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Strategic Workforce Services – Physiotherapy Workforce Assessment April 2017 0 Strategic Workforce Services Workforce Assessment Report DHB Physiotherapy Workforce April 2017

Strategic Workforce Services - TAS · Strategic Workforce Services – Physiotherapy Workforce Assessment April 2017 3 Executive Summary The Workforce Strategy Group commissioned

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Page 1: Strategic Workforce Services - TAS · Strategic Workforce Services – Physiotherapy Workforce Assessment April 2017 3 Executive Summary The Workforce Strategy Group commissioned

Strategic Workforce Services – Physiotherapy Workforce Assessment April 2017 0

Strategic Workforce Services

Workforce Assessment Report

DHB Physiotherapy Workforce April 2017

Page 2: Strategic Workforce Services - TAS · Strategic Workforce Services – Physiotherapy Workforce Assessment April 2017 3 Executive Summary The Workforce Strategy Group commissioned

Strategic Workforce Services – Physiotherapy Workforce Assessment April 2017 1

Copyright C/- Central Region’s Technical Advisory Services Limited (TAS)

PO Box 23 075

Wellington 6140

Phone 04 801 2430

Fax 04 801 6230

[email protected]

www.centraltas.co.nz

© Central Region’s Technical Advisory Services Limited

Copyright Statement The content of this document is protected by the Copyright Act 1994. The information provided on behalf of TAS may be reproduced without further permission, subject to the following conditions.

You must reproduce the information accurately, using the most recent version.

You must not use the material in a manner that is offensive, deceptive or misleading.

You must acknowledge the source and copyright status of the material.

Disclaimer While care has been used in the processing, analysing and extraction of information to ensure the accuracy of this report, TAS gives no warranty that the information supplied is free from error. TAS should not be liable for provision of any incorrect or incomplete information nor for any loss suffered through the use, directly or indirectly, of any information, product or service.

Document History

Date April 2017

Authors Sally McLean, Sam Valentine and Dale Shaw

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Strategic Workforce Services – Physiotherapy Workforce Assessment April 2017 2

Executive Summary ............................................................................................................................ 3

Recommendations ............................................................................................................................. 5

1. Purpose ........................................................................................................................................... 6

Background / Context ......................................................................................................................... 6

Physiotherapy Workforce Defined...................................................................................................... 6

Physiotherapy Workforce Overview ................................................................................................... 7

2. Current Status of the DHB Physiotherapy....................................................................................... 8

Overall Assessment of the Physiotherapy Workforce ........................................................................ 8

Summary of the Current Status of the DHB Employed Physiotherapy Workforce: ........................... 9

Key Issues .......................................................................................................................................... 10

2.1.1 Service Demand ............................................................................................................ 10

2.1.2 Supply ............................................................................................................................ 11

2.1.3 Operational Flexibility ................................................................................................... 13

2.1.4 Operational Capacity ..................................................................................................... 13

3. Operational Workforce Analysis ................................................................................................... 15

Headcount ......................................................................................................................................... 15

Full Time Equivalent (FTE) ................................................................................................................. 16

Turnover ............................................................................................................................................ 18

Age Distribution ................................................................................................................................ 21

Ethnicity ............................................................................................................................................ 24

HWIP Technical Notes ....................................................................................................................... 26

Physiotherapists Skill Mix (MECA Distribution) ................................................................................ 27

4. Non DHB Employed Workforce Information ................................................................................ 27

Physiotherapy Board of New Zealand – Annual Report ................................................................... 27

Workforce Supply Projections, 2014-2035: The Physiotherapy Workforce (August 2014) ............. 37

Tertiary Education Commission: Education Counts .......................................................................... 38

Immigration New Zealand Information ............................................................................................ 40

5. Appendices .................................................................................................................................... 41

Health Workforce Classification Scoring Matrix ............................................................................... 41

Contents

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Strategic Workforce Services – Physiotherapy Workforce Assessment April 2017 3

Executive Summary

The Workforce Strategy Group commissioned this workforce assessment to identify the current state, key

trends and emerging issues impacting on the Physiotherapy workforce. The drivers for the assessment

were that:

No workforce assessment has been done to date on the Physiotherapist workforce which is one of

the largest DHB Allied Health workforces;

The Physiotherapist workforce is connected to the New Zealand Health Strategy goal: Closer to

Home; and

Difficulty in recruiting to some specialist scopes.

The key findings of the assessment are outlined below.

