Every year, in January and over the summer I am contacted by physiotherapists who have read this article which I wrote a very looooooooong time ago. 

So I thought it time to update this a little with the information that I generally add when I get the emails!

Estelle Mitchell, a UK-qualified physiotherapist with more than 26 *ahem, it’s more like 40 now! years’ experience, came to work in southern Spain almost by chance after working extensively in both the health service and the private sector in the UK.

“I’d had my own private practice on Jersey for ten years, and we were about to take six months off to research various European locations, with a view to working abroad. We came to Spain for a holiday and we never left.” Estelle who continues to run their successful practice, Bodyworks Health Clinic, near Marbella, say that despite the wonderful lifestyle, working as a physiotherapist in Spain has been difficult.

Attitudes to physiotherapists are very different in Spain from those in the UK, for example. They treat on a prescriptive basis, as recommended by a doctor or a surgeon, rather than on a diagnostic basis, and they’re usually poorly paid in comparison with the UK.

Let's update this a little - the biggest difference is that in the UK the CSP has fought tooth and nail to define and defend the profession of physiotherapist. The equivalent here in Spain, the Colegio, is just starting to do that now. 

And everyone in Spain is poorly paid in comparison to the UK! An average salary for a university graduate with experience is 1,000€ a month! That's 12,000€ a year. Before tax. It's getting better but . .  slowly.

They knew that there were plenty of potential clients among the English-speaking population in southern Spain and wanted to offer them a ‘gold standard’: the best facilities and specialists they could. “For me, working in the Spanish health system wasn’t an option,” says Estelle. “Apart from anything else, you need to speak really fluent Spanish to do that, but more importantly I didn’t want to work in that way. I wanted to offer the kind of services I’d been able to offer in the UK. I knew there was a need for it.”

Yes, we do work hard to offer a high standard of service to our English speaking patients. But I also couldn't work in the Spanish health system because it was back in the dark ages! 10 minute appointments? Groups of 6-10 patients per physio? No thank you!

Getting the clinic going took just over nine months. “We wanted to do everything properly and legally from the word go, but achieving that hasn’t been easy,” explains Estelle. “We were going to work from home but discovered that it’s impossible because your place of work has to be authorised by the Andalusian government ( Junta de Andalucia). So we began the process of licensing the premises we’re in now. First, it’s hugely important that you have a fluent Spanish speaker to help you contact the Junta de Andalucía; and second, it’s vital to have a Spanish lawyer who really knows what he’s doing. He or she must be a specialist in this kind of area. Once the premises are registered, any medical staff who work there must also be registered which means you cannot employ anyone on an occasional basis, such as visiting specialists or locums.”

Oh the frustration of not being able to work with everyone I wanted to because to offer treatment of any kind here in Spain you MUST be registered with the right Colegio. 

And once we'd been settled in our previous premises for many years . . . we thought, "hey, let's do it all again!" and moved to San Pedro. I'm a glutton for punishment! 

Despite all of the problems that she has experienced getting things done properly in Spain, Estelle’s overriding advice to other physiotherapists who want to work there is to do things the same way: “If you value your profession, jump through all the hoops, because then you can hold your head up both in Spain and in your home country. Anything less devalues the profession.” She strongly advises less experienced physiotherapists not to try to work here until they’ve had plenty of varied experience in their home country: “There isn’t the same kind of back-up network here, and it would be irresponsible and unprofessional, as you could be seriously compromising your patient’s health.”

Like other health professionals in Spain, Estelle says it has been a long hard road and only recently, several years down the line, is she finding that all the hard work is paying off: “I’m very busy and, although we used advertising in the early days, now I tend to have more word-of-mouth recommendations. I’ve managed to build up my own network of health professionals both here and in the UK who I can refer to and who support my services. We work longer hours and for less money here in Spain, but the quality of life and the enjoyment and satisfaction we get from our work is second to none. The only problem is that we haven’t had a holiday since we arrived in Spain!”

I can now report I have taken a holiday. Possibly 2 in the last 18 years. People travel a long way to see me and are often on a tight schedule. I do my best to respect that effort they have made. Fortunately I've built a fabulous team who can continue to support my patients if I do dare to leave the building!

Qualifications & Insurance

In terms of qualifications, physiotherapists in Spain are regulated under the EU’s General Directive system of validation, which means that the required paperwork is far more comprehensive than it is for doctors, nurses and midwives.

The Spanish Physiotherapy Association ( Asociación Española de Fisioterapeutas) automatically recognises qualified physiotherapists from other EU countries but, as the WCPT website states, “reserves the right to prove individual cases and requires aptitude tests and adaptation periods if necessary.” The Ministry of Health in Spain decides on the procedures for these tests and the adaptation period can be up to three months. You must register with the Spanish Physiotherapy Association and there’s information on its website (www.aefi.net), which is also available in English, although you may experience difficulties accessing the English version.

Actually what you have to do is submit ALL the documents from your physiotherapy degree to the Ministerio de Educacion so that they can review them and to ensure they comply with the degree requirements in Spain. THIS is a long process, up to a year. After that it's really quite simple!

