Acknowledgements

Occupational Therapy Australia thanks those who contributed to the project and shared their views and information. This includes:

• Occupational Therapy Australia Workforce National Reference Group
• Occupational Therapists who participated in the consultations
• Occupational Therapists who completed the national survey
• Contributing regulators, peak bodies, interest groups and chief allied health officers

Background

Occupational Therapy Australia (OTA) represents the occupational therapy profession in Australia and has an important role in nurturing, supporting and representing the workforce. In 2023 OTA commissioned a significant workforce development project which aimed to formulate a workforce development plan in partnership with the occupational therapy profession. This report provides a summary of the key findings, details of the data analysis, and key priorities that were provided to OTA. The OTA workforce development plan identifies clear actions for OTA to support the occupational therapy workforce over the next 3-5 years.

Occupational therapy plays a crucial role within the health, mental health, community services, disability, and aged care workforce. Its unique emphasis on facilitating participation, meaningful engagement in occupations, and promoting independence serves as an important resource in supporting individuals to lead healthy, independent lives and contributes to the vitality and productivity of the community.

Occupational therapy in Australia has undergone very significant change over recent years. The profession has grown significantly in size as the fields of practice of occupational therapists have extended, the demand for therapists has increased and new occupational therapy training programs have been established.

The industry context within which occupational therapists work has also undergone transformation. This has been driven significantly by the development and implementation of the National Disability Insurance Scheme (NDIS). Industry change has also been related to expansions of community aged care and mental health services reforms.

The structural shift in the industry means that occupational therapists are increasingly employed in community rather than institutional settings. Concurrently, changed purchasing models have meant that therapists are increasingly working in private sector or quasi-private sector arrangements and are frequently working within a consumer directed care (CDC) context.

All of these changes, along with other contributing factors, have had direct implications for the occupational therapist workforce, creating both opportunities and challenges for the profession.

Workforce Plan Development

The workforce development plan was established using an evidence-based approach, drawing from multiple data sources and processes. This included an examination of occupational therapy workforce data, an examination of the national and international literature related to the occupational therapy workforce, an online national survey of registered occupational therapists and consultation with a segmented sample of occupational therapists and key stakeholders.

Literature Review

A literature review examined more than 300 articles from international and national scholarly and grey literature. It examined literature concerning the current workforce issues, having particular regard to the profile of the workforce, the policy and industrial context of practice, the educational preparation of occupational therapists, factors affecting the recruitment and retention of occupational therapists, professional issues and scope of practice, practice and business support needs of occupational therapists and the particular requirements of the workforce with respect to rural and regional practice and practice with Aboriginal and Torres Strait Islander communities.

Data Analysis

A data analysis examined data available from national databases concerning the occupational therapy workforce, including workforce demographics and distribution.

Survey

A national survey of occupational therapists in Australia was conducted, with 2,145 responses. Responses were broadly representative of the profession with respect to age, geographic location and field of practice. The survey collected data concerning workforce demographics, work history and fields of practice, work satisfaction and perspectives on organisational and professional support.

1:1 Interviews

1:1 interviews were conducted including 6 preliminary interviews and 14 structured interviews. Interviews were held with occupational therapists from a segmented sample of the profession as well as key professional stakeholders.

Focus Groups

10 Focus Groups were conducted. The focus groups had representation from the private practice/private group practice, rural and remote, public health, education, mental health, aged care, paediatrics and disability sectors and new graduate and 5 year graduate cohorts within the workforce.

Workforce Data Snapshot

The data analysis examined data available from national databases concerning the occupational therapy workforce, including workforce demographics and distribution. The analysis was prepared for the purpose of understanding key trends across the OT workforce for the development of the OTA Workforce Plan.

All data presented was last reviewed in August 2023. While every attempt has been made to ensure accuracy of the data, discrepancies in OT workforce data have been identified across multiple data sets and sources that were accessed.

In March 2023 there were 29,473 occupational therapists registered by the Australian Health Professions Registration Agency (AHPRA). This has increased from 15,769 in 2013, an increase of 171%. The states of NSW, Victoria and Queensland report the highest numbers of registered OTs at 7,884, 7,572 and 6,042 respectively.

Occupational therapy is one of the larger regulated allied health professions in Australia. In 2021, according to the National Health Workforce Dataset, Occupational Therapists formed 3.5% of the total registered health care workforce in Australia. In comparison, nurses and midwives formed more than half of the total national workforce at 54.7%, followed by medical practitioners at 16.2% and physiotherapists at 4.8%. Out of 15 registered health professions in Australia, OTs ranked the 6th highest group by volume.

