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An audit of physiotherapy vacancies over 2006: analysis of current workforce needs.

ABSTRACT

The aim was to identify the current physiotherapy workforce needs by categorising physiotherapy vacancies in terms of work type, work experience required and location. Advertised permanent physiotherapy vacancies between January and December 2006 were collected from four national newspapers and the New Zealand Society of Physiotherapy newsletter. A total of 539 new vacancies were identified. The majority of vacancies were located in Auckland (30%), followed by Wellington (15%), and Christchurch (7%). There were vacancies across all areas of physiotherapy, but private practice musculoskeletal vacancies were the most common (57%). When categorised according to the level of experience required, 45.5% did not specify the level of experience required and a further 16% specifically targeted new graduates. The number of re-advertised vacancies indicated that 16% of positions remained unfilled after three months. The results demonstrate a shortage of physiotherapists despite an increase in the number of practising physiotherapists. The profession needs to collect workforce data to determine whether shortages are due to the growth in services offered by private practices and District Health Boards (DHBs). Taylor L (2008): An audit of physiotherapy vacancies over 2006: analysis of current workforce needs. New Zealand Journal of Physiotherapy 36(1): 1-6.

Key words: Physiotherapy workforce, Allied health workforce, Vacancy

INTRODUCTION

Health workforce shortages are a global concern. The 2006 World Health Report, published annually by the World Health Organisation, details a crisis in the global health workforce (World Health Organisation 2006). The reasons for an increased demand for health care in developed countries (such as Australia and New Zealand) are the aging population, a greater incidence of chronic illness, technological developments in health care that aid diagnosis and treatment, and growing consumer choice and access to health services (Australian Health Workforce Advisory Committee, Australian Medical Workforce Advisory Committee and Australian Health Workforce Officials Committee 2005; Ministry of Health and DHBNZ Workforce Group 2007; New Zealand Institute of Economic Research 2004).

A renewed emphasis on health workforce planning in New Zealand began in 2001 with the development of the Health Workforce Advisory Committee (HWAC), in response to the New Zealand Health Strategy (Ministry of Health 2000, Ministry of Health 2004) and Primary Health Care Strategy (Ministry of Health 2001). Australia adopted a similar approach, with the development of the Australian HWAC in 2000 to specifically consider issues relating to the allied health workforce. Publications from both HWACs are concerned with over-arching recommendations for the workforce, rather than specific physiotherapy workforce requirements. However, the New Zealand physiotherapy workforce profile can be derived from the New Zealand Health Information Service's (NZHIS) annual workforce surveys. These summarise the physiotherapy workforce profile in terms age and gender, main employment settings and work types (NZHIS 2000, NZHIS 2001, NZHIS 2003, NZHIS 2004).

In terms of employment settings, over half of the physiotherapists in New Zealand work in private practice, followed by the District Health Boards (DHBs). In past years, there has been an increase in the proportion of physiotherapists working in private practice and a reduction of those working in DHB settings. In 2000, 50% of physiotherapists were in private practice, compared with 54.8% in 2004. By comparison, 30.5% were in DHBs in 2000 compared with 26.6% in 2004.

Sixty one percent of physiotherapists are under 45 years of age, although the trend is for an increasing median age of active physiotherapists (NZHIS 2001, NZHIS 2004). The workforce is predominantly female (80.3% in 2000; 81.2% in 2004) (NZHIS 2001, NZHIS 2004). Over this same period, there has been a gradual shift in ethnic representation, with a reduction in New Zealand European physiotherapists (from 80.1% to 72.5%) and a slight increase in New Zealand Maori representation (0.7% in 2000; 3% in 2004) (NZHIS 2001, NZHIS 2004).

The number of annual practising certificates issued by the Physiotherapy Board of New Zealand has increased by 36% percent in the past 5 years from 2551 in 2000 to 3480 in 2006. This increase is accounted for by almost equal increases in both overseas registrants and New Zealand graduates granted registration over this period (Physiotherapy Board of New Zealand 2004, Physiotherapy Board of New Zealand 2006).

