Putting regional physios first

A road winds through a country landscape, with fields on one side and trees on the other. A yellow road sign has an image of a mortarboard cap on it. The background has been converted to a sketch.

Putting regional physios first

A road winds through a country landscape, with fields on one side and trees on the other. A yellow road sign has an image of a mortarboard cap on it. The background has been converted to a sketch.

Starting a new physiotherapy program in Victoria’s Gippsland region has given Federation University the opportunity to work closely with the local community to design a program that has a distinct regional focus, while still providing students with a well-rounded foundation in physiotherapy. The program offers challenges and opportunities to both students and educators.

When Helen Lowe APAM, a physiotherapist in Warragul with a thriving practice looking after paediatric, neurological, vestibular and women’s health patients in Victoria’s Gippsland region, first heard about the plans to set up a physiotherapy program at Federation University’s Gippsland Campus, she was excited about the opportunities it could offer her practice.

‘Recruitment has always been a challenge for me. 

‘There’s an interesting link between having a local university and the workforce and I’m looking forward to seeing what’s going to happen,’ Helen says.

With the first cohort of students in Federation University’s program now in their third year, students will be starting clinical placements later this year and local practices as well as regional health services are putting their hands up.

Finding as many placements as possible in local and regional clinics and hospitals is a priority for Federation University’s clinical placement coordinator Jane Strachan APAM MACP.

‘I’ve been based in Gippsland as a physio since 2009, so building relationships in the area and responding to that crucial need to retain health professionals in Gippsland and other regional areas is important to me,’ Jane says. 

‘Coming in with a good knowledge of this area, how it works and what the needs are, and keeping that dialogue going between the providers—what they can offer us and what we can offer them—is a huge part of my role.’

The Gippsland opportunity

Gippsland stretches eastward from Melbourne to the coast and up to the New South Wales border. 

With a population of more than 300,000 in 2021, according to Australian Bureau of Statistics census data, the region is expected to keep growing. 

A 2019 Latrobe Valley Authority report on the needs of the health and community services workforce points out that the median age of the Gippsland population is rising and the ageing population is driving up service demand in the healthcare and community services sectors. 

Chronic disease is prevalent: Latrobe Health Assembly’s 2022 Chronic Disease Action Plan states that 33.5 per cent of the population in the Latrobe Valley in Gippsland have two or more chronic health conditions.

This demand is complicated by the fact that Gippsland has fewer healthcare professionals per 100,000 population than Australia as a whole. 

Physiotherapy is no exception—in 2016, there were 167 physiotherapists in Gippsland, equivalent to 62 per 100,000 population and well below the national figure of 104 physiotherapists per 100,000 population. 

Projections suggest that the number of physiotherapists in the region will grow to 199 by 2026 and to 237 by 2036 (Latrobe Valley Authority et al 2019). 

Similar growth is expected in other allied health professions including occupational therapy and speech pathology.

In 2020, Federation University launched the first of several allied health programs at its Gippsland Campus, a Bachelor of Occupational Therapy, followed by a Bachelor of Physiotherapy in 2021 and a Bachelor of Speech Pathology in 2022. 

The introduction of the programs has been supported by a $500,000 grant from the Victorian Government’s Regional Skills Fund. 

A $4.4 million Allied Health and Activity Centre, which opened in 2021, features a state-of-the-art Anatomage Table and teaching spaces designed to simulate clinical settings for allied health and nursing students.

‘People who are locally trained are more likely to stay and, if they do go, are more likely to come back,’ says Latrobe Health Advocate Jane Anderson, who provides advice to government about improving the health and wellbeing of the local community based on what she hears from them.

‘A program like this provides accessible training opportunities for people in Gippsland, who may have financial and geographical barriers to further education, and it contributes to the workforce that is required in the region.’

Building a regionally focused physiotherapy program

"Two men are looking at an anatomy image on a table. One is wearing a blue shirt and has dark hair. The other has red hair and is wearing a plaid shirt. The background including the table is sketched."
Course coordinator Christopher Snell uses the
Anatomage table with a student (original image: Federation University).

One of the main aims of the allied health programs at the Gippsland Campus, says Professor Louisa Remedios APAM, discipline lead for the physiotherapy program, is to prepare graduates to address the regional shortage. 

