A Physiotherapist’s Reflection on Institutional Racism in Health Education: When Systems Exclude

Starting a new teaching role at a major Australian university as a clinical tutor should have been a straightforward, exciting step in my career. I expected to be challenged in the classroom, to support students, and to grow in a new academic environment. What I didn’t expect was how the process itself would become a lesson—one that would shift my understanding of systemic inequities from theory into lived experience. I had encountered the concept of institutionalised racism before, mostly in academic contexts, but it wasn’t until I navigated the onboarding process as a foreign-trained professional that the reality of it became tangible. This post is a reflection on what that experience revealed.

As a physiotherapist educated and experienced overseas, I had already undergone thorough and costly credentialing through AHPRA (Australia’s Health Practitioner Regulation Agency) and APC (the Australian Physiotherapy Council)—the official institutions responsible for assessing the qualifications, clinical competence, and eligibility of internationally-trained physiotherapists. My qualifications had already been reviewed and accepted.

Yet despite that formal recognition, before I could begin work as a sessional academic tutor in a physiotherapy department, I was required to complete an additional qualification verification through a specific pathway at my own expense—even though my credentials had already been checked and approved. There was no alternative route or reimbursement available, and this requirement applied only to foreign-trained professionals. Australian-trained colleagues were exempt.

Alongside this, mandatory health screening checks had to be completed before starting, which is a standard requirement across health settings. I had already completed similar checks in France and the UK. However, the university’s policy required Australian evidence, and the internal health service had no available GP appointments for several months. Consequently, I had to organise everything independently and pay out of pocket—for two GP appointments and laboratory tests.

In total, the pre-employment compliance cost me over $620 AUD. Considering I was rostered for only three 3-hour shifts that month, I effectively worked for free the first month—just to meet the administrative requirements for the role.

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Unintended Consequences of a System Built for Some, Not All

These challenges didn’t stem from individual bias or intentional exclusion. They arose from policies designed around a narrow default: Australian citizens, trained locally, with Medicare access and domestic documentation.

This is what makes the experience an example of institutionalised racism—a term that refers to how seemingly neutral systems, policies, and procedures can disadvantage specific groups simply because they were not designed with them in mind. In this case, a foreign-trained professional faced duplicated checks, restricted access, and extra financial burden—for no other reason than the system failing to account for different contexts in its policies.

This made me wonder: if I had this experience, even while benefiting from several layers of privilege—I am white, young, Western, and fluent in English—
– How much harder is it for others who don’t share these privileges?
– And what about those without the financial means to absorb such costs?
– What opportunities might they lose simply because the system makes access harder from the outset?

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From Reflection to Action: How Systems Can Do Better

Many universities and health institutions proudly state their commitment to equity, diversity, and inclusion. But unless those values are embedded in their operational policies, they risk reinforcing the very inequities they aim to challenge.

This reflection isn’t about blaming individuals or institutions—it’s about recognising where systems fall short, especially for people who don’t fit into the default profile. It’s a call to examine how policies that appear “neutral” can still result in unequal outcomes.

To do better, institutions need to listen to lived experiences, invite meaningful feedback, and reflect on the unintended consequences of their current processes. Improvements might include streamlining procedures, avoiding duplication, ensuring cost equity between domestic and international staff, and designing systems that are flexible, transparent, and inclusive from the start.

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Decolonising Health Education Starts With Us

Institutional racism isn’t always loud or obvious. Often, it’s embedded quietly in outdated policies, unexamined assumptions, and standard procedures that reflect only a narrow segment of society. Addressing it requires openness, humility, and a genuine commitment to change.

Decolonising health education is not a symbolic gesture. It’s a long-term, active commitment to redesigning systems so they no longer exclude by default. It begins with asking whose needs are currently met—and whose are overlooked.

It starts with reflection, and continues through action.