Factors affecting recruitment of physical therapy personnel in Utah.

In the past few years, many journals have addressed the national physical therapy personnel shortage. (Note: In the context of this article, the term "physical therapy personnel" refers to both physical therapist [PTs] and physical therapist assistants [PTAs].) The US Bureau of Labor Statistics projects that the demand for PTs will increase 57% by the year 2000, which represents an increase from 68,000 in 1988 to 107,000 in 2000. According to Silvestri and Lukasiewicz,[1] physical therapy is one of the top 20 occupations with the fastest projected growth rates (52.5%) from 1988 to 2000.

In 1989, US News and World Report projected that by the end of the century, the demand for PTs is expected to nearly double.[2] A 1989 American Hospital Association allied health survey showed a national vacancy rate for PTs of 16%[3]; the US Bureau of Labor Statistics' projected net increase in growth for PT jobs to the year 2000 is 39,000.[1]

Not only are severe shortages projected throughout the physical therapy profession, but traditional places of employment, such as hospitals, are also having a difficult time retaining physical therapy personnel. Although hospitals attract new PTs right out of school, PTs do not appear to remain there. One author suggest, "A lack of upward mobility and a higher intensity workload than that found in other institutions are common reasons PTs leave the hospital."[4]

In addition, the National Academy of Science/Institute of Medicine (NAS/IOM), in a congressionally mandated allied health personnel study, reported that it was hampered by a lack of data. Investment of public resources in learning about the allied health work force was minimal. Thus, due to the absence of the necessary data elements and the uncertainty of occupational projections, the committee could not make quantitative predictions. If employees had accurate projections, decision making might be improved.[5]

Although some national research has been done regarding the physical therapy personnel shortage, very little research has addressed physical therapy staffing needs in many states, including Utah. T more clearly understand Utah's physical therapy personnel shortage and to determine whether the shortage is similar to that on a national level, this study assessed the current and future needs of physical therapy personnel in Utah. To understand Utah's physical therapy personnel shortage in more detail, the research consisted of two phases. The first phase examined the supply and demand of current and future physical therapy personnel, and the second phase addressed satisfaction, recruitment, and retention factors of current physical therapy personnel. Two separate questionnaires were developed for each of the two phases of the study. The physical therapy work force in Utah consists mainly of married women between 25 and 34 years of age. It is a young labor force, with only 20% projected to retire within the next 10 to 20 years.

This article (1) describes the methods used in gathering the date for this study; (2) examines current and projected future demands for physical therapy personnel in hospitals, long-term care facilities, home health care agencies, and clinics; (3) discusses job satisfaction, recruitment, and retention of physical therapy personnel; and (4) explains the implications of the data and makes recommendations as to how the date may be used.

Methods

As noted, two separate questionnaires were developed: The first questionnaire focused on current and projected demands for physical therapy personnel in Utah; the second questionnaire addressed current satisfaction, recruitment, and retention issues of physical therapy personnel in Utah. All data were coded and computerized using the Research Vax(*) and the SPSS program [dagger] at Brigham Young University in Provo, Utah.

Demand and Supply

Questionnaire

In attempting to address the data limitations referred to by the NAS/IOM, the first questionnaire developed dealt with the current and projected demands for physical therapy personnel in Utah. Four major employer groups of physical therapy personnel (ie, hospitals, long-term care facilities, home health care agencies, and clinics) were contacted throughout the state.

Questionnaire design. The Idaho Rural Education Center developed a questionnaire to assess the level of support in acute care hospitals for the development of an outreach educational program in radiologic technology. One of the questions in that survey asked human resource development directors to assess current and future needs for occupations within radiologic technology. Based on this study, a questionnaire was developed to project physical therapy personnel need in Utah. The questionnaire asked physical therapy department heads the following questions regarding their facilities: (1) What is the current number of full-time equivalents (FTEs), that is, positions in which a person works 8 hours a day or a total of 40 hours per week, in your department? (2) What is the number of current FTE openings? and (3) What is the number of new FTEs that are being projected for 1992? Department heads were asked to make projections for the need for both PTAs and PTs. Department heads were also asked in an open-ended question to indicate whether they had difficulty staffing any of these positions, and if so, which positions.

After the initial draft of the questionnaire was developed, it was reviewed by physical therapy department heads at several health care facilities in Provo, Payson, and Salt Lake City, Utah. The ideas and comments of these department heads were incorporated into the final survey instrument.

