thetasmanianphysiotherapy workforce areportresultingfromthetasmanianalliedhealthand...
TRANSCRIPT
THE TASMANIAN PHYSIOTHERAPY
WORKFORCE
A report resulting from the Tasmanian Allied Health and
Oral Health Workforce Study
A collaborative project between
The University Departments of Rural Health
Tasmania, Northern Rivers and Tamworth
Tasmanian allied health and oral health workforce study
The Tasmanian Physiotherapy Workforce
January 2010
With funding support from the Department of Health and Human Services, Tasmania
Authors
Mrs Shelagh Lowe, Associate Lecturer – Rural Allied Health, University Department of Rural Health Tasmania Locked Bag 1372, Launceston TAS 7250 Correspondence: [email protected]
Ms Sheila Keane, Senior Lecturer in Allied Health (Physiotherapist), Northern Rivers University Department of Rural Health, Lismore, NSW
Tasmanian allied health and oral health workforce study i
Table of Contents
Tables ..................................................................................................................................... ii
Figures .................................................................................................................................... ii
INTRODUCTION ................................................................................................... 1
METHODS .......................................................................................................... 2
Development of the survey tool ............................................................................................. 2
Survey implementation and subject recruitment ................................................................... 3
RESULTS FOR THE PHYSIOTHERAPY WORKFORCE ................................................ 4
Response rate ....................................................................................................................... 4
Geographic distribution of the sample ................................................................................... 4
Demographic profile ............................................................................................................... 5
Service Delivery ..................................................................................................................... 7
Length of time in current position .......................................................................................... 8
Outreach, home visits and on-call service delivery ............................................................... 9
Retention ............................................................................................................................... 9
Job satisfaction .................................................................................................................... 11
Recruitment ......................................................................................................................... 12
Retention – work/life balance .............................................................................................. 13
Retention – type of work/clients ........................................................................................... 15
Retirement in the physiotherapy workforce in Tasmania .................................................... 17
Continuing professional development (CPD) ...................................................................... 18
Student supervision ............................................................................................................. 20
DISCUSSION ..................................................................................................... 20
CONCLUSION ................................................................................................... 23
REFERENCES ................................................................................................... 25
Tasmanian allied health and oral health workforce study ii
Tables Table 1: Distribution of respondents by RRMA classification .................................................... 5
Table 2: Distribution by ASGC-RA ............................................................................................ 5
Table 3: Distribution by Tasmanian Health Region ................................................................... 5
Table 4: Demographic descriptors ............................................................................................. 6
Table 5: Mean and median of years of experience by region ................................................... 7
Table 6: Mean and Median of length of time in current position by region ................................ 8
Table 7: Number (%) of physiotherapists engaged in outreach, on-call and home visit service
delivery ...................................................................................................................................... 9
Table 8: Intention to leave job within next 2 and 5 years by region ........................................ 10
Table 9: Intention to leave position by region and by work sector .......................................... 10
Table 10: Average number of hours worked per week by region ............................................ 13
Table 11: Number of respondents working paid, unpaid overtime & on call hours by
profession ................................................................................................................................ 14
Table 12: Student supervision and supervision training by region .......................................... 20
Figures Figure 1: Age distribution ........................................................................................................... 6
Figure 2: Age distribution grouped ............................................................................................ 6
Figure 3: Years of experience of respondents .......................................................................... 7
Figure 4: Distribution by service delivery sector ........................................................................ 7
Figure 5: Length of time in current position of the physiotherapy workforce sample ................ 8
Figure 6: Number of physiotherapy respondents intending to leave current position ............... 9
Figure 7: Number of respondents and job satisfaction ratings ................................................ 11
Figure 8: Job satisfaction in the public and non-public sectors as a proportion within each
response category ................................................................................................................... 11
Figure 9: Intention to leave in relation to job satisfaction (proportion of respondents) ............ 12
Figure 10: Frequency of reasons cited why attracted to current position ................................ 12
Figure 11: Agreement with statements regarding service gaps and staff allocation* ............. 15
Figure 12: Agreement with statements regarding the type of work* ....................................... 16
Figure 13: Responses to the statement: "You feel professionally isolated" ............................ 16
Figure 14: Perception of professional isolation when working in sole practice ....................... 17
Figure 15: Age distribution of respondents planning to stay vs. those planning to retire from
their current position ................................................................................................................ 17
Figure 16: Uptake of a variety of modes of CPD in the past 12 months ................................. 18
Figure 17: Barriers to accessing CPD ..................................................................................... 19
Figure 18: Satisfied with access to CPD and colleagues for professional support ................. 19
P a g e | 1
Introduction
Allied health professionals make up a substantial proportion of the health workforce and make a significant contribution to the health and well being of the Australian population. About 18% of the Australian health workforce is allied health professionals(1).
A key to improving the health of Australian communities is well planned and integrated health services. Allied health professionals are essential members of the health team, providing a wide range of therapeutic and diagnostic models of care in both the public and the private health care sectors. Physiotherapists comprise part of the allied health workforce. In acute care, physiotherapists contribute to speedy discharge from hospital and to the prevention of readmissions, and are key team members in managing chronic conditions such as diabetes. Physiotherapists, as part of the allied health workforce, often work in multidisciplinary models of care, with an emphasis on preventative services and are well placed to provide interprofessional health and education and health promotion services.
Planning successful health services that meet the needs of disparate metropolitan, rural and remote communities are improved by accurate, detailed and contemporary workforce information enabling a match of health need to workforce supply. Workforce data is robust for medical practitioners(2) and for the nursing workforce (AIHW, 2008) including many peer reviewed publications and major government reports(3). In contrast there is very little data providing information about the current physiotherapy workforce, particularly in rural areas. Available studies are dated, based on a small sample size, geographically limited or report important inconsistencies(4). The Australian Institute of Health and Welfare released workforce reports in 2006 for the physiotherapy labour force based on data collected in 2002-2003. Reports by the AIHW are produced on a whole of state basis, with no breakdown of distribution across the state. The AIHW physiotherapy labour workforce report released in 2006 did not include data from Tasmania.
The Department of Health and Human Services undertook a comprehensive survey of the Tasmanian allied health workforce in 2001, producing workforce reports for allied health and the individual disciplines in 2003. These reports indicated the high turnover of staff within the public sector in Tasmania with major recruitment and retention issues. The reports focused on public sector employees only, so provided limited data for undertaking any comprehensive workforce planning for integrated health services in the primary and acute care, to meet the needs of the Tasmanian population.
The Tasmanian Primary Health Services Plan quotes data on the distribution of the allied health workforce in Tasmania (page 32). The data quoted comes from the Tasmanian Allied Health Workforce Report produced by Services for Australian Rural and Remote Allied Health (SARRAH) in 2004(5).
It is well known that there is a national shortage of allied health professionals, including physiotherapy, and that this problem is worse in rural areas(6). As the population density diminishes, the per capita reduction of allied health services also reduces. This reduction in allied health workforce per capita with increasing rurality has implications for meeting the health care needs of populations in increasingly remote areas. The limited ability to train in the allied health and oral health professions in Tasmania impacts on the ability for Tasmanian students to train as allied health or oral health professionals, also affecting the ability to access ongoing
P a g e | 2
professional development. At the time of this study, the ability to qualify as a physiotherapist was not available in Tasmania. It is understood that the University of Tasmania and Department of Health and Human Services are currently in discussion with regards to enabling a graduate entry Masters Physiotherapy program to be undertaken within Tasmania.
In 2006, the Australian Health Workforce Officials Committee advised that new projects must take into account future workforce requirements, the distribution and work contexts of existing workforce, training arrangements and workforce roles and scope of practice. The absence of data profiling the allied health workforce as whole and individual disciplines such as physiotherapy renders such analysis impossible.
The Tasmanian allied health and oral health workforce study undertook to identify the characteristics of the entire rural allied health workforce in Tasmania across all service sectors. This report will specifically focus on the results of the study obtained for the Physiotherapy workforce in Tasmania. Whilst a considerable proportion of physiotherapy services are funded by the Department of Health and Human Services, private, federally funded and non government organisations also account for a substantial proportion of physiotherapy service delivery. Service sectors have interactive effects, particularly in rural areas where practitioners can work in more than one health sector. Limited access in one sector can sometimes be compensated or supplemented through service provision in another sector.
Methods
Development of the survey tool The survey instrument used in this study was initially developed and piloted by the University Department of Rural Health, University of Newcastle. The results of the pilot study were presented at the 2006 National SARRAH Conference(7) and published in the Australian Journal of Rural Health in 2008(4). It was a recommendation of the 2006 and 2008 National SARRAH Conference that the study be rolled out nationally through the network of University Departments of Rural Health.
