The Northern Territory Allied Health Workforce Study A collaborative project between

The Northern Territory Clinical School and the University Departments of Rural Health at Northern Rivers, Tamworth and Tasmania

The Northern Territory Allied Health Workforce Study

Final Report – May 2010

Authors: Narelle Campbell Senior Lecturer in Allied Health (Speech Pathology) Northern Territory Clinical School, Flinders University, Darwin, NT Correspondence: [email protected] PO Box 41326, Casuarina. NT 0811 Anna Smedts Senior Lecturer in Research and Evaluation Northern Territory Clinical School, Flinders University, Darwin, NT Shelagh Lowe Associate Lecturer – Rural Allied Health, University Department of Rural Health Tasmania Sheila Keane Senior Lecturer in Allied Health (Physiotherapist), Northern Rivers University Department of Rural Health, Lismore, NSW Tony Smith Associate Professor, Deputy Director University Department of Rural Health, Northern NSW, Tamworth, NSW Suggested citation: Campbell N, Smedts A, Lowe S, Keane S, Smith T. 2010. The Northern Territory Allied Health Workforce Study. Final report. Northern Territory Clinical School, Darwin.

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Table of Contents THE NORTHERN TERRITORY ALLIED HEALTH WORKFORCE STUDY .......................................... 2  TABLE OF CONTENTS .................................................................................................................................... 3  INDEX OF FIGURES ....................................................................................................................................... 5  INDEX OF TABLES ......................................................................................................................................... 6  INTRODUCTION............................................................................................................................................ 7  METHODS .................................................................................................................................................... 9  DEVELOPMENT OF THE SURVEY TOOL ........................................................................................................................... 9  SURVEY IMPLEMENTATION AND SUBJECT RECRUITMENT .................................................................................................. 9  RESULTS ..................................................................................................................................................... 12  RESPONSE RATE .................................................................................................................................................... 12  GEOGRAPHIC DISTRIBUTION OF THE SAMPLE ............................................................................................................... 13  DEMOGRAPHIC PROFILE .......................................................................................................................................... 14  SERVICE DELIVERY .................................................................................................................................................. 16  EXPERIENCE AND LENGTH OF TIME IN CURRENT POSITION .............................................................................................. 17  OUTREACH, HOME VISITS AND ON‐CALL SERVICE DELIVERY, SUPERVISION OF THERAPY AIDE. ................................................. 18  RETENTION .......................................................................................................................................................... 19  JOB SATISFACTION ................................................................................................................................................. 21  RECRUITMENT ...................................................................................................................................................... 22  PROFESSIONAL DUTIES: TYPE OF WORK/CLIENTS .......................................................................................................... 23  PROFESSIONAL DUTIES:  WORK/LIFE BALANCE ............................................................................................................. 25  RETIREMENT IN THE ALLIED HEALTH WORKFORCE ......................................................................................................... 27 

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CONTINUING PROFESSIONAL DEVELOPMENT (CPD) ...................................................................................................... 28  STUDENT SUPERVISION ........................................................................................................................................... 29  DISCUSSION ............................................................................................................................................... 31  RESPONSE RATE & METHODOLOGICAL CONSIDERATIONS ............................................................................................... 31  GEOGRAPHIC DISTRIBUTION .................................................................................................................................... 31  DEMOGRAPHIC PROFILE .......................................................................................................................................... 32  SERVICE DELIVERY .................................................................................................................................................. 33  EXPERIENCE AND LENGTH OF TIME IN CURRENT POSITION .............................................................................................. 34  RECRUITMENT ...................................................................................................................................................... 34  RETENTION .......................................................................................................................................................... 35  Job satisfaction ............................................................................................................................................ 35  Work/life balance ........................................................................................................................................ 35  Student supervision ...................................................................................................................................... 35  CONTINUING PROFESSIONAL DEVELOPMENT (CPD) ...................................................................................................... 36  STUDENT SUPERVISION ........................................................................................................................................... 36  CONCLUSION ............................................................................................................................................. 37  REFERENCES ............................................................................................................................................... 39 