By comparison, the most recent data on the Australian physiotherapy workforce profile shows a 15% increase in the number of physiotherapists (between 1996 and 2001). The median age range is younger, with 73% under 45 years of age and there is greater proportion of males (27%) (Australian Health Workforce Advisory Committee 2004). The concerns raised from this work force profile, both here and in Australia are firstly that many current workers will be retiring in the next 15 years, and there will be a smaller population of workers to replace them. Secondly, as a female-dominated profession many therapists are likely to work part time, limiting the ability to meet demands (Ministry of Health and District Health Board's New Zealand Workforce Group 2007, Schofield and Fletcher 2007).

These profiles offer valuable information on physiotherapy workforce supply; however they do not address the question of whether the workforce is meeting the current demand for physiotherapy services in New Zealand. To address this question, the intention of this study was to identify the current workforce needs through the analysis of advertised physiotherapy vacancies over 2006. Vacancies were classified in terms of work type, work experience required and location of positions. This will provide an indication of whether the workforce is meeting current requirements and may provide insight as to how to plan for future physiotherapy service needs.

METHODS

Advertised physiotherapy vacancies for the period between January-December 2006 were identified from the following sources: The New Zealand Herald, the Otago Daily Times, the Dominion Post, the Christchurch Press, and the New Zealand Society of Physiotherapists' (NZSP) monthly newsletter. Newspapers were searched for vacancies on Mondays, Wednesdays and Saturdays. The NZSP newsletter vacancies were collected monthly.

Vacancies included in the analysis were permanent full- or part-time physiotherapy positions within New Zealand. Vacancies were classified according to (i) work type category (position description and employment setting), as listed in NZHIS publications (2000, 2001, 2003 and 2004); (ii) skill requirements (experienced or new graduate) and; (iii) location. The vacancy locations were demarcated into five main centres (Auckland, Hamilton, Wellington, Christchurch and Dunedin) and thirteen regions as defined by NZS.com (2007). Vacancies re-advertised over a period of three months of more were also identified. Excluded from the study were advertised vacancies of less than six months duration, locum/temporary positions and duplicate advertisements of the same vacancy published within the same month.

RESULTS

There were 539 new vacancies identified for the period between January and December 2006. Forty-five percent were advertised as full-time positions, 20% part time, 17% were advertised as either full or part-time positions and 19% did not state a fulltime equivalency.

Advertised vacancies by position description

When analysed by position description (work type), the largest group of advertised vacancies was for musculoskeletal physiotherapists (62.5%). This was followed in equal proportions by vacancies in adult neurology and cardiorespiratory physiotherapy (4.6% each). The remaining vacancies were spread over the work types detailed in Table 1.

Advertised vacancies by employment setting

The largest number of vacancies were in private practice (n=329), followed by the DHBs (n=171). Universities, schools and private hospitals contributed to the remainder (Table 2). Ninety-five percent of the vacancies in private practice were in musculoskeletal physiotherapy. DHB vacancies were spread over a range of areas including: musculoskeletal outpatients (15% of all DHB vacancies), cardiorespiratory physiotherapy (15%), musculoskeletal inpatients (13%) and adult neurology (9%).

Skill requirements

Vacancies were categorised according to the level of experience required for the position (Figure 1). Thirty-eight percent of positions required experience and/or post graduate qualifications. Work types specifically requiring experience were medical/ surgical cardiorespiratory (23/25 positions), paediatrics (9/13 positions), women's health (all positions), management roles (all positions) and research/teaching (10/16 positions). These work areas were typically located in DHB settings or Universities for research and teaching.

[FIGURE 1 OMITTED]

Thirty-two percent (n=108) of musculoskeletal outpatient positions required experience or postgraduate qualifications. Fifteen of those were located in DHBs (62% of DHB musculoskeletal outpatient positions) with the remainder located in private practice (30% of private practice musculoskeletal positions).

Eighty-four (15.7%) vacancies were specified as suitable for new graduates. Private practice musculoskeletal outpatients offered the largest number of those new graduate positions (n=55). A further 16 private practice musculoskeletal outpatient positions advertised for either experienced or new graduate physiotherapists, indicating they were prepared to employ a new graduate.

Nearly half of all vacancies (n=243, 45.5%) did not specify the level of experience required. The largest proportion of these were in private practice musculoskeletal positions (n=159), followed by musculoskeletal inpatients/orthopaedics (n = 11) and adult neurology (n = 9).

