Too Many Osteopaths in France, Not Enough Everywhere Else: What If the Fix Came From Abroad?

The number that caught my attention

This isn't the first time anyone has talked about "too many osteopaths" in France. What struck me was how fast it happened locally, and the fact that it coincides with a real shift in my own activity: fewer medium-term bookings, more last-minute requests, and patients who are starting to compare prices between colleagues in the same area, something that barely existed five years ago. It's not dramatic, but it's not trivial either. It's the symptom of a market absorbing more practitioners than it needs, locally.

What the national numbers say

I wanted numbers that would hold up, not coffee-counter impressions. Here's what I found.

As of January 1, 2024, France had 47,412 osteopaths registered with RPPS (the national healthcare professionals registry, the same one I'm registered in myself). The independent count run by osteopathes.pro, which cross-checks several sources to filter out duplicates and inactive practitioners, puts the number actually in practice at around 30,000 to 31,000 over the same period. The gap between the two figures is itself a signal: more and more graduates aren't practicing osteopathy as their main activity, or have stopped.

The growth rate shows no sign of slowing: between 2,000 and 2,500 new graduates join the profession every year. The Syndicat Français des Ostéopathes (French Osteopaths' Union) documented the long-term trend in its study "Economic situation of osteopathy from 2002 to 2020": the profession grew from a few thousand practitioners in 2002 to about 33,000 in 2020, with 93% growth between 2012 and 2020 alone, more than 16,000 additional professionals in eight years. For comparison, France's population grew by about 4% over the same period.

Financially, the same study is unambiguous: average net revenue went from €52,000 in 2002 to €51,000 in 2020, stagnant in current euros, so a real decline once inflation is factored in, for an average annual net profit of around €25,000, comparable to speech therapists. More recent figures from Ostéopathes de France and the Registre des Ostéopathes de France (ROF) drive the point home: average monthly income of €1,987 in 2024, down 10% over ten years, with a quarter of the profession earning under €800 a month. Meanwhile, the share of osteopaths registered as micro-entrepreneurs, often a sign of part-time activity or supplemental income, rose from 23.6% in January 2022 to 33.3% three years later.

It's against this backdrop that the Inspection Générale des Affaires Sociales (IGAS), the internal audit body of France's social affairs ministries, so not exactly an activist outfit, issued a report on May 24, 2023, on school accreditation and training capacity in osteopathy and chiropractic. Its wording is direct: France would rank "first in the world in terms of density and growth" of osteopaths, with an "uncontrolled demographic increase" and "professional integration difficulties." The report recommends lowering the training capacity of accredited schools.

What I take from all this: this isn't a demand problem. 85% of French people have a positive view of osteopathy, and a good part of the country is still underserved, I see it myself with my corporate clients. It's a volume and distribution problem. We're training faster than we need, and training in the same places.

Where this comes from

To understand how this got so large, you have to go back to law n° 2002-303 of March 4, 2002 (the "Kouchner law"), whose article 75 created the title of osteopath, without, however, creating a professional order, unlike doctors, nurses or physiotherapists. Decree n° 2007-435 of March 25, 2007 then defined the scope of practice. Then, in 2014, two texts structured the training: decree n° 2014-1043 of September 12, which created the National Accreditation Advisory Commission (CCNA) responsible for accrediting schools, and decree n° 2014-1505 of December 12, which set training duration at 5 years for 4,860 hours (including 1,500 hours of supervised clinical training, with 150 full consultations validated), a volume reduced to 1,900-2,300 hours for already-trained healthcare professionals, and 800 hours for doctors.

On paper, it's one of the most comprehensive curricula in the world. The problem is that there's no national numerus clausus: unlike medicine or physiotherapy, the number of accredited schools and the number of students they can take in aren't managed according to market needs. About thirty schools, mostly private and funded by student tuition fees, have a structural interest in maximizing enrollment rather than adjusting it to care demand. That's exactly what the 2023 IGAS report points to when it mentions a CCNA struggling to enforce pedagogical criteria and clinical competency thresholds.

Toronto, November 2025

In November 2025, I went to the annual general meeting of the Osteopathic International Alliance (OIA), the federation bringing together professional and regulatory organizations for osteopathy worldwide, in Toronto, to talk about the global osteopathic workforce. The OIA has just published its 2026 global report: the number of osteopaths worldwide has grown by 45.9% since 2020, with 171,573 "osteopathic physicians" (the American model, where the osteopath is a full physician) recorded in 21 countries, and 89,293 osteopaths in the European sense of the term across 35 countries. So the profession isn't in crisis globally. It's expanding. Except here.

In the conversations I had there with representatives from other countries, one observation kept coming up: France appears to be the only country in the world facing saturation this clear-cut, which, I realized afterward, almost exactly echoes what the IGAS report says about our "world's first rank" in density. Luxembourg, where I work daily with Heal on Site, isn't far behind: I see the same demographic dynamic taking hold there, though I don't yet have a published statistic to back it up precisely, it's a field observation, not an official figure, and I'd rather say that plainly than invent a source that doesn't exist.

By contrast, several countries struggle to cover their needs, with regulatory frameworks that are often more institutionally developed than ours. In Australia, osteopaths have been registered since 2010 with the Osteopathy Board of Australia, under AHPRA (Australian Health Practitioner Regulation Agency), the same national agency that regulates doctors, nurses and physiotherapists. That's an institutional recognition France still doesn't have, where the osteopath remains a "title" with no professional order. In Western Australia, the profession is officially classified as being in shortage by Jobs and Skills Australia, and several academic studies (notably work on retention and attrition published in the International Journal of Osteopathic Medicine) document real difficulty accessing osteopathic care in rural and regional areas. In New Zealand, the Osteopathic Council has regulated the profession since 2004 under the Health Practitioners Competence Assurance Act 2003, and the Ministry of Business, Innovation and Employment (MBIE) describes a sector that's "relatively easy" for new graduates to enter, with online job demand growing faster than the national average since 2008, even though the profession doesn't, as of now, appear on the official skilled-shortage list for immigration.

