Physiotherapy (Heilpraktikergesetz)
Since 2009 it has been possible nationwide to practice physiotherapy as an independent and definable medical profession with a subject-specific (sectoral) alternative practitioner license, without being referred by a doctor or (general) alternative practitioner. This currently only applies in the Federal Republic of Germany. Admission can take place according to the files, i.e. only by submitting the relevant evidence and qualifications, or by a written and / or oral examination. The approval is regulated by the health department, which is responsible for the respective place of residence.
history
The Heilpraktikergesetz only regulates the granting of a license to practice (comprehensive) medicine without having a license to practice medicine. Out of the desire to be able to practice psychotherapy not only as an auxiliary medical profession dependent on instructions, in addition to medical psychotherapists, qualified psychologists requested at the beginning of the 1980s, based on the Heilpraktikergesetz, to obtain an activity permit valid only for the field of psychotherapy (→ Psychotherapy (Heilpraktikergesetz) ) . Based on the idea that the Heilpraktikergesetz does not regulate such, but also does not prohibit such, the Federal Administrative Court finally created regulations in 1993 according to which anyone who has at least primary school education and the sectoral qualification can receive a sectoral alternative practitioner license in the field of psychotherapy. This made it possible to work independently without being referred by the doctor or alternative practitioner.
The obligation to use the professional title "Heilpraktiker" did not and does not exist for this job description. Since patients could also get false expectations about the activities (misleading), this designation is not to be used voluntarily.
In 2004, physiotherapists with the appropriate professional training and qualifications also coveted to be able to give up pure healing aid and treat independently. That, limited only to the field of physiotherapy and without the use of the professional title "Heilpraktiker". In doing so, they referred to the regulations in psychotherapy, in which people who had a correspondingly qualified previous education no longer had to take an examination and were given expressly limited permission according to the files.
After an initial rejection, they were found right before the Higher Administrative Court in Koblenz in the judgment of November 21, 2006 (6 A 1027/06). The granting of an objectively limited permit according to the Heilpraktikergesetz in the field of physiotherapy became possible at least in Rhineland-Palatinate. Because the title provision regulation "alternative practitioner" concentrates in its constitutional interpretation on the group of persons of alternative practitioners without special medical professional training, who, unlike the plaintiffs, can only be granted a comprehensive alternative practitioner license, this designation did not need to be used. “There is no objective reason to apply the professional title to the entire professional field of non-licensed medical practitioners without exception.” This can also be “indicated for reasons of traffic protection, if the person entitled only has a limited alternative practitioner license and this fact is in the professional title due to the lack of suitable additives, no corresponding precipitation can be found. "
A subject-specific review in the field of physiotherapy was dispensed with, because the authorization to use the professional title " Physiotherapist " requires appropriate training and state examination and thus minimum knowledge can be expected that excludes any risk to public health that could arise from the activity can.
Not all federal states wanted to follow this, so that ultimately the Federal Administrative Court had to decide. In the judgment of August 26, 2009 (- BVerwG 3 C 19.08) it was confirmed that such a sectoral alternative practitioner permit can be issued. The court made its considerations on the restricted permission in the field of psychotherapy from 1993 as generally valid for all possible future sectoral (objectively restricted) naturopath permits. Also with regard to the restriction of the obligation to use the professional title "alternative practitioner" only to persons with a comprehensive alternative practitioner license.
The Federal Constitutional Court reasoned that the job description of the physiotherapist, like other health professions, is geared towards medical treatment based on medical prescriptions. The training does not entitle to independent practice of medicine. But: on the other hand, the legal fixation of the professional profile does not stand in the way of independent practice of medicine with the means of physiotherapy if the requirements of the Heilpraktikergesetz (Heilpraktikergesetz) for the granting of a permit are met. In the case of trained physiotherapists, this permission could be restricted to their area. It is not justified to refer a physiotherapist to the acquisition of an unrestricted alternative practitioner license and thus to a comprehensive knowledge check if he only wants to work in the definable area of physiotherapy.