Service Demand

Demand for this workforce is growing driven by an aging population presenting with complex conditions,

co-morbidity and chronic illnesses. This contributes to increasing hospital admissions and surgical volumes

with associated physiotherapy services required for rehabilitation. Shifts toward conservative

management particularly in orthopaedics (i.e. delays or alternatives to surgery), decreasing length of stay

and new models of care have all contributed to increasing demand, particularly for services delivered in

the community. New standards of care (e.g. in stroke rehabilitation), expansion of scopes of practice into

new areas (e.g. ED) and pre assessments for joint replacement are also contributing to this growth. Demand

is further affected by the growth of other workforces, in particular the Senior Medical Workforce who are

growing at a steady rate of 4% a year.

Demand is high year round with a tendency for peaks during winter months. The growth in demand is also

accompanied by an increased requirement for services to be delivered outside of traditional working hours.

Workforce Supply & Operational Capacity

DHBs report that the supply of graduates is sufficient (and increasing) but significant issues are occurring

around the recruitment of experienced physiotherapists. This extends to physiotherapists with specialist

skills and experience to support the full continuum of care for chronic conditions, complex trauma and

neuro-rehabilitation. DHBs tend to source their experienced physiotherapists from each other or from

overseas and but face large lead times in recruitment. DHB reliance on overseas physiotherapists has

slightly decreased which is also the case in the New Zealand physiotherapy workforce as a whole. However,

there is still a significant reliance on this cohort with needs differing from DHB to DHB. Physiotherapists

remain on the long term skills shortage list. DHBs do not generally employ experienced physiotherapists

from the private sector as they tend not to able to be utilised across the full continuum of care or are able

to meet salary expectations.

While the physiotherapy workforce has remained constant on a per capita basis per resident population

nationally there is an uneven geographic distribution favouring the Northern Region and for large medium

sized DHBs. DHBs report Physiotherapists are attracted to the diverse opportunities offered by large

tertiary centres.

Operational Flexibility

DHBs report increasing inter-discipline substitution particularly to undertake tasks traditionally performed

by occupational therapists and nursing staff. This is particularly relevant as care is increasingly being

delivered in community settings. Some substitution is also present at the lower scope of physiotherapy

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practice to health/physiotherapy/allied health assistants. DHBs advise there are further opportunities to

utilise the non-regulated workforce provided appropriate training and oversight is in place.

Workforce overview and demographics

Headcount FTE Mean FTE Mean Age % Female

Mean

Length of

Service

Annual

Turnover

Rate

1,016

+3.0%

compared

to 1 year

ago

807.3

+3.2%

compared

to 1 year

ago

0.79

+0.2%

compared

to 1 year

ago

39.4 years

-1.0%

compared

to 1 year

ago

87.8%

88.7% at

Jun-15

6.2 years

-1.5%

compared

to 1 year

ago

16.8%

17.7% at

Jun-15

Other Ethnicity Asian Maori Pacific

89.7% 7.5% 2.1% 0.6%

Workforce growing at approximately 3% annually.

Annual rate of turnover for physiotherapists has fluctuated between 15% and 18%. However, this

includes inter DHB movement.

Overall there has been an increasing length of service to 6.2 years from 5.4 six years ago.

A majority female workforce (87.8%) although new entrants are increasingly male.

Very gradual increase in age but relatively young workforce with a mean age of 39.5 years and only

15% over the age of 55.

Under-representation of Māori (2.1%) and Pacific (0.6%) ethnic groups in the workforce. Over representation ‘Other’ and Asian ethnicities when compared to the general population.

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Recommendations

It is recommended that the Workforce Strategy Group consider the following actions in relation to the

Physiotherapy workforce:

Request the Directors of Allied Health to;

1. Continue to support and promote the unregulated workforce (Allied Health Assistants/Health

Assistants/Advanced Health Assistants) in obtaining suitable training and qualifications

through accredited training pathways offered by Careerforce.

2. Support the development of standardised practices for the development of competency

training in the unregulated workforce which will facilitate the delegation of tasks and the

implementation of new models of care (e.g. the Calderdale Framework).

3. Review the ‘skill mix’ of physiotherapy services and consider whether there are opportunities

for change in order to provide improved care and enhanced career development

opportunities for regulated and unregulated staff.

4. In conjunction with the recommendation above, consider the current career path for

Physiotherapists and whether there are opportunities for the implementation of Advanced

Practice roles.

5. Review the trans-discipline approach to health care delivery being offered by

Physiotherapists, Occupational Therapists and Nurses and consider if there are (further)

opportunities for standardisation and the application of any practices for other workforce

groups (Ideally any review would include feedback from patients).