Sample. Three hundred twenty-two Utah health care facilities were selected and represented the total limited universe of facilities identified by appropriate agencies that had maintained licensed physical therapy personnel. Four major employer groups (54 hospitals, 55 long-term care facilities, 46 home health care agencies, and 167 clinics) were surveyed. The Utah Hospital Association, The Utah Health Care Association, and the Utah Home Health Care Association provided mailing lists for the Utah hospitals, long-term care facilities, and home health care agencies. The clinic addresses were obtained from city and state telephone listings.

The questionnaire were numbered and mailed to all 322 facilities, which were given 2 to 3 weeks to respond. Those who had not responded within that time period were again mailed the same survey instrument and asked to respond. Finally, a telephone follow-up to those who had not responded to the mailings was conducted.

Physical Therapy Personnel

Recruitment and Retention

Questionnaire

Questionnaire design. The second phase and questionnaire focused on the recruitment and retention of physical therapy personnel in Utah. The questionnaire objectives determined by a focus group of four physical therapy personnel. The focus group's input helped to finalized the objectives that were used to developed the final survey instrument. The final instrument consisted of a series of multiple-choice and open-ended questions that dealing with objectives that might affect the shortage issue, including recruitment, retention, job satisfaction, and occupational choice, which were discussed one half of the questions were multiple choice, and the others were open-ended.

The questionnaire asked some demographic information of the respondents, including age, marital status, and gender. Physical therapy personnel also identified in a multiple-choice question the type of facilities in which they were employed. Respondents were asked via multiple-choice questions how they decided on their profession, how they financed their education, methods used by those surveyed to find their jobs, and whether they would choose this profession again if given the opportunity. Open-ended questions asked what the therapist felt should be included in a recruiting program and the reasons they would or would not choose the physical therapy profession again.

In the retention section of the questionnaire, respondents were asked to rank, from a list of eight job satisfaction determinants, factors of job satisfaction according to importance. Each respondent selected and ranked three factors. The most important determinant was ranked 1, the next most important determinant was ranked 2, and the third most important determinant was ranked 3. In addition, open-ended questions asked respondents to list and rank three items that would help keep them in their current position and what advice they would give to someone about their profession.

Sample. A total of 590 physical therapy personnel were surveyed, which represented the limited universe. The mailing list was obtained from the Utah Division of Occupational and Professional Licensing. Questionnaires were mailed to all names on the list.

Demand and Supply

Projection Results

Our research assess both current and future demands for physical therapy personnel in hospitals, long-term care facilities (nursing homes), home health care agencies, and clinics in Utah. Table 1 shows the response rate for each facility group. The overall response rate for the demand and supply portion of the research was 76%; hospitals and home health care agencies had a 96% response rate.

Responses Rate for Major Facility Groups (n=244)

Facility Group               Total       Total     Response
                            Surveyed   Responded   Rate (%)
Hospitals                    54         52         96
Long-term care facilities    55         45         82
Home health care agencies    46         44         96
Clinics                     167        103         62
Total                       322        244         76

Table 2 shows that each facility group reported a percentage increase in 1992 for PTs and PTAs of at least 13%. Home health care agencies projected the greatest need for PTAs, with an additional 5 PTAs needed in 1992, a 125% increase over 1991 FTEs. Nursing homes projected the greatest need for PTs, with an additional 7.5 PTs needed in 1992, a nearly 37% increase over 1991 FTEs. Table 3 shows that Utah health care facilities projected a 1992 need for an additional 28 PTAs and 46 PTs - percentage increases of 45% and 17%, respectively. Those who answered the open-ended question indicated that PTs were the most difficult to staff.

In addition, an administrator at one Utah hospital (S Robertson, Compensation Analyst, LDS Hospital; personal communication; December 1991) commented

From recent recruiting efforts, physical therapists, especially in pediatrics are currently treated as hard-to-recruit positions. Typically, recruiting is done locally. Hard-to-recruit-for position recruiting is done on a much broader basis. This includes statewide to national recruiting searches. The time and cost involved in recruiting the identified positions are a significant drain on our recruiting dollars.

Physical Therapy

Recruitment and Retention

Survey Results

Of the 590 physical therapy personnel surveyed, 198 responded, for a response rate of 33.6%. This response rate was generated with both an initial mailing and a follow-up request to those who did not respond to the first mailing. The results presented represent the perceptions of those who responded to the survey.