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Index of Figures FIGURE 1: AGE DISTRIBUTION ...................................................................................................................................... 14  FIGURE 2: YEARS OF EXPERIENCE BY RESPONDENTS .......................................................................................................... 16  FIGURE 3: DISTRIBUTION OF RESPONDENTS BY WORK SECTOR ............................................................................................. 16  FIGURE 4: PROPORTION OF RESPONDENTS INTENDING TO LEAVE THEIR CURRENT POSITION ...................................................... 20  FIGURE 5: JOB SATISFACTION ....................................................................................................................................... 21  FIGURE 6: JOB SATISFACTION BY SECTOR ........................................................................................................................ 22  FIGURE 7: INTENTION TO LEAVE IN RELATION TO JOB SATISFACTION (PROPORTION OF RESPONDENTS) ......................................... 22  FIGURE 8: FREQUENCY OF REASONS CITED WHY ATTRACTED TO CURRENT POSITION ................................................................ 23  FIGURE 9: AGREEMENT WITH STATEMENTS REGARDING THE TYPE OF WORK* ........................................................................ 24  FIGURE 10: RESPONSES TO THE STATEMENT "YOU FEEL PROFESSIONALLY ISOLATED" .............................................................. 24  FIGURE 11: AGREEMENT WITH STATEMENTS REGARDING SERVICE GAPS AND STAFF ALLOCATION* ............................................. 27  FIGURE 12: PERCENTAGE OF TOTAL RESPONDENTS IN AGE CATEGORY THAT LISTED RETIREMENT AS REASON FOR LEAVING, AND THE  TIMEFRAME INDICATED TO LEAVE ......................................................................................................................... 27 

FIGURE 13: UPTAKE OF A VARIETY OF MODES OF CPD IN THE PAST 12 MONTHS .................................................................... 28  FIGURE 14: BARRIERS TO ACCESS CPD .......................................................................................................................... 29  FIGURE 15: SATISFACTION WITH ACCESS TO CPD AND COLLEAGUES FOR PROFESSIONAL SUPPORT ............................................. 29 

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Index of Tables TABLE 1: RESPONSE RATES BY PROFESSION ..................................................................................................................... 12  TABLE 2: DISTRIBUTION BY ASGC‐RA ........................................................................................................................... 14  TABLE 3: DISTRIBUTION BY NORTHERN TERRITORY TOWNSHIP ............................................................................................ 14  TABLE 4: MEAN AND MEDIAN AGES OF RESPONDENTS BY PROFESSION ................................................................................. 15  TABLE 5: DEMOGRAPHIC DESCRIPTORS BY OCCUPATION .................................................................................................... 15  TABLE 6: DISTRIBUTION BY PROFESSIONS ACROSS SERVICE DELIVERY SECTORS ........................................................................ 17  TABLE 7: MEAN AND MEDIAN YEARS OF EXPERIENCE BY PROFESSION ................................................................................... 17  TABLE 8: MEAN AND MEDIAN LENGTH OF TIME IN CURRENT POSITION BY PROFESSION ............................................................ 18  TABLE 9: NUMBER (%) OF PROFESSIONALS ENGAGED IN HOME VISITS, OUTREACH AND SUPERVISION OF AN AIDE ......................... 19  TABLE 10: PROPORTION OF RESPONDENTS PROVIDING OUTREACH SERVICE FROM EACH RA ZONE.............................................. 19  TABLE 11: INTENTION TO LEAVE JOB WITHIN 2‐5 YEARS BY PROFESSION 2 YEARS 5 YEARS N ..................................................... 20  TABLE 12: REASONS CITED FOR LEAVING WITHIN 5 YEARS .................................................................................................. 21  TABLE 13: WORKING HOURS PER WEEK BY PROFESSION .................................................................................................... 25  TABLE 14: NUMBER OF RESPONDENTS WORKING PAID AND UNPAID OVERTIME ...................................................................... 26  TABLE 15: STUDENT SUPERVISION AND SUPERVISION TRAINING BY PROFESSION ..................................................................... 30 