6. In conjunction with Human Resources, consider whether there are opportunities for an inter-

DHB ‘talent pool/ bureau’ of physiotherapy staff to fill short term vacancies to minimise

service disruptions while also potentially providing development opportunities.

7. In conjunction with Planning and Funding, review the provision of physiotherapy/

rehabilitation services to identify opportunities for further integration and workforce

development.

8. In conjunction with the SWS team, to work with HWNZ, the Physiotherapy Board and

Physiotherapy NZ to look at opportunities to share appropriate information for the

development of the workforce as a whole.

9. In conjunction with the SWS team, continue to monitor workforce information and the need

for Physiotherapy’s presence on the Immigration New Zealand skill shortage list.

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1. Purpose The purpose of this paper is to provide an overview of the current Physiotherapy workforce and

recommend actions for the development of this workforce based on the feedback received from DHBs

and the workforce information data.

The report has been developed in consultation with the Directors of Allied Health to be presented to

the Workforce Strategy Group and its subgroup the Employment Relations Strategy Group to r inform

strategic employment relations advice in relation to the Allied workforce.

Background / Context

Ongoing health workforce development is a key accountability for DHBs and has a significant impact

on DHB outcomes. The Workforce Strategy Group (WSG) has an operational governance role over 20

DHB workforce activity and has mandated a range of advice to ensure that workforce planning via

Strategic Workforce Services (SWS) is well supported.

The purpose of the operational advice is to ensure that annual workforce planning processes have the

required level of workforce analysis, wherever additional focus or information is required. It is about

improving overall accuracy of information to this group in order to allow informed decisions to be

made regarding any potential intervention required. The purpose is to identify any staffing capacity

and/or capability issues related to DHB operational delivery and/or service development needs, some

of which may be addressed through the annual WSG workforce workplan process.

The catalyst for this paper comes from the annual planning process directly.

Physiotherapy Workforce Defined

This paper contains a summary of information that is predominately on the DHB employed Physiotherapist workforce. A small amount of information has also been included on the non DHB employed workforce. Sources for this information are contained in the body of the report.

Purpose

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Physiotherapy Workforce Overview

This section provides a snapshot of the DHB workforce as at 30 June 2016:

Increasing numbers with an overall increase of 91.6 FTE or around 13% since September 2010.

Increase in the last 12 months was 3.2%.

National FTE per 100,000 resident population has remained constant, at around 17 FTE Uneven

geographic distribution - increases in FTE in favour of the Northern region DHBs and for Large

and Medium DHBs.

The turnover rate has fluctuated between 15-18% over last six years.

Under-representation of Māori and Pacific ethnic groups in the workforce and over

representation of ‘Other’ and ‘Asian’ when compared to the general population and largely

unchanged over the last six years

The proportion of females to males has remained high but new entrants are increasingly male.

Very gradual increase in age but relatively young, with only 15.1% of employees over 55 years

of age.

The youngest workforce in the Northern region DHBs, the older and therefore with the greatest

length of service are in the South Island region DHBs.

Females tend to be slightly older than males overall.

Steadily increasing number of Annual Practising Certificates issued since 2006.

54% were issued to New Zealand trained graduates in 2015.

Around 80% of overseas registration came from the UK and Ireland.

Physiotherapists on the Long Term Skill Shortage list.

Number of enrolments in bachelor degrees in physiotherapy has increased slightly in the last

two years, from 895 to 920 students in 2015.

This increase, especially in 2015 can be attributed to mostly Asian ethnicity students.

The number of completions of bachelor degrees in physiotherapy has remained constant since

2009, at around 210 per year.

Given the increasing in enrolments, it can be expected to see an increase in completions from

2019, relative to the numbers in 2015.

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2. Current Status of the DHB Physiotherapy

Overall Assessment of the Physiotherapy Workforce

The current status of the DHB employed Physiotherapy workforce was assessed by DHB Allied Health

Directors, Allied Health Service Managers, Allied Health Team Leaders, Physiotherapy Teams Leaders

and Human Resources Managers using a structured screening tool. (Appendix 1)

The screening tool assigns a score to the workforce being considered according to:

1. Service Need - the operational stability/instability of the service; 2. Supply - demographic factors impacting on the overall availability of this workforce; 3. Operational Flexibility - operational flexibility around this workforce for service delivery and

innovation; and 4. Operational Capacity - recruitment and retention.

