The internship year for the Doctor of Physical Therapy (DPT) program in Pakistan is intended to be a supervised bridge between academic instruction and full professional clinical practice. However, in many institutions, this period has become a site of exploitation: unpaid or brutally undercompensated labor, excessive work hours, and a lack of structured learning, mentorship, or evaluation. Public and private hospitals often assign interns full outpatient duties with minimal oversight, while others restrict meaningful clinical exposure in favor of clerical or menial tasks, unlike MBBS, BDS, or Pharm-D graduates, who are protected under well-defined regulatory frameworks. DPT interns function without legal safeguards, exposing them to overwork, burnout, and academic compromise. Globally, similar patterns emerge. Physical therapy or physiotherapy interns in some countries report unpaid placements, long hours, and variable support structures, most specifically in underdeveloped and developing countries, including Pakistan. The consequences include feeling underprepared for clinical challenges, discouragement from critical components such as evidence-based practice, and attrition from clinical work to academia or abroad.  I write to express this concern over a growing and ethically troubling trend that remains largely unaddressed within Pakistan’s healthcare education framework – the unregulated and often exploitative nature of the clinical internship year for Doctor of Physical Therapy (DPT) students. Although this year is intended as a supervised transition into professional clinical practice, its current implementation in many institutions reflects systemic neglect, inadequate oversight, and academic compromise.

Across both public and private teaching hospitals, DPT interns are frequently placed in full-time clinical roles, often working five to six days a week, 6-8 hours daily, without financial support or recognition.[1] In government-run hospitals, interns are often assigned to outpatient departments where they independently manage patient caseloads, frequently without structured supervision or learning objectives. While clinical engagement is vital for professional development, the absence of regulated mentorship undermines both patient safety and the educational development of these future professionals.[2] While Pakistani DPT interns often work without pay, fresh graduates in Pakistan who enter the workforce typically earn only PKR 15,000–25,000 monthly (≈USD 55–90), reflecting one of the lowest earning brackets among health professionals in the region.[3,4] Comparable figures from a major neighboring developing country, India, exemplify similar trends where fresh physiotherapy graduates report salaries of INR 20,800–25,000 per month (≈USD 250–300), further supporting the evidence of low entry-level pay in developing nations.[5] In stark contrast, developed countries provide markedly higher entry-level compensation in comparison. Illustrated in Figure 1, newly licensed physical therapists in the United States earn on average USD 4,200–4,500 per month. [6,7] In the United Kingdom, Entry-level Band 5 NHS physiotherapists begin at GBP 2,300–2,600 monthly (≈USD 2,900–3,200).[8] In Australia, entry-level physiotherapists earn AUD 4,500–5,200 monthly (≈USD 3,000–3,500). [9,10] This wage gap underscores the structural inequities in how developing versus developed nations value and support physical therapy graduates. The lack of stipends for interns in Pakistan further deepens this disparity, positioning young professionals at a financial and academic disadvantage even before they formally enter the workforce.

Figure 1: Compensation comparison of the physical therapy fresh graduates between developed and developing countries

The consequences: The absence of structured learning and legal protection has serious long-term consequences. Many fresh graduates report feeling underprepared in critical areas such as differential diagnosis, evidence-based practice, and patient documentation. Clinical reasoning, which is a hallmark of any allied health professional, is seldom nurtured due to rote task assignments and a lack of feedback. Consequently, a growing number of young professionals express disillusionment with clinical practice, with many opting to pursue careers in academia, research, or emigration, further depleting Pakistan’s clinical workforce.[11,12] This exploitative model is not only damaging to the individual but also harms the healthcare system by failing to produce well-trained professionals capable of meeting the growing demand for physical therapy services in Pakistan.

A key reason for the persistence of such exploitation is the systemic neglect in Pakistan’s higher education and health governance. Unlike medical and dental house jobs, which fall under established statutory frameworks, the physical therapy internship year has been left in a regulatory grey zone. The Higher Education Commission (HEC) and provincial health departments have yet to issue clear directives, leaving institutions to design their own loosely structured internship models. This absence of oversight has fostered a culture where hospitals benefit from unpaid manpower without being held accountable for providing structured training. Furthermore, the delay in operationalizing the Allied Health Professionals Council (AHPC) has created a vacuum in professional regulation, leaving young physiotherapists without legal safeguards, grievance mechanisms, or standardized clinical competency requirements. The responsibility, therefore, lies not only with individual institutions but also with the fragmented policy environment that has failed to recognize physiotherapy interns as stakeholders deserving of protection, compensation, and structured mentorship.

