When algorithms don’t care: physiotherapy and the post-professional turn

Author: David A. Nicholls, MA, PhD, SFHEA 

AIM

This paper asks what the rapid growth of artificial intelligence, predictive algorithms and other forms of technological disruption might mean for physiotherapy as a profession, rather than simply how physiotherapists might use new technologies.

Nicholls develops an earlier argument that physiotherapy is entering a “post-professional” era: a gradual decline in the power of established professions to control how their work is organised and delivered. Drawing particularly on Foucault and Deleuze, he proposes a further transition towards what he calls a “Society of Indifference”, where algorithms increasingly make decisions previously left to professionals or individual consumers. 

This is a conceptual and sociological argument rather than an empirical study testing whether these changes will occur. Its contribution lies in offering a theoretical framework through which physiotherapists might interpret changes already taking place around digital healthcare, AI, professional expertise and the organisation of rehabilitation.

METHODS

There is no conventional empirical methodology, sample or outcome measurement. Nicholls constructs an argument by bringing together literature from the sociology of professions, political economy, philosophy, digital health and physiotherapy.

The paper builds particularly on Foucault’s societies of discipline and Deleuze’s societies of control. Foucault is used to understand how institutions such as hospitals, universities, professional regulation and clinical expertise historically helped create and sustain professions such as physiotherapy. Deleuze provides a framework for understanding the later shift towards more dispersed forms of control based around markets, individual choice, continuous monitoring and consumerism.

Nicholls then argues that recent developments require another conceptual step. He draws on literature concerning algorithms, Big Tech, surveillance, digitalisation and changing consumer behaviour to propose the “Society of Indifference.”

The paper also uses Flok Health, an AI-based musculoskeletal service in the UK, as a contemporary case through which to illustrate this argument. Flok is presented as particularly significant because its stated ambition extends beyond supporting clinicians: assessment, diagnosis, treatment and discharge can occur through an automated pathway without routine human clinician involvement. 

The Flok example is illustrative rather than a formal empirical case study. Some performance figures discussed in the paper come from company-reported media material, and Nicholls explicitly notes that raw data supporting these claims were not publicly available for scrutiny.

FINDINGS

Nicholls’ central argument begins with post-professionalism. He describes this as neither the disappearance of physiotherapists nor the sudden death of the profession, but a gradual movement of professional knowledge, authority and decision-making towards other actors and systems. 

He identifies three interconnected forces driving this transition.

The first is the atomisation of health under late-stage capitalism. Health and the body have increasingly been divided into numerous products, measurements and services: wearables, fitness platforms, online advice, wellness services, direct-to-consumer testing and many other markets. Physical rehabilitation consequently becomes something that can increasingly be purchased or accessed outside conventional physiotherapy.

The second is the unbundling of professional goodness and expertise. Healthcare professions historically derived authority partly from assumptions that professionals possessed specialised knowledge and could be trusted to use it in the public interest. Nicholls traces how this position has been challenged from different directions: through criticism of professional monopolies and paternalism, growing emphasis on patient expertise and choice, interprofessional practice, managerial oversight and the democratisation of previously specialised knowledge.

The third is digitally mediated technological disruption. Technologies can increasingly separate tasks from the professionals who historically performed them. In physiotherapy this potentially includes education, exercise prescription, monitoring, triage, assessment and clinical decision-making.

Flok Health makes this possibility concrete. Nicholls highlights the significance of an AI service capable of providing much of an MSK pathway without a physiotherapist continuously involved. The conceptual question therefore moves beyond whether AI can help physiotherapists towards whether some forms of physiotherapy can be organised without physiotherapists at their centre.

Nicholls places this transition within a longer history of changing forms of power. Foucault’s “society of discipline” depended heavily on institutions and experts: hospitals, clinics, universities, examinations, regulation and professional boundaries. Deleuze’s later “society of control” described something more dispersed, flexible and continuous, compatible with consumerism and an emphasis on individual choice.

The proposed Society of Indifference adds another change. Nicholls argues that digital systems increasingly promise to relieve people of the burden of choosing altogether. Recommendation algorithms already anticipate what music, videos, products or information someone might want. Applied to healthcare, predictive systems could increasingly select or recommend pathways using large quantities of data without requiring either traditional professional authority or extensive individual deliberation.

“Indifference” therefore refers less to a lack of compassion than to a changing relationship with human judgement and subjectivity. The system can function increasingly independently of whether decisions originate in the judgement of a professional or the reflective choices of a patient.

