OCCUPATIONAL THERAPIST: OCCUPATIONAL SKILL SHORTAGE ASSESSMENT

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1 NOVEMBER 2005 OCCUPATIONAL THERAPIST: OCCUPATIONAL SKILL SHORTAGE ASSESSMENT Current situation: Recruitment and retention difficulties Short-term outlook: Recruitment and retention difficulties 1 Executive Summary 1.1 Results from the 2004 Survey of Employers who have Recently Advertised indicate that employers have difficulty filling occupational therapist vacancies in New Zealand. Only 52% of vacancies were filled within eight to ten weeks of advertising. The Department of Labour, however, does not believe this is an indication of a genuine skill shortage of occupational therapists. The annual level of Table 1: Employer Survey Indicators, 2004 Occupational Therapist All Professionals Surveyed Fill Rate Average Suitable Applicants 52% % 1.7 Source: Survey of Employers who have Recently Advertised, Department of Labour. addition to supply from both training and immigration suggests that there is a considerable supply of qualified occupational therapists in the New Zealand labour market. However, a significant proportion of these do not want to take up positions at current levels of remuneration and other conditions of employment. This situation is thus described as a recruitment and retention difficulty. 1.2 Employment of occupational therapists grew on average by 4.3% per annum between 1991 and 2001, as a result of rising demand for occupational therapy services. There will be a continuing demand for occupational therapists in the short term, as the underlying demand for occupational therapy services continues to grow. 1.3 An average of about 115 occupational therapist qualifications have been achieved annually over the past few years, and this is being matched by a similar level of migratory inflow of overseas-trained professionals. These two flows have contributed to the almost 230 new registrations received by the Occupational Therapist Board of New Zealand each year between 2000 and But despite the high number of people presenting themselves as potential supply, the actual supply of occupational therapists (as measured by the number with annual practising certificates) only increased by about 100 each year over the same period. This suggests that there is some level of occupational detachment (employees who voluntarily leave an occupation) occurring in this profession. This Unisys House, 56 The Terrace, PO Box 3705, Wellington, New Zealand. Tel Fax

2 2 may be due to occupational therapists changing occupations, leaving the workforce, or withdrawing from the labour market to raise families. Employers interviewed in the 2004 Survey of Employers who have Recently Advertised have linked the occupational detachment to salaries which are low relative to other professional occupations. Other factors are also likely to cause occupational detachment. Additional research is required to better understand the causes and the implications for the labour market. 1.4 Current demand and supply trends are expected to continue in the short-term. The recruitment and retention difficulties faced by employers are likely to persist until conditions change to ensure that sufficient numbers of registered occupational therapists practise in the profession.

3 3 2 Introduction 2.1 The purpose of this report is to investigate skill shortages in the occupational therapist profession in New Zealand. The report aims to assess whether there is a shortage of occupational therapists and to provide an insight into the demand and supply factors contributing to this situation. It also offers a short-term outlook for shortages in this occupation group. 2.2 Occupational therapists (code in the New Zealand Standard Classification of Occupations 1999) are registered health professionals who use processes of enabling occupation 1 to optimise human activity and participation in all life domains 2 across the lifespan, and thus promote the health and well-being of individuals, groups, and communities 3. According to the Occupational Therapy Board of New Zealand (OTBNZ) 4, in 2004 there were 1,783 occupational therapists holding current annual practising certificates in New Zealand. The occupational therapist workforce is predominately female (89%, according to 2001 Census figures) and 15.1% of occupational therapists work 19 hours or less per week Further background to this occupational report, including a discussion of the methodology; a glossary of terms; and an overview of the Department s Survey of Employers who have Recently Advertised (SERA), including the survey questionnaire, can be found in the Background and technical note at 3 Demand for Occupational Therapists 3.1 Historical Demand Employment of occupational therapists grew strongly between 1991 and 2001, with annual growth averaging 4.3%. Demand for these services has been increasing due to factors such as: increased funding for the mental health sector leading to growth in the number of occupational therapists working in the mental health field, and an ageing population, which increase the demand for rehabilitative health services Enabling occupation incorporates the application of knowledge, principles, methods and procedures related to understanding, predicting, ameliorating, or influencing peoples participation in occupations within life domains. Life domains include: learning and applying knowledge; general tasks and demands; communication; mobility; self-care; domestic life; interpersonal interaction and relationships; major life areas; and community, social and civic life. Occupational Therapy Board (Scope of Practice) Notice Occupational Therapy Board Annual Report 2003/2004. New Zealand Health Information Service, Health Workforce Annual Survey, 2003.