To be fully honest: Canada turned out to be a more nuanced case than I expected before looking into it. The framework varies enormously from one province to another, and in Ontario, the most populous province, manual osteopathic practice is not currently a regulated health profession under the Regulated Health Professions Act of 1991: the professional association (the OAO) still operates on a voluntary basis and has been actively working, for several years, to obtain that recognition from the Ministry of Health. On this specific point, Canada is actually behind France, not ahead of it. What does remain true, though, is the real need for practitioners on the ground, that's what came up repeatedly in the discussions at the AGM, even without a fully developed statutory framework everywhere.

The real bottleneck: degree recognition

This is where the question of equivalence becomes central, and it's the point that blocks everything, even before getting to curriculum. Within the European Union, directive 2005/36/EC sets up a system of mutual recognition of professional qualifications: a degree obtained in one member state can, under certain conditions, be recognized in another. In theory that eases mobility, but osteopathy isn't a profession harmonized at the European level (unlike doctors or pharmacists), so each state keeps wide discretion. Outside the EU, it's even heavier: the Osteopathy Board of Australia, for instance, has set up a specific assessment pathway for "Overseas Qualified Osteopaths," with exams and case-by-case checks.

In other words: today, a French osteopath who wants to settle in Australia or Canada has to go through a long and uncertain equivalence procedure, diploma in hand. A programme that would let a student obtain the host country's degree directly, by genuinely studying their final year of training there, short-circuits the problem at the root instead of working around it afterward.

The idea I'm putting on the table

Here's where I've landed. In France, we train over 5 years and 4,860 hours, one of the most comprehensive curricula in the world, worth repeating. Why not build, at the end of the bachelor's stage (so before the 4th year, the first year of the master's), a real mobility programme for volunteer students, toward countries facing osteopathic workforce shortages?

Not a few weeks of observation: a full academic year, at a partner school, with two possible outcomes depending on the country and the student's preference, obtaining the local degree on-site (which would solve the equivalence problem along the way, since there'd be nothing left to get recognized), or coming back to finish their training in France. We could even go further with a cross-border fifth year: a thesis co-supervised by two schools, in two different countries, a way to produce comparative research on a profession that badly needs it.

What already exists (and why it isn't enough)

I checked before writing this, because it would be a shame to propose something that already exists without knowing it. There are mobility schemes for osteopathy students in France, but none of them match what I'm describing.

The OSEAN network (Osteopathic European Academic Network) brings together about thirty partner schools, including CSO Paris, for short exchanges, from one week to one month. Useful for discovering other practices, but it doesn't replace a full year of study.

"Classic" Erasmus exchanges between osteopathy schools exist too: IdHEO Nantes, for example, has a long-standing partnership with Helsinki Metropolia University, allowing stays of 3 months to a year. But the student stays enrolled and keeps paying tuition in France, and comes back with a simple "Europass Mobility" note added to their diploma supplement, not a foreign degree, and no real option to settle there afterward.

What doesn't exist, as far as I know, is a pathway that genuinely leads to a degree issued by the host country, with a concrete possibility of practicing there afterward. That's precisely the blind spot I want to fill.

I'm not kidding myself

This isn't a ten-day project, and I'd rather say that plainly than sell a miracle solution. Curricula that don't resemble each other from one country to the next would need to be harmonized, ours, very clinical and tightly supervised, has little in common with Anglo-Saxon programmes often attached to general universities. Schools, professional unions and regulatory authorities, on several continents, would need convincing to work together on an issue where everyone has their own interests. And whatever happens, degrees issued under this scheme would still need to be recognized, which brings us right back to the starting problem, except more complex, since it would need to be solved upstream rather than downstream.

Why it's worth it anyway

I think this kind of programme could serve a second purpose, almost more important than the first: speeding up, in some countries, the legal recognition of the profession itself. Luxembourg is a good example of what this kind of effort takes. The profession was first governed there by a grand-ducal regulation in 2017-2018, in connection with ALDO. In 2021, the Constitutional Court ruled that the matter fell under the law rather than regulatory power alone, which sent the issue back to Parliament. A bill (n° 8108) was finally passed by the Chamber of Deputies on June 29, 2023, and published in the Mémorial the next day. So that's more than six years, between the first text and a stable legal framework, for a country of under 700,000 people. A structured academic partnership, with students genuinely coming to train and potentially settle, carries weight in that kind of process, it gives authorities negotiating a profession's recognition a concrete argument: we have trained professionals, ready to go, all that's missing is the framework.

Who's taking this on?

I've already been asked this question, and whoever asked it already half-knew the answer: a project like this doesn't get decided from a practice in Yutz.

I'll say it anyway, plainly: I'm happy to take it on, if enough people feel strongly enough about it that we can move forward together. I don't have a polished file, no funding plan, no list of schools already on board. What I have is an observation many of you already live with day to day, the conviction that student mobility is the right lever to act at the source rather than subsidize the problem after the fact, and the will not to just watch it happen.

If you're a student, a teacher at an osteopathy school, a member of a professional union, head of an organization abroad, or simply an osteopath living through the same thing I am, on either side of the problem, write to me. I'll also be at the Osteopathic International Alliance (OIA) annual general meeting in Paris on November 5, 2026 (Maison de la Chimie): if you're there, let's talk directly.