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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. For example in acute care, physiotherapists, occupational therapists and social workers contribute to speedy discharge from hospital and to the prevention of readmissions. Podiatrists, exercise physiologists and dieticians are key team members in managing chronic conditions such as diabetes. Audiologists and speech pathologists provide screening and therapy to children with developmental difficulties. Medical laboratory scientists and radiographers provide essential diagnostic services. Psychologists help to address the rising prevalence of depression. Allied health professionals often work in multidisciplinary models of care, with an emphasis on preventative services and are well placed to provide interprofessional health education and health promotion services. Planning successful health services that meet the needs of disparate metropolitan, rural and remote communities is improved by accurate, detailed and contemporary workforce information enabling a match of health need to workforce supply. However, in the case of the allied health professions, the ability to plan services is hampered by a lack of a clear definition of ‘allied health’ accepted by all jurisdictions, and the quality and availability of allied health workforce information. Workforce data is robust for medical practitioners2 and for the nursing workforce3 including many peer reviewed publications and major government reports3. In contrast, there is very little data providing information about the current allied health workforce, particularly in rural areas.4 Available studies are dated, based on a small sample size, geographically limited or report important inconsistencies.5 The Australian Institute of Health and Welfare released workforce reports in 2006 for the physiotherapy, podiatry, occupational therapy, and psychology labour forces based on data collected in 2002-2003. It has been a number of years since reports were made available for the pharmacy (2003), and optometry (1999) labour forces. It is well known that there is a national shortage of allied health professionals and that this problem is worse in rural areas.6 As the population density diminishes, there is a per capita reduction of allied health service. 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. Additionally, the limited ability to train in the allied health and oral health professions in the Northern Territory impacts the ability for NT residents to train as allied health or oral health professionals.

In 2006, the Australian Health Workforce Officials Committee (AHWOC) 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 renders such analysis impossible. The Northern Territory Allied Health Work-integrated Learning (AHWIL) research project, in partnership with the Rural Allied Health Workforce study (RAHWS) in New South Wales and Tasmania, undertook to identify the characteristics of the entire allied health workforce in the Northern Territory across all service sectors. Whilst a considerable proportion of allied health services, and services provided by oral health practitioners (dental therapists, dental hygienists), are employed by the Department of Health and Families (DHF), private, federally-funded and non-government organisations also account for a substantial proportion of allied health service delivery. Service sectors have interactive effects, particularly in rural and remote 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.

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Methods Development of the survey tool The survey instrument used in this study was tailored for the Northern Territory from one 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 Conference7 and published in the Australian Journal of Rural Health in 2008.5 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, as well as 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. Participants reported that the questionnaire canvassed issues of concern to remote and rural practitioners. 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 For use in the Northern Territory, the survey was adapted to suit local conditions and then piloted with a number of Northern Territory allied health professionals to ensure that the data collected would provide relevant local information. The final survey tool used in the Northern Territory study is appended (Appendix).

Survey implementation and subject recruitment For the purposes of determining the inclusions of professions in this study, the “Framework for the classification of the allied health workforce” was used. This document, published by Services for Australian Rural and Remote Allied Health (SARRAH), defines rural and remote allied health and provides a structure for categorisation within the allied health workforce based on qualification/skills level and direct impact on health outcomes of health consumers.13 It was determined that the study would

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include those non-medical and non-nursing health professions that provide direct therapeutic and diagnostic health services. The Department of Health and Families was consulted to determine workforce data collection priorities and support with survey distribution. Ethics approval to undertake the study was obtained from the Menzies School of Health Research, Charles Darwin University. Allied health professionals are both widely dispersed across the Northern Territory and transient, making them difficult to locate. Survey distribution was therefore undertaken using purposive sampling with a number of overlapping recruitment strategies and response methods. An online option for participation was developed by using SurveyMonkey. The convenience and cost advantages of the online response were considerable: online responses were immediately entered into the database, the cost of administrative support was reduced, and accuracy of data was increased through minimising the possibility of data entry error. Hardcopies of the survey were distributed to allied health groups or departments where electronic distribution was not an option. The survey was distributed to DHF allied health professionals through professional email distribution lists. Contact was also made with the Department of Justice and Department of Education and Training to locate potential participants and invitations were issued through an emailed SurveyMonkey link. Hand searching of the Yellow Pages telephone directory for all professions was conducted to recruit private practitioners and to recruit allied health professionals located with nongovernment organisations (including aboriginal community controlled organisations, Commonwealth government health service providers and business corporations known to employ allied health staff). Purposive snowball sampling was also encouraged. Professional boards and associations were provided with information about the study to pass on to their members for those professions registered within the Northern Territory. Discussions with the Pharmacy Board led us to believe that their membership list would not accurately reflect pharmacists living in the NT. For this reason we elected to contact via telephone and fax, the six hospitals in the NT and the yellow pages listings of private pharmacies. The three larger hospitals requested hard copies of the survey for both radiography and pharmacy as many of their staff did not regularly access their department email. Private pharmacies generally requested faxed copies. Consideration was given to the participation of allied health professionals who were currently in the NT working under the Federal government Northern Territory Intervention. It was decided not to include these professionals given the temporary nature of their NT employment and with consideration for artificially inflating the workforce size compared with usual staffing levels. The survey opened on December 1, 2008 and closed on March 20, 2009. Over this period three reminders were broadcast via either email or follow up phone call where hard copy had been requested. Survey data were entered into a secure electronic database either by direct online responses from