The purpose of the screening tool is to provide an overall assessment of the workforce to highlight

any pressures impacting on the workforce operationally and/or in the context of wider planning

processes. Results of the screening, place the workforce in one of 4 categories as shown in the figure

below. Results should be considered indicative only.

Health Workforce Classification Table

Overall Classification Intervention Overall Score

Stable Occupation WATCHING BRIEF 4 < 6

Transitional Occupation SOME INTERVENTION RECOMMENDED ≥ 6 < 10

At Risk Occupation INTERVENTION REQUIRED ≥ 10 < 15

Occupation Under Pressure INTERVENTION IMPERATIVE ≥ 15

Pre-Focus Group (Survey) Scoring was as follows:

Domain Score

out of 4

Descriptor for Score

Service Need 3 Service Demand Progressively increasing / impacting on service level or peak demand periods increasing.

Supply 3 Distribution and supply issues increasingly impacting on wider system. Issues with overall size of workforce available.

Operational Flexibility 3 Emerging requirement for more flexible workforce options

Operational Capacity 3 Generalised recruitment and retention issues are occurring

total 12 AT RISK OCCUPATION – INTERVENTION REQUIRED

Current Status of the Workforce

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The table above displays the DHB Physiotherapy workforce assessment (aggregated results from the

online survey) as ranked for the by sector experts. Forty stakeholders of varying roles (including DHB

Allied Health Directors, Allied Health Service Managers, Allied Health Team Leaders, Physiotherapy

Team Leaders and Human Resources Managers) contributed to this workforce assessment.

The aggregation of individual responses has resulted in a score in the ‘at risk’ range. Comments

referenced the difficulty in recruiting experienced and specialist staff, the relatively high turnover and

the perceived mismatch of resources to demand.

A subsequent teleconference with a subset of the group above confirmed this assessment. Issues of

increasing demand, difficulties in sourcing appropriately experienced staff and limited career

pathways were highlighted.

The quantitative information indicates a growing workforce with more entrants being trained and

more registrations being issued, a relatively stable turnover rate (with an annual fluctuation pattern),

a stable length of service and mean FTE, and constant FTE per 100,000 population nationally (albeit

mal-distributed geographically). The workforce also has a reasonable bell shaped distribution with

only 15% being over 55 years of age. These factors tend to suggest a more stable occupation than the

‘at risk- intervention required’ category would indicate.

The Strategic Workforce Team will be reviewing the workforce tool and its operation over the next

few months. Originally designed for use as an input to bargaining strategy development, it may be

that some adjustments are required for wider application.

Summary of the Current Status of the DHB Employed Physiotherapy Workforce:

The table below provides a summary of the key elements of the Physiotherapy workforce.

Summary of Key Service, Operational Workforce and Employment Drivers

1. Operational Service Needs

Current Increasing demand in both acute and in the community

12 month outlook Current trends likely to continue

1 - 3 years outlook Watching brief of increasing demand vs available appropriate FTEs

2. Employed Workforce Structure (Demography)

Average age Average age of workforce 39 years

Ethnicity Lack of Maori and Pacific

Gender balance Predominantly female overall although male dominated in younger age bands

3. Recruitment Current vacancies Issues exist with filling senior roles

Average time to fill Long lead times for senior & specialist roles

Distribution Some issues with skew to Northern region and major centres

Pressures on related workforces No major issues identified

Turnover Relatively stable

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4. Retention Factors

Sick Leave No reports of current issues

Part-time /Fulltime Stable at .80 FTE

Skill Mix Issues with having adequately experienced skill mix in all areas

Access to Clinical leadership Relatively good access to clinical leadership

Clear career path Some issues identified

Development Some issues identified

Workload management Difficult in certain areas

Roster management Some difficulties in some areas

5. Ongoing Training and Development

Entry/ Transition competency No reported issues

Match to service requirements Some reported issues

Access to ongoing training (progression)

Some reported issues

Access to training to maintain practising cert

No reported issues

Key

Working Well - no current problems, no immediate action required

Moderate Alert - action required in short / medium term

High Alert - immediate action required, extreme risk to occupation group

Key Issues

The observations below highlight likely trends that are impacting on DHBs based on sector expert

views and currently available workforce information.

2.1.1 Service Demand

Service stability:

Increased presentation of complex conditions, co-morbidities and chronic illnesses driven by New

Zealand’s aging population resulting in a nationwide increase in service demand. This has been

backed up by evidence provided in Trendcare.

Service demand increasing in the weekends e.g. areas such as ED where the number of elderly

patient presenting have increased.

