Japan’s primary care system is evolving from a specialist-dominated model to one incorporating board-certified family physicians and generalist training pathways. However, the system remains fragmented, with limited integration of multi-professional teams. Primary care due to legal and systemic barriers, including the requirement for physician referrals and limited training for autonomous practice. Drawing on international evidence, this paper examines the potential role of physiotherapists as first-contact practitioners (FCPs) and advanced practice physiotherapists (APPs) within Japan’s evolving primary care system, with particular attention to system integration, workforce capacity, and care for musculoskeletal and chronic conditions. Studies demonstrate improved clinical outcomes, patient satisfaction, operational efficiency, and cost-effectiveness with physiotherapy-led models. FCPs reduce physician workload, medication use, and diagnostic imaging, while enhancing patient self-management and adherence to guidelines. However, challenges such as role ambiguity, diagnostic uncertainty, and inadequate funding hinder effective integration. Addressing these barriers requires legislative reform, comprehensive training, role clarity, and improved inter-professional collaboration. For Japan, embedding physiotherapists in multidisciplinary primary health care could support integrated community care, addressing the needs of an aging population and fragmented services. This transition necessitates redefining physiotherapy roles, expanding the scope of practice, and aligning with chronic care models. Coordinated policy initiatives on funding, training, and regulation are essential to develop multi-professional primary care teams and optimize patient outcomes. Lessons from international models provide valuable insights for advancing physiotherapy’s role in Japan’s primary care system.
Stephen Peckham (2026) studied this question.