The survey instrument was designed in consultation with clinicians in the public and the private health care system, Allied Health academics from 3 Australian universities and public health care administrators. An extensive literature review was undertaken to identify key areas relating to allied health workforce practice, recruitment, retention, professional development and support (8-11). Questions on the survey tool were modified and added to reflect literature findings. Included within the content of the questionnaire were items which match that of workforce minimum data set collections undertaken by the Australian Institute of Health and Welfare.
The revised survey tool was validated with a number of clinicians within rural NSW who volunteered to complete it and provide feedback. Taking 15 minutes to complete the survey, the report from those evaluating the questionnaire was that it was relevant to their concerns. Concurrent validity was assessed by comparing the content of the survey items to that of the 1999 SARRAH survey. Items on the questionnaire matched 89% of the content covered in the SARRAH study with 39 added items that were not included in the SARRAH data (12)
The final survey tool used in the Tasmanian study is attached.
P a g e | 3
Survey implementation and subject recruitment Ethics approval to undertake the study was obtained from the Tasmanian Social Science Human Research Ethics Committee.
To locate the physiotherapists for the distribution of the survey instrument a multipronged process was taken. Contact was made with Tasmanian Physiotherapy Registration Board and with the Tasmanian branch of the Australian Physiotherapy Association to assist in marketing and distributing information about the study to encourage participation. The Tasmanian Principal Allied Health Advisor provided access to the allied health survey through email distribution to physiotherapists employed by the Department of Health and Human Services.
Physiotherapists are not currently able to obtain their qualifications within Tasmania. The lack of training within Tasmania impacts on the ability of Tasmanian students to undertake training in physiotherapy as well as on the ability to access ongoing professional development – both formal and informal – for qualified physiotherapists. For this purpose Hobart has been included in this study regardless of the rural classification structure being used to analyse the resultant data.
The UDRH Tas developed an online option for responding to the survey. The convenience and cost advantages of the online response option are considerable: online responses are immediately entered into the database and the cost of administrative support is considerably reduced. As a security consideration, a system whereby each participant was required to have a unique URL in order to access and complete the online survey was utilized for the Tasmanian study.
Electronic distribution was implemented through the Department of Health and Human Services database. An email merge system was implemented whereby each email recipient received a copy of the information relating to the survey with a unique URL in order to access the online system.
Hardcopies of the survey were distributed to all physiotherapists registered in Tasmania where electronic distribution was not an option for privacy reasons. Participants were also asked to pass information onto work colleagues. The Professional association and workplaces were used to market the study to their members and employees. Practitioners who had not received a copy of the survey in the mail or by electronic methods were asked to contact the UDRH-Tas to receive a unique URL to access the online system, or to be posted a hardcopy of the survey.
A final reminder was widely broadcast through email channels, utilizing the professional association, DHHS and UDRH networks.
Survey data were entered into a secure electronic database either by direct online responses from participants or by administrative staff employed by the UDRH – Tas in the case of returned hardcopy surveys.
A total of 1193 records were entered into the database. Data was subsequently cleaned to eliminate duplicate records or ineligible records. 11 records were eliminated from those working outside of Tasmania. Incomplete records were identified and where possible missing data were imputed from existing data.
A total of 11 records were eliminated leaving a sample size of 1182 respondents. 162 of these respondents indicated that they were working as physiotherapists. These records are included for the purposes of this report.
Statistical analysis was conducted using SPSS versions 16 and 17.
P a g e | 4
Results for the Physiotherapy Workforce
After data cleaning a total of 162 physiotherapy respondents were included in the sample for statistical analysis.
Response rate Response rates have been calculated using the following method.
Hardcopies of the survey form were mailed to registered physiotherapists using the Tasmanian Physiotherapy Registration Board mailing lists. Only those practitioners with Tasmanian registration addresses were included in the study. As registration is a requirement to practice as a physiotherapist in Tasmania it is possible to calculate the response rate for the physiotherapy workforce using the number of surveys distributed by those returned. Physiotherapists may have received information about the survey from a number of sources, both through the supply of the hard copy of the survey form, electronically through the DHHS distribution list and through marketing by the University and the Professional Association. However, participants were encouraged to provide only one response. The data was checked and cleaned of any duplicate records.
332 surveys had been distributed to physiotherapists listed by the Registration Board. The response rate was 50.31%.
It should be noted that according to the Australian Bureau of Statistics 2006 Census Data, 269 physiotherapists indicated that they were currently working as physiotherapists within Tasmania1. It is known that there are physiotherapists that had Tasmanian addresses included on the registration list that are not currently working as physiotherapists or have left the state. If the ABS figures for physiotherapists within Tasmania were to be used, it could be argued that the response rate for the survey was 60.22%.
Geographic distribution of the sample Respondents to the survey were asked to provide their work postcodes. Using the work postcodes supplied, respondents were also grouped according to the Rural, Remote, and Metropolitan Areas Classification and Australian Standard Geographic Classification for Remote Areas (RRMA) systems to determine geographic distribution. Using the Australian Standard Geographic Classification Remote Areas (ASGC-RA) codes for defining rurality no area within Tasmania is classified as a major metropolitan area. It should be noted that from 2009, the ASGC-RA system for classifying rurality has been adopted by the Australian Government for administration of rural health programs.
Other work sectors included federally funded programs such as Regional Health Services, More Allied Health Services; non-government organisations, higher education and other areas such as Defence and consultancies.
It should be noted that a number of respondents worked in more than one sector, hence the higher number of responses than respondents. The total column does provide the total number of respondents in each RRMA zone.
1 Sourced from Australian Bureau of Statistics Census CData Online, 2006 Census of Population and Housing, Hhttp://www.abs.gov.au/CDataOnlineH, accessed 26 November 2009
P a g e | 5
Table 1 shows distribution by RRMA zones. Tasmania does not have any region that is classified as RRMA 2. Hobart is classified under the RRMA system as a capital city, putting it in the same zone as Sydney and Melbourne. Table 1: Distribution of respondents by RRMA classification
Public (State) Private Other N
A capital city (RRMA 1) 46 40 14 85 Large rural centre (RRMA 3) 23 19 4 39 Small rural centre (RRMA 4) 15 6 2 20 Other rural area (RRMA 5) 10 8 4 17 Other remote area (RRMA 7) 0 1 0 1 Total 94 74 24 162
Under the ASGC-RA system, Hobart is considered as ‘inner regional’. With a lack of availability of training to qualify as a physiotherapist, Hobart will be considered as rural for future work where data from other states is analysed for comparative purposes. As with RRMA the total column provides the number of respondents in each geographic zone. Table 2: Distribution by ASGC-RA
Public (State) Private Other N
Inner Regional 72 58 20 127 Outer Regional 22 15 4 34 Very remote 0 1 0 1 Total 94 74 24 162
Using the work postcodes provided, respondents were grouped into Tasmanian health service regions within Tasmania using the Australian Bureau of Statistics Statistical Subdivision from the ABS Postal Area 2006 Concordance2. Table 3: Distribution by Tasmanian Health Region
Public (State) Private Other N
Southern 52 42 16 94 Northern 26 22 6 43 North West 16 10 2 25 Total 94 74 24 162
Demographic profile Respondents were asked to provide their year of birth. All respondents provided data for this question (n=162). The mean age of the sample was 43.32 years (SD 12.724), with ages ranging from 22 to 72 years. Respondents age was calculated by taking the year of birth from the year that the data was collected (2008). The median age of the sample is 42 years, a non-significant skew in the data. 2 Australian Bureau of Statistics 2007, 2905.0.55.001 – ABS Postal Area Concordances, accessed from Hhttp://www.abs.gov.au/AUSSTATS/[email protected]/39433889d406eeb9ca2570610019e9a5/5942283858e38743ca25730c00009f2e!OpenDocumentH, access date August 2008.
P a g e | 6
Figure 1: Age distribution
Figure 1 illustrates the range of ages of the sample from the physiotherapy workforce, with a peak at age 37. Figure 2 shows the proportions of the physiotherapy sample aged below 30 and over 45. Figure 2: Age distribution grouped
19%
35%
46% Under 30
30‐44
over 45
No respondent to the survey from the physiotherapy workforce identified as being of Aboriginal or Torres Strait Islander background.
