Future Proofing

Workforce planning

Despite a growing pool of physiotherapists, the ability to meet workforce demand remains uncertain.

There is now strong evidence of growing shortages in the physiotherapy workforce, with a rapidly diminishing workforce in residential aged care. New data on the top 20 occupations in demand nationally places physiotherapy at number 17 (Labour Market Update, Feb & May 2023).

The APA welcomes the investment to increase payments for the Workforce Incentive Payment (WIP) to improve access to medical, nursing, and allied health services in regional, rural and remote areas. However, broader strategies are required for increasing physiotherapy recruitment and retention in rural areas, including a redesign of the WIP so that it directly supports physiotherapy.

We want the government to incentivise the physiotherapy workforce in the same way as GPs. This will ensure that training can be built into physiotherapy business models to address the barriers that limit clinical supervision capacity.

Greater focus on the improved utilisation of skills through advanced scope of practice roles to address current and future workforce issues is also needed.

Actions we are calling for

We are calling for a range of measures, including more focus on national policy setting which should be strengthened through:

• A national allied health workforce strategy encompassing needs assessment and targets for physiotherapy workforce growth.

We are calling for strategies to optimise scope of practice through two key measures:

• The development of advanced practice physiotherapy roles to improve the patient journey and strengthen care.
• Funding for an advanced skill pathway to support physiotherapists to upskill to meet a need in their community.

To help address immediate supply challenges, we call for settlement supports for our skilled migrants:

• Direct attraction packages and retention supports for skilled migrant physiotherapists.

To address the impending workforce shortage in aged care, we are calling for:

• Immediate action to address job losses in residential aged care facilities as a consequence of recent policy action.

How this helps

The entire health workforce is in desperate need of attention, investment and reform. There are broader economic benefits to be found through efficiencies, such as moving care from hospitals into primary and community health services.

Workforce policy solutions are needed to deliver contemporary care models and clinical excellence. Solutions must ensure a greater emphasis on multidisciplinary care in the healthcare system. Investing in the development of physiotherapists is essential to delivering on these commitments and taking the pressures off the high-cost parts of the system.

Relevant information

• December 2022 Submission – Public Consultation: A Migration System for Australia's Future
• December 2022 Submission – Employment White Paper 
• August 2022 Statement – Response to the Jobs and Skills Summit Issues Paper

Next generation

Significant investment is required to secure the next generation of physiotherapists. The singular focus on medical workforce investments ignores the critical role of physiotherapy and allied health.

To attract the next generation of physiotherapists we need a more supportive pathway experience. This means strategies that offer students and graduates the opportunity to experience both short- and longer-term placements, within both the private practice and hospital settings, and alongside targeted rural exposure.

Actions we are calling for

More investment to secure the next generation of physiotherapists – a funded training pipeline will ensure that physiotherapy graduates have the required skills to enter the workforce.

1. Invest in a training pipeline to support successful adaptation to practice through a flexible framework of support and training that can be applied at any career stage.
2. Develop physiotherapist teaching capacity and provide a more supportive training pathway through funded supports for clinical placements via teaching incentives.
3. Legislative change to address the barriers that prevent physiotherapists from billing against MBS items for supervising a student to treat eligible patients.

How this helps

A funded training pipeline will ensure that physiotherapy graduates have the required skills to enter the workforce. Physiotherapy training programs must therefore include funded clinical placements to provide the opportunity for students to implement their learning in a supervised environment.

Due to an increasing number of training programs, there is a growing demand for clinical placements. Investment in teaching capacity (i.e. supervision) is required to support supervisors in their key role in developing a strong and capable physiotherapy workforce.

Legislative change is required to address the current provisions that prevent physiotherapists from billing against MBS items 10960, 81335 and 82035 for supervising a student to treat eligible patients for the required period of time.

Rural workforce

Many rural communities have no physiotherapy services. This widens the disparities in healthcare. Barriers to the supply of public and community sector physiotherapists are complex and require significant policy action.

Rural physiotherapists work mainly in private practice, often in areas of disadvantage and social and economic inequity, where access to hospitals and even GPs is limited. These factors impact significantly the viability of rural practices that face significant challenges in delivering high-quality sustainable rural health services – and we need governments to address this.

The incentivised supports provided to support the rural workforce are predominantly wrapped around general practice and not allied health. The one key measure that does extend reach towards allied health is the Workforce Incentive Program (WIP) but this program is poorly targeted and does not support the distribution of the physiotherapy workforce. A Strategy that directly funds GPs in rural areas to employ physiotherapists is counterproductive as it threatens the practice viability of independent physiotherapy practices already well established in their local communities.

Actions we are calling for

We want urgent policy reform to address the health inequities and access constraints for the seven million Australians living in rural and remote areas. Increasing retention of physiotherapists nationally will help build workforce capability to meet changing health care needs and increasing service demand.

1. Financially incentivise physiotherapists to enter training and practices where they are needed most.
2. Restructure the Workforce Incentive Program to directly fund physiotherapy practices.
3. Extend the Higher Education Loan Program (HELP) for Rural Doctors and Nurse Practitioners initiative to rural physiotherapists.
4. A broader ‘rural pipeline’ investment to build capacity providing a flexible framework of entry to rural practice that can be applied at any career stage.

How this helps

Practice viability remains a major factor in the recruitment and retention of physiotherapists, with a need for incentives to facilitate training across the full training continuum. Increasing the retention of physiotherapists nationally will help build workforce capability to meet changing health care needs and increase service demand. Addressing rural maldistribution requires increasing rebated allied health services and providing investment in practice viability support that factors in the geographic an demographic workforce, and training variables.

Beyond practice incentives, another key attraction strategy is the elimination of HELP debt for graduate physiotherapists working in rural and remote regions. Physiotherapists should be offered the chance to have their university debt cleared if they work in rural areas in the same way that doctors and nurse practitioners are incentivised. Expanding such a program to include allied health will support the growth of multidisciplinary care in areas of Australia where it is needed most.

Digital Health

We need to build the data infrastructure to ensure all Australians can benefit from digital health solutions. This includes addressing interoperability as a core component of health reform. To achieve better outcomes we need a mature digital heath ecosystem to effectively utilise My Health Record (MHR).

The physiotherapy workforce is key to ensuring that digital health is adopted across the entire health care landscape. If we are to harness the full potential of digital health care in Australia, targeted investment is required to leverage digital health solutions across all patient pathways. This requires a broader funding commitment to test and trial system-wide solutions encompassing physiotherapy.

Actions we are calling for

1. Fund physiotherapists to embed digital health through extending the Practice Incentives Program (PIP) eHealth Incentive.
2. Fund a physiotherapy-led pilot within primary care and the hospital system to support interoperability and streamline the patient journey.

How this helps

Integration in healthcare is reliant on more alignment through connected platforms that enhance interoperability in digital health. Currently, our system actively discourages GPs from working in teams and more broadly we lack enablers, including in digital health, to address the significant disconnect between primary care and hospital systems. To drive integration forward, integrated care must now be supported through funded pilots and trials including in targeted digital health solutions from within physiotherapy.

A PIP eHealth Incentive for physiotherapy would ensure the take-up of new digital health technology and facilitate a more integrated approach to patient care. An interoperability pilot would help to streamline the number of patient interactions with physiotherapists and other health care professionals, and ultimately strengthen patient care.