Internship-Year Exploitation: Unpaid Internships, Excessive Work Hours, and Lack of Structured Learning in Doctor of Physical Therapy Programs in Pakistan

To the Editor, The internship year for 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 under-developed 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.