Location of vacancies

The majority of vacancies were located in Auckland (n=164), followed by Wellington (n=83), Christchurch (n=39) and Hamilton (n=34) (Table 3). In Auckland, 114/164 (70%) were in private practice, while in the Wellington region, 43/83 (52%) were in private practice.

Vacancies re-advertised over three months or more

Over the twelve month period, 16% (n=88) of all newly advertised positions were re-advertised for a period of three months of more. Of these, musculoskeletal outpatients comprised 87% (77) of the re-advertised positions, with the remainder in adult neurology (4), community (2), general (1), cardiorespiratory (1) paediatrics (1) and musculoskeletal inpatients (2).

DISCUSSION

The purpose of this study was to identify the current workforce needs through the analysis of advertised physiotherapy vacancies. The results demonstrate a shortage of physiotherapists, despite an increase in the number of practising physiotherapists in recent years. This shortage is best illustrated by the 16% of vacancies that remained unfilled after three months or more of advertising. Of importance, the majority of unfilled vacancies were in the area of musculoskeletal outpatient physiotherapy. The current findings replicate the results of a previous audit of physiotherapy vacancies over 2005, where 20% of vacancies were advertised for three months or more (Taylor et al 2006). The similarity of results between 2005 and 2006 indicates that these figures are not aberrant, but a reflection of current New Zealand physiotherapy work force shortages.

Physiotherapy vacancies were identified in all New Zealand locations, with the largest number in the main urban centres. While the number of vacancies remains high in urban centres, recruitment to provincial settings is likely to be more difficult. Therefore, these results support the concerns of DHBs regarding the difficulty in attracting staff to rural settings (Health Workforce Advisory Committee 2001).

Vacancies were identified across all work types, which indicates a generalised shortage of physiotherapists. However, the number of vacancies in musculoskeletal outpatient (private practice) far out numbered those in other work types. In terms of experience required, over half of the advertisements either did not specify the level of experience required or specifically advertised the position as suitable for new graduates. In addition, there were a number of vacancies advertised as available with either full- or part-time options. These factors indicate employers' willingness to consider flexible employment opportunities.

Most of the vacancies specifically advertised as suitable for new graduates were located in private practice. Given that the numbers of vacancies in private practice are almost double those of the DHBs, it is not surprising that private practice owners are actively advertising for new graduates. These results lend support to the assertion that recruitment difficulties in DHBs are in part caused by competition with private practices for new graduates (Health Workforce Advisory Committee 2001). Conversely, the majority of advertised positions that required experience and/ or postgraduate qualifications were located in DHBs, specifically in cardiorespiratory physiotherapy and paediatric settings. In musculoskeletal outpatients, DHB positions required previous experience in more than half of the vacancies advertised. This likely reflects the need for physiotherapists who can manage the more critical and complex nature of hospital admissions as well as mentor junior staff members.

The type of healthcare services available and hence the workforce requirements are dictated by government health care strategies. In this respect, the New Zealand Health (2000) and Primary Health Care (2001) strategies promote improved access to health care and prevention through increased primary health care services. While pertinent to physiotherapy workforce planning, the focus of primary health care organisations to date has largely been on services provided by general practitioners and practice nurses.

On the other hand, the Accident Compensation Corporation's strategies (as the purchaser of approximately 80% of private practice services) have played a substantive role in shaping physiotherapy work force requirements in past years. The Accident Compensation Corporation's current priorities include: the reduction of injuries and occupational diseases (including initiatives such as falls prevention programmes for the elderly) and improved rehabilitation focused on returning to productive life (including initiatives such as the Endorsed Provider Network to improve access to services and activity-based programmes). The result of these strategies is a 30.2% increase in physiotherapy claims over the period 2002-2006 (Accident Compensation Corporation 2007, Goddard 2007). This growth in demand for services is likely a causal factor in the physiotherapy workforce shortage demonstrated in the current study. Whether the Primary Health Care Strategy has resulted in similar increases in demand for physiotherapy services is unknown.

