The National Commission for Allied and Healthcare Professions (NCAHP) Act of 2021 marks a significant first step in regulating healthcare and allied health professionals in India. Although long overdue, its introduction is a positive development. The Act must fulfil its three core objectives: 1) Regulating education and services, 2) Maintaining a union and state register of professionals and evaluating institutions, and 3) Enhancing access to healthcare, promoting research, and fostering scientific advancements.
In the absence of regulation of education and services, the academic curriculum is not current, and lots of Illegal practices have mushroomed as a result. Compared with other countries, our healthcare professionals are far behind in R&D and scientific advancement, something that affects the quality of care received for the patients.
The enforcement of the NCAHP Act remains unclear, with only a few states having established functional councils, resulting in delays to national standardisation. The Act lacks emphasis on continuous professional development (CPD) and lifelong learning, which are essential for keeping physiotherapists up-to-date with current advancements in their field. Although it encourages interdisciplinary collaboration, the Act does not clearly define the professional boundaries between healthcare practitioners, potentially leading to conflict of interest and boundaries with medical professionals. Moreover, the Act fails to allocate resources or provide incentives for physiotherapy-specific research, missing a key opportunity to enhance India’s healthcare R&D and to highlight the role of physiotherapy in preventive care and cost-effective treatment solutions.
Though the NCAHP Act being in force since May 25, 2021, after three years of its enactment, only 14 states have established councils, many of which are non-functional. The Honourable Supreme Court of India has expressed disappointment over the government’s failure to meet its legal obligations.
However, we must understand that healthcare, by law, is not monopolised by modern medical practitioners, though they do hold a monopoly over medicine and surgery. It is in society’s best interest to respect and protect this monopoly over medicine and surgery for the greater interest and safety of the public. As a physiotherapist, I understand the disappointment when medical practitioners intervene in the core areas of physiotherapy practice, as it sometimes does not lead to better patient outcomes. Fortunately, the situation is gradually improving, and the National Commission for Allied and Healthcare Professions Act 2021 provides us with greater legal autonomy in our practice area, clearly defining our scope and limitations.
The National Medical Commission (NMC) Act of 2019 addresses medical professionals as medical practitioners, not doctors in the Act. The title “Doctor” for medical practitioners was not automatically granted but was the result of a long, strategic effort, hard-fought and pushed for by medical practitioners in Europe since the 18th century. This underscores the historical importance of professional titles and the power dynamics involved in securing them. Since then, we as a society have considered medical practitioners as doctors. This perception and belief stems from a deep respect for the selfless service provided by modern medical practitioners. This belief is so ingrained that “doctor” is almost exclusively associated with medical doctors, often excluding even those with doctoral degrees in other fields.
As physiotherapists, we can operate independently, but we must also recognise the “collaborative autonomy” nature of our profession, which positions us uniquely in healthcare. Collaborative autonomy focuses on independent expertise, interdisciplinary collaboration, shared goals, respect for boundaries, and patient-centred care.
In his Book “The Age of Scientific Wellness”, Dr Leroy Hood, who is a Nobel laureate, says in his introduction that there is need for a new paradigm shift in healthcare as he calls the present system as sick care, not healthcare. As he suggested, the “4P Medicine” is predictive, preventive, personalised and participatory. As a physiotherapist, NCAHP law, by definition, gives physiotherapists the right to follow the “4P Model of Healthcare” within the scope of our practice.
I still have one disappointment with the progress made by National Commission for Allied and Healthcare Professions Act 2021. This is purely from a physiotherapist’s point of view. The Act classifies physiotherapists as healthcare professionals, whereas, in Australia, they are regulated by the “Health Practitioner Regulation National Law Act 2009” and refers to Physiotherapists as “health practitioners”. Additionally, the Act limits physiotherapists from using the “Dr.” prefix. I believe the government should have made a clearer distinction between “medical practitioners” and “health practitioners.”
The omission of a distinct title or status for physiotherapists in modern legislation is regretful. This highlights a potential gap in how physiotherapists are treated compared to medical practitioners, raising concerns about fairness in policy decisions. Our professional body should have fought for this distinction rather than focusing on the “Dr.” prefix.
In essence, while all practitioners can be considered professionals, not all professionals qualify as practitioners due to differences in education, regulation, and ethical responsibility. This marks a significant injustice for physiotherapists.
My initial decision to use the ‘Dr.’ prefix stemmed from the common misconception that physiotherapists are equal to medical doctors within their own scope of practice, similar to dentists. I had included the prefix alongside ‘PT’ on my professional material such as letterheads and business cards. However, after a thorough review of the Indian Medical Association (IMA) white paper, I decided to discontinue using the ‘Dr.’ title.
The NCAHP Act of 2021 removes physiotherapists from the ambit of the outdated RCI Act, providing physiotherapists with clear autonomy and recognising them as independent healthcare professionals, not just rehabilitation specialists. This expanded scope allows physiotherapists to diagnose and treat functional impairments and movement disorders within their defined practice, challenging the IMA’s restrictive interpretation under the RCI Act.
Physiotherapists, unlike allopathic doctors, do not claim to practice medicine and the use of the ‘Dr.’ title, reflects their doctoral-level expertise, as is common in countries like the U.S. and Canada. When properly communicated (e.g., “Dr. [Name], Physiotherapist”), the title does not mislead patients.
Whether medical practitioners or healthcare professionals, our primary aim should be maximising patient benefits and focusing on patient-centred care rather than practitioner- or professional-cantered care. Patient-centred care emphasises collaborative decision-making, a holistic approach, empowerment, communication, trust, and respect for patient preferences. In contrast, practitioner- or professional-cantered care focuses on expert-led decisions and standard protocols and less emphasis on patient input. While this approach is not entirely wrong, its use should be selectively applied based on the situation and necessity rather than as a standard operating procedure.
In the coming decades, the physiotherapy profession in India is poised for achieving significant progress, embracing scientific rigour to serve people in innovative ways. This can be achieved without the need for the ‘Dr.’ prefix by fostering collaborative autonomy and prioritising patient-centred care.