Wake up coming.

How I imagine the powers that be at Physio HQ meet...

There have been a couple of news stories over the past 6 months that I hope have the decision makers at Australian Physio HQ (that's a thing.  I'm sure it's a thing...  well it should be a thing...) have been paying attention to.  

Firstly, quite a few months ago the Government in Australia chose to stop subsidising private health insurance rebates for a whole series of alternative treatments that - upon careful examination of all published literature - did not show any GOOD evidence of efficacy.  For a great synopsis, go here and then poke around the website and read about all sorts of interesting articles (I love that website... and yes, raw water is a health craze).

This means that as of next year, you will no longer be able to claim a subsidy for all sorts of weird and wonderful treatments.  Surprisingly, yoga and Pilates have both been included in the list of treatments no longer subsidised for the same reason: there is no credible evidence of these interventions working.  It is sad that two plausible treatment options are not to be subsidised, as opposed to some of the ludicrosities (my new favourite portmanteau I just made up - a ludicrous atrocity) such as homeopathy, iridology and faith healing...  I mean reiki...  but currently, there is no evidence of benefit for pilates and yoga as well.

So that was the first piece of news that should have "Physio HQ" shaking in it's boots. 

The second article came out in the Weekend Australian (we subscribed for a free Google Home...  I swear...) "Debatable ops Boost Premiums" (I can't link to it because it's behind a paywall...  thanks Rupert.)  Go to Twitter and follow the journos @Sarah-JaneTasker and @SeanParnell and you will get a good idea of the types of stories they're running about waste in healthcare and how the Government and health insurers are trying to rein in spending on unnecessary treatments/procedures, as well as on treatments that don't work.

The story in a nutshell is that big insurers have flagged at least $700m worth of procedures PER YEAR that either don't work, or are no better than less invasive options for the conditions reviewed.  It didn't mention that surgery also has a great deal of risk to the person being treated related to it as well (one example of a risk of surgery would be death... imagine losing a loved one to a surgery that they didn't need...), which warrants a whole other investigation.

So we have two of the key contributors to the funding of the healthcare industry - insurance companies and the Government - in Australia starting to pay attention to which treatment works, and which doesn't.  If they were to look at physiotherapy, how would we stand up?  

Ultrasound and acupuncture are considered by many practicing physios to be cornerstones of their treatment.  And yet, acupuncture works just as well if you put the needles in a rubber arm as they do when inserted into the person's actual arm, and there is no discernible difference in outcomes of ultrasound, whether the machine is plugged in or not.  Seriously.  Follow the links I've added to the above sentence.  There have been question marks over both of these options literally for decades (I started my undergrad course in '98 and ultrasound was openly questioned by my lecturers and tutors then), and yet we STILL make physio students (remember, physio is a SCIENCE degree) learn all about how to apply ultrasound to clients, and there is a whole special interest group in the Australian Physiotherapy Association dedicated just to acupuncture.

Are the powers that be frightened???

So are the powers that be at the (mythical) Physiotherapy HQ shaking in their boots?  Is there any movement towards redefining the scope of practice of a physio to exclude stuff that doesn't work?  Are we making any changes?  Clearly this change won't be driven by ethical considerations such as providing your paying customers with effective treatments, but perhaps if the threat of losing Government-subsidised private healthcare rebates were hanging over our heads, there would be a drive to either prove that these implausible treatment options work, or exclude them from what it means to practice physiotherapy.

Somebody step up please!!