Demand for specialist services is increasing in certain areas such as hand therapy, Lymphedema,

MSK, cardio-pulmonary and women’s health. Some DHBs have seen significant increases in

waiting lists for these services.

Decreasing length of stay, increasing admissions and volume of surgical patients has increased the

demand for in-patient and outpatient physiotherapy treatments.

Inpatient rehabilitation and older person’s services have to manage increased demands

particularly in ‘winter demand’ period which can extend well into spring.

During peaks in demand constant prioritising of caseloads required to reduce risk to patients from

non-intervention.

Increasing demand for services delivered in the community.

Increases to the ACC surcharge has increased the demand for DHB services in low-decile areas.

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Operational deployment and intensity of use:

Changes in service needs have meant that patients are seeking services outside of traditional

business hours.

Difficulties experienced in community especially rural settings responding to fluctuations in

demand.

‘Closer to home’ initiatives implemented across many DHBs which provide community services

typically increase time spent per client.

Physiotherapy services report some difficulty in getting business bases approved for

relative/proportionate increases in FTE in when responding to increases in medical staff or the

commissioning of new services.

Clinical processes / models of care influence on occupational requirements:

A shift towards conservative management has resulted in a greater demand on community and

outpatient services.

Increasing specialist referrals as physiotherapy assessment is often used as pre-requisite to

prevent or avoid more invasive interventions such as surgery.

In some cases physiotherapists have been delegated RMO tasks in relation to specialist

assessments, particularly in Orthopaedics.

Elective surgery drivers increasing the demand on pre and post-operative physiotherapy services

in some DHBs.

Proactive development of new services e.g. a community stroke service without a decrease in

service requirements elsewhere adds to demand.

2.1.2 Supply

Community / population health requirements:

No issues with the supply of physiotherapists for graduate positions (except in a small number of

provincial/ rural DHBs) but supply of experienced physiotherapists i.e. over five years is less than

demand

The supply issues with senior physiotherapists can impact on service provision especially in

specialised disciplines.

These supply issues can mean that some DHB physiotherapy services are not able to supply the

full continuum of care for chronic conditions or complex trauma and neuro-rehabilitation.

Service delivery in the community requires experienced physiotherapists and with the increasing

demand for community delivery this requires a more experienced workforce.

Providing a consistent service to meet all the clinical needs of the community is difficult in some

regions. Some DHBs report FTE gaps which impact on the delivery of health targets.

HWIP data demonstrates an increasing number of physiotherapists nationally (13% since 2010

and 3.2% in the past 12 months).

The FTE per resident population has remained relatively constant over both periods at 17FTE per

100,000 population i.e. the increase in population is being matched by a proportionate increase

in physiotherapists, albeit with an uneven distribution (see below). However, this does not take

into account of the aging of the general population which will require a higher relative supply of

physiotherapists into the future.

Data from the Tertiary Education Commission shows that the number of enrolments in Bachelor

Degrees in Physiotherapy has increased in the last two years, from 865 in 2013 to 920 students in

2015.

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The number of completions of Bachelor Degrees in Physiotherapy has remained constant since

2009, at around 210 per year. However given the increases in enrolments, it can be expected to

see an increase in completions from 2019, relative to the numbers in 2015.

Distribution:

HWIP data suggests there has been uneven geographic distribution of increases to FTE since 2010

favouring the Northern Region and for large and medium sized DHBs. Large and medium DHBs

have seen an increase of 16% while small DHBs have seen a decrease of 9%.

Some supply issues in provincial/ rural areas can lead to difficulties in providing a consistent

service and specialist services.

Recent closure of private providers in isolated locations has meant that DHB is the sole service

provider in some regions (e.g. Buller & Karamea).

Some geographic areas report only having access to a part-time physiotherapy workforce which

can impact on service delivery with increasing demand. HWIP data suggests the mean FTE has

remained constant at 0.79 nationally.

South Canterbury and others have implemented the placement of physios in the Emergency

Department full time. DHBs report this is without replacing their FTE at their source.

Demography:

DHBs report “a shortage of male physiotherapists” employed by DHBs. HWIP data shows 88.7 %

of the workforce are females. However, new entrants to the workforce are increasingly male but

females tend to stay longer in post than males.

DHBs advise that males tend to move more quickly into managerial roles or private practice than

their female colleagues.

DHBs report female staff tend to move to working part-time over time.

