In Tough Market, Israeli Physiotherapists Moonlighting as Waiters

The number of graduates keeps growing but not the number of job openings, forcing many to moonlight.

They put in four years at university combined with hands-on clinical experience at hospitals, rehabilitation institutions and schools for special education, but most of today's Israeli graduates in physiotherapy can't find work because there are few job openings.

With the fierce competition to land jobs, physiotherapists can't be insistent about salary. Late last month, physiotherapy students took the first step in making themselves heard when hundreds set out for Jerusalem to demonstrate against growing unemployment in their field. The Histadrut labor federation was quick to take the demonstrators under its wing.

The employment situation for physiotherapists has been tough for several years. But the proximate cause behind the demonstration was the cancellation of a physiotherapy job fair that was to have taken place at Assaf Harofeh Hospital, the first time in its five-year existence that the fair has been called off. The reason: Not enough hospitals, rehabilitation centers or geriatric institutes could be found to participate in the event.

Alon Block, 32, a certified physiotherapist for three years, claims the number of courses in the field keeps growing while the number of workplaces hasn't changed.

Physiotherapy departments have also opened up at Ono Academic College and at Safed Academic College in the past two years, he says. Which in turn has lowered the standards required of applicants. The number of graduates entering the labor market has reached 300 a year, compared with 250 in 2012, 200 in 2011 and 180 in 2010.

"However, in the past year only 25 physiotherapists have been hired by hospitals and public sector clinics, from 250 who completed the required course of studies," Block says. "There are another 250 students who studied in Europe and Jordan and want to work in Israel, bringing the total to 500 graduates desperately looking for work. There are no data on the private sector, but the job openings there aren't much different."

Can't graduates open a private clinic?

"Yes, but it's not practical for a physiotherapy graduate," says Block. "When a student finishes his studies, he needs to first gain experience in a medical institution in order to set out afterwards on his own."

What about working abroad in the United States, Canada, or Western Europe?

"It used to be possible to find work in these countries," he says, "but those places already have a glut in the field too."

Moonlighting as waiters

Since she was a child, Stephanie Liebson, 26, wanted to work in the medical field. In high school she volunteered in Magen David Adom as a first-aid provider in an ambulance and was considering studying dentistry. "In the end I opted to study physiotherapy, where there's more personal contact with patients."

Liebson is now in her third year of the four-year physiotherapy program at Tel Aviv University. Students in their third and fourth years combine classroom studies with hands-on volunteer training for one to two months in medical institutions. Even at this stage, students encounter a shortage of potential slots. As a result, some students don't acquire training in pediatric physical therapy and only treat children for the first time after starting to work.

"I'm worried about the growing difficulty in finding work in the profession," says Liebson. "Most physiotherapist positions aren't full-time, not to mention the pay, which is lower than the average. I have friends in the field who moonlight as waiters. Although I'm a tenacious type who sets a goal and meets it, I'm taking into account that I'll also have trouble making a living exclusively from the profession I learned."

Eli Gabay, 50, chairman of the Israeli Association of Physiotherapists and a physiotherapist at Beilinson Hospital in Petah Tikva, is well aware of the young physiotherapists' grievances. "There aren't enough places for interning or training students because employers are interested in absorbing the large number of physical therapy graduates, and don't devote significant resources to the matter," he says.

"It's reaching a danger point for the patients," Gabay maintains. "Certain graduates haven't done the course of clinical training as recommended by the universities. For example, you can run into physiotherapists who are treating respiratory patients but who haven't undergone any hands-on training in the field, or are working in orthopedic departments when their instructor was actually a respiratory specialist."

Gabay blames the Council for Higher Education for the problem. A professional committee appointed by the CHE and headed by Prof. Menachem Fainaru had determined that the number of physiotherapy courses should be frozen, forecasting that no shortage in the field would develop before 2020. The committee even recommended that the number of students be reduced by 10% a year.

"The CHE remains unmoved and has been approving new courses without any public discussion," Gabay says. Physiotherapy departments have been opened at the Ono Academic College, backed by Sheba Medical Center and the Maccabi health maintenance organization. Ariel University is doubling the number of physiotherapy students to 80.

"There are already about 700 physical therapists not working in the profession or unemployed - and who gives a damn?"

Gabay points out that 450 of Israel's 4,500 physiotherapists do not have work in the profession, and that affects the wages of those working in the field.

"During the third- and fourth-year training periods, lasting 30 weeks overall, there is already an indication of pay conditions for physiotherapists," he notes.

Wages for physiotherapists in the public sector are among the lowest in the country, even lower than for waiters, for example, or for hospital maintenance staff, Gabay says.

According to figures from the Israeli Association of Physiotherapists, starting salaries are NIS 4,000 a month, entitling beginning physiotherapists to income supplements to make up the difference from the legal minimum wage of NIS 4,300. Weekend shifts can add a few hundred shekels in pay, but these are few and far between. In recent years there has been more interest in being employed by research foundations or through personal contracts where salaries can reach NIS 6,000, but without any job security.

Pay at the Clalit and Maccabi HMOs starts at NIS 5,000 a month, rising to NIS 12,000 after 15 years. Physiotherapists with 15 yearsin the public sector, however, make no more than NIS 7,500 a month, less than the average wage.

The CHE responds that it hasn't any authority over the establishment of a private academic institution like the Ono Academic College and can't prevent these from opening new departments. It can only oversee the curriculum. The Health Ministry, however, says that it's the CHE and not the ministry that determines the opening of educational frameworks.

"We regret that the association, acting from irrelevant considerations, ignores the shortage of physiotherapists in two sectors, the Haredi and Arab populations," said Ono Academic College. "The periphery also suffers a shortage of physiotherapists as noted in the State Comptroller's Report."

Daniel Bar-On