We get a lot of questions about working internationally as a therapist. While we don’t personally work internationally, we’ve had the opportunity to talk to many therapists who have. Most of the therapists we know who have done this go overseas more long-term, not short-term. But nevertheless it’s interesting to hear their stories and the processes they went through to be able to work abroad as therapists. We’re excited to share American PT Britni’s insights on moving to Belgium and becoming a physiotherapist there.
My name is Britni Keitz, and I have been a physical therapist for over 4 years. I previously worked as a Travel PT in California, Washington state, and Florida, until I moved to Belgium permanently! I got married last year to a Belgian national, and we both decided it was easier career-wise for me to move to him than vice versa, so now I am working as a physiotherapist/kinesitherapeut (aka “physio” or “kine”) here in Belgium! I’d like to share some information about the process of moving here and being able to work as a physio/kine!
The Licensing Process
This process of getting licensed to work in Belgium is fairly easy, but took very long for me due to the pandemic and delays, including summer holidays where nobody works. Typically this should take up to six months, but it took me ten months. It should be known that the process I’ll describe is for Belgium only. It is going to be different in every country throughout Europe.
My process for getting licensed to work here was slightly different because I am now considered a permanent resident because I am married to a Belgian. If you are not, you would have to apply via the work visa route. I just skipped that step and waiting period because I got my residency card instead.
Once you have your work visa or residency card, then you have to apply for a degree recognition through NARIC Vlaanderen. This is to make sure our degrees correlate with theirs for the specific job. Since our physical therapy degree is a doctorate program, there is no problem because here it is a master’s degree. (Also, little Belgium is very complex with two separate governments within this country- the French side and the Flemish side- Wallonia and Flanders). So, when you apply for your degree recognition you have to decide which process you will go through. I was told the Flemish one is faster and easier, so I chose that route. I had to submit a whole list of things such as diplomas, official transcripts, course description of every course you took that includes undergraduate and graduate courses, work history (resume), work license, state license, passport, background checks, etc., along with an application. It took about four months to get everything back and receive my degree recognition for my Master of Science in “de revalidatiewetenschappen en de kinesitherapie” (rehabilitation sciences and physiotherapy).
After that, I had to apply for what’s called a “visa,” but this is different than a work visa, it’s for insurance here. You apply through the Agentschap Zorg & Gezondheid. You have to submit basically all the information again plus the degree recognition. This took the longest because it had to go through so many loops of signatures within the healthcare government here, and they only meet once or twice a month, so that was a very long wait. Five months later, I received the green light to proceed, and that was submitted to the healthcare insurance here. Then I received my INAMI number, which is basically my insurance practicing number to work here as a kine/physio. This also allows me to give my patients a receipt for their visit to submit to their insurance and receive a reimbursement for their session. I started this whole process in February of 2021 and was officially able to work in December of 2021. Because of this long process, I would generally only recommend going through the process to be licensed in Belgium if you plan to work here for a longer period of time, not short term.
Job Hunting and Working
This process was actually not bad at all, but it took a lot of research and contacting places. I knew the year before that I was going to move to Belgium, so I started early and just asked around about what I found online. I got EXTREMELY lucky, I should add, because I connected with a therapist here who is actually from the US and moved here over ten years ago and started her own practice. She was a life saver because she helped me with the whole process of being able to work and was able to send me the direct links on where to go. We kept in touch that year, and when I moved here I reached out again and we were officially able to meet in person. She took me in and has helped me so much! I am beyond grateful for this woman!
It’s important to know that working in Belgium is different from the US. Here, all therapists are independent contractors basically, and you pay a certain percentage per month to the facility where you rent out space. So, I rent clinic space from the therapist I mentioned above, and I pay her a monthly percentage of my earnings. The clinic is fully stocked with supplies just like any clinic in the US. Getting patients here is from physician referrals only. There can be direct access, but if they go through direct access, they will not get their insurance to cover it or get reimbursed. So, the majority of patients get a referral from their general practitioners for physiotherapy, and it’s typically for 9-10 sessions (similar to the US), unless it is post-op, then it’s more. You can always get more sessions just like in the US with medical necessity and more paperwork after 18 sessions. So, in order to work here, you will need to meet and network within your area of physicians or specialists in order to get patients.