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participants or by administrative staff employed by the Northern Territory Clinical School in the case of returned hardcopy surveys. A total of 202 records were entered into the database. Data was subsequently cleaned to eliminate duplicate or ineligible records. 23 records were eliminated; many were near or totally empty, four were not AH professions (nursing or administration). Final sample size was 179. Statistical analysis was conducted using SPSS 17 and Microsoft Excel 2007. In general, analysis data sets excluded cases where data were incomplete. Missing data were imputed from existing data where appropriate. If relevant, a ‘no response’ category was included in the data analysis. Demographic, professional, and training factors were compared using chi-square and ANOVA tests, as appropriate. The Shapiro–Wilk test was used to evaluate skew within the sample. This report does not generally show data for professional groups with where n< 5.

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Results Response rate After data cleaning, a total of 179 respondents were included in the sample for statistical analysis. The total number of respondents listed by occupation is shown in Table 1. Table 1: Response rates by Profession

Profession 

# Surveys Sent 

# Surveys Returned 

Return  Rate 

15  13  50  34  2  62  33  80  1  6  16  4  3  26  68  3  29  103  38  586 

5  1  22  6  1  16  8  24  0  2  5  1  0  13  20  0  7  33  15  179 

33%  8%  44%  18%  50%  26%  24%  30%  0%  33%  31%  25%  0%  50%  29%  0%  24%  32%  39%  31% 

Audiology  Chiropractor  Dietetics/Nutrition  Environmental Health  Exercise Physiology  Imaging  Medical Laboratory Science  Occupational Therapy  Orthoptists  Optometry  Oral Health  Orthotics/Prosthetics  Osteopaths  Pharmacy   Physiotherapy  Podiatry  Psychology  Social Work  Speech Pathology  Total 

Because of the multiple, overlapping recruitment strategies, the overall response rate could only be estimated. Response rates were calculated as follows: Within the Northern Territory, some allied health professions have small numbers and are well networked. These professions included speech pathology, occupational therapy, audiology, podiatry, prosthetics, dental therapy/hygiene, orthoptics, nutrition & dietetics, and environmental health. Using networks, professional associations, and Department of Health and Families distribution lists, it was determined that we had sampled at, or close to, 100% of the population in these professions. These professionals all received electronic surveys via SurveyMonkey. Thus the return rates for these professions were readily calculated. The return rates for the other professions were more difficult to quantify. Utilising registration board estimate of numbers was limited as described in the methods section. Additionally, anecdotal information on workforce size was not reliable and informal comprehensive networks across the professions were less strong. The major employers for radiology, pathology and pharmacy professionals

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were both the public and private sector hospitals, as well as the private sector corporates, however many individuals in these groups did not have ready access to email distribution lists to enable good survey return rate calculations. It was particularly difficult in the pharmacy private sector to estimate response rates as the anecdotal reports were that many pharmacists worked part-time across a number of sites making workforce size calculations problematic. Social work and psychology data included professionals employed in a range of Territory and Federal Government departments (Department of Health and Families, Department of Justice, Department of Education and Training, Centrelink, Commonwealth Rehabilitation), as well as the higher education, non-government sector and private providers. Compared to the other Australian states, the NT allied health workforce is small, both in absolute numbers and in relation to total population size. This, coupled with a somewhat disappointing survey response rate (~31%), limited our scope to perform large multivariate analyses, and yielded percentages and ratios that reflect small group sizes. Nonetheless, we feel confident that the analyses are reliable and depict important trends and circumstances. Significance was set at p 60

> 60

50-60

Answer the following questions in relation to your MAIN JOB 4. 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):__________________________________________________________________ 5. About how long have you worked in the region you now work in?_____________ years

6.