For physiotherapy, Nicholls sees a deeper issue than automation replacing individual tasks. If routine components of practice become automated, delegated or directly available to consumers, the pathways through which physiotherapists historically acquired expertise may also change. A profession that loses routine work may eventually find it harder to reproduce the experience, institutions and professional authority from which advanced expertise emerged.

Yet the argument also creates a paradox. Human professional expertise may remain important precisely when automated systems, self-management and consumer choice reach their limits. Nicholls therefore asks what happens if society simultaneously weakens the professional infrastructure that would otherwise provide this expertise.

His proposed response is deliberately different from defending physiotherapy’s professional territory. He suggests identifying the “intensities” underlying physical therapy—including movement, touch, rest and other forces that have sustained physical therapeutic practices long before the modern profession existed—and reorganising physiotherapy around these. His most radical proposal is that physiotherapists might stop trying primarily to protect ownership of their expertise and instead share it as widely as possible: effectively, “giving physiotherapy away.”

LIMITATIONS & INTERPRETIVE CAUTIONS

The paper’s strength lies in bringing several bodies of thought together to provide a different lens through which current developments in physiotherapy can be examined. AI is situated within much longer changes in professional power, capitalism, consumerism, expertise and healthcare organisation. This makes visible questions that a narrower discussion about whether AI improves efficiency or clinical outcomes might leave untouched.

The Society of Indifference is a proposed conceptual framework, however, rather than an empirically established stage of social development. Its value therefore depends on the coherence and explanatory usefulness of the argument and on how well future developments fit it.

Nicholls himself recognises important boundaries. Much of the research informing theories of discipline, control and professional change concerns medicine and high-income countries. Post-professionalisation may therefore develop very differently between professions, countries and healthcare systems.

The Flok example also carries an important evidential boundary. It demonstrates that substantial components of an MSK pathway can now be organised around an AI system, making it useful for Nicholls’ conceptual argument. The reported clinical and service outcomes cited in the paper were partly company-reported and lacked publicly available raw data, so they provide a much weaker basis for judging how effective this model of care actually is.

Some parts of the argument consequently function more as possible trajectories than demonstrated futures. Whether automation ultimately reduces professional expertise, creates different forms of expertise, changes physiotherapists’ roles, or coexists with strengthened human practice remains open. Nicholls’ contribution is principally to make these possibilities visible and connect them to broader transformations in professional power.

IN PRACTICE

For physiotherapists, this paper encourages a different starting question about AI.

Instead of asking only “How can AI help me perform physiotherapy?”, it raises the question: “Which parts of what I currently do actually require a physiotherapist?”

Exercise programmes, information, progress monitoring and elements of clinical reasoning may become increasingly easy to reproduce and distribute. If they do, professional value cannot automatically be assumed simply because these activities have historically belonged to physiotherapists.

More broadly, Nicholls invites us to separate physical therapy from the physiotherapy profession. Humans used movement, touch, physical activity, rest and other physical approaches to health long before a regulated profession called physiotherapy existed. The survival of those practices therefore does not necessarily depend on preservation of the profession in its current form.

This creates an interesting tension around professional identity. Protecting physiotherapy’s boundaries may preserve professional status, but it may also conflict with making useful rehabilitation knowledge widely accessible. Nicholls’ suggestion of “giving physiotherapy away” asks whether the profession could define its contribution through what it enables in society rather than what it exclusively owns.

For education, the argument raises another useful question: what expertise should we cultivate when information and routine clinical processes become increasingly reproducible? If some current tasks become automated, curricula built mainly around those tasks may become increasingly fragile. Nicholls instead encourages attention to aspects of physical therapy worth sustaining and to the social conditions required for meaningful human expertise to continue developing.

The paper ultimately offers fewer answers than questions, and that seems consistent with its purpose. Its contribution is to shift AI from being understood simply as another clinical tool towards being considered as part of a broader transformation in who produces healthcare knowledge, who makes decisions, who delivers care, and how much control professions retain over any of these things.

That perspective makes the future of physiotherapy a question not simply of adapting to new technology, but of deciding what aspects of physical therapy are worth carrying forward—and how widely we are prepared to share them.

Reference

Nicholls, D. A. (2026). When algorithms don’t care: Physiotherapy and the post-professional turn. Physiotherapy Theory and Practice. Advance online publication. https://doi.org/10.1080/09593985.2026.2718438