Working as a Physical Therapist in Europe (Belgium)

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 Keitz, PT, DPT

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.

Canadian Travel Therapy: Can Canadian Therapists Work in the US?

Image of woman hiking with words "Canadian Travel Therapy: Can Canadian Therapists Work in the US?" Guest post written by Eni Kader for Travel Therapy Mentor

So… you’re Canadian… but you can work as a physical therapist in the U.S… but you don’t live here… ?

—These are the inevitable follow up questions I get from patients, colleagues, Canadians and Americans alike. The answer is “yes,” and I’ll tell you how I did it! 

Guest Post Written for Travel Therapy Mentor by Eni Kader, Canadian PT working in the US as a Travel PT

Licensing & Education

The Canadian and U.S. physical therapy (or physiotherapy) licenses are unfortunately not equivalent. In order to work in the US, a Canadian-trained physiotherapist would have to choose a state to become licensed in, then go through the process of applying for and writing (taking) the NPTE, prior to attempting working and travelling in the U.S. 

I personally went to PT school at D’Youville College in Buffalo, NY. I decided to continue living in Canada and commute over the border for school instead of living in the U.S. To make this process easier, I applied for my Nexus Trusted Traveller pass, which expedited the border process significantly. In fact, some of my Buffalonian classmates had a longer commute to school than I did!

I went to school under an F-1 Visa, which meant that I was approved to commute over the border to school while maintaining my residence in Canada. In order to be approved for the F-1 Visa, I had to first be accepted to the school, then for each year of study, I had to have the immigration officer at my school sign off on my I-20 which I brought to the border for approval. More info on this here.

After completing my Doctor of Physical Therapy degree in the United States, I wrote the NPTE and went through the licensing process for NY physical therapy licensure. Unless you are a dual citizen, this still does not allow you to legally be employed in the U.S. See the Work Visa section below to learn more about the next steps.

For those who went to PT school in Canada, you would need to check the state-specific guidelines for internationally-educated applicants, but for the most part, the NPTE eligibility criteria is your first hurdle to overcome. In order to be eligible for the NPTE, you must have been educated by a CAPTE accredited institution, and some Canadian physiotherapy schools are listed in their Previously Accredited Foreign Programs. Some states may require you to show proof of eligibility to work in the U.S. (see work visa info below), and an equivalent education.

Work Visa 

If you are a Canadian who has gone to school in the U.S., F-1 students are eligible for the Optional Practical Training (OPT) Visa, which allows you to work in your field of study in the US for up to 12 months after graduation. There are some restrictions around this Visa, and you can find out more about it here. I personally chose not to go this route because I was late for the application process and wasn’t sure what my moves were going to be when applications were due. I did have Canadian classmates go this route and the immigration officer at my school was an excellent resource for information. 

As a skilled healthcare worker and Canadian citizen, I was eligible for a TN Visa under NAFTA, which is what I work under now. The TN visa is different from the H1B because it does not allow you to work permanently in the U.S. as a resident, however it can be renewed indefinitely. It tends to be a little more cost-effective and time-efficient if you don’t plan on settling in the United States permanently. More about H1B visas here.

The TN visa is specific to the travel company you are working with. This means if you plan on working with multiple recruiters, each one would have to sponsor you for a separate TN visa once you sign a travel contract and are ready to work with them (more on the TN visa process below). 

The licensing and work visa process can take a lot of time, especially if you miss any steps or paperwork. Thankfully, I work with a large travel recruiting company with an immigration department that was very knowledgable about the whole process and helped guide me through it. I used the Department of Homeland Security websites, travel therapy and immigration forums to answer my questions. I didn’t personally go this route, but some people choose to consult with an immigration lawyer to make sure the process goes smoothly. 

TN Visa

The TN visa requires a Visa Screen for approval, so you can start the Visa Screen process before you plan on working, and once you have the Visa Screen in-hand, you can actively look for travel contracts without the TN. Once you have a contract, you’d take the Visa Screen with all the things (see below) to the border for TN approval and then you can officially work! 

