Given the rapidly changing demand for the allied health workforce, why is it that we know so little about the allied health workforce and lack the planning tools to help manage allied health supply and demand?
Registered health professions include Aboriginal and Torres Strait Islander health practitioners, chiropractors, Chinese medicine practitioners, medical radiation practitioners, occupational therapists, optometrists, osteopaths, pharmacists, physiotherapists, podiatrists, psychologists, oral health therapists, dental hygienists, dental therapists, dental prosthetists, dentists, nurses, midwives and medical practitioners.
Several other groups of allied health professions (including some large professions) are self-regulating, therefore not registered with NRAS. These include speech pathologists, dietitians, social workers, medical scientists, sonographers and music therapists – to mention only a few. The exact numbers of self-regulated professionals is unknown in Australia for the reasons listed below, but it is likely that the allied health workforce, collectively, represents closer to 40% of the health workforce nationally… and possibly more, depending how allied health is defined within a particular jurisdiction.
This article draws on our experience of undertaking a large, state-wide environmental scan of 27 allied health professions in 2015 using routinely available data from government, the professions themselves and other sources (where it existed). We discuss the challenges of capturing data on the allied health workforce and the implications of this for allied health workforce planning.
- There is no standard definition of the allied health workforce
- Allied health workforce data sources are inconsistent
- We lack of measures of service demand for the allied health workforce
- Lack of any data for smaller professions or Indigenous status
- There is little coordination between the supply (training) and the demand for the allied health workforce
- Taxonomies within professions are unclear
- How do we improve allied health workforce planning?
There is no standard definition of the allied health workforce
- There is no, standard and accepted national definition of the allied health professions in Australia. Each state recognises different practitioners as allied health, as does the peak body, Allied Health Professions Australia (AHPA). This partly reflects the responsiveness of the allied health professions and the ability of new professions to emerge in response to new market needs, however the lack of a single definition or taxonomy makes national planning the of collective allied health workforce nearly impossible.
- Different jurisdictions use different ANZSCO (Australian and New Zealand Standard Classification of Occupations) coding categories for allied health, and some are more specific than others. For example, not all jurisdictions use the most sensitive codes for specific professions (e.g. since 2013 nutrition and dietetics have had separate ANZSCO codes, however at the time of undertaking this project, some jurisdictions still collected data against a single code).
- Not all allied health professions have a unique ANZSCO code, particularly small or newer professions (e.g. music therapy).
- For those professions do have a unique ANZSCO code, there were anomalies with some of the coding categories which meant that the professions could not be uniquely identified (e.g. Australian Bureau of Statistics (ABS) data on dental therapists and oral health therapists was combined).
- Some ANZSCO coding was not logical and therefore, even with the introduction of ANZSCO codes, the available information was not useful. For instance, at the time of doing the study, exercise physiology shared an ANZSCO code with ceramic scientists; medical physicists shared a code with astronomers.
- Training data also presented challenges. Medical and nursing training programs are coded in such a way that they can be readily recognised as entry level degrees. In contrast, at the time of this study, AHP courses were not coded this way, limiting the ability to determine which allied health degrees were entry level courses. This inhibited the accurate reporting of numbers of commencing students and course completions.
Allied health workforce data sources are inconsistent
- Our environmental scan of the allied health professions relied on a range of different data sources from a variety of jurisdictions that collected non-standardised variables across different timeframes. These inconsistencies limited our ability to bring these data together because none of the attributes could be accurately combined or contrasted. This meant it was impossible to obtain a snap-shot of the allied health workforce at a single point in time.
- Several state-wide, local and national surveys of the allied health workforce are undertaken regularly. For instance, rural health workforce agencies are reasonably active in allied health data collection; however, while there is some consistency in the approaches used, there is no common, agreed minimum dataset for allied health which facilitates data comparisons. The result is a patchwork of allied health workforce data fragmented by time, jurisdiction, professions and content.
- The ABS Census does not include ‘not-for-profit’ as a sector of employment. From the data provided we assumed that those working in the not-for-profit sector were bundled within other sectors (i.e. Commonwealth Government, State/Territory Government, Local Government, Private Sector, and not stated). This omission further limits workforce planning in an important employment sector that contributes to provision of aged care and the National Disability Insurance Scheme (NDIS).
- Organisations that employed allied health professions were unable to provide detailed or specific data about the specific professions they employed.
- Allied health professions work across a wide range of different settings, including health, government, industry, corrections, education, disability, aged care – to mention only a few. Self-regulating professions (such as speech pathologists and dietitians) may not be registered with their professional body, may move into roles where they are not using their primary skills, and work in organisations where their allied health title is not captured. Therefore they become difficult to count.
We lack of measures of service demand for the allied health workforce
- There are no measures of allied health service demand to help inform workforce planning, needs, gaps and future training. We have developed a new company, HealthWork Solutions to start to address this problem. HealthWork Solutions draws on expertise in town planning and demography combined with our health workforce expertise to develop population based demand and need algorithms, mapped with workforce supply using geospatial mapping tools.
- Some of the data that do exist are difficult to interpret. For instance, Medicare Benefits Scheme (MBS) service use data shows substantial increases in the use of MBS codes for allied health services over time. However, the reasons for these changes are unclear. A cursory analysis might suggest a simple increase in demand, but it is unclear whether other reasons are at play, such as increased awareness of the ability to access Medicare rebates for specific services or whether there has been a shift from using private health insurance to MBS funding.