While the physiotherapy program takes students from both regional and metropolitan backgrounds, it is especially interested in attracting local students, who may be more inclined to stay or return to the Gippsland region to work. 

In its first year, about a third of the student intake came from Gippsland and about half from Melbourne. 

The remainder were from other, predominantly Victorian, regions.

As such, the physiotherapy program is designed to provide students with a good understanding of what it means to be a physiotherapist in regional Victoria, says program coordinator Christopher Snell APAM.

‘Rural physios tend to rely on a broader scope of knowledge and skills day to day. 

We wanted a course that would manage that side of it, making connections between the musculoskeletal, the neuro and the cardio and presenting the idea of being the generalist expert rather than necessarily homing in on being a knee expert or something more specific. 

‘But at the same time we want students to be able to graduate and go into any work environment,’ Christopher says.

The course aims to provide a rural perspective on physiotherapy, teaching students to consider the challenges unique to the rural regions when treating the whole patient rather than just the presenting problem. 

Christopher says this can be especially important in rural areas, where patients may travel long distances to see a physiotherapist and where the work environment can be quite different, such as on farms or mine

Local needs are also considered—the ageing population, the chronic conditions that are prevalent in Gippsland, and the health needs of the Gunai-Kurnai People, whose Lands encompass most of the region.

Students say the program has shown them the potential benefits of working in a regional setting.

‘I’d love to stay regional—I feel like you get a wider range, that there’s a bigger aspect to everything you’re doing. 

‘It’s less specialised and you see everything,’ says second-year student Ella Rees, who moved to Gippsland from western Victoria to do the program.

Third-year student Julia Malan says that in addition to the program, her part-time job as an allied health assistant in Gippsland town Bairnsdale has opened her eyes to working regionally.

‘There’s such a need for physios in regional Victoria and allied health assistants and healthcare workers in general. 

‘I didn’t really notice that before,’ she says.

It’s a small program. 

The current year-level cohort numbers around 40 students and the aim is to build the program up to accept a maximum of 60 students each year, straight from high school or as mature age students, drawing from both regional and metro areas. 

Some spend a couple of days a week living on or close to campus, while others commute from Melbourne or from further out in Gippsland.

The small size of the program has its benefits, says Louisa, not least the ability to be more responsive to the individual needs of students than possible in a larger program.

‘In big universities, you invest all your energy in the students who are not coping, the ones in the middle are fine and you notice the ones at the top. 

‘Whereas here we pay attention to every student; we know their names and we have regular conversations with them—I can name every third-year student and most of the second-year students and I know how each of them are progressing with their learning,’ she says.

Jane Strachan agrees.

‘I love that familiarity that you get with the other staff and with the students. 

‘We get to understand them on a personal level rather than just their student ID number.

‘You can be a bit more individual in how you interact with them and where you find placements for them,’ she says.

Starting a new physiotherapy program from scratch is hard enough, but this one also needed to adapt to delivery in a regional environment, where both staff and students might have to travel some distance to attend classes on campus. 

As it turned out, the program’s first year coincided with the second year of the COVID-19 pandemic lockdowns, making a blended model of online and face-to-face learning practical. 

Typically, students spend two days on campus and two days online.

Christopher and physiotherapy lecturer Paul Kemel APAM MACP were also able to design the new classrooms, with innovations including a mobile camera over the examination bed that allows students to follow what the instructor is doing on a screen, both from within the room and remotely.

While some of the staff commute to Gippsland from Melbourne for the one or two days a week that they work with students, others—like Jane and Helen Lowe—are based locally. 

As students start graduating to work in the local area, Louisa and Christopher say that the program will eventually source more educators locally as well as providing professional development for regional physiotherapists.

‘The story around here is that there are not many people with academic experience and those with experience prefer to work at the larger universities in the city. 

In fact, there are huge possibilities. 

We just need to find a way to make sure that people working regionally can develop their careers—that they feel supported, that they can specialise. 

‘It’s hard because all professional development courses are scheduled in Melbourne,’ Louisa says.

The team is keen to provide physiotherapists in the region with professional development opportunities and eventually a master’s program.

Jane, for example, is one of only a handful of APA Women’s, Men’s and Pelvic Health Physiotherapists based in regional Victoria, which means that she tends to mentor other local physiotherapists with an interest in pelvic health and continence.

In addition to her role as placement coordinator, she lectures in anatomy and women’s health.