The occupational therapy workforce in Australia is predominantly female. In the last decade, there has been a small but increasing representation of males in the OT workforce, though this percentage is small and sits at approximately 10%.

The occupational therapy workforce is relatively young with 51% of the workforce in the 20-34 years age bracket.

The National Health Workforce Dataset demonstrated that registered occupational therapists have been practicing for an average of 11.2 years (mean 9.0 years). Over the 8-year period of 2013 to 2021, average and median years worked have remained largely static.

According to the National Health Workforce Dataset, the distribution of the workforce has changed considerably over a relatively short period. The fields of practice that have grown most significantly in the 2013 – 2023 period have been disability services (9% growth) and paediatrics (6% growth).

Rehabilitation has seen the largest percentage decrease over the same time period at a decline of 6%. Over the 8 year period, as a percentage of the total workforce, there has been a small percentage decrease of OTs working in aged care and mental health, but an increase in absolute numbers (with an additional 1,294 and 1,090 OTs respectively). The areas of driving assessments and palliative care have seen minimal change in workforce numbers across this time period.

There has been very significant growth in private sector employment of occupational therapists.

When reviewing and grouping OTs by job settings captured in the National Health Workforce Dataset, 25.7% are employed in the private sector in 2021, compared with 22.8% in hospital and rehabilitation services that had previously been the major employer.

Across the 5-year period from 2015 to 2019, there has been an increasing number of graduating OTs in Australia from 1,474 new graduates in 2015 to 1,919 new graduates in 2019 (NHWDS, Occupational Therapists, 2015 - 2019). The replacement rate of new entrants and exits has varied year on year, with 2018 to 2019 having the biggest variation from a replacement rate of 2.9 in 2018 to 5.1 in 2019 (NHWDS, Occupational Therapists, 2015 - 2019). The replacement of OTs has exceeded the exit of OTs each year across the data reviewed.

The Australian government forecasts an approximately 7.1% increase in demand for OTs across Australia from 2021 to 2026. This is considered a moderate growth rate. For more information refer to the Workforce Development Project Data Report.

Key Findings

The key project findings are drawn from analysis of the literature review, data analysis, and consultation with the profession and key stakeholders.

Students

• Clinical placements during training are essential for the development of an OT professional. Many training programs report limited quality placement positions being available for students.
• Students approaching graduation are not always aware of the range of benefits and challenges of working in different workplace settings and can find it difficult to decide what is the best workplace for them.
• Students would benefit from more information around what to expect in their first graduate OT role, including information & resources to assist their transition to practice.

New Graduates

• Clinical supervision is considered to be essential for recently graduated therapists.
• There is inconsistency in the level and quality of supervision received by graduates.
• There is significant variation in the experience of recently graduated OTs. Some graduates report that their early careers are stressful with high work demands and little professional support, while others reported feeling well supported and report gaining confidence and professional skills.
• Effective transitioning to practice requires strong supervision, challenging professional opportunities undertaken with good support, and a positive workplace culture.
• Recent graduates would benefit from greater access to resources and support to aid their transition to practice.

Recruitment and Retention

• There are recruitment and retention challenges in most practice settings.
• Recruitment and retention are impacted by a range of factors including remuneration, flexibility and responsiveness of employment conditions, the availability of support and supervision and opportunities for professional and career advancement.
• Career satisfaction is higher when OTs are able to work to their full scope of practice and where the workplace is supportive and safe.
• Feelings of belonging and strong professional identity can support career satisfaction and resilience.
• The greatest risk to the profession identified in the survey responses was unsustainable workloads.
• Some OTs move into non-clinical roles that draw upon their OT skills and they wish to maintain their OT identity and connection to the profession while in these positions.
• Some OTs believe there is limited opportunity to progress to advanced clinical roles or that professional recognition is not available to them, limiting their career opportunities as an OT.
• Some form of credentialing is widely supported as a means of acknowledging advanced standing.

