In 2005, Nicholls and Larmer argued in this journal that the culture of physiotherapy practice in New Zealand was undergoing radical transformation brought on by the rapidly changing economy of healthcare. In 2007, a paper by Reid and Larmer picked up on many of these arguments in its analysis of the changing face of private practice in New Zealand. Since that time, there is evidence that the profession is beginning to take stock of its position and explore new directions. This paper expands on our earlier writing to further examine some of the issues raised and outline some of the challenges now emerging for physiotherapists. We consider the impact of our ageing population on workforce reform, shifting governmental priorities and the raise of new public health, and finally the effect these changes are having on education and practice.