- As we demonstrate in our “quick and dirty” analysis of allied health job advertisements on Seek.com.au, there is a lack of specificity of particular professions in job advertisement data. For example, several positions advertise for “occupational therapy OR physiotherapy”. “Social work” advertisements incorporate nearly every care coordination and social care based role (including peer workers and mental health workers), including several roles that are not at all related to social work.
Lack of any data for smaller professions or Indigenous status
- Several of the smaller professions (e.g. arts, music and child life therapists) lacked any data at all. They were absent from the ABS Census, AIHW, the Payroll Datasets and public service data. The small size of the professions and the limited resources of their professional associations also limited their capacity to collect and collate workforce data. In this project, we assumed that their workforces had been labelled as other professions, suggesting distortion to figures for professions that do have ANZSCO codes.
- Professions that were not included in the NRAS lacked workforce data on Indigenous status. Those professions that did capture indigeneity had very low rates of Aboriginal and Torres Strait Islander members. There was limited evidence that the peak professional associations were proactively addressing this issue. This finding suggests that this is a significant workforce priority for attention.
There is little coordination between the supply (training) and the demand for the allied health workforce
- The drivers for the provision of allied health training are not aligned with the actual demands on the health workforce. University training is largely determined by higher education funding instruments and models that are largely completely unaligned with workforce demand. In some instances universities continue to train professionals who are unlikely to get jobs, while failing to invest in training workers in disciplines where there are shortages or offering post-graduate training in specialist roles. This has been fueled historically by incentives that rewarded universities for throughput, not graduate destination, and a lack of data to clearly inform health workforce demand.
- Professions and the universities have pushed models of allied health training that have resulted in increased training times and credential creep. This increases the cost and duration of training the allied health professions, and therefore reduces the flexibility and responsiveness of those professions to rapid changes in community demand. For example most allied health training is now a minimum of four years, and some (such as psychologists) require post-graduate qualifications.
Taxonomies within professions are unclear
We surveyed 11 allied health profession groups in-depth between 2015 and 2018. To do this, we had to develop a survey tool that allowed some comparison between professions. However in the development of the survey tool, we learned several lessons that are relevant for capturing a minimum dataset across a wide range of allied health professions. Specifically:
- Without exception, the professions had difficulty meaningfully defining their professional areas / scope of practice (this surprised the professions and the researchers). This was compounded by challenges differentiating what people do (eg rehabilitation, chronic disease management) with the populations they work with (eg women’s health, children’s health).
- We had challenges separating the concepts of sector (eg who employs the worker, such as government, not-for-profit, education); the funding source (such as DVA, NDIS, fee-for-service, state government etc); and place of work (for example, schools, community, hospital).
- We aimed to capture career pathways, but there were no available tools to enable us to meaningfully document or compare this, and once the data were captured, they were difficult to aggregate meaningfully .
- There were large variations in professional cultures, the language used and the types of populations AHPs work with. This was particularly pronounced when comparing, say medical scientists, who predominantly worked with human tissue and laboratory specimens, with practitioners involved in high levels of social care (such as occupational therapists and social workers).
How do we improve allied health workforce planning?
One of the challenges of capturing meaningful allied health data to inform workforce planning is the lack of a single coordinating body to oversee allied health in Australia. There is no single, statutory body with responsibility for allied health workforce planning – and allied health workforce shortages affect a wide range of sectors, including healthcare, disability, aged care, education, corrections and industry.
The Commonwealth Government Department of Health appointed a Chief Allied Health Officer in 2020. Other peak bodies for allied health include Allied Health Professions Australia (AHPA), the Australia Allied Health Leaders Forum (AAHLF), Services for Australian Rural and Remote Allied Health (SARRAH), Indigenous Allied Health Australia (IAHA) and the Australian Council of Deans of Health Sciences (ACDHS).
There is a great deal of cross-representation across these peak bodies – and most of them represent the supply side of the workforce equation. Workforce planning also needs to take into account the demand for allied health. This would require consultation with employers of allied health, including aged care, disability, ideally primary health networks (they are not employers, but should understand regional workforce needs) and perhaps even private health insurers.
None of the peak bodies above has the resources or the remit to undertake workforce planning. Allied health workforce planning, where it does exist, is undertaken by the states, and to a certain extent, by the professions themselves. Allied heath workforce planning is uniquely complicated by the interaction between the professions – both in terms of potential substitution of workers (for example, many mental health positions advertise for psychologists, counsellors, social workers, occupational therapists or mental health nurses), and the need for interdisciplinary collaboration.
Allied health workforce planning is further complicated by the jurisdictional and political differences over ‘membership’ to the allied health club. Given the very large unmet needs for allied health, it may make sense to take an inclusive approach to allied health membership, but use existing systems (such as self-regulation or negative licensing) to ensure quality standards are maintained.
Ultimately, a national register (note – not a regulator) of the allied health professions is likely to be the only way to understand the supply side of the equation. Demand is far more complex, and should include a national advisory committee with representation from those groups most likely to employ allied health professionals.
At a micro level, data collection needs to improve, including:
- Each allied health profession should have a unique ANZSCO code.
- Improve capture collection on the Indigenous status of allied health professionals.
- Identify indicators of service demand for allied health services, such as changes in MBS usage, job applications and vacancy rates.
- Develop a standardised, consistent approach to data collection that can be applied and captured nationally (ie a minimum dataset), but is able to account for the complex cultural and taxonomic variations across the different professional groups.
- At an organisational level, it may be appropriate to undertaking modelling around AH staffing numbers to determine the minimum staffing levels required to maintain current service capacity; and below which, service capacity and quality decreases.