Practicing Environment

• Major changes in the industry profile (such as the introduction of National Disability Insurance Scheme (NDIS) and My Aged Care) have required changes in the clinical, professional, and business management skills required by OTs.
• Professional supervision is considered critical for quality assurance, worker support and for the safety and reputation of the profession.
• Those who reported they receive no supervision have a generally more negative perspective on multiple indicators. They have a dramatically negative view on the adequacy of supervision structures, team leadership and the availability of professional development. They also report a less positive work/life balance.
• Occupational therapists highly value opportunities to connect with one another to provide personal and professional support and exchange knowledge.
• The demand for OT services across multiple sectors has placed pressure on established professional training, supervision, and support structures.
• The NDIS presents a challenging working environment for OTs because its commercial requirements can feel in tension with professional values.
• Good clinical governance is critical to ensure the quality and safety of services.
• There is an absence of quality and safety standards and reporting with respect to OT services provided in the private sector in some cases.
• There are significant opportunities for OTs across multiple sectors including NDIS services, acute, rehabilitation, residential aged care, public health services, community aged care, mental health and primary health care including new and emerging roles. The role of OT should be promoted in these areas.

Professional Recognition

• Failure to recognise high levels of professional competence can negatively impact on retention of experienced occupational therapists.
• Development of capability frameworks was well supported to guide professional development and career progression and protect against unqualified practice.
• Respondents overwhelmingly believed that the role of occupational therapists was not well understood in the community which contributed to feelings of being underutilised and undervalued.
• There was strong support for some form of credentialling of key skills and capabilities for occupational therapists.
• OTs who are working within their competency and capabilities report difficulties where professional judgements are second guessed by purchasers and where consumer expectations conflict with clinical judgements.

Career Viability

• Career satisfaction was much lower where the therapist did not believe that they were well remunerated for their work.
• Loss of experienced OTs is exacerbated by an absence of advanced clinical roles, inadequate remuneration and inflexibility of working conditions.
• Occupational therapists have personal and professional support needs that vary across the career span and at different life stages.
• High levels of stress and burnout were reported within the profession.
• Employees in NDIS funded services, other compensable schemes and public health services reported poorer work/life balance than those working in other settings.
• There are particular challenges for the OT workforce in rural and remote communities that can in part be addressed by support for training of local students, including First Nations community members, providing better compensation for the costs of rural servicing, and developing innovative models that support private OT practice in rural communities.
• Evidence based practice and interprofessional collaboration are identified as priorities in the development of the profession.

Digital Health

• Many therapists are incorporating the use of telehealth into their regular practice.
• Developments in technology and Artificial Intelligence present large opportunities in developing efficiencies and enhancing practice but also carry risks if not well understood and used appropriately.
• Technology is advancing rapidly, and it can be difficult for occupational therapists to retain currency in their knowledge.

OTA Workforce Development Plan

The Occupational Therapy Workforce Plan is a response by the profession to the current workforce issues and opportunities. The plan has identified 7 priority areas with 3 key cross cutting themes. All actions are focused within OTA’s scope and influence and will be actioned over the next 3-5 years, with both immediate and longer term priorities.

Cross-cutting themes are as follows

• Enhance the understanding of OT Roles and Contributions: A consistent theme in discussions with occupational therapists is the contradiction that they experience between the demand for their knowledge and skills and what they perceive as a poor understanding in the care systems and within the community, of the richness and complexity of their roles. OTA will address this on multiple levels including advocacy with decision makers and opinion leaders, engagement in the public space to defend and support the profession, and in general engage in media and promotional activities that communicate the diversity of occupational therapy roles and the importance of these to the independence and vitality of consumers.

• Build the community of practice of occupational therapists: Occupational therapy is a collegial profession. Occupational therapists enjoy and look to the support that they provide to one another. Connecting and building unity amongst the profession will assist to reduce tensions that can arise in an environment of significant and rapid industry change. It can also serve to increase OT’s sense of belonging, resilience, and satisfaction in their roles. OTA will continue to support occupational therapists to link with one another to provide personal and professional support. This may involve facilitating connections around specific issues for groups within the profession or less issue-driven connections that support occupational therapists in their roles.

• Enhance occupational therapists’ wellbeing: A connecting theme across the priority actions is the range of activities that assist occupational therapists across their professional career to maintain themselves. This includes actions to enhance personal and professional support, guidance through clinical frameworks and the further development of professional supervision and mentoring. It includes initiatives that support therapists to be appropriately valued, recognised, and remunerated. It recognises that occupational therapists will have personal and professional support needs that will vary across a professional lifetime, and modifies the supports provided accordingly.

Next Steps

OTA is beginning to implement the actions required to achieve the 7 key priorities outlined in the workforce development plan.

The plan will be implemented over two phases spanning 3–5 years and will involve further collaboration with the occupational therapy profession. A comprehensive review will be conducted at the completion of each phase.

Updates on the workforce development project will be found on the Workforce Development Project webpage and OTA Connect.