Table 4 provides demographic descriptors of the physiotherapy workforce sample including gender and marital status. Table 4: Demographic descriptors
Profession Female Partnered Dependents
Southern 80 85% 73 78% 38 40% Northern 33 77% 28 65% 21 49% North-West 19 76% 15 60% 10 40% Total 132 81% 116 72% 69 43%
Of the 116 respondents from the physiotherapy workforce who were in a married or de facto relationship, 71 (61.2%) had partners who were working full-time, 34 (29.3%) part-time and 11 (9.5%) were not working.
Respondents were also asked to provide the year in which they obtained their allied health or oral health qualifications. The years since they had qualified was calculated by taking the year of qualification from the year of data collection (2008). This data is
P a g e | 7
reported as ‘years of experience’. The mean ‘years of experience’ of the physiotherapy sample was 21 years with a range from new graduates to 51 years. Figure 3: Years of experience of respondents
Table 5 provides shows the distribution of years of experience by the physiotherapy sample. The skew is not significant for whole sample, or in the south or north regions. However, there is a significant skew in the North West where the average number of years experience was 16 years but half the sample size had 12.5years or less. Table 5: Mean and median of years of experience by region
Profession N Mean (SD) Median (Skew) Significance
Southern 88 23. (14) 23 (0.159) Not significant Northern 43 19 (13) 17 (0.186) Not significant North West 24 16 (14) 12.5 (1.056) SIGNIFICANT Total 155 21 (14) 19 (0.291) Not significant
Service Delivery Respondents to the survey were asked to nominate which health sector they work in. Figure 4 displays the distribution of the physiotherapy sample across the work sectors. Figure 4: Distribution by service delivery sector
0% 20% 40% 60% 80% 100%
Southern
Northern
North West
Total
Public
Private
Other
Mixture
74 respondents were working 100% of their time in the public sector. 51 respondents worked exclusively in the private sector. A further 25 respondents were working in a
P a g e | 8
mixture of service delivery sectors. Respondents working in the public sector were asked to nominate which government department they were working for. Of the 94 respondents working in the Public Sector, 6 (5 in the South and 1 in the North) did not specify which department they work for. Of the 88 respondents who provided information for this question all were working for the Department of Health and Human Services.
9 respondents worked 100% of their time in federally funded programs, in non-government organisations or in ‘other’ areas such as the consultancies or not working due to family commitments.
The North West region had a higher proportion of its sample working in the public sector 100% of the time, and the smallest proportion of physiotherapists working across multiple sectors. The southern region had the highest proportion of the sample working 100% of the time in “other” areas including federally funded programs, NGOs and other areas.
Length of time in current position 159 respondents provided information on how long they had been in their current position. The median length of time in the current position for the Tasmanian physiotherapy workforce was 5 years (Significant skew of 1.616).
The southern region sample of physiotherapists had the longest average length of time in their current position (7.45years) when compared with their northern counterparts, with the north-west region having the lowest average length of time in position (5.79 years). However across all regions the samples are significantly skewed to fewer years in current position with 50 percent of the sample in the south having worked in their current position for 6 years or less. This figure was 4 years or less in the north and northwest of the state. Table 6: Mean and Median of length of time in current position by region
Professions N Mean (SD) Median (Skew) Significance
South 93 7.45 (7) 6 1.295 SIGNIFICANT North 41 6.29 (7) 4 1.627 SIGNIFICANT North West 25 5.79 (7) 4 3.004 SIGNIFICANT Total 159 6.89 (7) 5 (1.616) Significant
Figure 5: Length of time in current position of the physiotherapy workforce sample
P a g e | 9
Figure 5 illustrates the significant skew to fewer years in current position of the physiotherapy workforce sample.
Outreach, home visits and on‐call service delivery Twenty one percent of physiotherapists responding to the survey provided sessional outreach services to other communities within Tasmania (Table 7). 11 of the 17 respondents from the south of the state who provided outreach were working for the Department of Health and Human Services, the remainder are private practitioners. 4 of the 6 respondents from the north and 8 of the 11 physiotherapists from the northwest are DHHS physiotherapists. Table 7: Number (%) of physiotherapists engaged in outreach, on-call and home visit service delivery
Profession Home visits (%) Outreach (%) On Call (%) Total
South 44 (47%) 17 (18%) 19 (20%) 94 North 16 (37%) 6 (14%) 16 (37%) 43 North West 15 (60%) 11 (44%) 4 (16%) 25 Total 75 (46%) 34 (21%) 39 (24%) 162
Physiotherapists from the northwest region were more likely to be providing outreach and home visits than their counterparts from either the north or south of the state, with the north having the lowest proportion of respondents providing these services. However, respondents from the north of the state were more likely to be providing on call services than either of their southern or north western counterparts.
Retention 156 of the 162 respondents from the physiotherapy workforce provided information regarding their intention to leave their current position. 71 (44%) of respondents to the question intend to leave their current position within the next 5 years (Figure 6). 36% have no plans to leave. Figure 6: Number of physiotherapy respondents intending to leave current position
.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
2 years 5 years 10 years > 10 years
No plans Not specified
NA
Percen
t
Table 8 shows the intent of respondents from the physiotherapy workforce to leave within the next 5 years by region across the State. There are a higher proportion of respondents intending to leave from the north and northwest regions of the state, with 30% of respondents from the north of the state intending to leave within 2 years.
P a g e | 10
Table 8: Intention to leave job within next 2 and 5 years by region
Profession 2 years 5 years N
South 19 (20%) 19 (20%) 94 (40%) North 13 (30%) 5 (19%) 43 (49%) North West 5 (20%) 7 (28%) 25 (48%) Total 37 (23%) 34 (21%) 162 (44%)
44 of 91 (48%) physiotherapy respondents working in the public sector in Tasmania indicated that they intend to leave their position within the next 5 years. 29 of 70 (41%) of respondents from the private sector intend to leave within 5 years. For respondents working in ‘other sectors’ the figure was 9 of 20 respondents (45%).
Table 9 provides information on intention to leave position for the physiotherapy workforce by work sector and work region. Table 9: Intention to leave position by region and by work sector
Profession 2 years 5 years N
South Public 13 (26%) 8 (16%) 51 (41%) Private 7 (18%) 9 (23%) 40 (40%) Other 3 (25%) 2 (17%) 12 (42%)
North Public 10 (42%) 4 (17%) 24 (58%) Private 4 (20%) 6 (30%) 20 (50%) Other 1 (17%) 2 (33%) 6 (50%)
North West Public 5 (31%) 4 (25%) 16 (56%) Private 0 (0%) 3 (30%) 10 (30%) Other 0 (0%) 1 (50%) 2 (50%)
The north and northwest of the state have the highest proportions of physiotherapists intending to leave within 5 years, particularly from the public sector.
Reasons cited for leaving work within the next 5 years were (in order of citation frequency):
• Retirement (22) • Preferred location (18) • Better career prospects (14) • Job dissatisfaction (13) • Better income (12) • Family reasons (10) • Other (17)
The most common ‘other’ reasons given included: • Family reasons such as to start a family or children’s education • Further education or training • Changing career, profession, scene or priorities, • Work life balance • Health problems, looking to reduce stress • Management issues • Termination or completion of contracts • Moving to full time or part time position, looking for flexibility • Travel
P a g e | 11
• Looking for new challenges
Job satisfaction Due to respondents working across sectors it should be noted that the total responses from the public/private & other sectors do not add up to the grand total. The grand total represents the total number of physiotherapy respondents (N=162) to the survey. Eighty two percent of respondents were satisfied or extremely satisfied with their employment (Figure 8). Figure 7: Number of respondents and job satisfaction ratings
Job satisfaction in the public sector in Tasmania is proportionally lower as compared with other service sectors. Of the respondents that were extremely dissatisfied with their employment 63% worked in the public sector. There are a higher proportion of respondents in the private and other sectors (70%) who are extremely satisfied.
0 20 40 60 80 100 120
Dissatisfied
Neutral
Satisfied
Extremely Satisfied
Count
Total Private & Other Public (State)
Figure 8: Job satisfaction in the public and non-public sectors as a proportion within each response category
63%
72%
52%
30%
38%
28%
48%
0% 10% 20% 30% 40% 50% 60% 70% 80%
Dissatisfied
Neutral
Satisfied
Extremely Satisfied70%
Private & Other Public (State)
P a g e | 12
Consistent with the literature, there is a strong relationship between job satisfaction and intention to leave in the short term (9, 11, 14-16). A larger proportion of physiotherapists with high job satisfaction ratings planned to remain in their current jobs as compared with those with low job satisfaction. Figure 9: Intention to leave in relation to job satisfaction (proportion of respondents)
0%10%20%30%40%50%60%70%80%90%
100%
Dissatisfied Neutral Satisfied Extremely Satisfied
No plans
> 10 years
10 years
5 years
2 years
Recruitment 62 of 162 (38%) of physiotherapy respondents grew up in a rural or remote area. 80 (49%) experienced a rural clinical placement during their training. The literature discusses rural origin or rural experience during training as attractors for rural careers (17).
