws were placed and now the sciatic nerve is causing problems. Urs Keizer continuously adapts his language, depending on the patient and the clinical picture. Terms such as infiltration, osmosis, plasmacytoma and sensorimotor cortex are used. To make it more understandable, the physiotherapist sometimes describes the action of a muscle as ‘sandwich-like’.

After a short lunch break, Urs Keizer cycles five minutes away to a retirement and nursing home. He works there one afternoon a week.

The first patient is already waiting in the entrance area. Peter* was a construction worker. But shortly before he was sixty, he suffered a brain hemorrhage. Since then, the left side of his body has been paralyzed. Peter is an IV retiree. A nursing case. Living at home is no longer possible. Keizer mobilizes the paralyzed limbs and performs walking exercises together with Peter. They work together to coordinate this.

Forty-five minutes later, Mrs. Huber* talks from her wheelchair about her fall in the apartment. She lay injured for days until she was discovered. Now Keizer will work with her to ensure that she can at least walk again with the walker. The next patient, Mrs. Stalder*, is over 80, looks fit from the outside, but has had breathing problems for years and receives oxygen through a tube. In addition to various other conditions, she suffers from the lung disease COPD.

Respiratory therapy was prescribed, but that is of no use. Mrs. Stalder, who has severe dementia, forgets after a minute who Keizer is and why he is in her room. When he assigns an exercise, the older woman immediately panics. She just wants to take a walk in the fresh air and the nursing staff can guide her. That is not his job, says the physiotherapist. He will therefore cancel the prescribed therapy. This example also shows that physiotherapy does not entail unnecessary costs.

A short break. Urs Keizer sits on a lounge chair in the treatment room under bright neon lights and talks about money. A young professional can expect to pay 5,400 francs per month in a hospital after completing a four-year university degree. In private practice it is a few hundred francs more after a few years of professional experience. However, these differences would be compensated because cantonal physiotherapists benefit from wages that increase with age. As is the case with the teaching staff.

There are of course regional differences. The tax point is higher in Zug or Zurich. His wages are not competitive in the canton of Obwalden. Also because more and more administrative tasks are being added. The existing rate does not compensate for these additional costs.

Investments in equipment and materials, for example, are hardly possible, says physiotherapist Keizer. “When we had to temporarily close the practice during the Covid pandemic, we were immediately in the red.” In hospitals, physiotherapy is generally inadequate in many cases. This minimum is subsidized with tax money for hospital care. A process that is not possible in a private practice.

Physiotherapists cannot understand the Federal Council’s determination procedure because the tax points have not increased since 1998. The tax points determine how much can be charged for a treatment. There has never been an adjustment for inflation.

Service providers (physiotherapy) and payers (health insurers) are legally obliged to conduct collective labor agreement negotiations. According to Keizer, health insurers were never prepared to make concessions; only one rate item for complex treatments was slightly expanded in terms of content. However, this is only because there are increasingly complex diseases. “In real, everyday situations, a physiotherapist has been earning the same amount for over twenty years,” says Keizer, bewildered. “Almost no profession with a technical college education is so poorly rewarded.”

And what about the offspring? Urs Keizer knows the numbers here too. There is a need for approximately 800 new physiotherapists in Switzerland every year. However, only about 350 people are trained, causing the industry to resort abroad. In addition, approximately one-third of trained physiotherapists in private practice leave the profession each year.

It is becoming increasingly difficult to recruit staff. Especially for practices on the periphery. Physiotherapists from Germany and the Netherlands had previously contacted us. Nowadays, requests also come from Morocco, Israel and Russia. You can only find local physiotherapists through personal contacts, says Keizer. These are people from the area who, for example, no longer want to commute. “They accept lower wages in return.”

The bicycle is parked, Keizer is back in his practice, it is just before 5 p.m. The physiotherapist has already treated thirteen patients. The boy with the damaged knee mentioned at the beginning is sitting in the waiting area. To be on the safe side, the boy will skip floorball training tonight. There are two more treatments until half past seven, after which Urs Keizer takes care of administrative matters that there was not enough time for during the day. Today this lasts until well after 7 p.m.

Due to his age, Keizer is in the last quarter of his professional career. Is the 55-year-old more relaxed about the upcoming rate adjustment or is he even more concerned about the younger generations? No one has ever asked him this question, Keizer answers, visibly moved. “When I heard the plan of the covenant and became aware of its implications, I thought: the God of Jesse. If you really follow through with this, I’m glad I won’t have to do this much longer.”

He is generally very resilient when it comes to such matters. This time he didn’t feel well for a few days. He always strives to ensure that “the young people have perspective,” says Keizer. “But if the rate adjustment comes, I don’t know whether the profession will still exist in ten years.”