Demographics

According to our survey, the typical Utah physical therapy professional is a married woman between 25 and 34 years of age. Approximately 58% of the respondents were female and 42% were male. Figures 1 and 2 show additional demographic information As shown in Figure 2, only 7% of the Utah physical therapy personnel population are projected to reach retirement age within the next 5 to 10 years, and only 20% are projected to reach retirement age within the next 10 to 20 years.

Place of Employment

The survey reflected that many of the respondents worked in more than one facility (Fig. 3). Physical therapy professionals have a variety of options regarding the facilities in which they can practice. According to our research, hospitals are the single largest employer of physical therapy personnel in Utah, followed by clinics, home health agencies, and nursing homes. Other places of employment mentioned were educational facilities, private practice, rehabilitation, and outpatient facilities.

Recruitment Findings

Decision on profession. The majority of respondents (close to 70%) stated that someone influenced them to look into physical therapy as a profession. Some of these influential people were parents, relatives, friends, guidance counselors, and people already in the profession. Knowing someone who was treated by a PT or personally being treated by a PT was also an influence. Some comments were

A friend suggested that I go into physical therapy, so I checked into it and liked it.

My grandfather had a stroke, and I was influenced by his care - or lack of it.

In addition, literature about physical therapy was also a source of influence. Some comments regarding this influence were

I read about the profession in a job description.

I read about it in the newspaper.

Approximately 15% of the respondents stated they had an interest in science or health care and wanted to pursue a medical-related career. Some of the comments were

I was interested in medicine, but not in becoming a medical doctor or a nurse. I selected physical therapy on my own.

I had an interest, and I liked sports, science, and medicine.

Nearly 10% of the respondents stated that they entered the physical therapy profession by accident or that it was not their first choice. Some responses that substantiate this finding were

I decided this was more fun dental school.

I wanted to be an occupational therapist, but there was no school in Utah.

Financial sources for education. Figure 4 shows that approximately 76% of the surveyed physical therapy personnel used personal savings, help from parents, or loans as their major monetary sources to complete their education, whereas only 19% of the respondents indicated that scholarships helped them finance sources mentioned were pell grants, stipends, and the GI bill

Methods used to find first and current jobs. Figures 5 and 6 show that physical therapy personnel found both their first and current job through friends and personal job search efforts. Others methods mentioned in job searches were being hired at their place of internship, "they called me," placement services, classified advertisements, and professional journal advertisements.

Factors included in a recruiting program. The following is a ranking of the top three factors physical therapy personnel thought should be included in a recruiting program:

1. Pay and fringe benefits.

2. Continuing education.

3. Chances for promotion.

Other comments made by the respondents were "diversity of opportunities in profession," "education about what fields are and what they do," "great and varied job opportunities all over United States," and "relocation assistance and recruitment signing bonuses."

In addition, respondents offered some specific ideas that employers could implement in their recruiting programs. Some of these comments were "scholarships specifically for allied health students," "professional organization affiliation/membership in Utah Chapter of American Physical Therapy Association," "better advisement in junior and senior high schools," "senior staff members to serve as mentors," and "opportunity to observe member of profession in an actual work setting."

Would physical therapy personnel choose the profession again? Ninety-eight percent of the respondents would choose their profession again. This finding suggests that, over-all, respondents in our survey were satisfied with their profession reasons physical therapy personnel gave for pursuing their profession again were "rewarding and satisfying occupation," "job variety in both employment opportunities and type of work performed," "job flexibility," and "challenging profession." A variety of comments indicate the satisfaction among these professionals:

It's a great profession and worth it. You're helping people to get better, and they love you for helping them.

I can make a difference in people's lives, and I enjoy what I do.

There is a wide variety of places and therapy to work in.

Allows for creativity and autonomy.

Only four responding physical therapy professionals indicated they would not choose their profession again, giving the following reasons:

The many changes and attitudes of newer therapists are not improvements.

I would pursue a medical career.

After practicing for 3 years, I no longer enjoyed it.

I would go to medical school and learn more.

Retention Findings

Factors contributing to job satisfaction. The data revealed the top three job satisfaction factors were

1. Amount of freedom on the job.

2. Opportunity to develop skills.

3. Pay and fringe benefits.

Other job satisfaction determinants listed were a better or more flexible schedule; better support and respect by physicians, other health care professionals, and the administrative staff; ability to help sick people become well; and continuing education program.

