Degrees of readiness: graduates

 

With an increasing number of new graduate physiotherapists entering the workforce, employment availability and students’ preparedness for what lies ahead will have a significant impact on the profession. In this second of a two-part series, Melissa Mitchell looks at the changing physiotherapy workforce and the impact on private and public sector employment.

It was a perfect storm of circumstances that saw a boon in the number of physiotherapy schools opening at universities across the country from 1995 to 2005. The introduction of tiered tertiary education fees was just one factor, but it helped make physiotherapy a highly attractive field of study. The rise in popularity helped drive up entry standards and physiotherapy schools were populated with intelligent, motivated, enthusiastic and passionate cohorts who, back then, predominately went on to commence their careers in the public sector.

There’s been a little increase in the last 20 or so years—nothing dramatic that aligns with the number of graduates that have increased over that same time period.’
Sandra Brauer, APAM

It was an era that saw the number of entry-level physiotherapy programs at Australian universities jump by a whopping 150 per cent—eight schools became 20 within a decade, making it the most significant spike of its kind in the profession’s history. Since then the number of physiotherapy programs has continued to increase, albeit at a slower pace. There are now 22 schools (two are yet to graduate students) offering some 27 programs and the number of students enrolled in these programs has steadily continued to grow. The APA’s InPractice 2025 report showed the number of graduates was projected to increase by 56 per cent between 2012 and 2016—and more students means more demand for jobs. So where are all these new graduates going?

This is one of the questions many of the profession’s leaders are asking, and it’s something the president of the Council of Physiotherapy Deans of Australia and New Zealand (CPDANZ), Professor Sandra Brauer, APAM, ponders as she views the growth and change of the profession through an education lens. ‘So where are they going? Well they’re going to a variety of places, and it depends on where you get the data from to work that out,’ Sandra says. Although students experience something akin to survey fatigue by the time they graduate, the compulsory graduate destination survey of all students by the three-month postgraduate mark is a fair indicator of just where all the new graduates are finding employment.

‘That survey shows that over 97 per cent of physiotherapists are working postgraduation, so they seem to have jobs,’ Sandra says. ‘The survey is not specific to physiotherapy. The same broad questions are asked of an engineering student or an arts student or a physiotherapy student … “Are you working in the public sector, private sector or other?”. And so when we examine physiotherapy data it shows that about 40 per cent are going to the public sector, 60 per cent are going to the private sector and minimal to “others”,’ she says.

The InPractice 2025 report shows the proportion of graduates employed in private practices increased from 34.7 per cent to 41.8 per cent between 2011 and 2012. In contrast, graduates employed in the public sector fell from 48.3 per cent to 38 per cent in the same period (Health Workforce Consulting 2013). As far back as 2006, figures indicated the largest employer of new graduates was the private sector. Data from the Physiotherapy Labour Force report 2006, part of the National Health Workforce dataset, show residential aged care facilities and private practice were already employing the bulk of new physiotherapists.

‘We do think that there’s a greater trend towards employing graduates in the private sector in general. In talking to our public sector colleagues, and knowing their data quite well, they haven’t identified a great increase in the number of positions they’ve given to new graduates, either their dedicated new graduate positions or in the number of new graduates they employ,’ Sandra says. ‘There’s been a little increase in the last 20 or so years—nothing dramatic that aligns with the number of graduates that have increased over that same time period.’

With so many new graduates headed for the private sector, which includes, but is not limited to, private practice, just how prepared undergraduates are to take on the role once they get there is another question being asked. Sandra believes an emphasis on working in the private sector that is reflected in the current curriculum has seen students graduate a lot more prepared for private practice than previously.

‘When I graduated virtually everyone worked in a hospital first, in their first year out. It was quite rare if someone didn’t,’ Sandra says. ‘But these days we can assume that most won’t work in a hospital. So there is a much greater emphasis on contextualising learning to include a range of sectors such as private practice in teaching … whether in terms of case studies, or simulation, or whether there’s a greater proportion of students now doing placements in private practice, or whether it’s an expansion of business skills that are embedded in the curriculum.

‘But I also think that it’s challenging for us to fully prepare people for such a variety of specific workplaces. There is a broad range of considerations even if you just consider the private practice context … the expectations of what one private practitioner will want their staff to do may be actually a bit different to what a second private practitioner would like their staff to do. Practices in different fields will all have varying needs and expectations. I think we can get students ready to a certain point, which is entry to practice, but beyond that, and with the support of their employer, graduates gain further skills suited to the context of their employment. Their employer has in mind what they want their employee to go beyond being a competent clinical physiotherapist who is able to assess, evaluate, manage patients and communicate well,’ she says.

‘If we all admit that part of our professional responsibility is to foster the next generation, then that’s something that we should really take on board.’
Lucy Chipchase, APAM

Different approaches to business education by individual universities can also influence the preparedness of graduates for private practice, as can the availability of clinical placements in private practice. The latter can be something of a stumbling block for universities as an increase in the number of physiotherapy programs and students does not necessarily translate to the number of readily-available clinical placements, Sandra says. ‘There has been a slow growth over time in students having placements in private practice … it is not mandatory to have private practice placements but more and more universities seek to incorporate this opportunity in their programs because we want to support our students to experience the settings where they’re going to be working.’ To help increase the number of private practitioners taking on students for clinical placements, the University Clinical Educator Managers group is putting together guidelines to support placement providers, she says. This was one of the key recommendations arising from the 2018 APA CPDANZ Student Summit.

Although it is in a constant state of renewal, the jam-packed curriculum has a heavy clinical focus while also concurrently managing demand for more private practice skills and attributes in undergraduates. Universities are required to report annually to the Australian Physiotherapy Council about their programs as well as undertake internal reviews of the curriculum. As part of their accreditation process, universities must also demonstrate how they are working with employers and responding to feedback.