31 (33%) of the 94 physiotherapy respondents from the south grew up in a rural or remote region. For the north of the state this figure is 20 (47%) of 43 and on the northwest 11 (44%) of 25. The higher proportion of rural origin physiotherapists in the more rural regions of the state supports the literature.
48 of 80 of those physiotherapists who went on a rural clinical placement grew up in a metropolitan area, the rural clinical placement giving them an experience of rural practice. A total of 68% of the respondents had either rural origin or rural experience and are now working in Tasmania, which under the Australian Standard Geographic Classification Remoteness Area codes has no region considered a major metropolitan area. For the health regions within Tasmania the proportions of physiotherapists responding to the survey with either rural or remote background and/or having had a rural placement during their training was 64% for the South, 72% for the North and 76% for the North West. Rural origin and rural experience is potentially a factor to be explored when recruiting physiotherapists to work in Tasmania.
Respondents were asked to select from a number of tick box options in response to the question “What most attracted you to your current position?” The frequency count of the responses is given in Figure 11. As respondents could select as many boxes as were applicable to their circumstances the number of responses (440) to this question is more than the number of participants (n=162).
A further option was provided for narrative response.
Figure 10: Frequency of reasons cited why attracted to current position
P a g e | 13
100
49
26
30
77
23
35
17
29
10
25
19
0 20 40 60 80 100 120
Work/life balance
Climate/location
Income
Career advance
Type of work
Marriage/Partner
Raise kids
Family/Social
Come from area
Cost of living
Housing
Other
Of the 19 respondents who provided a narrative response to working in Tasmania 8 stated they were attracted by the opportunity the position gave them – to do further study, to gain experience, to have a flexible position, or to semi-retire. 4 stated the environment (rural location, wilderness, outdoor activities) and 5 by the availability of employment (no other choice), or for immigration reasons.
Retention – work/life balance The most frequently cited reason for recruitment was work/life balance. Table 10 shows the hours worked by respondents. 42 (26%) practitioners are working more than 40 hours per week. However in the North and North West the proportion of the sample that is working more than 40 hours per week rises to 40% compared with just 16% in the South. Table 10: Average number of hours worked per week by region
Profession Less than 30 hrs (%)
30‐40 hrs (%) More than 40 hrs (%)
N
South 39 (41%) 40 (43%) 15 (16%) 94 North 13 (30%) 13 (30%) 17 (40%) 43 North West 8 (32%) 7 (28%) 10 (40%) 25 Total 60 (37%) 60 (37%) 42 (26%) 162
Fifty two percent of physiotherapy respondents agreed with the statement that they were chronically short staffed. There was some variation in responses between public (75% of 88 respondents) and private (40% of 60 respondents) with regards to this statement. There was variation in the response by health service region with 41% of 94 respondents from the South, 70% of 43 respondents from the North and 60% of 25 respondents from the North West reporting they were chronically short staffed.
P a g e | 14
Respondents were also asked about staff turnover. For 18 respondents this question was not applicable. Forty five percent of the remainder (N=144) agreed or strongly agreed that there is a high level of staff turnover. Again there is some difference in the proportions between the public (59%) and private (30%) sectors. There is also a difference in the proportions between the south (30%), north (66%) and northwest (65%) regions of the state
Work/life balance is also affected by the number of hours per week working overtime or being on call. Table 11 shows the number of participants who spent some time on call or doing overtime hours. The north of the state has the highest proportion of respondents working both paid and unpaid overtime, and being on call. Table 11: Number of respondents working paid, unpaid overtime & on call hours by profession
Profession Paid Overtime (%)
Unpaid Overtime (%)
On Call (%) N
North 7 (7%) 42 (45%) 19 (20%) 94 South 8 (19%) 22 (51%) 16 (37%) 43 North West 4 (16%) 10 (40%) 4 (16%) 25 Total 19 (12%) 74 (46%) 39 (24%) 162
The median number of hours of paid overtime from the 162 respondents in the sample was 5 hours (Significant Skew of 2.120). The median number of hours of unpaid overtime was 4 hours (Significant Skew of 2.879).
The majority of respondents (57%) consider that their workload is reasonable. There was some difference between public (49%) and private (70%) sectors. There was also some variation between the health regions with 60% of the south and 68% of the north agreeing or strongly agreeing that their workload is reasonable. This figure fell to 47% for physiotherapists responding from the north of the state.
Thirty five percent of respondents agreed or strongly agreed with the statement “You feel burnt out”. Again there are differences between work sectors with 43 percent of 91 physiotherapy respondents from the public sector reporting that they feel “burnt out” compared with 27 percent of 73 respondents from the private sector. There is also variation across the regions with 49 percent of physiotherapists responding from the northern region reporting that they feel “burnt out” compared with 29 percent in the south and 32 percent in the northwest.
Sixty percent (60%) of the physiotherapy sample reported that they are able to take annual leave when they wanted. For the private sector, sixty seven percent (67%) of respondents were able to take annual leave when they wanted compared with fifty eight percent (58%) from the public sector. The degree of flexibility in taking annual leave when wanted was lowest in the north of the state with fifty percent (50%) of respondents able to take annual leave when wanted compared with sixty two percent (62%) in the south and seventy five percent (75%) in the northwest region of the state.
However, locum backfill for annual leave and unfilled positions was not available. For respondents where locum backfill was applicable, eighty three percent (83%) disagreed with the statements “Locum backfill available when away” and seventy seven percent (77%) with “Locums available for unfilled positions”. Ninety percent (90%) of physiotherapists responding from the public sector disagreed with the statement that “locums backfill was available when away” compared with eighty percent (80%) from the private sector. Access to locums when away from work is lowest for the respondents from the north west of the state (95% of respondents
P a g e | 15
disagree of strongly disagree with the statement that locums are available), compared with eighty three percent (83%) for the south and seventy seven percent (77%) for the north of the state. With regards to the statement that “locums are available for unfilled positions”, eighty two percent (82%) of respondents from the private sector and seventy seven (77%) from the public sector disagreed with the statement. The availability of locums for unfilled positions impacts across the state. Seventy four percent (74%) of respondents from the north of the state, seventy eight percent (78%) from the south and eighty three percent (83%) from the northwest disagree with the statement that locums are available for unfilled positions.
Fifty six percent (56%) of physiotherapy respondents agreed or strongly agreed with the statement “There are service gaps because of limited human resources” and fifty one percent (51%) agreed with the statement that “Personnel are allocated according to areas of clinical needs.” Gaps in services as a result of human resources are higher in the public sector with seventy one percent (71%) of public sector respondents and forty percent (40%) of private sector respondents agreeing or strongly agreeing with the statement. Sixty eight percent (68%) of respondents from the north of the state agreed that there are service gaps as a result of limited human resources compared with fifty one percent (51%) from the south and fifty six percent from the northwest. Fifty two percent (52%) of respondents from the public sector and forty five percent (45%) from the private sector believe that “personnel are allocated according to areas of clinical need. (Another 43% were neutral with regards to this statement). Across the state fifty seven percent (57%) of respondents from the northwest felt that personnel are allocated according to areas of clinical need compared with fifty six percent (56%) in the north and forty seven percent (47%) in the south.
The perceived relationship between the appropriateness of staff allocation and existing service gaps warrants further exploration in order to assure the best use of health service resources (Figure 11) Figure 11: Agreement with statements regarding service gaps and staff allocation*
11
32
23
31
1
91116
36
10
1
31
0
10
20
30
40
50
SD D N A SA Not specified
NA
55 5760
Perceived service gaps Staff allocation
*Level of agreement is in relation to the following two statements: “Personnel are allocated according to areas of clinical needs” &” There are service gaps because of limited human resources”
Retention – type of work/clients The second most cited reason for being attracted to employment in Tasmania was the “Type of work/clients.” Considerable information can be gained from the survey about the type of work physiotherapists are doing in Tasmania.
P a g e | 16
Respondents reported the need to become multi-skilled to meet the demands of their clinical practice. They also agreed that they had to use a wide range of skills. Figure 12: Agreement with statements regarding the type of work*
17
12
72
60
197
24
75
43
1
12
01020304050607080
SD D N A SA Not specified
NA
Wide range of skills Multi‐skilled
*Level of agreement is in relation to the following two statements: “You use a wide range of clinical skills in your work” & “You have had to become multi-skilled to meet clinical demands”
Eighty four percent (84%) of physiotherapy respondents agreed or strongly agreed that they were working in their area of clinical expertise.