To address this critical educational and professional gap, I urge policymakers, academic councils, and regulatory authorities to consider the following reforms:

• National internship framework: Since the lack of a centralized policy has led to exploitation, Regulatory bodies such as the Higher Education Commission (HEC), Allied Health Professionals Council (AHPC), and Health Education Regulatory Authority (HERA) should jointly develop a standardized DPT internship curriculum. This should include competency-based rotation plans under expert supervision, defined learning outcomes, and skill assessments, ensuring uniformity across all institutions.
• Financial stipends or support: The absence of a financial policy has allowed institutions to use unpaid labor. While full salaries may not be immediately feasible, providing interns with monthly stipends, meal subsidies, or transport allowances is a necessary first step. Models from existing MBBS house officer stipends can be adapted for DPT internships nationwide, ensuring that financial constraints do not limit access to training.
• Certified clinical supervisors: The current vacuum in supervision standards leaves interns unsupervised and misused. Clinical supervision should be mandatory and conducted by licensed physical therapists certified in clinical instruction. Faculty involvement during mid-term and final evaluations will ensure that interns receive consistent and high-quality feedback.
• Assessment and feedback mechanisms: Because no evaluation or reporting structures exist, interns lack both accountability and voice. Introducing competency-based assessments, structured feedback channels, and confidential grievance systems would counteract the unchecked exploitation. Interns must undergo formal assessments in core areas such as documentation, ethical practice, and patient-centered care. Additionally, confidential feedback channels and grievance reporting systems should be established to allow interns to voice concerns safely.
• Legal protections and institutional audits: The absence of professional regulation by AHPC and weak institutional oversight have fueled systemic neglect. Regulatory bodies should implement regular audits of clinical training centers to ensure compliance with training guidelines and internal welfare standards. Establishing a legal framework for DPT internships would provide crucial protection for interns, ensuring that they are not exploited.

The DPT internship year should be a time of professional growth, not a period of silent endurance. By taking actionable steps to regulate and improve internship conditions, we can ensure that DPT students receive the high-quality training they deserve, which will ultimately benefit both the profession and the patients they serve.

Doctor of Physical Therapy, Clinical internship, Pakistan healthcare education, Unregulated training, Exploitation.

In conclusion, the internship year for DPT students in Pakistan must no longer be treated as a free source of hospital labor. The DPT internship year should be a time of professional growth, not a period of silent endurance. Without stipends, structured supervision, or regulatory safeguards, young physiotherapists are exploited, undervalued, and pushed away from clinical practice. Policymakers and regulatory authorities can no longer afford inaction. Establishing a standardized national internship framework, financial support mechanisms, and strict oversight is not a luxury – it is an ethical obligation. By taking actionable steps to regulate and improve internship conditions, we can ensure that DPT students receive the high-quality training they deserve, which will ultimately benefit both the profession and the patients they serve. The future of the physical therapy profession, and the quality of care patients receive, depends on ending this exploitation and treating interns with the dignity and protection they deserve.

We would like to express our sincere gratitude for the strength, patience, and perseverance that enabled us to endure and reflect upon the challenges encountered during our internship year. The ideas presented in this piece emerged directly from our lived experiences of exploitation, working without pay, enduring extended duty hours, and struggling in the absence of structured learning. These difficult yet formative observations shaped our perspective and became the driving force behind writing this Letter to the Editor. By transforming personal hardship into collective awareness, we aim to highlight the struggles faced by many interns and advocate for meaningful change in official policies.

No funding from any organization/institution was received for the study.

Corresponding Author:
Etisam Wahid
Department of Physical Therapy
Faculty of Allied Health Sciences
University of Veterinary and Animal Sciences (UVAS), Swat
Email: etisamwahid35@gmail.com

Co-Authors:
Shahzad Ahmad
Department of Physical Therapy
University of Veterinary and Animal Sciences (UVAS), Swat, KP, Pakistan

Mehran Khan
Department of Physical Therapy
Hope Rehabilitation Hospital, Saidu Sharif, Swat, KP, Pakistan

Amir Ali
Department of Physical Therapy
Professional Development Center, Jinnah Sindh Medical University (JSMU), Karachi, Pakistan

Soom Khalil
Department of Physical Therapy
Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, KP, Pakistan

All authors contributed to the conceptualization, investigation, and data curation by acquiring and critically reviewing the selected articles. They were collectively involved in the writing – original draft preparation and writing – review & editing to refine the manuscript. Additionally, all authors participated in the supervision of the work, ensuring accuracy and completeness. The final manuscript was approved by all named authors for submission to the journal.

Not applicable

Authors declare no conflict of interest.

Etisam Wahid serves as the guarantor for this study and takes full responsibility for the integrity of the work, including the accuracy of the data and opinions.

https://doi.org/10.63096/medtigo30623313

Wahid E, Ahmad S, Khan M, Ali A, Khalil S. Internship-Year Exploitation: Unpaid Internships, Excessive Work Hours, and Lack of Structured Learning in Doctor of Physical Therapy Programs in Pakistan. medtigo J Med. 2025;3(3):e30623313. doi:10.63096/medtigo30623313 Crossref