4 4 Table 2: Employment of Occupational Therapists, Annual Growth in Employment Occupational Therapists 4.8% 3.7% 4.3% All Professionals 2.7% 4.0% 3.4% All Occupations 3.1% 1.2% 2.1% Source: Census of Population and Dwellings, Statistics New Zealand. 3.2 Future Demand Factors that have historically driven demand for occupational therapy services will continue to do so. The implementation of several Government health strategies could also potentially increase demand for occupational therapy services. These strategies include: the New Zealand Disability Strategy - with its emphasis on full participation of people with disabilities in society; the New Zealand Health of Older People Strategy - with its emphasis on coordinated, responsive, and preventative health and disability support for older people; and the Primary Health Care Strategy which provides a clear direction for ensuring that primary health care services play a central role in improving the health of New Zealanders In the longer term, employment growth of occupational therapists is likely to be strong as the baby-boom generation moves into middle age, a period when the incidence of heart attack and stroke increases. Growth in the number of people aged 65 years and older, an age group that suffers from a high prevalence of disabling conditions, will also increase the demand for therapeutic services. 3.3 Summary Employment of occupational therapists grew by an average of 4.3% per annum between 1991 and 2001 as a result of rising demand for occupational therapy services. Demand for occupational therapists is expected to continue growing in the future due to the implementation of Government health strategies and an ageing population requiring more therapeutic services. 4 Supply of Occupational Therapists 4.1 Tertiary Education There are two entry level qualifications for occupational therapy in New Zealand: the Bachelor of Health Science (Occupational Therapy) at Auckland University of Technology; and the Bachelor of Occupational Therapy, at Otago Polytechnic. Data from the Ministry of Education show that an average of 115 students achieved one of these degrees each year between 1999 and 2003 (see Table 3).

5 5 Table 3: Enrolments and Achievements of Occupational Therapy Qualifications, Year Total Students Enrolled Achievements 1999 n/a Source: Ministry of Education A comparison of graduate output with the number of occupational therapists holding annual practising certificates yields a training rate of 5.2% (see Table 4). The training rate is a rudimentary measure of the rate at which the supply of occupational therapists can potentially grow through tertiary training. This rate is marginally lower than the training rate for all professional occupations surveyed by the Department of Labour (the Department). The equivalent training rate for occupational therapists in New South Wales, Australia is 11.3% 6. Table 4: Training Rates for Occupational Therapists, 2003 Indicator Explanation Occupational Therapists (NZ) All SERA Professionals Surveyed (NZ) Occupational Therapists (NSW, Australia) Training rate persons achieving a relevant qualification expressed as a percentage of the number of occupational therapists holding annual practising certificates 5.2% 5.5% 11.3% Source: Department of Labour (New Zealand), Department of Employment and Workplace Relations (Australia). 4.2 Occupational Detachment 7 and Migration In order to practise in New Zealand, occupational therapists need to be registered with the OTBNZ. Once registered, an occupational therapist wishing to practise must obtain a practising certificate on an annual basis from the OTBNZ. The number of occupational therapists with annual practising certificates (APCs) is the most meaningful measure of the supply of occupational therapists in the country as it is a measure of the number of occupational therapists willing and able to work. Fluctuations in this number reflect all the factors influencing supply, including migratory flows, retirement, occupation change, and withdrawal from the labour market. 6 7 In this report, comparisons are made between New Zealand and New South Wales, Australia to contextualise the findings. No national level estimates of training rates are available for Australia, so statelevel data have been used. New South Wales is Australia s most populous state with the largest economy and its economy most closely resembles the structure of the New Zealand economy. It was thus deemed to provide the most suitable jurisdiction for labour market comparisons. Occupational detachment refers to individuals who choose not to continue practising in their occupation but retain a connection to the occupation (e.g. move into a management or supervisory role, or retain professional registration), or who leave the occupation entirely (e.g. by changing occupation or withdrawing from the labour market).

6 Between 2000 and 2004, the number of occupational therapists with practising certificates (i.e. supply) increased by an average of 102 each year. In contrast, there was an average of 229 new registrations with the OTBNZ each year, over the same period. By registering, these individuals have presented themselves as potential additions to the supply of occupational therapists in New Zealand. The sources of these new registrations include recent graduates and new migrants. That the growth in actual supply (increase in occupational therapists holding APCs) is considerably lower than potential supply (new registrations), indicates that there is a loss of occupational therapists from the occupation each year It is not clear where this loss is occurring. Some occupational therapists holding APCs will retire, but the Department s estimates from Census data suggest that retirements account for a loss of only about 20 occupational therapists each year. Others will register and not go on to obtain an APC due to a decision to leave New Zealand or take a different career path. Some occupational therapists holding APCs may also make a career change or withdraw from the labour market to raise families. As occupational therapy is a female dominated occupation, the latter factor is likely to be of some importance. Irrespective of where this loss is happening, it indicates that there is some occupational detachment occurring. Table 5: Registration of Occupational Therapists, Year Current Annual Practising Certificates Growth in Current Annual New Registrations Practising Certificates Overseas New Zealand Total Average Source: Occupational Therapy Board of New Zealand Occupational detachment was raised as an issue by employers interviewed in the Survey of Employers who have Recently Advertised (SERA). Numerous employers mentioned that occupational therapists left the occupation due to relatively low salaries. That salaries are not competitive is supported by results from a salary survey of 16 of the 21 District Health Boards 8 conducted by the New Zealand Association of Occupational Therapists in July The survey showed that salaries for occupational therapists range from an average starting salary for a new graduate of $32,672 to an average top salary of $50,677. These compare poorly with the mean salary of all professional occupations of $63,537, measured in the Labour Cost Index 9. Other factors are also likely to contribute to 8 9 According to the New Zealand Health Information Service s 2003 Health Workforce Annual Survey, 53% of the occupational therapists surveyed were employed by District Health Boards. It can be noted that the PSA has recently concluded negotiations with District Health Boards New Zealand for a new national pay settlement for occupational therapists, although the settlement has not yet been ratified. The agreement would mean that the new salary range would be from $40,000 to $82,086 and would be progressively applied over the 2005/2006 years. Occupational therapists in the special education field have also negotiated significant increases to pay scales (between 9.7% and 10.9%).