Others, like Helen, assist with practical classes as practitioner experts.

‘I’m the second teacher in their neuro physiotherapy practicals. 

‘I’ve always wanted to teach, so the opportunity to come in as the practitioner expert is perfect because I don’t have to give up a lot of my case load to prepare the lectures. 

‘I can just come in. 

‘I need to know what the content is for the day but I don’t need to create it all,’ Helen says.

The shortfall in physiotherapists in the region is another issue as many of them don’t have time to teach.

‘Given the limited number of physios working regionally, it can be difficult for organisations to release staff so they can come in and teach for us,’ Christopher says.

‘It’s very hard for rurally based physios to do higher qualifications. 

‘They might have a wealth of experience but not the piece of paper. 

‘So we want to offer micro-credentialing pathways to allow rural staff to build on their skills,’ he says.

Placement challenges and opportunities

"A man is taking notes while a woman is examining the ankle of another woman sitting on an examination table. The background is sketched."
Physiotherapy lecturer Paul Kemel and students in a practical
session (original image: Federation University).

Christopher and Jane say that the plan for clinical placements is to give students a well-rounded experience across the profession, with both regional and metro placements. 

As in most programs, students start with observational placements scattered across the first three years and complete their block placements in the third and fourth years.

‘We obviously want to make sure that our students get exposure to metro environments as well. 

‘But instead of prioritising metro placements with maybe one regional placement, we’re looking at providing those regional placements as a first option,’ says Jane, adding that it’s a goal for her to give the students as many regional experiences as she can.

‘The feedback we used to get when I was a clinician, taking my own students, is that the way you’re welcomed into a placement in a regional area is very different from being one of 10 students on a ward in a metro area. 

‘The experience the students have here leads to a different sort of growth and a different perspective in physio.’

Jane and Christopher say there is a lot of interest in taking students on for placements at local hospitals, community health services and private practices.

‘They’re all keen to take students, which has been fantastic, so we’ve got strong support out here and we’re building those relationships in the metro space. 

‘We have already secured placements in the metropolitan hospitals, even though we have not yet started our clinical block placements,’ Christopher says.

Local physiotherapists and health services are hoping that the local placements will translate into a pipeline of potential employees. 

Mitch Schwenke APAM, physiotherapist and director of community services at Orbost Regional Health, says that recruitment has been a real issue for his organisation.

‘Previously we’ve hosted students from metro universities and we got the sense that a lot of the work we were putting in was for the benefit of the broader community but not ours. 

‘We’d tell the students coming through that there are gaps here, you can apply [and we’d ask] where do you see yourself working?

‘They’d all talk about the big metropolitan hospitals. 

‘It’s quite resource-intensive for us to offer those placements and reap no reward for it. 

‘So when there’s a local university and people who are predominantly from the region or living in the region come out to work with us, it’s a brilliant opportunity,’ Mitch says.

Helen says her practice takes on students for a couple of reasons.

‘We want to invest in the profession and we want to be able to meet and recruit final-year students. 

‘We can’t do what we want to do here unless we’ve got enough bodies to do it,’ she says.

Stepping stones to physio

Like other regional hospitals, hospitals in Gippsland make use of allied health assistants to supplement their physiotherapy and occupational health services. 

Many of the students in the Federation University allied health programs work as allied health assistants part-time or casually while studying.

‘Our students are becoming part of the health services in their towns,’ says Jane Strachan, clinical placement coordinator for the physiotherapy program. 

‘Because we’ve structured the program so they typically have only two on-campus days, they can retain those jobs and work around their studies. 
‘And the hospital staff can mentor our students.’

Discipline lead Professor Louisa Remedios says the university is supporting students to do cadetships with regional health services, where the employer would help pay for the student’s program and provide guaranteed employment at the end of their studies.

Third-year student Jack Beechey-Danvers works as an allied health assistant in Traralgon and says it has opened his eyes to what a physiotherapist can do.

‘I used to think it was just private practice—rehabbing injuries and stuff like that. 

‘Now I know it’s more than that,’ Jack says.

His classmate Julia Malan says it’s a fantastic complement to their studies.

‘We learn about things like stroke and we’ll watch videos, but actually working in that environment is a beautiful way to get more exposure to the conditions that we’re learning about, working with patients and seeing physios doing their thing firsthand,’ Julia says.


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