Other comments made regarding job satisfaction determinants included "supervisory duties/changes in duties prevent getting bored," "diversity of patient diagnoses and having the time to provide quality care," "opportunity to learn from all health care professionals," and "feeling like I'm offering a service that is needed and appreciated."

Incentives for retention in current position. The top three responses of factors influencing job retention were

1. Pay and fringe benefits.

2. Continuing education program.

3. Better or more flexible schedule.

Some comments indicating the importance of these retention factors included "support to develop programs and areas of interest," "recognition for my ideas and programs," and "maintaining competitive salaries and benefits."

The majority of the respondents gave positive and encouraging advice to those who might consider joining the physical therapy profession:

Volunteer in a variety of settings involving physical therapy personnel before committing the time and money required to complete your education.

It is wonderful - lots of job security, and you can work anywhere in the country.

It is wonderful profession, but very competitive to get into.

Summary and Implications

During 1992, Utah was projected to need a 22% increase in physical therapy personnel to meet the projected demand. The specific recruitment and retention implications of this research provide some helpful insight into what employers can do to help combat the physical therapy personnel shortage.

Recruitment Implications

Nearly 17% of the respondents indicated that their first job was with the hospitals at which they interned during their training. Employers should recognize that student interns are an excellent source for future full-time employees. If a student has already worked at the facility, the training time and training cost are reduced for full-time employees. In addition, employers should also assist with educational expenses by setting up scholarship funds. In our study, only 19% of the respondents used scholarships to help with educational expenses.

Retention Implications

Once physical therapy personnel are successfully recruited, employers should take all possible measures needed to retain them. Retention of physical therapy personnel is a major concern, especially to hospitals. Rose stated, "Physical therapy practitioners who previously were employed exclusively in hospitals now provide the majority of their services in out-of-hospital settings ."[6](p354)

One physical therapy professional in our study stated, "Currently, hospitals are more interested in productivity and how many patients you can see a day - this has become the emphasis and has discouraged many therapists." Two findings in our research indicate why Utah employers, and specifically hospitals, need to make efforts to retain current physical therapy personnel. First, Utah's physically therapy personnel population is fairly young,, with close to 80% under the age of 44 years. Thus, the majority of the current pool will not reach retirement age for 20 to 25 years, implying the need for employers to seek ways to retain this work force so that physical therapy personnel do not leave the profession. Second, physical therapy personnel have many options for employment and often choose to seek a diversity of opportunities.

The majority of physical therapy personnel in our study indicated that the most important job satisfaction determinants were the amount of freedom on the job and the opportunity to develop skills. These two determinants were mentioned before pay; thus, physical theraphy personnel appear to place more importance on "Maslow's secondary needs" of esteem and actualization than on pay. In our study, however, physical therapy personnel still rated pay and benefits as their most important retention determinant. Thus, as the NAS/IOM stated, beginning pay for PTs is fairly high compared with that of other allied health professionals, but over the long run, salaries are compressed.[5] On the basis of these implications, hospitals need to allow physical therapy personnel freedom, variety, and diversity in their work, as well as provide increased compensation to avoid losing physical therapy personnel to more "lucrative" offers.

Conclusion

Although Utah's shortage does not appear to be as severe as the national shortage, a definite shortage of physical therapy personnel does exist in Utah. By analyzing both the demand and supply components, this study identified some effective methods of attracting physical therapy students and professionals as well as suggested methods for increasing job satisfaction, thereby reducing turnover of present employees and increasing recruitment of future employees. By implementing the strategies mentioned in this and other articles, employers can help to alleviate physical therapy personnel shortages and can help to ensure that high-quality health care continues to be delivered.

References

[1] Silvestri G, Lukasiewicz J. Projections of occupational employment, 1988-2000. Monthly Labor Review. 1989; 112:42-65. [2] Saltzman A. One physical therapist, 10 job offers. US News & World Report. 1989; 106:67. [3] Rush MK. Personnel shortage. Kentucky Hospital Association Task Force 1990 Publication. 1990:6-10. [4] Davis K. Rehabilitation growth fuels PT shortages. Hospitals 1989;63:32. [5] Institute of Medicine, National Academy of Sciences. Allied health services: avoiding crisis. J Allied Health. 1989; 18:335-347. [6] Rose SJ. Editor's note: Gathering storms. Phys Ther. 1989; 69:354-355. [7] Karni KR, Feickert JD. Occupational reinforcers for medical technologies in clinical laboratories - 1966 and 1987. Clin Lab Sci. 1989; 2:355-361.