Physical Therapy Korea

Since the mid 1990’s, developed countries in North America and Europe have advanced physical therapy into a highly specialized science [1]. Numerous studies have been conducted on evidence-based physical therapy, resulting in highly effective intervention methods with proven results. Most developed countries that joined the World Federation of Physical Therapists have also established a 4-year physical therapist education system or a specialized graduate school system based on their national standards. Additionally, they expanded their laws and systems according to the level of healthcare services required by their citizens, which in turn led to policies that ensured physical therapists’ right to autonomy and independence and enabled them to provide related care to people with physical disabilities in their own clinics. Among the top 20 countries regarding their economies, which are members of the Organization for Economic Cooperation and Development, five countries, including Japan and Korea, do not provide physical therapists with the autonomy and independence to deliver care at their own clinics [2].

As of 2023, countries such as France, Belgium, Luxembourg, the United States, Ireland, Iceland, and Canada have implemented professional graduate school systems to foster physical therapy personnel, while the Netherlands, Switzerland, Spain, Argentina, Brazil, and Australia have adopted a 4-year school system for physical therapy education [3]. In the Asia-Pacific region, New Zealand, Australia, India, Indonesia, Kuwait, and the Philippines have implemented a 4-year school system, whereas Taiwan and Saudi Arabia have adopted a 5-year school system; all of these countries in the Asia-Pacific region have the right to self-reliance [2,4]. In Korea, physical therapy was introduced by American missionaries in 1949 and has been practiced for over 70 years [5]. However, compared to developed countries in North America and Europe, there are not only issues in Korea regarding regulations and laws to ensure the right to independence and autonomy for physical therapists, but the social status and recognition of the profession are also lagging.

Not all diseases and pain-related problems can be managed using physical therapy alone. For example, if a client has complex or dangerous health conditions (e.g., cancer or fractures) or requires special attention because of psychosocial problems, they should be referred to a medical institution. In countries where autonomy and independence are guaranteed for physical therapists to deliver care, they can partner with doctors to evaluate patients and develop treatment plans tailored to their health conditions. These professionals can then monitor the treatment process together and provide appropriate physical and medical treatment for the patient, ensuring the provision of effective physical therapy while protecting the patient’s health and safety. Thus, as mentioned above, developed countries with legal guarantees of autonomy and independence for physical therapists have created conditions for the development of these partnerships in the healthcare sector and improved the convenience for healthcare service consumers. These processes have made physical therapy rooms and clinics accessible as pharmacies in these countries.

As the general population’s level of consciousness increases, the state’s responsibility to provide relevant social services increases as well. However, comprehensive home-based social service centers for nursing and childcare face scalability limitations because they have difficulty competing in the service market [6]. If these services do not meet consumers’ expectations, they lose competitiveness. Thus, to meet the rising expectations of the general population in Korea and reduce the burden on the aging society, it is crucial to advance physical therapy in the country through healthcare policies.

In order to provide the advanced physical therapy services demanded by developed nations, it is imperative to develop the advanced education system and foster the development of exceptional professionals. These professionals, who derive satisfaction from their occupation as physical therapists and continuously strive for professional development, will gain a competitive edge in delivering advanced services. This will contribute to enhancing public health in a super-aging society and alleviating the national burden. To accomplish this, it is crucial to identify the challenges faced by physical therapists in South Korea, who currently exhibit low license utilization rates. Furthermore, this research aims to elucidate the reasons why the field of physical therapy should progress to the level of developed countries, with a particular focus on the career aspirations of the younger generation and the pursuit of economic advancement.

According to a 2018 survey conducted by the Korea Institute for Health and Social Affairs on Health and Medical Personnel, most physical therapists in Korea work in clinics (47.1%), followed by hospitals (38.7%), and general hospitals (9.5%). Furthermore, in 2018, only 57.01% of the 60,000 licensed physical therapists were active in the profession [7]. As of 2022, there were approximately 80,000 licensed physical therapists, among whom approximately 40,000 did not utilize their licenses. This creates a significant form of workforce waste from the perspective of parents who invest in their education, universities that provide education, people who require physical therapy, and the country’s healthcare delivery system. Thus, the underutilization of the physical therapist workforce at the national level is a problem that needs to be addressed.