Interpretation of the data from this study is subject to the following limitations. Firstly, the number of vacancies identified in this study will have underestimated the absolute number of vacancies available in 2006. Vacancies listed on job search web sites, DHB and educational web sites were not included in this audit. These media tend to be used mainly by DHBs and recruiting agencies for private health agencies, so the data presented may specifically under estimate vacancies in these settings. Secondly, the analysis is limited to advertised vacancies, so does not acknowledge positions available through word of mouth. Most importantly, there is an assumption that once an advertised vacancy was no longer listed, then the position had been filled. This may not have been the case. Employers may have simply reduced the services they offer based on the inability to fill these vacancies. Therefore, the number of unfilled positions is likely to be higher than the 16% stated.

CONCLUSIONS

The results of this audit demonstrate a shortage of physiotherapists in both private practice and DHB settings. This is despite an increase in the number of practising physiotherapists. The increase in Accident Compensation Corporation physiotherapy claims in recent years and the increase in the proportion of physiotherapists working in private practice both suggest that growth in demand for private practice physiotherapy services has contributed to this workforce shortage. To confirm this, we need information on: the number of private practices and their location; the number of fulltime equivalent staff operating within individual DHBs and private practices; and service delivery indicators such as waiting list time or changes in services offered. The onus now rests with the physiotherapy profession in New Zealand to monitor its workforce, so that it is better placed to plan for future requirements.

Key Points

1. The number of physiotherapy annual practising certificates issued has increased 36% over the period 2001-2006.

2. There are vacancies in all areas of physiotherapy but the majority are in musculoskeletal private practice.

3. Sixteen percent of all advertised positions remained vacant for period of three months of more. These vacancies were mainly musculoskeletal outpatient physiotherapy positions.

ACKNOWLEDGEMENTS

The author would like to acknowledge the following participating investigators:

Jaime Fenton BHSc (Physio), Roma Forbes BHSc (Physio), Chris Sherer BHSc (Physio), Stephen Young BHSc (Physio) for assistance with data collection.

REFERENCES

Accident Compensation Corporation (2007): Annual Report 2007. http://www.acc.co.nz/PRD_EXT_CSMP/groups/external_ communications/documents/internet/dis_ctrb097219.pdf [Accessed Dec 10, 2007].

Australian Health Workforce Advisory Committee, Australian Medical Workforce Advisory Committee and Australian Health Workforce Officials Committee (2005): Demand for Health Services and the Health Workforce--Information paper, Health workforce Information paper 3, Sydney. http://www. healthworkforce.health.nsw.gov.au/amwac/ahwoc/pdf/ demand_paper.pdf [Accessed Nov 30, 2007].

Australian Health Workforce Advisory Committee (2004): The Australian Allied Health Workforce--An Overview of Workforce Planning Issues, AHWAC Report 2006.1 http://www.health. nsw.gov.au/amwac/ahwac/reports.html [Accessed Nov 30, 2007].

Goddard D (2007): Review of the Way in Which Physiotherapy Services are Funded and Accredited by ACC. http://www. dol.govt.nz/consultation/physiotherapy/acc-final-report.pdf [Accessed Dec 19, 2007].

Health Workforce Advisory Committee (2002): The New Zealand Health Workforce: A Stocktake of Issues and Capacity 2001. http://www.hwac.govt.nz/publications/stocktakereport/11. pdf [Accessed June 26, 2007].

Health Workforce Advisory Committee (2003): The New Zealand Health Workforce Future Directions--Recommendations to the Minister of Health 2003. http://www.hwac.govt.nz/ publications/HWACfuturedirections03.pdf [Accessed June 25, 2007].

Ministry of Health (2000): The New Zealand Health Strategy. Wellington: Ministry of Health. http://www.moh.govt.nz/ publications/nzhs [Accessed June 25, 2007].

Ministry of Health (2001): The Primary Health Care Strategy. Wellington: Ministry of Health. http: //www.moh.govt.nz/ publications/nzhs [Accessed June 25, 2007].

Ministry of Health (2004): Implementing the New Zealand Health Strategy. http://www.moh.govt.nz/moh.nsf [Accessed June 25, 2007].

Ministry of Health Tertiary Education Commission (2004): Qualifications Supply Analysis - The New Zealand Health Sector. http://www.tec.govt.nz/upload/downloads/healthqualanalysis.pdf [Accessed June 25, 2007].