The responses also indicate that members of the Tasmanian physiotherapy workforce agree or strongly agree that they are able to work autonomously and to set their own work priorities (82%).
The perception of professional isolation for the physiotherapists as a group followed a normal distribution (Figure 13). Figure 13: Responses to the statement: "You feel professionally isolated"
6
19
50
39
26
19
3
0
10
20
30
40
50
60
NA SD D N A SA Not specified
However, physiotherapists working as sole practitioners (always and often) were more likely to feel professionally isolated (Figure 14).
P a g e | 17
Figure 14: Perception of professional isolation when working in sole practice
0
5
10
15
20
25
Sole practitioner
N/A
SD
D
N
A
SA
Not specified
Retirement in the physiotherapy workforce in Tasmania A quarter (25%) of the 162 physiotherapists responding to the survey stated that they plan to retire from their current position within the next decade.
Forty five percent (45%) of those planning to retire intend to do so within the next five years (14% of total physiotherapy sample size within 5 years). Of those planning to retire within 5 years half work in the public sector and half in the private sector.
The median age of the sample of respondents planning to retire within the next decade is 56 (Significant Skew of -1.361) Figure 15: Age distribution of respondents planning to stay vs. those planning to retire from their current position
0
1
2
3
4
5
6
7
22 26 30 32 35 37 39 41 44 46 48 50 52 54 56 58 60 62 66 68
Age in years
No plans to leave
Plans to retire
P a g e | 18
Continuing professional development (CPD) The literature cites access to CPD as having a positive influence on the retention of allied health professionals. However access to CPD is problematic in rural areas(18). Respondents to the survey were asked to select by what method they had accessed CPD activities in the previous 12 months. Figure 16: Uptake of a variety of modes of CPD in the past 12 months
0 20 40 60 80 100
International/state
Web based
Reg/local workshop
Prof journals
Tertiary education
Other
Non‐Public
Public
The favoured method of accessing CPD by Tasmanian physiotherapists in the past 12 months was through face to face contact at regional or local workshops, and through the reading of professional journals. This preference for face to face delivery of CPD is an issue in Tasmania where the number of registered physiotherapists in the state is small in comparison with interstate counterparts. With no local tertiary level training available, the facilitators/presenters for many workshops often need to be sourced from other states. There is an increasing use of the web based learning options to improve the access to CPD, particularly for those clinicians in rural and remote areas. Whilst the data shows a preference for face to face learning at local or regional level, a number of practitioners are making use of email and web-based material. The questionnaire did not investigate the nature of the online learning with regards to undertaking formal modules, or ad hoc searches for information through the use of search engines such as Google or publication databases.
The fourth most popular method for accessing CPD is by travelling to major conferences, which also provides opportunity for face to face learning.
Several sources of CPD were commonly cited in the “other” narrative descriptors. These included:
• Interstate short courses • In-service training • Videoconferencing • Attending lectures and paper presentations • Text books • Working with sporting team
Eighty five percent of the sample (N=162) have access to email at work and seventy eight percent have email at home. However, considering the internet is cited as a source of CPD by a reasonable proportion of the sample, only half the sample (51%) had access to Medline (a major internet based source of published journal material
P a g e | 19
which contributes to evidence based practice) at work. Only 21% have access to Medline at home. Figure 17: Barriers to accessing CPD
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Lack of employer support
Personal cost
Lack of local access
Time away from home
Time away from work
Lack of backfill
Not specified
Greatly
Moderately
A Little
Not at all
Lack of local access and personal costs are the most frequently cited reasons limiting access to CPD.
The Employer (59%) and Professional Association (43%) were identified as the major providers of CPD activities although 130 respondents (80%) undertake self directed CPD activities. Seventeen percent of respondents access CPD activities through the university sector.
Only thirty two percent of the physiotherapy sample (N=162) are satisfied with their access to CPD and thirty eight percent (38%) with access to more experienced staff in their field. Fifty eight percent (58%) of the sample are satisfied with their face to face contact with colleagues. Figure 18: Satisfied with access to CPD and colleagues for professional support
6
18
4740
36
14
15
14
2427
60
31
18
24
35 3642
16
10
10
20
30
40
50
60
70
NA SD D N A SA Not specified
Satisfied with access to CPE
Regular face‐to‐face contact with colleagues in field
Access to more experienced staff in your field
P a g e | 20
Student supervision The proportion of the Tasmanian physiotherapy sample that supervises students is shown in Table 12. This table also shows the number of respondents who have indicated that they have had training in supervision and/or mentoring. Table 12: Student supervision and supervision training by region
Health Service Region N Supervise students
Supervision or mentor training
Yes (%) Yes (%)
Southern 94 42 (45%) 33 (35%) Northern 43 23 (53%) 17 (40%) North-West 25 12 (48%) 10 (40%) Physiotherapy 162 77 (48%) 60 (37%)
Forty eight percent of the physiotherapy sample supervises students with 77 respondents having taken students on clinical placements.
There was variation across the work sectors with regards to the proportion of the sample supervising students and in receipt of training in supervision and/or mentoring. Sixty seven percent of the sample from the public sector supervised students compared with thirty one percent from the private sector. Fifty one percent of the public sector physiotherapy sample had received supervision/mentor training compared with twenty five percent from the private sector.
Of concern is the number of respondents who identified that they have not had training in student supervision and/or mentoring. Thirty seven percent of the total physiotherapy sample (60) indicated that they had received training. Lack of training in supervision and mentoring has the potential to impact on the quality of the student clinical placement and on the learning experience for both the student and the supervisor. At the time of this study the University of Tasmania did not offer entry level training for physiotherapy students. The lack of locally available training in the profession of physiotherapy is potentially impacting on the number of qualified physiotherapists working in the state who have had training in student supervision and mentoring.
Discussion
The methodological limitations of the study do need to be acknowledged. The response rate for the survey is an educated estimation. The researchers can be reasonably confident in calculating the response rates for those professions who are registered within the state of Tasmania, such as physiotherapy. Registration is a necessity to practice in this state. Survey forms were sent in hard copy to all names on the Registration Board with Tasmanian addresses. Rate of responses is calculated from the identified profession on the response against the numbers distributed through the Registration lists. Professional Association membership lists were used to market the study. It is not clear from the responses that the distribution between public and private sector is representative of the physiotherapy workforce
P a g e | 21
distribution in Tasmania. Nevertheless, this was a large sample of 162 respondents and the results can be considered with some confidence.
The physiotherapists taking part in this Tasmanian study form a mature and experienced workforce, with half the sample having 19 years or more of experience and half being over the age of 43. Respondents reported that they use a broad range of skills in their practice, have had to become multi-skilled to meet the needs of their consumer base, and are autonomous and able to set their own work priorities. However, of significance is the length of time that the Tasmanian physiotherapy workforce had been in their current positions, with half the sample having been in their position for less than 5 years (Table 6).
It is important to recognise that according to the ASGC-RA classification for rurality to be used now by the Australian Government for determination of funding for rural health programs, the whole of Tasmania is classified as rural. This is exacerbated by the lack of locally available training facilities in physiotherapy. Working as a physiotherapist in Tasmania can therefore be argued to be “rural practice’. Needing a wide range of skills and having to become multi-skilled to meet the needs of clients argue in favour of recognising the rural nature of the practice is a clinical specialisation. It supports consideration of extending the scope of practice to meet the need in some circumstances(19). Recognising rural practice and potential to extend the scope of practice could have a substantial impact on the attraction and retention of physiotherapists to Tasmania and other rural areas of Australia. The evidence to support this comes from the frequent citation of “type of work” as an attractor to come and work in the area.
It is known that physiotherapists contribute substantially to the primary health and acute care sectors. They are involved in illness prevention, health promotion, occupational health and safety in order to prevent the onset of chronic illness and injury. Early intervention and rehabilitation services limit the impact of disability from injury and illness. Physiotherapists work to get people out of hospital and to prevent readmission. However, there is limited evidence on the cost effectiveness of allied health services, including physiotherapy, in preventing injury, reducing the onset of chronic disease, reducing hospital readmissions, speeding up discharge. As with costing the benefits of services, no research has been done on the impact of physiotherapy workforce shortages on increased disability, higher rates of chronic disease, increased length of hospital stays, or on benchmarking of physiotherapy services to meet the needs of local population and requirements for the local health service facility (e.g. intensive care, orthopaedic surgery, acute/subacute rehabilitation service). More research is required to investigate cost effectiveness and calculate workload measures and benchmarking for physiotherapy services across different rural and remote regions to meet the needs of local communities. This will enable staff ratios for physiotherapy services to be calculated and funded based on evidence.
