The backbone is walking out
A peer-reviewed survey of 578 Health New Zealand physiotherapists has landed a number that should alarm every employer running a physical workforce. 39.6% intend to leave their current roles, and a further 19.4% often or always consider leaving the profession entirely.
These are not graduates testing the waters. 59.3% of respondents have more than a decade of career experience. They are the senior clinicians who run complex caseloads, train students, and hold the institutional knowledge that keeps public rehabilitation functioning. 56.6% currently supervise students and 49.3% cover out-of-hours rotas. When they leave, they do not just take themselves. They take the training pipeline with them.
Musculoskeletal injuries account for up to a quarter of all GP consultations, according to Physiotherapy NZ President Mark Quinn. For employers in construction, manufacturing, agriculture, and transport, these injuries are the single biggest driver of workplace absence. How fast a worker gets back on the job depends almost entirely on how fast they access quality physiotherapy. That system is now shedding its most experienced people.
A legislative bottleneck that costs millions
Here is the regulatory absurdity that compounds the workforce problem. Under current ACC legislation, only GPs and nurse practitioners can certify work capacity, the formal sign-off that determines whether an injured worker stays on weekly compensation or returns to work. Physiotherapists, the professionals most clinically qualified to assess musculoskeletal function, cannot sign that form.
The practical result is a queue inside a queue. A worker sees a physio, gets assessed, begins treatment, but cannot access ACC compensation or be cleared for return until a GP also sees them. With GP wait times already stretched, Physiotherapy NZ President Kirsten Davie has described this as “a real bottleneck” in the system. Workers wait without income, ACC pays weekly compensation longer than necessary, and employers wait longer to get staff back.
Physiotherapy NZ is calling for ACC legislation to be amended so physiotherapists can certify work capacity. This is a legislative change, not a spending commitment. It would reduce ACC’s compensation bill while speeding up return-to-work outcomes. The government has not picked it up.
ACC spent $74 million making things slower
The bureaucratic friction runs deeper than legislation. ACC spent $74 million on a case management restructure that was supposed to boost productivity. Instead, it created a system where physiotherapists are “waiting weeks, if not months for a simple yes or no response” on treatment approvals, according to Physiotherapy NZ chief executive Sanda Kirby.
Kirby was blunt about the downstream cost: “Any delay in providing physiotherapy treatment impacts the lives of all New Zealanders, delaying return to work and daily activities, resulting in poorer outcomes and ultimately costing taxpayers more as untreated injuries exacerbate and lead to long-term problems.”
For employers, the translation is direct. Longer treatment approval delays mean longer periods of reduced capacity or absence, and higher costs flowing through ACC levies.
The workers who can least afford to wait are waiting longest
An independent report commissioned jointly by ACC and Physiotherapy NZ found the co-funding model, where patients pay a portion of physiotherapy costs alongside ACC, is pricing lower-income and rural patients out of the system. Access is effectively concentrated among wealthier urban populations.
For employers with lower-wage workforces or regional operations, this is a direct cost exposure. Workers who cannot afford private co-payments end up in the public queue, which is the queue now losing 40% of its experienced staff. The rehabilitation delay compounds. The sick leave extends. The employer absorbs it.
The survey found only 5.9% of Health NZ physiotherapists identify as Maori and 2.4% as Pacific, well below population representation. The workforce does not reflect the communities it serves, and the communities with the highest injury rates in physical industries have the worst access to timely care.
Cutting the workforce while acknowledging the shortage
The government is spending $58 million to cut 2,800 roles across Health NZ over two years, even as hospitals were already 600 nurses short per shift before those cuts began. Health NZ’s own workforce plan acknowledges capacity gaps in rehabilitation therapy. Publishing a plan to grow the workforce while spending money to shrink it is the kind of contradiction that accelerates the exit intentions the survey captures.
Mark Quinn has argued publicly that greater use of physiotherapy in primary care could cut surgery wait times, reduce costs, and deliver better outcomes. The Ministry of Health’s own allied health data confirms the workforce gaps and how they have grown since 2018.
The evidence base for reform is sitting on the table. Letting physiotherapists certify work capacity costs nothing and saves money. Addressing the co-payment barrier would speed up rehabilitation for the workers who need it most. Every month of inaction is another month where employers in physical industries carry the cost of a system that cannot get their people back to work.
Sources
- NZ Journal of Physiotherapy: Workforce profile and turnover intentions of Health New Zealand physiotherapists
- RNZ: Physiotherapists want ACC laws changed to let them certify work capacity
- RNZ: Physiotherapy patients waiting ‘weeks, if not months’ for ACC cover
- Newsroom: Physio sector warns ACC is short-changing high-needs patients
- Physiotherapy NZ: Physiotherapists ready and willing to help ease current GP crisis
- NZ Doctor: Minister’s winter spin can’t mask Health NZ’s staffing crisis
- Ministry of Health: Hauora Haumi Allied Health Report 2024
- Health NZ: Health Workforce Plan 2024 – Profession-Specific Analysis