While some DHBs expressed concern about an aging workforce HWIP shows the physiotherapy

workforce is relatively young with only 15% over the age of 55 years of age. This compares with

22% for the Allied workforce as a whole. On average Physiotherapists tend to be slightly older in

the Southern region and with the youngest in the Northern region.

DHBs report low participation by Maori and Pacific Islanders in the workforce. This is especially

commented on by DHBs with high Maori and Pacific Island resident populations. This is confirmed

by HWIP data which identifies Maori and Pacific Island representation nationally at 2.1% and 0.6%

respectively.

Conversely HWIP shows there is an over-representation of ‘Other’ and ‘Asian’ ethnicities in

physiotherapist workforce compared to the population.

The Physiotherapy Board of New Zealand reports a steady increasing number of practicing

certificates issued since 2016 and of those issued in 1015, 54% were issued to New Zealand trained

graduates. Around 80% of overseas registration came from the UK and Ireland.

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2.1.3 Operational Flexibility

Ability to substitute:

Increasing demand for trans-disciplinary work especially with Occupational Therapists and Nurses

particularly in community settings.

DHBs report in some areas (burns, hand therapy) there is no differentiation between

Physiotherapy and OT roles but in others (women’s health, MSK) this does not apply.

Some substitution at lower range of scope of practice from Allied Health Assistants.

Particularly in acute care, the requirement of assessment and reassessment can limit ability to

utilise Assistants or transfer to other disciplines.

DHBs advise that there is capacity for increasing training to Assistants to provide an Advanced

Assistant role capable of more substitution.

DHBs report that the preference for part time work can be a constraint on flexibility especially in

community settings.

Senior staff and those returning from private practice tend to become more specialised which can

limit flexibility.

Scope of practice:

DHBs report that Physiotherapists are taking on some roles previously performed by other

professions (e.g. Occupational Therapy).

Services are introducing new models of care. This is particularly in community physiotherapy and

includes supported discharge, rapid response, falls prevention etc. DHBs are also offering group

classes and education to shift patient strategies to self-management and education.

While DHBs are utilising trained assistants in physiotherapy, the scope of practice is limited. In

most cases that the interventions need to be therapist-led due to regulatory risk and responsibility

issues. (Physiotherapy NZ have a document relating to code of practice PT assistants and all such

workers must be under the supervision of a physiotherapist).

Expectations for staff working in isolated areas is to be generalists as all referrals need to be

assessed and appropriate (evidence based / best practice) treatment. ‘Experts’ within the team

are available to provide support / advice through tele-health but direct contact is required when

‘a hands on technique’ needs to be demonstrated. The rural generalist is not seen as a specialist

yet although it cannot be easily filled.

Some DHBs have introduced evidence based, standardised training (e.g. Calderdale Framework)

for non-professional staff and along with supervision of home based workers has the potential of

providing another tier for community intervention.

South Island DHB’s have implemented Clinical Task Instruction (CTI) to enable the health assistant

(Kaiawhina) workforce to be able to assess and decide on appropriate actions whether it is safe to

proceed with delegated tasks, recognise warning signs that indicate the need to stop a delegated

task.

2.1.4 Operational Capacity

Recruitment issues:

DHBs report difficulty in recruiting experienced physiotherapists throughout New Zealand.

There are difficulties recruiting to medical and surgical wards, orthopaedics, neuro-rehabilitation,

older people and community services.

Recruitment of new graduates is generally not reported as a problem.

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Some DHBs have converted senior roles into junior roles as a response to difficulties recruiting

senior staff resulting in a more junior workforce.

DHBs report that the absence of generalised roles present in the private sector means make it

more difficult to reemploy experienced private sector staff in the DHBs.

Salaries in the public sector are viewed as not competitive with the private sector.

Some DHBs report that most experienced staff are recruited from within.

DHBs report difficulties recruiting physiotherapists in semi-rural, rural and isolated locations,

during the winter months and to cover maternity leave.

Threshold and cost of registration has increased which may be resulting in difficulties sourcing

overseas applicants.

Retention issues:

Smaller, provincial DHBs can have issues with retention of graduates who seek greater

opportunities in larger centres where there are specialist centres of excellence.

Several DHBs report turnover because there is limited opportunity to move out of a rotational

position or into a senior position.

Some DHBs experts consider that ability to advance within a DHB and the salary progression is

restricted when compared to the private sector.

Further, some consider there is little financial incentive to progress to advanced practice or

undertake postgraduate study.

DHBs also have reported some issues with access to mentoring and that there are a lack of training

opportunities to develop advanced practice.