Chronic insufficient staffing was commonly reported: 52% of respondents reported being short staffed, 45% reported a high staff turnover, and 77% reported that locum backfill for vacant positions were not available. Just over half of respondents (60%) are able to take annual leave when wanted and 57% agreed that their workload was reasonable. 51% of the physiotherapy sample agreed that personnel are allocated according to areas of clinical need, with 84% agreeing that they are working in their area of clinical expertise and 86% agreeing that they use a wide range of clinical skills. 79% of the physiotherapy sample responded that they had had to become multi-skilled to meet clinical demand. With the type of work being a key factor in why physiotherapists come to work in Tasmania (48%), the ability to become multi-skilled and use a wide range of skills has potential to be used as a recruitment factor.
P a g e | 22
A quarter of respondents are working more than 40 hours per week and 46% are working unpaid overtime in order to meet the demands of their position. These factors need to be reconciled against “Work/life balance” being the statement most cited by physiotherapists as a reason for working in Tasmania. It would seem that working long hours and doing unpaid overtime to meet the clinical demands of the job takes precedence over work/life balance for a large number of clinicians. “Work/life balance” is one factor that will warrant further investigation with the physiotherapy workforce in Tasmania to unpack the term and investigate what the statement means to different people. Such a meaning cannot be determined from the results of the survey.
The issue of job satisfaction is a complex matter that will be further investigated with a more detailed analysis of the data in the survey. 82% of respondents agreed or strongly agreed that they had job satisfaction. However there is also a significant number of people (44%) intending to leave their current positions within the next 5 years for a number of reasons. The relationship between job satisfaction and intention to leave is supported by the results (Figure 9). Contributors towards job satisfaction and intention to leave might include workload, access to continuing professional development, professional isolation, management issues, the length of time the clinician had been in their current position and burnout. The relationship between satisfaction rates on these factors and the intention to leave warrants further investigation.
Climate/location is the third most frequently cited reason for being attracted to work in Tasmania. Together with the type of work, climate and location and the number of respondents who cited the environment, outdoor and leisure activities in the narrative “other” section could also potentially be utilized in recruitment campaigns to attract physiotherapists to Tasmania.
“Income” was not a major factor in attracting physiotherapists to work in Tasmania coming sixth on the list of factors. However the need for financial incentives to work in Tasmania as a rural state, and equity of income with interstate counterparts will need to be considered for recruitment, but particularly for retention of the physiotherapy workforce.
The data is suggestive that an effective recruitment campaign could focus on clinicians who are seeking work/life balance, performing work that enables them to use and develop a wide range of skills, working autonomously, in an attractive location and climate where outdoor, adventure and other leisure opportunities present. Financial incentives will need to be considered.
Professional isolation was not a major factor for physiotherapists working in Tasmania with 27% of respondents stating they felt isolated. However, just over half (58%) were satisfied with their face to face opportunities to meet with colleagues in their field, which is a contributor to a sense of professional isolation. There were a considerable proportion of respondents (80%) who reported utilizing self directed learning methods (Figure 16). However, the preference by respondents was for face to face CPD opportunities from local workshops, seminars and in-service training. A number were also participating in more formal education opportunities provided by the university sector. From narrative responses, the participation in other face to face learning opportunities provided by videoconference, in-service training and interstate short courses was also valued. Facilitating the access to direct local and regional face to face learning opportunities, formal and informal, and through self directed mechanisms such as web-based learning, DVDs, books and journals could become part of a valuable retention strategy.
Respondents identified lack of local access and personal costs as factors that impede the uptake of CPD. The uptake of web-based learning and resources may be
P a g e | 23
impacted by the restricted access to IT infrastructure (access to email and Medline at home and work). The study did not investigate preferences for web-based learning. These could either be formal online interactive learning modules or more ad hoc web-based research utilising Medline and other such databases, or search engines such as Google. The issues of how to best structure web-based learning to meet the needs of rural and remote physiotherapists, how best to facilitate access to such learning, and its impact on reducing isolation and assisting in retention needs to be further researched.
The age profile of the Tasmanian physiotherapy workforce sample had a mixture of younger and older practitioners, with half the sample over the age of 43. Tasmanian workforce planning for the physiotherapy workforce will need to take into account changes in the age profile and the years of experience that will eventuate as the current workforce reaches the age of retirement. Retention strategies to facilitate older members of the physiotherapy workforce may assist in sustaining the workforce into the future. Making use of the older clinicians’ years of experience for supervision and teaching, particularly with the advent of physiotherapy entry level training at the University of Tasmania is one possibility that may be attractive when getting near the age of retirement or extending work past the normal age for retirement. The ability to work part-time or to job share may be a consideration. This would also be an attraction for younger clinicians who have children.
Forty eight percent of the physiotherapy sample was supervising students on clinical placement. 67% of those working in the public sector and 31% in the private sector indicated that they supervise students. Only 37% of the sample had received training as a supervisor or mentor. This is an issue as it has an impact on the quality of the clinical placement for both the student and the supervisor. Reasons for the low level of training for supervision and the impact of supervising a student without training need to be further explored. The literature supports the experience of a clinical placement in a region with taking up work in that or a similar area. Clinical placements for physiotherapists in Tasmania must be supported as part of the State’s recruitment and retention strategies for the physiotherapy workforce. It will be worth looking to build the capacity within the State to take students through the delivery of appropriate training, and through the exploration of issues to support students to undertake clinical education in Tasmania. This may be through the provision of accommodation and travel subsidies for the students. Staffing levels and the experience of staff, locum backfill, clinical loads, and infrastructure such as office space and IT access within the clinical placement environment will also need to be explored. The appointment of clinical placement coordinators, and allied health clinical supervisors to the major teaching hospitals, shared with smaller rural facilities is an option worth considering. It is also recognised that there will be an impact on student placements and the ability to access supervision training once an entry level course in physiotherapy is implemented in Tasmania.
Conclusion
The collection of workforce data from the physiotherapy workforce is essential for health workforce and health service planning for the future. Physiotherapy is one of the health professions that is collectively known as ‘allied health’. This report has been produced from a subset of data collected by the University Of Tasmania University Department Of Rural Health for the Tasmanian Allied Health and Oral Health Workforce Study.
P a g e | 24
The methodology used by the Tasmanian Allied Health and Oral Health Workforce study, together with its NSW counterpart, the Rural Allied Health Workforce Study (RAHWS), has demonstrated that the use of overlapping recruitment strategies and response methods is both feasible and effective. The importance of the paper based method of recruiting does need to be recognised as many of the Registration Boards do not maintain electronic methods for group mailings to Registrants. Paper based data collection is more expensive in terms of printing, mailing and data entry costs but in Tasmania proved effective with 66% of the responses being received by hard copy. “Word of mouth” is a key method in recruiting participants; however this method has an impact on calculating response rates.
The collaborative studies between the researchers in Tasmania and NSW have demonstrated that the survey is applicable to any rural region in Australia. The survey has also been undertaken in the Northern Territory and in South Australia. The South Australian study will also test the effectiveness of the survey instrument in profiling the workforce in a metropolitan setting. It is felt that the multiple distribution and sampling methodology is equally applicable in rural and urban settings. The use of the same survey tool will enable the data from each state and territory to be compared across jurisdictions to determine national patterns and regional particularities that may assist in planning health policy.
Whilst the survey does not enable a head count of the physiotherapy workforce, it does give a very rich profile of how the profession is working. Blending this information with head count data from the Australian Bureau of Statistics National Census has the potential to provide a detailed description of who, where and how the physiotherapy workforce as a whole, and the individual professions within it, operate. Information relating to access to CPD and student clinical supervision will enable the training needs and future workforce requirements to be informed by evidence. The data will assist in informing the planning currently underway within Tasmania to implement an entry level Physiotherapy course through the University of Tasmania and University of South Australia.
Federal funding is needed to allow for a more coordinated approach to implementing the study on a national basis. Longitudinal studies to track the changes in the workforce can easily be undertaken by repeating the survey at regular intervals. National profiling, as well as the ability to compare results across jurisdictions and regions, would be helpful to state and national workforce planning.