One of the main challenges faced by physical therapists in Korea is their exclusion from government negotiations even though these professionals experience high stress and poor working conditions because of the demanding nature of their work. According to a report by the Korea Institute for Health and Social Affairs, the primary factor contributing to the decline in occupational motivation among physical therapists are their low annual salaries. The average monthly wages of physical therapists were 87% of those of nurses and 21.3% of those of doctors surveyed in the same year [6], which makes it challenging for many physical therapists in South Korea to sustain their careers.

The second factor contributing to the reduction in occupational motivation among Korean physical therapists is the difficulty of taking vacations and leaves of absence. Adequate rest is necessary for professionals to perform their job duties stably and develop their job skills. Good health is defined as a state of physical, mental, social, and spiritual well-being [8]. Because physical therapists can also experience fatigue and illness, they require appropriate vacation time and leaves of absence for personal reasons. However, physical therapists working in small hospitals and clinics in Korea may find it difficult to take time off, because there are no substitutes. The Constitution of the Republic of Korea recognizes citizens’ rights to pursue happiness and protect their dignity and values as human beings. Thus, the Act on Medical Technicians must promote future-oriented healthcare policies and revise outdated laws to ensure that physical therapists are proud of their jobs and pursue happiness, while maintaining a healthy life and personal and economic stability.

The third factor contributing to the reduction in occupational motivation among Korean physical therapists is personnel issues, which involve fees for physical therapy services and promotion systems. Currently, the fee for physical therapy covered by health insurance systems is so low that it is difficult for medical institutions to achieve expected profits, which leads medical institutions to tightly control the number of personnel allocated to operating physical therapy rooms based on the number of patients and the rate of return. Furthermore, although physical therapists have excellent job skills and contribute positively to institutional development, their jobs require physically demanding tasks. Medical institutions in Korea feature a dual promotion system, meaning that employees are either rank-and-file employees or managers; therefore, they do not feature a promotion system with various positions, something that exists in companies from other sectors in Korea. Because of this dual promotion system, even if physical therapists have over 10 years of work experience, they may still have a senior manager with many more years of experience and are expected to perform the same job they performed when they first joined the company. This may lead to a lack of professional identity, which is another factor that lowers their motivation to work.

In Korea, the physical therapy care system has remained virtually unchanged for the past 70 years. The current bill for medical technicians is based on the outdated 1963 Medical Assistance Act, which denies autonomy and independence rights to those with successful careers and who have worked in medical institutions for over 30 years [9]. This entails the need to expand the laws and systems for physical therapists who have worked for over 20 years in medical institutions, enabling them to perform their duties independently based on appropriate qualification screening (e.g., graduate degree or higher or specialized physical therapist qualifications). Such actions may help prevent physical therapists who have been transferred to physical therapy care for older adults at risk of dementia and those with chronic degenerative diseases, which are becoming a serious public health problem in Korea owing to an aging society, from being neglected. By increasing the license utilization rate, physical therapy treatment, and volunteer services for older adults in medically underserved areas, such as rural areas, physical therapists can be deployed as an essential workforce in the right place. This will enable the development of both the welfare of older adults in Korea and the physical therapy services that they receive in the country.

The “Study on the Supply and Demand Prospect and Policy Direction of Physical Therapist Manpower in Korea” provides an estimate of 5,000 new licensed physical therapists per year from 2023 to 2030 in Korea, and the number of licensed physical therapists in the country by 2030 may exceed the demand in the healthcare market [10]. Although these estimates may change with an increase in the older adult population and government policy changes, there has been a focus on meeting the rehabilitation needs of the aging population by expanding the basis of rehabilitation services, providing high-quality physical therapy services, and efficiently utilizing physical therapists. Therefore, the development of welfare policies and improvements in social systems are necessary [11].

By 2025, Korea is expected to become a super-aged society. To reduce the financial burden of healthcare and welfare on the government, it is necessary to extend the time spent by older adults on independent activities and minimize their time spent using medical services. To achieve this goal and maximize the active life of older adults, a plan to efficiently use licensed physical therapists in the country should be prepared. This may include the operation of senior community health facilities in locations close to where older adults live and the expansion of home-visit physical therapy services.