Ministry of Health and District Health Boards New Zealand Workforce Group (2007): A career framework for the Health Workforce in New Zealand. http://www.dhbnz.org.nz/Site/ Current-Issues/Career-Framework-for-HW-in-NZ.aspx [Accessed Nov 30, 2007].

New Zealand Health Information Service (2000): Physiotherapy Workforce. Summary Results from the 2000 Workforce Annual Survey. http://www.nzhis.govt.nz/moh.nsf/ pagesns/74/$File/healthprofs00.pdf [Accessed December 19, 2007].

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Schofield D and Fletcher S (2007): The physiotherapy workforce is ageing, becoming more masculinised, and is working longer hours: a demographic study. Australian Journal of Physiotherapy 53: 121-126

Taylor L, Roigard A, Sung T and Vuletich J (2006): The New Zealand physiotherapy workforce: an audit of current gaps and implications for future needs [abstract]. New Zealand Journal of Physiotherapy 34: 112.

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Lynne Taylor, MBA, MSc, MNZCP

Lecturer, School of Physiotherapy

AUT University

ADDRESS FOR CORRESPONDENCE

Lynne Taylor, AUT University, Private Bag 92006, Auckland, New Zealand. Email:ltaylor@aut.ac.nz. Ph +64-9- 921 968
Table 1: Physiotherapy vacancies in New Zealand
categorised according to position
description.

 Vacancies
 Number
Position Description (Percentage)

Adult Neurology 25 (4.6)
Care of the Elderly 15 (2.8)
Community 16 (3.0)
General 5 (0.9)
Burns and Plastics 3 (0.6)
Management 5 (0.9)
Medical/Surgical Cardiorespiratory 25 (4.6)
Mental Health 1 (0.2)
Musculoskeletal Inpatients 21 (3.9)
Musculoskeletal Outpatients 337 (62.5)
Occupational Health 3 (0.6)
Paediatrics 13 (2.4)
Rotation 15 (2.8)
Special Education 4 (0.7)
Research/Teaching 16 (3.0)
Women's Health 2 (0.4)
Other or not stated 33 (6.1)
Total 539 (100.0)

Table 2. Number of physiotherapy vacancies in New
Zealand categorised according to employment setting
for each work type.

 Employment Setting

 Private
Work Type DHB Practice University

Adult Neurology 16 7
Burns and Plastics 3
Care of the Elderly 7
Community 6 10
Special Education
General 5
Management
Medical/Surgical 3
Cardiorespiratory 25
Mental Health 1
MS-IP 21
MS-OP 25 312
Occupational
Health
Other or not stated 33
Paediatrics 9
Research/ 16
Teaching 15
Rotation 2
Women's Health
TOTAL 171 329 16

 Employment Setting

 Private
Work Type Schools Hospital Other

Adult Neurology 2
Burns and Plastics
Care of the Elderly 8
Community
Special Education 4
General
Management
Medical/Surgical 2
Cardiorespiratory
Mental Health
MS-IP
MS-OP
Occupational 3
Health
Other or not stated
Paediatrics 4
Research/
Teaching
Rotation
Women's Health
TOTAL 4 10 9

Abbreviations: MS-IP: musculoskeletal inpatients; MS-OP:
musculoskeletal outpatients; DHB District Health Board.

Table 3. Physiotherapy vacancies in New Zealand
categorised according to
location

 Vacancies
Vacancy Number
Location Percentage)

Auckland 164 (30)

Hamilton 34 (6)

Wellington 83 (15)

Christchurch 39 (7)

Dunedin 19 (4)

Bay of Plenty 27 (5)

Canterbury 11 (2)

Central 15 (3)
Plateau

East Coast 3 (1)

Hawkes Bay 11 (2)

Marlborough 4 (1)

Manuwatu- 19 (4)
Wanganui

Nelson 22 (4)

Northland 20 (4)

Otago 32 (6)

Southland 11 (2)

Taranaki 5 (1)

Waikato 14 (3)

West Coast 5 (1)

TOTAL 538 (100)
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Title Annotation:Research Report
Author:Taylor, Lynne
Publication:New Zealand Journal of Physiotherapy
Geographic Code:8NEWZ
Date:Mar 1, 2008
Words:3573
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