The survey instrument used in the Tasmanian allied health and oral health workforce study, and in the NSW RAHWS provides a detailed physiotherapy workforce data subset that is not available through any other source. These data provide essential information about the Tasmanian physiotherapy workforce demographics, work practices and training needs. It will provide evidence to inform effective strategies for recruitment and retention of physiotherapists in Tasmania and other rural areas of Australia.
The University Department of Rural Health Tasmania gratefully acknowledges the funding support provided by the Tasmanian Department of Health and Human Services in support of this study.
P a g e | 25
References
1. Australian Government Department of Health and Ageing. Report on the Audit of Health Workforce in Rural and Regional Australia, April 2008. Canberra: Commonwealth of Australia; 2008.
2. Australian Institute of Health and Welfare. Medical labour force 2006. AIHW catelogue number HWL 42. Canberra: AIHW; 2008.
3. Australian Institute of Health and Welfare. Nursing and midwifery labour force 2005. Journal [serial on the Internet]. 2008 Date [cited 2008 26 Nov].
4. Smith T, Cooper R, Brown L, Hemmings R, Greaves J. Profile of the rural allied health workforce in Northern New South Wales and comparison with previous studies. Australian Journal of Rural Health. 2008;16(3):156-63.
5. Lowe S, O'Kane A. The Tasmanian Allied Health Workforce. Canberra, ACT: SARRAH; 2004.
6. Lowe S, O'Kane A. The Australian Allied Health Workforce. Canberra, ACT: SARRAH; 2004.
7. Smith T. An Investigation of the rural allied health workforce in northern New South Wales. 2008 National SARRAH Conference; 2006 September 2006; Albury, NSW. SARRAH; 2006.
8. Fitzgerald K, Hornsby D, Hudson L. A study of allied health professionals in rural and remote Australia: SARRAH; 2000 2000.
9. McCarthy G, Tyrrell M, Lehane E. Intention to 'leave' or 'stay' in nursing. Journal of Nursing Management. 2007;15(3):248-55.
10. Stagnitti K, Schoo A, Dunbar J, Reid C. An exploration of issues of management and intention to stay: Allied Health professionals in South West Victoria. Journal of Allied Health. 2006;35(4):226-32.
11. Stagnitti K, Schoo A, Reid C, Dunbar J. Retention of Allied Health professionals in the sourth-west of Victoria. Australian Journal of Rural Health. 2005;13(6):364-5.
12. Keane S, Smith T, Lincoln M, Wagner S, Lowe S. The rural Allied Health workforce study (RAHWS): background, rationale and questionnaire development. Journal [serial on the Internet]. 2008 Date; 8(4): Available from: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=1132.
13. Lowe S, Adams R, O'Kane A. A framework for the categorization of the Australian Health Workforce – a discussion paper. Canberra, ACT: SARRAH; 2007.
14. Allen O. SARRAH: Recruitment and retention of Allied Health workforce. Australian Journal of Rural Health. 2005;13(3):198.
15. Hegney D, McCarthy A. Job satisfaction and Nurses in rural Australia. Journal of Nursing Administration. 2000;30(7-8):347-50.
16. Meyer D. Technology, job satisfaction, and retention: rural mental health practitioners. Australian Journal of Rural Health. 2006;22(2):158-63.
17. Playford D, Larson A, Wheatland B. Going country: rural student placement fators associated with future rural employment in nursing and allied health. Australian Journal of Rural Health. 2006;14(1):14-9.
P a g e | 26
18. Stagnitti K, Schoo A, Reid C, Dunbar J. Access and attitude of rural Allied Health professionals to CPD and training. International Journal of Therapy and Rehabilitation. 2005;12(8):355-62.
19. Productivity Commission. Australian Health Workforce Research Paper. Canberra, ACT; 2006.
TASMANIAN ALLIED HEALTH WORKFORCE SURVEY
An Investigation of the Allied Health Workforce in Tasmania
Investigators:
Mrs Shelagh Lowe, Associate Lecturer in Rural Allied Health Tasmanian University Department of Rural Health, Launceston, Tasmania Ph: 03 6374 1015 or 0418 374 105 Associate Professor Sue Kilpatrick, Director Tasmanian University Department of Rural Health, Launceston, Tasmania Ph: 03 6324 4011 Ms Sheila Keane, Senior Lecturer in Allied Health (Physiotherapist) Northern Rivers University Department of Rural Health, Lismore, NSW Ph: 02 6620 7238 Dr Tony Smith, Senior Lecturer in Medical Radiation Science (Diagnostic Radiographer) University Department of Rural Health, Northern NSW, Tamworth, NSW Ph: 02 6767 8464
Address for correspondence: University Department of Rural Health University of Tasmania Locked Bag 1372 Launceston TAS 7250 E-mail: [email protected]
Thank you for taking time to complete this questionnaire. It is also available for completion online
at http://www.ruralhealth.utas.edu.au
Once you have completed it please insert it into the replied-paid envelope provided and mail it back.
For assistance or further information please contact any member of the research team listed above.
© University Department of Rural Health, Northern NSW, Faculty of Health, The University of Newcastle, 2007
THE AUTHORS RESERVE THE RIGHTS DETAILED IN THE COPYRIGHT ACT OF 1986. NO PART OF THIS DOCUMENT IS TO BE REPRODUCED IN ANY FORM, INCLUDING ELECTRONIC MEDIA WITHOUT
THE PRIOR PERMISSION OF THE AUTHORS.
TASMANIAN ALLIED HEALTH WORKFORCE SURVEY
SECTION ONE: SOME BACKGROUND INFORMATION 1. Which Allied Health Profession do you belong to?
Aboriginal Health Worker Audiologist Chiropractor Dentist Dental Therapist Dietitian Exercise Physiologist (Registered) Medical Scientist
Nuclear Medicine Scientist Occupational Therapist Optometrist Orthoptist Orthotist Osteopath Hospital Pharmacist Community Pharmacist Paramedic
Physiotherapist Podiatrist Psychologist Prosthetist Radiation Therapist Radiographer Social Worker Sonographer Speech Pathologist
Other (Please specify):_____________________________________________________________________
2. In what year did you qualify in this profession?
3. What is your gender? Male Female
4. IN WHAT YEAR WERE YOU BORN? 5. WHAT IS YOUR POSTCODE AT WORK: ; AT HOME:
6. What is your current marital status? Single Separated or divorced Married or Defacto relationship Widowed
7. Does your partner also work? Full-time Part-time Casual No
8. Do you have dependant children? Yes No If ‘Yes’, what are their ages? ____________________________________________________________
9. Are you of Aboriginal or Torres Strait Islander decent? Yes No
10. What country were you born in?
11. What is your current citizenship?
12. Where did you obtain your initial Allied Health Professional qualification? In Australia Overseas - If so, where? __________________________
13. Which of the following best describes where you grew up?
A Capital City Other Metropolitan (population ≥ 100,000) Large Rural Centre (25,000 – 99,000) Small Rural Centre (10,000 – 24,999) Other Rural Area (< 10,000) Remote Centre (5,000 – 9,999) Other Remote Area (< 5,000)
14. If originally from a rural background (population < 100,000), prior to becoming 18 years old …
a. For how many years was your home address in a rural area?
b. For how many years did you go
to school in a rural area?
= ______ years = ______ years
15. Did you have any rural placements during your education and training?
Yes No
16. Did you attend a non-metropolitan or regional University or College?
Yes No
© University Department of Rural Health, Northern NSW, Faculty of Health, The University of Newcastle, 2007 THE AUTHORS RESERVE THE RIGHTS DETAILED IN THE COPYRIGHT ACT OF 1986. NO PART OF THIS DOCUMENT IS TO BE REPRODUCED IN
ANY FORM, INCLUDING ELECTRONIC MEDIA WITHOUT THE PRIOR PERMISSION OF THE AUTHORS.
TASMANIAN ALLIED HEALTH WORKFORCE SURVEY Section two: Your current employment 17. Do you have more than one paid position with different employers?