Auckland DHBs report experienced and specialist members of the workforce have left the

Auckland region to move to more affordable areas of New Zealand.

Some DHBs report having overseas trained physiotherapists often only stay for a limited time

within the department (1-2 years). Others rely on overseas staff especially from the UK to fill core

roles within the service.

HWIP data suggests that the annual rate of turnover for physiotherapists has fluctuated between

15% and 18%. 150 physiotherapists have departed in the year to June 2016 however, this includes

staff moving within DHBs. Overall there has been an increasing length of service to 6.2 years.

Lead in time for recruitment:

DHBs report advertising multiple many times to recruit experienced physiotherapists.

Some DHBs undertake overseas recruitment to fill the gaps (especially from the UK and Ireland)

which adds several months to the recruitment process.

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3. Operational Workforce Analysis

Headcount

Over the six years of data shown, the DHB employed physiotherapist workforce has seen a small, but

steady increase in the number. The increase in headcount between September 2010 and June 2016

was 120. On average, this equates to an increase of 20 employees per year.

Headcount by Sex

When observing the changes in the headcount by sex since September 2010, the increase in

headcount is greater in female employees.

Operational Workforce Analysis

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Full Time Equivalent (FTE)

Similar to the observations in physiotherapist headcount, nationally the increase in full time

equivalent (FTE) employees has been small and steady. There are 91.6 more physiotherapist FTEs in

June 2016 than there were in September 2010, equivalent to a 12.8% increase.

FTE by Region

When observing the change in FTE over the last six years at a regional level, it shows the greatest

relative increase has occurred in the Northern region DHBs. It is also evident that the Northern region

DHBs have seen a marked increase in physiotherapists in March 2016. Since September 2010 the

Northern region DHB FTE increase has been 21%, the Midland region has been 11%, both the Central

region and South Island regions have been 7%.

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FTE by DHB Size

When observing the change in FTE over the last six years by DHB size, it shows that the largest relative

increases have occurred in the Large and Medium DHB categories. For the Small DHB category, there

has been slight decrease in FTEs. Since September 2010 both the Large and Medium DHBs FTE increase

has been 16% whereas the Small DHBs has seen a decrease of 9%.

FTE per 100,000 population

Since September 2010, the national FTE per 100,000 population has remained constant, at around 17

FTE per 100,000 population. Given the uneven increases in FTE observed in the Northern region and

for Large and Medium DHBs this could infer a possible maldistribution of physiotherapists. When

observing the resident population increases since September 2010 (sourced from Stats NZ) the

Northern region DHBs has seen an increase in FTEs nearly twice the rate of the increase of its resident

population. The Central and South Island region is around 1.5 times and the Midland region DHBs FTE

increase matches the rate of population increase.

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Cumulative Increase in FTE and Population

When looking at FTE and population increases since September 2010, using September 2010 as an

index, the FTE increases exceeds the population increase. As described in the FTE per 100,000

population section, the increases are observed in the Northern, Central and South Island regions

mostly.

Mean FTE

When observing the Mean FTE, a measure of ‘Part-time’ status – calculated by dividing the FTE by

Headcount, the value has been very consistent. The Mean FTE has remained around 0.79 for the

observable period. A Mean FTE of 1.0 represents a full-time worker.

Turnover

Turnover is calculated by summing the number of positions terminated over the previous year, then

divided by the mean number of positions employed at each of the reporting quarters over the previous

year. Turnover calculations exclude those staff with zero contracted hours, those on fixed-term

contracts, those with a reason for leaving in the following list: (Restructuring / Redundancy, Dismissed,

Health, Death). Reason for Leaving is only complete in HWIP for 32% of leavers as at June 2016.

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The chart demonstrates a consistent annual year-to-date turnover rate. The rates have remained

between 12% and 18% for the duration of the reference period, which indicates a reasonably stable

workforce in terms of leavers. It is important to note that the turnover rates include movement

between DHBs. DHBs do not provide enough information to HWIP on the intended destination of

leavers.

Mean Length of Service

The mean length of service has very gradually increased in a consistent manner over the reference period until March 2015 where it has since levelled out.

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Mean Length of Service by Sex

The mean length of service at the national level, when comparing males and females, shows that the

growth trend is similar as the national view for both sexes. There is a difference in length of service

however, with females tending to stay longer in post, on average, than males.

Mean Length of Service by Region

Physiotherapists tend to stay in post, on average, for a longer period of time in the South Island

region. The Northern region DHBs, followed very closely by the Central region DHBs, see the shortest

average length of service.