To develop the authority and capability of physical therapists to perform their vocational duties, the current dichotomy of 3- and 4-year education systems must be unified into an advanced education system, and the curriculum must be standardized and become more similar to that of developed countries [12]. The demand for community-based physical therapy services, that is, services that can be conveniently used by older adults with reduced mobility and residents of rural areas with difficulty in accessing related services, will increase. Physical therapists with extensive clinical experience in delivering healthcare services for older adults and residents of rural areas need to have the right to autonomy, independence, and the authority to perform their jobs in their own clinics. Thus, Table 1 shows the current status of the autonomy and independence of physical therapists in advanced countries that have joined the Organization for Economic Cooperation and Development (World Physiotherapy, 2023). Korea, as a developed country with a super-aging population, should reduce waste at the national level by increasing the license utilization rate of physical therapists and the professional hope of the younger generation of physical therapists. Moreover, talented physical therapists are required to provide services tailored to the individual characteristics of older adults.

Table 1 . Current status of the autonomy and independence of physical therapists in developed countries that have joined the Organization for Economic Cooperation and Development (World Physiotherapy, 2023).

Country	Minimum qualification required to practice	Academic yeara	Number of program	Autonomy and independenceb
Netherlands	Bachelor	4	12	Yes
Norway	Bachelor	3	5	Yes
New Zealand	Bachelor	4	3	Yes
Denmark	Bachelor	3.5	10	Yes
Germany	Diploma	3	267	No
Luxembourg	Master	5	2	Yes
United Statesc	Professional doctorate	7 (4+3)	277	Yes
Belgium	Master	4	17	No
Sweden	Bachelor	3	8	Yes
Swiss	Bachelor	4	9	Yes
Iceland	Master	5	1	Yes
Ireland	Master	5	1	Yes
United Kingdom	Bachelor	3	105	Yes
Austria	Bachelor	3	9	No
Italy	Bachelor	3	42	Yes
Japan	Diploma	3	277	No
Canada	Master	6 (4+2)	15	Yes
France	Master	5	53	Yes
Finland	Bachelor	3.5	15	Yes
Australia	Bachelor	4	50	Yes

aSubstituted “equivalent fulltime years” into “academic years.” bSubstituted “act as first contact/autonomous practitioners” into “autonomy and independence.” cThe United States has an educational program of professional graduate school (3–4 years of university plus 3 years of professional graduate school, totalizing 6–7 years), which provides the title of Doctor of Physical Therapy (DP) and the autonomy and independence to work at own clinics; it also has an educational program of college (2 years, 5 semesters) for the title of Physical Therapy Assistant (PTA), which does not provide the professional with the autonomy and independence to deliver physical therapy services in own clinic..

Korea is expected to gradually become a developed country. As a nation’s status improves, the national population’s expectations of healthcare services also increase. Accordingly, the physical therapy education system and workforce must also be developed at the national level. To create healthcare policies that focus on the use of the physical therapy workforce in developed countries, it is necessary to unify educational systems and produce an excellent physical therapy workforce. Furthermore, physical therapy practices in Korea must be of the highest quality globally, and physical therapists must be able to deliver services with a quality similar to that of those in developed countries.

For future physical therapists in Korea to have career prospects, the occupational difficulties experienced by current physical therapists must be resolved. Development of professional autonomy can help professionals experience a sense of job satisfaction. This is because outstanding talents choose physical therapy as a profession if they see hope for their future as physical therapists. Furthermore, by ensuring that physical therapy services delivered in Korea are of similar quality to those delivered in developed countries, physical therapy in Korea will develop into a healthcare service that the general population desires. This will enable more people in this super-aging society to receive customized physical therapy services and improve their physical well-being, which may pave the way for a brighter future for Korea and its citizens.

The conclusions of this study are as follows:

1. The professional treatment experienced by physical therapists in South Korea, as observed earlier, does not reflect the treatment deserving of professionals. Such low professional treatment and conditions will continue to diminish the utilization rate of physical therapists’ licenses.

2. To achieve the autonomy that physical therapists in OECD advanced economies possess, the following issues need to be addressed promptly: the prompt unification of fragmented academic disciplines into an advanced 4-year degree program and the development of the healthcare industry’s vision and expectations through the production of excellent professionals in line with advanced countries.

3. South Korea will become a super-aged society after 2025. To conserve the National Health Insurance and elderly welfare budgets, it is crucial to rapidly advance the field of physical therapy in South Korea by implementing services that align with advanced countries.

4. To achieve this, discussions and shared understanding within a governance framework consisting of government officials, civic organizations, the medical field, and representatives from the physical therapy field are necessary. It also requires interdisciplinary decision-making and bipartisan efforts to establish a national healthcare system that can effectively care for our citizens in a manner befitting advanced countries, which involves revising outdated educational systems and legal frameworks.

None.

None to declare.

No potential conflicts of interest relevant to this article are reported.