‘In terms of what needs to be included beyond clinical skills … I think one of our big opportunities and challenges are that we’re preparing people to work in a variety of areas such as health promotion, residential aged care, technology and more. So we want to make sure that our graduates are problem solvers, that they can critically analyse the information they get because they’re going to be constantly at the forefront of doing new things,’ Sandra says. ‘And they need to be able to be responsive to advances in technology and adopt a life-long approach to learning.’

The increasing number of new graduates entering the market has required many leaders of the profession to become innovative and think differently about clinical education and ways to support new graduates in the workplace. Professor Lucy Chipchase, who is on the Board of Directors of the Australian Physiotherapy Council and is a member of the APA’s Educators group, says fostering innovation and change as well as supporting the next generation of physiotherapists coming through is not something that can be done in isolation.

‘I think everyone’s working fairly well collaboratively together ... I think universities, providers, private practitioners, professional bodies and the like can develop a physiotherapy workforce that is really solid. But we have to work collaboratively,’ Lucy says. ‘I think it is really important for all physiotherapists working in the profession … we really need to see that everyone has a role in educating the student body. If we all admit that part of our professional responsibility is to foster the next generation, then that’s something that we should really take on board.’

Lucy says the workforce expects more of graduates than ever before, particularly in leadership skills; however, more work needs to be done in determining exactly what skills are being demanded, given that there are a myriad of different private practice settings available to new graduates. Postgraduate education, too, is also a concern for universities.

With the profession facing a high attrition rate of physiotherapists who are five to 10 years out of university, retention of the profession’s young, brilliant minds is also a vitally important focus for professional bodies as well as employers, she says.

‘So in terms of keeping undergrads, retention is incredibly important,’ Lucy says. ‘Part of the APA’s role is to provide ongoing education to make sure people are still learning, growing and developing. And that’s also part of every practitioner’s role, to keep developing the people that are coming through behind them. It’s also up to the individual around making sure they keep learning and developing these skills, and universities play a part in that by providing postgraduate qualifications.’

To that end, the APA’s Career Pathway ‘will be a significant change in the way physiotherapists can access and seek postgraduate education,’ says the immediate past chair of the APA Educators group, Sara Carroll, APAM, a senior lecturer at the School of Physiotherapy and Exercise Science at Curtin University.

Offering career-long support from graduation to retirement, the Career Pathway is ‘a framework of quality-assured coursework, mentoring and research with clearly defined optional assessment points. This framework joins the universities, the APA and commercial professional development companies to share standards, competencies and learning outcomes at each step of a physiotherapist’s career’, as outlined in the APA’s Career Pathway White Paper 2016.

‘I think the APA’s pathways are … a great opportunity for universities to work in conjunction with the APA to offer unit, master’s degrees and graduate diplomas that help a physiotherapist achieve their goal to gain access to the college [Australian College of Physiotherapists]. I don’t think either the APA or the profession on its own or the universities on their own can achieve it, so it’s really got to be a partnership,’ Sara says.

Lucy adds that graduates these days need skills above the direct physiotherapy clinical skills of previous generations. ‘They need skills in leadership and supervision and mentorship and entrepreneurship ... as educators we need to work out the balance of that with clinical skills and make sure we enable both in our graduates.’


Summit tackles work readiness issues

Future-proofing the physiotherapy profession to ensure new graduates and early-career physiotherapists have the necessary skills and abilities to work in private practice was the driving force behind the inaugural summit hosted in Melbourne last year by the Council of Physiotherapy Deans of Australia and New Zealand (CPDANZ) and the APA.

Representatives from across a broad spectrum of the physiotherapy profession united for the day-long summit which sought to understand the university and primary healthcare landscape and to develop learning opportunities to ensure the future workforce is ready to work in the primary healthcare sector, particularly in musculoskeletal private practice.

The immediate past chair of the APA Business group and current APA Board member, Scott Willis, APAM, said the event attracted some 45–50 attendees including physiotherapy educators, leaders, private practitioners and delegates from professional bodies.

On the agenda, Scott says, were issues including the challenges faced by private practices employing new graduates, the gap between new graduates’ knowledge and the realities of working in private practice, and developing a better understanding of the issue of students providing services when reimbursement from third parties is involved.

‘We were asking questions such as what are some of the issues that new graduates are facing? What are some of the issues that private practice owners are seeing of students and also of new graduates? How are we going to support practices to take on students? What are some of the models that are currently out there that people are using for students in private practice clinical placements?,’ Scott says.

‘We’ve been inundated by members and private practice owners saying that students aren’t 100 per cent ready to come into private practice as a  new graduate … if we don’t have students ready for private practice, how are the universities going to sustain clinical placements in the public system? So we, as a profession, thought this is a serious issue that could really stall the profession and we felt we really needed to move forward on it. We didn’t want a talkfest, we wanted clear outcomes at the end of the day. We’ve got to keep the momentum going now.’

‘We heard from private practitioners passionate about clinical education—some who take 50 students a year on clinical placement and some who take two students a year. They identified benefits and challenges and how they make

it work for them. It was clear from university representatives and private practitioners that there are many varied, successful models of clinical education, with the Australian Physiotherapy Council strongly encouraging innovation in clinical education,’ she says.

Guidelines to inform and support private practitioners engaged with clinical education was one key outcome from the summit, Sandra says. Another included understanding work readiness in private practice and identifying what key skills and attributes are required at a new graduate level to operate well in a private setting. It is expected that last year’s summit was the first of many to take place over the next five years.

Further reading

National Health Workforce dataset 2015

Physiotherapy Labour Force report 2006

APA InPractice 2025 report

APA Career Pathway video

APA Career Pathway White Paper 2016

 

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