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Parlez vous francais?

France may lie just across the channel, but new registration requirements mean physios seeking work there can face tortuous journeys.  Robert Millett reports

Sian Lewis lives in Courchevel, a beautiful ski resort in the French Alps, where she is the managing director of a chain of physiotherapy clinics.

She has lived and worked in France since 1995. After establishing her company, Ski Physio, in Courchevel, she now runs clinics in other French ski resorts – Méribel, Val d’Isère, Tignes, and La Plagne.

The close proximity of France has made it a popular destination for UK physiotherapists seeking summer jobs, or ones in winter that also offer skiing opportunities.

Already this year, Ms Lewis has received more than 80 applications from physios who are interested in working for her company during the 2012 to 2013 ski season.

But she believes that new registration requirements are now making it harder for ‘holiday season’ physios to work legally in France.

‘When I first came here it was pretty straightforward. A physio degree more than qualified me to register and work in France,’ says Ms Lewis.

‘But since the professional body was set up a few years ago it has become much harder. There is now an extra stage to go through to be registered, which involves a language test.’

The Ordre des Masseurs-Kinésithérapeutes, which acts as the French equivalent of the Health Care Professions Council, expects international applicants to prove a good level of French prior to registration.

However, they have recently increased the language level requirement of the Test de connaissance du français (TCF).

The TCF is a language test awarded by the French ministry of education and physiotherapists are now required to obtain TCF level B2.

This involves taking a one-and-a-half hour examination and demonstrating ‘advanced elementary’ skills of listening comprehension, use of language structures and reading comprehension.

Communication problems emerging

In addition to the new language requirements, CSP international adviser Birgit Mueller-Winkler says many members have reported increasing difficulties in their dealings with the Ordre des Masseurs-Kinésithérapeutes.

Communication with the regulator has proved frustrating for many physiotherapists, as they have not received responses to emails, and applications have been rejected on unclear grounds.

According to the regulator, some applications have been turned down because the submitted applications were not considered to be complete,’ says Mrs Mueller-Winkler.

‘As a result some CSP members are considering lodging complaints about the handling of their applications, by using the European SOLVIT tool.’

Mrs Mueller-Winkler explains that SOLVIT is an online problem-solving network that operates in all European Union (EU) member states.

It handles legal proceedings and cross-border problems that arise from bad application of EU law by public authorities in member states.

Ms Lewis believes changes in the French registration requirements may mean that many international physiotherapists who come to France could end up working illegally – and some of them might not even realise that this is the case.

‘I just want to warn people that it is really hard to be legal here in France - you cannot just turn up and do physio or massage for a season,’ says Ms Lewis.

‘If you are doing physiotherapy you have to be registered as a physiotherapist. Otherwise you are illegal as far as the French authorities and the legal system are concerned.’

Ms Lewis adds that even if physios work under the auspices of an insured British tour operator they will still not be considered to be working legally. This can only be achieved by registering as a physio with the official bodies.

The fine for not being registered can amount to €30,000 (around £24,000) and prosecution can lead to a two-year prison sentence.

Practice can be restricted

Aside from gaining full registration and the required legal status, Mrs Mueller-Winkler warns physios to be aware that various restrictions apply to physiotherapists in France.

From a clinical point of view there are many things physiotherapists are not permitted to do in France, including manipulation and acupuncture.

‘As a physio you can do massage but you are not insured by the CSP unless you are registered as a physio,’ says Ms Lewis.

‘Only registered physiotherapists are allowed to use the word “massage”, and you are only allowed to offer a well-being, beautician-style massage – no sports, deep tissue or therapeutic massage.’

Additionally, from a financial perspective, the pay for physiotherapists who are required to work within the French social security system can prove relatively low.

Advertising is also very restricted, with limitations on the claims that can be included on promotional documentation or on websites.

‘Physiotherapy, as we know it, does not exist as a position here in France,’ says Ms Lewis.

‘Masseur kinésithérapeute is the nearest title. This, therefore, is what we have to register as and we have to work within their guidelines.’

While awareness of the profession in France has grown in recent years, Ms Lewis points out that it still lacks the kind of autonomous standing physiotherapy enjoys in the UK, for example. fl

Further information and advice on working abroad is available on the CSP website.Visit: www.csp.org.uk and search for ‘working internationally’. For more information on SOLVIT, visit:  http://ec.europa.eu/solvit/site/index_en.htm French speakers who are keen to work in a ski resort are welcome to contact Ms Lewis at: info@ski-physio.com

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