However, it insisted that physiotherapists licensed under the Physiotherapists Act also have to pass a restricted examination. There was no exemption from this only due to the physiotherapist training. It overturned the OVK Koblenz judgment in this area. However, this review may only refer to:
"The respective applicant must prove that he has sufficient knowledge of the delimitation of the medical activity as a physiotherapist compared to the medical treatments reserved for doctors and those generally active as alternative practitioners and that he has sufficient diagnostic skills with regard to the relevant clinical pictures. In addition, knowledge of professional and legal knowledge including the legal limits of non-medical practice of medicine must be proven. "
The practice of general medicine beyond the field of physiotherapy is forbidden under threat of punishment for persons who have this sectoral (limited) license. Possible disease relationships beyond the field of physiotherapy must be clarified by a doctor or (real) alternative practitioner.
Situation now
A whole range of physiotherapists make use of this opportunity to work independently (without a doctor's referral) in the physiotherapy profession as a health care professional. However, you cannot bill for these activities with statutory health insurance. This cash settlement also assumes that the treatment takes place on the basis of and only to the extent of a doctor's prescription. The health insurance approval for this field of activity as a health care professional is probably not canceled by the sectoral health practitioner license . The reimbursement of costs by private health insurances and the aid agencies are possible depending on the contract. Patients should ask.
The practice activity is still limited to the manual skills learned by physiotherapists. The exercise of the
- Osteopathy
- Chiropractic
- invasive interventions (acupuncture with needles and injections including blood sampling)
- drug treatments including the writing of prescriptions for this purpose
Job title
The job title is called "Sectoral alternative practitioner for physiotherapy" or "Alternative practitioner physiotherapy".
Situation in the federal states
The approvals are not carried out uniformly nationwide.
Officially, it is decided everywhere “according to the files” whether the permit is granted. In North Rhine-Westphalia, the rule has been in effect since the end of 2012 that a 60-hour special training must be completed. If this is carried out at a school recognized by the health department, which is based on the official so-called criteria catalog, and the final school-internal examination is passed, the application for permission for post-qualification can be submitted to the respective responsible health department. An official medical examination is not required.
The situation is similar in most federal states. The prerequisite is the officially recognized training. In Lower Saxony, most of the applicants are treated in a similar way to those in North Rhine-Westphalia, but this can vary from office to office. In NRW, the office in Düsseldorf is usually responsible, otherwise Dortmund. The Berlin health authorities have so far accepted this regulation without complications if the training is recognized. The Berlin candidates clarify this beforehand with their responsible offices.
Schleswig-Holstein has not been accommodating until now, an examination by the medical officer is usually required there, as is the case in Hamburg and Bremen. Saxony, Saxony-Anhalt, Thuringia and Mecklenburg / Western Pomerania are also relaxed like Berlin (no medical examination), in Thuringia, however, some applicants have to submit their applications to the regulatory office, as the new regulations for the sectoral HP are not yet uniformly known. There can still be delays and complications before permission is granted.
Hessen does not seem to have developed a uniform line, some get their permission after a short medical examination, others have great difficulties. The Düsseldorf training criteria are not accepted there. It has not been clarified in Saarland either, but no rigorous rejections are known. Baden-Württemberg always requires a medical examination, as does Bavaria. Here, however, the approvals have been granted by a few offices and the Düsseldorf criteria have been accepted. Most Bavarian offices are still very rigid in the treatment of candidates for the sectoral alternative practitioner physiotherapy.
Due to the individual implementation in the various federal states, one now speaks of "permit tourism", i.e. H. Some Bavarian, Hessian or Württemberg physiotherapists register their first place of residence for a period in a federal state of their choice, where it is more relaxed and achieve their qualification there. An alternative practitioner permit issued in Berlin or elsewhere is valid in any other federal state.
fees
A fee is charged by the health department for admission to the "Sectoral Alternative Practitioner in Physiotherapy". The amount of the fees can be set by the offices at will up to a maximum of 800 euros. The fees currently fluctuate between 150 euros and 660 euros, depending on the health department and federal state.
formalities
To apply for admission you have to submit a large number of documents (certified):
- Professional certificate physiotherapist
- Proof of at least 4 years of professional activity
- resume
- police clearance certificate
- Birth certificate
- medical certificate
- Proof of residence
- a health certificate
- various declarations and assurances regarding the practice of medicine
The list of documents to be submitted may vary slightly within the health authorities.
Web links
- Judgment of the Federal Administrative Court 3 C 19.08 of August 26, 2009
- Report in Dtsch Arztebl 2009 (106 (50): A-2527 / B-2179 / C-2111)
Individual evidence
- ↑ Differentiation from the unrestricted alternative practitioner permit ( memento of the original from January 8, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