UK qualified physiotherapists can obtain help and advice about working in Spain from the Overseas Recruitment office of the Chartered Society of Physiotherapy. The Society provides general information sheets about working in particular countries, including Spain, and information about professional liability insurance cover. They can also advise about how to stay abreast of developments in the profession while you’re abroad, and they offer a Return to Practice pack to support physiotherapists returning from abroad.

Estelle Mitchell says that getting her qualifications recognised and validated was an experience she wouldn’t want to repeat. It took nine months and she had to produce a copy of the original curriculum that she had studied and detail all her work experience. Everything had to be translated into Spanish by an official translator and her documents had to be notarised originals. “Now, thankfully, everything is fully recognised and validated by both the Ministry of Health ( Ministerio de Sanidad y Consumo) and with the local Spanish Physiotherapists’ Association ( Ilustre Colegio Profesional de Fisioterapeutas de Andalucia).”

Estelle is insured through her professional college in Spain and is a member of the Organisation for Chartered Physiotherapists in Private Practice (OCPPP, www.physiofirst.org.uk), which also insures her. However, to maintain her registration of OCPPP and the UK regulatory body, the Health Professions Council (HPC), Estelle must do a minimum of 25 hours of postgraduate work per year, all of which must be properly certified.

Except of course that the OCPPP no longer exists in that form! I am still a member of CSP though!

“There’s no easy facility for postgraduate education here, but I work hard to do all the work that’s required because it’s important to me that I keep up my registration and so can maintain my professional standing. One of the other conditions of my UK insurance is that my equipment is serviced regularly, but I’ve found that difficult too, so I’ve had to fly an expert over to ensure that the equipment is up to the required standard.”

A useful website for physiotherapists is the European region of the World Confederation for Physical Therapy (WCPT, www.physio-europe.org). This provides helpful information on migration to all European countries, including Spain, and lists requirements for applying to the competent authority, which in Spain is the Ministry of Health ( Ministerio de Sanidad y Consumo)A

Osteopaths & Chiropractors

Osteopaths and chiropractors who want to work in Spain find themselves in something of a grey area, as neither profession is officially recognised by the Spanish government.

Moreover, both osteopaths and chiropractors may find it difficult to become established, especially with Spanish patients, who are generally conservative about trying what they consider to be ‘alternative’ therapies. It may make sense to work in an area where there’s a large expatriate population, who are familiar with osteopathic and chiropractic treatments in their home countries.

HUGE developments in this area. The Colegio de Fisioterapeutas are really cracking down on what they call "intruismo", which is other professions doing the work that "should" be a physio. This has implications on every manual therapist - osteopaths, chiropractors, sports massage therapists . . . .they are being fined and possibly jailed if found guilty. There is also a huge piece of new legislation going through which might affect acupuncturists, osteopaths, chiropractors and a whole host of other practitioners who aren't strictly (conservatively?!) clincial.

Osteopaths

The General Osteopathic Council (GOC) in the UK is currently talking to a number of other European countries about recognition procedures, but Spain isn’t among them. The Spanish government has said that it will consider recognition, but is waiting to see which other countries approve it. However, although the profession isn’t officially recognised in Spain, it isn’t illegal and there are many osteopaths practising there, some of whom are listed on the GOC website (www.osteopathy.org.uk). If you want to practise as an osteopath in Spain, it’s worth contacting one or two of those listed, especially those practising in the area that you’re considering, although they may not all relish the prospect of your setting up in competition and either decline to offer advice or, worse, give you misleading information.

Here in Spain you become a physiotherapist and THEN go on to become an osteopath. Which means if you qualified elsewhere and didn't become a physiotherapist along that path you may not be legal to practice in Spain. To be a legal osteopath in Spain you need to be registered with the Colegio de Fisioterapeutas in your province. Many degrees from other countries are not recognised here in Spain.

Chiropractors

Most chiropractors working in Spain are foreigners, as it isn’t yet possible to study for a career as a chiropractor there and all the members of the Spanish Chiropractic Association ( Asociación Española de Quiropráctica, www.quiropractica-aeq.com), which is affiliated to 
the European Chiropractors’ Union (ECU), gained their degrees in foreign universities.

The General Chiropractic Council (GCC) in the UK doesn’t list members working abroad in the same way as the GOC, but you can find details of members of the ECU practising in Spain on its website (www.chiropractic-ecu.org). Try to make contact with one of them and ask his advice.

There is not currently a school for Chiropractic in Spain. Which means we go back to the same issue externally qualified osteopaths have - if the Colegio de Fisioterapeutas and Ministerio de Educacion doesn't recognise your degree and register you, you can't perform any clinical treatments. 

This also applies to sports massage therapists - they can't "treat" here in Spain. They can do massage but not the kind of clinical work they would be accustomed to in the UK. 

This results in highly qualified, experienced professionals having to work around the grey edges because only physiotherapists with a Colegio number are allowed to practice clinical work.

This article is an extract from Making a Living in Spain. Click here to get a copy now.

If, after all of that you still think you might want to work in Spain or you have a Colegio Number and are looking for work why not get in touch? We're actively recruiting English speaking physiotherapists and always welcome other health professionals.