The Swiss "Stress Test": A Crisis of Identity and Regulation
According to Mario Muilwijk’s 2026 report, Switzerland has become the primary "stress test" for the osteopathic profession in Europe. On February 1, 2025, the end of transitional legal provisions (LPSan/GesbG) triggered a massive regulatory crisis that left hundreds of practitioners in professional limbo.
The Reason for the Loss
The Scale: Between 800 and 1,000 osteopaths reportedly lost their license or were forced to shutter their private practices.
The Regulatory Barrier: New Swiss federal regulations now strictly require either a Master’s degree from a recognized Swiss university or a foreign diploma specifically accredited by the Swiss Red Cross (SRC).
The "Cross-Border" Trap: Many affected practitioners held degrees from prestigious UK institutions. While these were marketed as "recognized," they often lacked the specific professional registration (GOsC) or the clinical hours required by Swiss federal law, leading to practitioners being downgraded to "assistants" or barred from practice entirely.
Physiotherapy and the Dilution of Identity
A critical factor in this crisis—often overlooked in the "practitioner-as-victim" narrative—is the specific struggle of the Physiotherapist-Osteopath. Unlike other medical professionals, many in this group merged two distinct practices, which ultimately backfired during the Swiss regulatory crackdown.
1. The "Double Identity" Confusion Unlike a cardiologist who remains a physician, or an anesthesiologist who remains a nurse, the "Kiné-Osteopath" navigated two different legal frameworks. By mixing physiotherapy (rehabilitation) and osteopathy (holistic/systemic approach) in the same clinical space, the profession became "illegible" to Swiss regulators. When a profession lacks clear, exclusive borders, the State is less likely to grant it independent healthcare status.
2. Regulatory Arbitrage vs. Medical Standards In other medical fields, identity is non-negotiable; a surgeon cannot practice dentistry simply because they understand facial anatomy. However, many physiotherapists viewed osteopathy as a "commercial extension" or a "toolbox" rather than a standalone profession. By opting for part-time or "light" foreign degrees to supplement their physiotherapy practice, they engaged in regulatory arbitrage. Switzerland’s 2025 deadline effectively ended this, demanding a "pure" professional identity that these hybrid practitioners could not prove.
Why "Soft-Law" Failed the Hybrids
Muilwijk argues that "soft-law" (voluntary standards like the WHO or CEN benchmarks) failed these professionals. Because their education wasn't anchored in a binding framework like Directive 2005/36/EC, they lacked judicial protection.
However, for the physiotherapist-osteopath, the problem was twofold:
No Home-State Anchor: Many were not registered as osteopaths in the UK (the country of their degree), meaning they weren't "migrating professionals" under EU law.
Lack of Specialized Recognition: By failing to establish a standalone identity separate from physiotherapy, they remained under the "General System" of recognition, which allows host states like Switzerland to impose much harsher "compensation measures" or total practice bans.
The Cost of Overlap
The Swiss crisis demonstrates that professional maturity requires more than just clinical skill; it requires regulatory clarity. The physiotherapists who lost their right to practice in Switzerland are a cautionary tale of what happens when a profession allows its identity to become blurred. For the European regulator, osteopathy must either be a standalone, federally-regulated medical profession or it will be relegated to a secondary "technique" with no legal protection under international law.