In Belgium, you have the option to be “convention” or “non convention” status. When you select “non convention” status, this allows you to bill and see patients for how long you would like, versus having to stick with the government’s rules of only billing patients 22 euros for a 30 minute visit. Whatever you charge, the patient pays you directly and you keep that amount. Then, after 9 -10 visits or sooner, we write them a receipt with certain codes like in the US with an initial evaluation code and then a general treatment code. (There are no different codes and costs for TherEx verse TherAct vs. NMR, etc). Patients will submit the receipt to their insurance and get reimbursed, but the amount of reimbursement varies based on their insurance. Most of my patients and clientele work for the European Commission, and they have separate insurance here compared to everyone else which pays for everything in full. Everyone else that does not work for them will get a smaller reimbursement back.
For example, I charge 65 euros for initial eval (45 minutes) and treatment sessions I charge 55 euros for 45 minutes. Patients would usually get back around 18-20 euros back per session from their insurance. That part doesn’t affect me; I keep the full 65 or 55 euro. If I was convention status I would be only allowed to charge 22 euros per visit. So, for some people they don’t want to pay my rate because they don’t get back as much money as if they went to a convention status therapist. So, that could be challenging. But, I always try to provide the best quality of care and information for my patients to make it worth while, and it’s working.
Documentation
Documentation is AMAZING here. It is not strict, because we don’t submit anything to the insurance company. We just write a ticket/receipt with certain codes for pathology and treatment, and give it to the patient. Then they have to submit that plus their prescription to their insurance for reimbursement. So, it is very laid back in terms of documenting! I continue to do a SOAP note format with abbreviations for myself, plus goals. There is no set number to my goals or anything, it is just specifically depending on the patient and their baselines.
Language and Culture
The official languages of Belgium are French, Dutch, and German. Also depending on where you work, there could be a further language barrier due to other ex-pats moving to Belgium from other countries. But, in many cases you’ll luck out with ex-pats who are English speaking. I would recommend taking an intense language course of French if you plan on working in Brussels or the French part of Belgium, and Dutch if you plan on working in the Flemish part. Again, I am extremely lucky again where I work because my clientele is pretty much all English speaking with the European commission and ex-pats. I have taken four months of French classes and began Dutch classes recently, because the prescriptions and everything else are either in French or Dutch depending on where the patients went for their general practitioners or specialists.
The culture here is similar to the US with treating patients. I do 45 minute evaluations and treatment sessions. It is a similar structure to what we learned from school. There is no change with that. There are also continuing education classes and specialties available here as well to further improve your skill set, but it is not required like in the States with CEUs.
Where I Am Now
I am officially working here and loving it! I have more freedom as a physio here and create my own schedule. I am working in two locations, one in Brussels near the European Commission (https://berlaymonthealth.eu/) and one outside of Brussels in the clinic where the therapist from the US took me in (http://lvwphysiobrussels.com/)! I also work for an international school here that is English speaking only, and I am the sports physio for the school and go to their games. There I have connected with athletic trainers through the international school system. Because of all of her connections, the therapist I mentioned has introduced me to this school as well as a midwife/lactation consultant company who is based out of the UK and Belgium now. There is much more to happen for me in the future, but I am beyond grateful for this woman I met who has helped me every step of the way.
If you have any questions about working in Belgium, I would be more than happy to help you as well!
Britni is an American Physical Therapist who now lives and works in Belgium. She received her Doctor of Physical Therapy degree from Clarkson University, and is originally from Armada, Michigan. She enjoys anything outdoors and active. She loves hiking, climbing, backpacking, snowboarding, fishing, dancing, and soccer. Before moving to Belgium, she did US travel physical therapy immediately after graduation and absolutely loved it! Britni traveled all along the west coast and in Florida. Now that she is getting situated in Belgium, she and her husband enjoy exploring and hiking (yes, there are some good hikes/trails in Belgium). They both love to travel, and now living in Belgium and being so close to everything, she plans on spending some time in Italy in the Dolomites for hiking and backpacking sometime in the summer! You can find her on Facebook or on Instagram @britni3. You can reach her by email at: keitzbritni@gmail.com.