Are you a ‘sole practitioner’ where you work? Always Often Sometimes Rarely Never

7. Approximately how long (in minutes) does it take for you to travel between home and work? 8. 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 ________________________________________ p44 (Survey)

=

%

=

9. Do you provide a service in venues outside of your main work base?  Yes No If you answered ‘yes’, please indicate the frequency of this work based travel? Monthly Fortnightly Weekly Daily Other (please specify) _______________ If you answered ‘yes’, please indicate the duration (number of nights absent from home) of this work-based travel Nil 1 night 2-3 nights 4 or more nights Other (please specify) _________ 10. What form of transport do you use for work-related travel? (Do not include conference attendance, study or

recreational travel.) Own car Car provided Plane Other __________________________ 11. Estimate the furthest distance you travel from your employment base for work-related activities?__________ km 12. Estimate the average number of hours you spend in work-related travel per month (exclude home-work travel time)__________________________ 13. In what size community is your current employment based? >99,000 25,000 – 99,000 10,000 – 24,999 5,000 – 9,999

10 years? Your child(ren)’s education I have no plans to leave my job Moving to a preferred location Extended family commitments or obligations Partner (change in job, transfers) Other ____________________________________

p45 (Survey)

Section Three: Education & Professional Development 24. 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 _____________________________

25. Are you currently studying for a further tertiary qualification? No Yes – If so, what? ____________________________________________ 26. 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 inservice Formal tertiary education program / enrolment

Email or Web-based material Reading professional journals Other ______________________________

27. 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

28. 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 organization – not employer Professional Organization University or University Department of Rural Health Other tertiary education provider

29. 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 Greatly Greatly Greatly Greatly Greatly

Moderately Moderately Moderately Moderately Moderately Moderately

A little A little A little A little A little A little

Not at all Not at all Not at all Not at all Not at all Not at all

Other factors? ____________________________________________________________________________ 30. Do you have Information Technology access at work and/or at home? (Tick all relevant boxes) Work E-mail access Work Internet access Work Electronic Libraries access

Home E-mail access Home Internet access Home Electronic Libraries access

I have broadband access I do not have email or internet access

31. Do you participate in the supervision of students on professional placements in your workplace? No, please go directly to question 37 Undergraduate Post graduate entry level 32. During the past 12 months how many student placements have you offered? _____________ How many of these placements were taken up by a student? ______________________

p46 (Survey)

Post graduate

33. During the last 12 months please identify the number of students to whom you provided a: Extended placement (eg; day placements over an extended period of time, or blocks of a week or more) One-off placements (eg generally less than 2 days total duration) 34. During the last 12 months please indicate the number of placements where your supervision responsibilities were: shared with at least one other health professional sole 35. Please identify the discipline(s) of students you have supervised in the past 12 months?

36. Please identify the university(s) of origin for students you have supervised in the past 12 months?

37. Do you have other teaching responsibilities besides placement supervision (eg tutes/lectures) to students? No Yes Please specify ______________________ 38. In your opinion, what is the biggest barrier you face in supervising students?

39. In your opinion, what is the most valuable support you have in supervising students?

40. Thinking about the last 12 months has the amount of student supervision you have provided suited you? Yes, just right No, I would have liked more No because I didn’t supervise but I would have liked to No I would have liked less supervision responsibilities Not applicable 41. What is your opinion about the impact(s) of supervising students on: Increases

Decreases

Doesn’t change

Safety and quality of patient care Your job satisfaction Your workload Your clinical knowledge Your professional support network Recruitment to your workplace Viability of your profession 42. Have you had training in student supervision and /or mentoring? Yes No 43. Have you need training in student supervision and /or mentoring? Yes No 44. Have you participated in the mentoring of other allied health professionals? Yes other States NT only p47 (Survey)

Internationally

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

SA

A

N

D

SD

NA

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)

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

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

p48 (Survey)