Yes No If ‘Yes’, how many positions? ______________
18. In what sector do you work? (Tick more than one box if appropriate)
Public (State) Private Federally funded program Non-Government (NGO)
Other – Please specify _______________________________________
If you work in multiple sectors please indicate the average proportion of your work-time spent in each. + + + + =
19. If you selected Public (State) sector for your employment, under which Department are you employed?
Department of Health and Human Services Department of Education Department of Justice Other:_____________
20. Estimate the average total hours that you spend at work each week in all your positions?
< 15 15-29 30-34 35-40 41-49 50-60 > 60
About how many of those hours would be (a) paid overtime = ________ : (b) unpaid overtime ________
Answer the following questions in relation to your MAIN JOB
21. According to your ‘position description’ what is your current employment status? (Tick more than one box if appropriate) Full time Permanent Casual Self Employed Part time Temporary Locum Explanatory notes (if required):_____________________________________________________________________
22. How long have you been in your current job?
____________ years
23. Are you a ‘sole practitioner’ where you work?
Always Often Sometimes Rarely Never
24. Indicate below the percentage (%) of your time spent in each of the following organizational roles. (Please ensure that the total equals 100%)
Individual patient clinical care = % Clinical services
management tasks = % Research related activities / travel = %
Non-individual clinical care = % Travel linked to
management or care = % Teaching and training = %
Other – Please specify _____________________________________________ = %
25. If you, personally, provide sessional outreach services to other communities please describe below the frequency and duration of these sessions.
Frequency of sessions: Monthly Fortnightly Weekly As necessary
Duration of sessions: ½ day 1 day > 2 days
Other (Please specify frequency & duration): _____________________________
Does not apply
26. What are the postcode/s of the communities to which you provide outreach? ____________________________
Total Other NGO Federal Prog Private Public (State)
© University Department of Rural Health, Northern NSW, Faculty of Health, The University of Newcastle, 2007 THE AUTHORS RESERVE THE RIGHTS DETAILED IN THE COPYRIGHT ACT OF 1986. NO PART OF THIS DOCUMENT IS TO BE REPRODUCED IN
ANY FORM, INCLUDING ELECTRONIC MEDIA WITHOUT THE PRIOR PERMISSION OF THE AUTHORS.
TASMANIAN ALLIED HEALTH WORKFORCE SURVEY
Section Two Cont’d /- 27. (a) Approximately how long does it take for you to travel between home and work? _____________
(b) Estimate the hours per week spent in work-related travel (excluding home-work-home)? _________
(c) Estimate the farthest distance you travel from your employment base __________ km
(d) What form of transport do you use for this work-related travel?
Own car Car provided Other __________________________
28. In what size community is your employment based?
> 99,000 25,000 to 99,000 10,000 to 25,000 5,000 to 10,000 < 5,000
29. Do you, personally, provide home visits to clients/patients? Yes No If ‘Yes’, how many visits per week, on average? _____________
30. Do you do ‘on-call’ duty? Yes No If ‘Yes’, estimate the average ‘on-call’ hours per week: (a) at work = _____ ; (b) not at work = _____
31. What most attracted you to your current position? (Tick more than one box if appropriate)
Work/life balance
Income
Career advancement
Type of work/clients
I come from the area
Marriage / partner
Good place to raise kids
Family / social attachments
Climate / location
Housing affordability
Cost of living
Other ____________________
32. How would you describe your level of satisfaction with your current job?
Extremely satisfied Satisfied Neutral Dissatisfied Extremely dissatisfied
33. During the time that you have worked in this job have you received a promotion, upgrade or higher reclassification of your position? Yes No
34. During the time you have worked in this job have you had a salary increase through a competence progression or recognition of relevant post graduate degree?
Yes No
35. Do you currently work with or supervise an aide or therapy assistant? Yes No
36. What is the professional background of your line-manager?
Same allied health profession as yourself Other allied health (Specify ___________________ )
Not an allied health professional Not a health professional
37. Do you plan to leave your job within the next: 2 years? 5 years? 10 years? > 10 years? I have no plans to leave my job
38. What is the motivation for planning to leave your job in the time frame indicated? (Tick more than one box if appropriate)
Job dissatisfaction To earn a better income Better career prospects Retirement Your child(ren)’s education Moving to a preferred location Extended family commitments or obligations Partner (change in job, transfers) Other _______________________________________
© University Department of Rural Health, Northern NSW, Faculty of Health, The University of Newcastle, 2007 THE AUTHORS RESERVE THE RIGHTS DETAILED IN THE COPYRIGHT ACT OF 1986. NO PART OF THIS DOCUMENT IS TO BE REPRODUCED IN
ANY FORM, INCLUDING ELECTRONIC MEDIA WITHOUT THE PRIOR PERMISSION OF THE AUTHORS.
TASMANIAN ALLIED HEALTH WORKFORCE SURVEY
Section Three: Education & Professional Development 39. What is the highest level of qualification you have completed?
Certificate Associate Diploma Diploma Bachelor Degree
Honors Degree Coursework Graduate Certificate, Diploma or Masters Research Higher Degree (Masters or PhD) Other _____________________________
40. Are you currently studying for a further tertiary qualification? No Yes – If so, what? ____________________________________________
41. What continuing professional development (CPD) activities have you participated in over the past 12 months? (Tick more than one box if appropriate)
International, National or State Conference Regional or local workshop, seminar or in-service Formal tertiary education program / enrolment
Email or Web-based material Reading professional journals Other ______________________________
42. Estimate the number of days spent doing CPD activities over the past 12 months? < 1 day 1 - 2 days 2 - 5 days 5 - 10 days > 10 days
43. Who has been the provider of your CPD in the past 12 months? (Tick more than one box if appropriate) Self-directed Employer State or Australian Government funded – not
employer Non government organisation – not employer
Professional Organisation University or University Department of Rural Health Other tertiary education provider
44. To what extent do you feel the following factors inhibit you from accessing CPD? Lack of employer support The personal financial cost Lack of local access Time away from home Time away from work Lack of backfill/locum support
Greatly Moderately A little Not at all Greatly Moderately A little Not at all Greatly Moderately A little Not at all Greatly Moderately A little Not at all Greatly Moderately A little Not at all Greatly Moderately A little Not at all
Other factors?____________________________________________________________________________
45. Do you have Information Technology access at work and/or at home? (Tick all relevant boxes)
Work = E-mail Medline, CIAP, etc Home = E-mail Medline, CIAP, etc
Tick here if you have no internet access to either e-mail or an electronic library either at work or at home
46. Do you participate in the supervision of students on professional clinical placement in your workplace? No Undergraduate Postgraduate entry level Postgraduates
47. If you do, for how many students have you provided supervision in the past 12 months? _____________ Please list the university(ies) and number and discipline of student(s) from each.
University Number of students Discipline of student
48. Have you had training in student supervision and/or mentoring? Yes No
© University Department of Rural Health, Northern NSW, Faculty of Health, The University of Newcastle, 2007 THE AUTHORS RESERVE THE RIGHTS DETAILED IN THE COPYRIGHT ACT OF 1986. NO PART OF THIS DOCUMENT IS TO BE REPRODUCED IN
ANY FORM, INCLUDING ELECTRONIC MEDIA WITHOUT THE PRIOR PERMISSION OF THE AUTHORS.
TASMANIAN ALLIED HEALTH WORKFORCE SURVEY
© University Department of Rural Health, Northern NSW, Faculty of Health, The University of Newcastle, 2007 THE AUTHORS RESERVE THE RIGHTS DETAILED IN THE COPYRIGHT ACT OF 1986. NO PART OF THIS DOCUMENT IS TO BE REPRODUCED IN
ANY FORM, INCLUDING ELECTRONIC MEDIA WITHOUT THE PRIOR PERMISSION OF THE AUTHORS.
Section Four: Some More Important Questions Please respond to the following statements by indicating your preferred response, where: SA = Strongly agree; A = Agree; N = Neutral; D = Disagree; SD = Strongly disagree; NA = Not applicable Statement SA A N D SD NA
Your work hours are flexible
You are always able to schedule annual leave when you want it
Locum backfill is always available when you are away on leave
Your department / practice is chronically short-staffed
There is a high level of staff turnover where you work
You have good facilities and equipment to work with
You have good admin. support (enquiries, appointments, etc)
You have good clinical support (colleagues, therapy assistants)
SA A N D SD NA
Recruitment for vacant positions always occurs in a timely way
Temporary and/or part-time positions are often hard to fill
Locums are always available for unfilled positions
Personnel are allocated according to areas of clinical need
You are working in your area of clinical expertise
You participate in clinical rotations / rosters across practice areas
You use a wide range of clinical skills in your work
You are satisfied with your access to CPD opportunities
You have regular face-to-face contact with colleagues in your field
You have good access to more experienced staff in your field
You feel professionally isolated
SA A N D SD NA
You have had to become multi-skilled to meet clinical demands
Clients often miss out because of limited human resources
Your workload is reasonable
You are autonomous and can decide your own work priorities
You feel ‘burned out’
Your grading and salary are appropriate for the job you do
You believe your manager understands your professional role
You believe your manager values the work you do
You get along well with your work colleagues
You feel that your work makes a difference to patients / clients
You enjoy living in your local community
You feel that your work is valued by the local community