These days more and more people are needing physiotherapy but there is a serious lack of trained professionals employed by the health service in Malaga, says the president of the College of Physiotherapists of Andalucía, Juan Manuel Nieblas, in this interview. He says at least 400 are needed, twice the present number, because some patients are having to wait an unacceptably long time for their treatment. Nieblas has just been appointed president of the Professional Health Union of Malaga (Uprosama) with a two-year mandate. Uprosama has members from 11 different professional colleges in the health field.
What questions have arisen and achievements have there been since 23 September 2017, when you became president of the College of Physiotherapists?
We have reduced the fees that the members pay every three months, and we have maintained all the services we provide. We have also improved relations with the Andalusian Health Service, as they had deteriorated. As a result of that we have achieved 69 new physiotherapy posts at health centres, and another 200 are going to be appointed in February under the OPE employment scheme.
How many physiotherapists are there in Andalucía at the moment?
The College has 7,400 fee-paying members, of whom 1,450 are in Malaga province.
How many more do you believe the health service in Malaga needs?
In total we calculate that there ought to be at least 400, double the present number.
Where are they lacking the most, in health centres or hospitals?
That's a good question. Our Achilles heel, and that of the Andalusian health service, is in health centres. We are not exactly in the Champions League of European health services because our medical centres lack resources. I'm sorry to have to say this but it is a disaster. We don't have enough resources, we don't have enough professional staff, it isn't clear how they can work in the health service, many medical centres are being asked to provide services which should be the responsibility of hospitals...if the work done in health centres isn't good enough, it overloads the system in the hospitals.
Is that a problem in all the provinces of Andalucía?
It happens in all of them, but unfortunately the situation has become unsustainable in Malaga and Granada.
Has the Junta de Andalucía said it will increase the number of physiotherapists?
We're working on that. We'll have to see what happens now that there is a new regional government. Marina Álvarez, who was the Junta's Minister for Health until recently, introduced a very ambitious plan for health centres. In our case, there is a signed agreement which the new government cannot ignore, but we don't know what will happen with things which were still up in the air. The Junta had said it was committed to reviewing the number of physiotherapists in the health service every year, and gradually increasing them.
What is the situation regarding physiotherapy in the private sector in Andalucía?
Many physios are working in the private sector because there are so few jobs available in the health service. When your mother has had a stroke and you're told she will have to wait a couple of months for physiotherapy under the health service, you'll normally look for a private physiotherapist straight away. The problem we have in the private sector is that the insurance companies are an oligopoly, which means they can set the prices and pay poorly: they only pay five euros per physiotherapy session, in some cases.
How long are the waiting lists for physiotherapy at health centres and in hospitals?
For chronic pain, which is the most common, it can take up to a year for a patient to see a physio for the first time. In the case of neurological patients the wait is shorter, about three months, but that is still ridiculous. In the civilised world, we are always told that patients who have had a stroke need immediate rehabilitation to prevent further problems occurring.
What other targets have you set for the rest of your mandate as president of the College of Physiotherapists of Andalucía?
As well as continuing to push for more posts for physios in the public health service, and getting the insurance companies to pay more, we want to reduce the number of university places for physiotherapy. The market has reached a level of maturity where 400 new physiotherapists qualify in universities in Andalucía every year. That rate is unsustainable, because it means that in this region they will find it difficult to get a job for four to five years.
How many students who decide on physiotherapy as a career find work at the moment?
Technically, at the moment we have full employment in the sector, with under five per cent out of work.
Your college is working hard to control professional encroachment and you began a campaign a few months ago to tackle the problem. How is that going?
That publicity campaign, which we did with Canal Sur, was very successful. We called it 'Do you believe it?' because it was designed as a sort of parody. We started off with adverts for courses on how to fly an aircraft, and how to carry out organ transplants, and ended them with "Do you believe it"? As if you could believe that somebody could be a professional masseur or physiotherapist after doing a six-month course. The biggest fraud is that they lie to young people and make them believe that if they pay 2,000 euros for this short course, they will then be fully trained.
Professional encroachment of this type, as well as being a type of fraud, also puts patients at risk and that is even more serious.
We know about a case of a masseur who did a course at an academy, manipulated a young patient, caused him to have a stroke and left him permanently affected.
If there are any doubts about the qualifications of someone who claims to be a professional, what should people do?
The quickest and best way, when planning to consult a physiotherapist, is go to the Colegio de Fisioterapeutas de Andalucía website, put in the person's name and see whether they are registered with us or not. It's that simple.