Adapting the German demand planning guideline for physiotherapy: a cross-sectional analysis from Lower Saxony

The Demand Planning Guideline aims to ensure equitable and needs-based outpatient care in Germany but currently excludes allied health professions such as physiotherapy. This study investigates current and projected regional supply levels of physiotherapists in Lower Saxony, a federal state in Germany, applying the physician-based planning methodology to highlight workforce imbalances. This cross-sectional study used administrative address data from January 2021 to determine the number and distribution of physiotherapists. These data were geolinked at the district level and combined with population projections for 2040 from the Federal Institute for Research on Building, Urban Affairs and Spatial Development (BBSR). The methodology of the Demand Planning Guideline was applied, including age-adjusted correction factors, to assess regional care levels and future trends. Significant regional variation in supply was found. In 2020, no district was formally undersupplied, but corrected supply levels ranged from 55.7% to 146.4%. By 2040, assuming a constant workforce, disparities are expected to increase, with 17 districts becoming oversupplied and none formally falling below the 50% threshold, despite indications of structural undersupply in several areas. Adapting the Demand Planning Guideline to include physiotherapy enables the identification of regional supply disparities and better forecasts of future care needs. A more inclusive planning framework is required to ensure equitable access and sustainable care provision in light of demographic change.