As I mentioned before, I found it very helpful woking with a larger travel company that was familiar with the TN Visa process. I prioritized looking for a recruiter and travel company that was experienced working with Canadian Citizens because I wanted to make sure I didn’t make costly mistakes in the process. Thankfully, my recruiter and travel company had tons of experience and access to immigration specialists that answered any questions that arose. 

Visa Screen

In order to be approved for a TN visa, all applicants are now required to produce a Visa Screen. The Visa screen is a tool that allows border officers to verify an applicant’s credentials when they apply for approval. 

There are two main companies that do the Visa Screen: CGFNS and FCCPT.  I opted to go with CGFNS due to cost and my recruiter’s experience with them.

Visa Screen process:

When I was ready for my contract, I took the Visa Screen, letter of employment + contract dates from my company, my US (New York) PT license, PT school diploma & Canadian passport to the border for validation, and then I was eligible to begin work in the US!

More Info Here: https://www.uscis.gov/working-in-the-united-states/temporary-workers/tn-nafta-professionals

Note, this is simply what I did for my situation. Each individual should take their own situation into consideration and contact immigration services in the respective countries for accurate, up to date info. 

Other Considerations

In addition to getting your license and work visa taken care of to be allowed to work in the US, there are some other logistical considerations for working and living temporarily in the US:

Banking 

  • As a Canadian Citizen, I had to apply for a SSN with my TN visa in order to be able to open a US bank account and be put on payroll. I found it easiest to go with my Canadian bank’s U.S. Branch and have my U.S. credit card through them too. 
  • Exchange rate: consider when paying Canadian bills such as your rent or loan payments. 
  • US credit card: to save on exchanging rates and fees that a Canadian credit card would place on you.
    • I also applied for this low-limit credit card to begin building my credit score in the U.S. which has come in helpful when doing background checks for landlords

Health Insurance 

  • Go through your travel company as anybody would normally because Canadian health insurance doesn’t typically cover your expenses when you’re abroad. 
  • I make sure I get appointments scheduled in between contracts and travel home for those.
  • At the time of writing this, some people may also need to consider a 14 day mandatory quarantine coming into Canada, so take that time into consideration as well and call ahead to your border crossing as regulations are constantly changing.

Taxes 

  • Travel tax & tax home are the same as for U.S. travellers but you claim your tax home in Canada instead. I used TravelTax.com for their expertise, and they helped me when it came time to filing taxes as well. 
  • As my tax home is in Canada still, I pay my taxes to the U.S. first then pay the difference to Canada (since Canadian taxes are higher). As I mentioned, I used a tax professional to avoid mistakes. 

Tips for Canadian Travel Therapists

  • Give yourself lots of time to get through the process from start to finish 
  • Keep documents with you at all times during your travel assignment, especially if you will be travelling via airplane or crossing the border. I keep an electronic scanned copy of my documents on my phone using the Genius Scan app so I can access things quickly. 
  • Try and get your healthcare check ups done in between assignments as mentioned earlier. This is typical of any traveller, though! 

Summary

If you’re a Canadian looking to travel the U.S., learn a ton, and have greater flexibility with your career, don’t let the process stop you from going after it! I’d highly recommend beginning the process as soon as you can and just taking it one step at a time. I’ve been grateful to take advantage of the flexibility of my travel therapy career, live in some amazing places, and connect with other incredible professionals as well. If given the opportunity, I hope you do too!

Bio

Dr. Eni Kadar is a travelling physical therapist and holistic health & fitness coach. She is a first generation Canadian and calls Niagara Falls, Ontario home. You can connect with her on LinkedIn, Instagram or via email!

Instagram: www.instagram.com/holisticdpt

LinkedIn: https://www.linkedin.com/in/ekadar9/ 

Email: ekadarPT@gmail.com 


We would like to thank Eni for this educational guest post! If you have further questions specifically about traveling in the US as a Canadian citizen, please contact Eni via the links above. If you’d like help getting started with travel therapy in general or getting connected with travel therapy recruiters, please contact us here.