7 7 occupational detachment. Further research needs to be conducted to establish all the reasons for it and the significance of it for the labour market SERA 2004 results also indicate that there is a high level of turnover which could be related to salary levels. The survey shows that 95% of occupational therapist vacancies included in the sample were for existing vacancies (compared with an average of 69% for all professionals surveyed). This suggests that turnover in the profession is high and employers have difficulty in retaining occupational therapists Registration data shows that inbound migration is an important source of supply for occupational therapists in New Zealand. On average over the last three years, there were only slightly fewer overseas occupational therapists registering than there were New Zealand-based graduate registrations. 4.3 Summary An average of about 115 occupational therapist qualifications have been achieved annually over the past few years, and this is being matched by a similar level of migratory inflow of overseas-trained professionals. These two flows have contributed to the almost 230 new registrations received by the OTBNZ each year between 2000 and But despite the high number of people presenting themselves as potential supply, the actual supply of occupational therapists (as measured by the number with annual practising certificates) only increased by about 100 each year, over the same period. This suggests that there is some level of occupational detachment occurring in this profession. This may be due to: changing occupations, leaving the workforce, or withdrawing from the workforce to raise families. Employers interviewed in the 2004 SERA have linked the occupational detachment to salaries which are low relative to other professional occupations. 5 Employer Recruiting Experiences the Survey of Employers who have Recently Advertised 5.1 Overall Shortage of Occupational Therapists The 2004 SERA results show that employers have considerable difficulty in filling occupational therapist vacancies in New Zealand. Only 52% of vacancies were filled within eight to ten weeks of advertising 10. Table 7 shows the fill rate for occupational therapists is slightly lower than that for all professionals surveyed (56%). There was an average of 0.9 suitable applicants for each occupational therapist vacancy, compared with 1.7 for all professionals surveyed. 10 Occupations with fill rates lower than 80% are typically regarded as being in shortage.

8 8 Table 7: SERA Results for Occupational Therapists and All Professionals Surveyed, July 2004 Employers Vacancies Vacancies Filled Fill Rate Suitable Applicants Average Suitable Applicants per Vacancy Occupational Therapists All Professionals Surveyed % % Source: Survey of Employers who have Recently Advertised, Department of Labour Employers reported difficulty in recruiting occupational therapists in certain specialisations such as mental health, seating, and driving assessment. They also reported difficulty in finding occupational therapists with the required level of experience. 5.2 This is a Recruitment and Retention Difficulty not a Genuine Skill Shortage While fill rates are low for this occupation (52%), the Department does not believe this is an indication of a genuine skill shortage of occupational therapists. The analysis of supply presented in this report indicates that there is a high number of qualified occupational therapists with attachment to the New Zealand occupational therapy labour market. However, many of these occupational therapists are not prepared to take up the positions on offer. The Department therefore describes this situation as a recruitment and retention difficulty rather than a genuine skill shortage (see Box 1 for definitions of these concepts). 6 Outlook Box 1: Skill Shortage Definitions Genuine skill shortage Occurs when employers have difficulties filling their job vacancies because there are not enough individuals with the required skills in the potential labour market to fill the positions on offer. Recruitment and retention difficulty Occurs when there is a considerable supply of individuals with the required skills in the potential labour market but they are unwilling to take up employment at current levels of remuneration and conditions of employment. Retention problems are often a major contributor to this condition. 6.1 Current demand and supply trends are expected to continue in the short term. Recruitment and retention difficulties are likely to persist until conditions improve whereby sufficient numbers of registered occupational therapists are actually willing to practise in the profession. For queries regarding this report please contact

9 9 Disclaimer: The Department of Labour has made every effort to ensure that the information contained in this report is reliable, but makes no guarantee of its accuracy or completeness and does not accept any liability for any errors. The information and opinions contained in this report are not intended to be used as a basis for commercial decisions and the Department accepts no liability for any decisions made in reliance on them. The Department may change, add to, delete from, or otherwise amend the contents of this report at any time without notice. The material contained in this report is subject to Crown copyright protection unless otherwise indicated. The Crown copyright protected material may be reproduced free of charge in any format or media without requiring specific permission. This is subject to the material being reproduced accurately and not being used in a derogatory manner or in a misleading context. Where the material is being published or issued to others, the source and copyright status should be acknowledged. The permission to reproduce Crown copyright protected material does not extend to any material in this report that is identified as being the copyright of a third party. Authorisation to reproduce such material should be obtained from the copyright holders.

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