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Age Distribution

The chart detailing age distribution per age group is based on two snap-shots of data. The snap-shots

show how the age distribution of physiotherapists has changed over the last five years. Between

2010 and 2016 the distribution of physiotherapist has seen a shift in the distribution towards in the

35-44 years age group and the 55-64 years age groups. The distribution in the <25 years and below

age group has also increased slightly.

Age Distribution by Sex

The chart detailing age distribution per age group and by sex is based on a single data observation in

June 2016. Female physiotherapists have a slightly older age distribution than male physiotherapists.

Male physiotherapists have the greater concentration of employees under 44 years; the female

distribution is greater amongst those 45 and over.

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Age Distribution by Sex and Age Band

The chart shows the June 2016 proportion of male and female physiotherapists by age group category.

The male proportion decreases as the age group increased, which implies more male physiotherapists

are entering the workforce than seen historically.

Average Age

Between 2010 and 2016 nationally the average age of physiotherapists has been gradually and

consistently increasing, albeit with some minor fluctuations. The scale of the chart axis demonstrates

the over the reference period the increase nationally has been 1.3 years between September 2010

and June 2016.

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Average Age by Sex

When observing the average age by sex, females track very closely to the overall national average,

which is unsurprising given they make up around 88% of the total workforce. On average, the male

physiotherapist is around 4 years younger.

Average Age by Region

Physiotherapists tend to be slightly older, on average, in the South Island region. The Northern region

DHBs have the youngest physiotherapy workforce and, unlike the other regions, has seen almost no

change in the average age since September 2010. The Central and Midland region DHBs observed the

greatest increase in average age relative to September 2010.

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Percentage of Workforce Over 50 Years Old

The percentage of the workforce has gradually increased over the referenced period from around 13%

to 15%. This is lower than compared to the national average for all Allied Health occupations as at 30

June 2016, which is 22.7%.

Ethnicity

Between 2010 and 2016 the ethnicity distribution of physiotherapists has seen increases in the

proportion of Asian ethnicity and decreases in the European ethnicity category. The ethnicity

distribution in all the remaining categories has remained largely unchanged. Maori and Pacific are the

least represented ethnicities in physiotherapists.

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Headcount of unknown ethnicity

The chart shows the number of physiotherapists by headcount whose ethnicity is unknown. As at June

2016, 84 physiotherapists have an unknown ethnicity, around 8% of the national total. This figure has

been very gradually reducing since March 2011.

DHB Workforce ethnicity compared to population ethnicity

For the purposes of the chart above the ethnicity categories are those described by Statistics New

Zealand. ‘Other’ ethnicity is a grouping which includes all ethnicities except Maori, Pacific and Asian.

Between 2010 and 2016 the ethnicity distribution of physiotherapists when compared to the ethnicity

distribution of the population has remained largely unchanged. What can be seen as consistent is the

over-representation of the ‘Other’ and Asian ethnicities in the physiotherapist workforce when

compared to the population. Conversely, Maori and Pacific ethnicities are under-represented when

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compared to the distribution of the population. This over and under representation has remained

consistent in both yearly observations.

HWIP Technical Notes

The data is drawn directly from the central repository (HWS) of all HWIP data, except population

data which has been supplied by Statistics New Zealand.

Excludes staff with zero contracted hours and those on long term leave (where paid Employment

Status = '4', '5' or '6' in HWIP).

Only staff employed on the reporting dates (quarter end dates) are included - except those used

for leaving/turnover calculations.

All FTE figures are Contracted FTE (2086 hours per annum) - see the Practical Guide to FTE

Calculations for more details on how this is calculated.

Turnover is calculated by summing the number of positions terminated over the period being

measured, then divided by the mean number of positions employed at each of the reporting

quarters over the reporting period. Turnover calculations exclude those staff with zero contracted

hours, those on fixed-term contracts, those with a reason for leaving in the following list: (42, 43,

51, 53) and all Junior medical staff. Reason for Leaving is only complete for 32% of leavers as at

June 2016.

Calculations involving sex exclude the few employees with an unreported sex.

Calculations involving ethnicity exclude employees with an unknown ethnicity.

Averages are shown as mean unless otherwise stated.

Disclaimer: While care has been used in the processing, analysing and extraction of information

to ensure the accuracy of this report, TAS gives no warranty that the information supplied is free

from error. TAS should not be liable for provision of any incorrect or incomplete information nor

for any loss suffered through the use, directly or indirectly, of any information, product or service.

HWIP Occupational Coding of Physiotherapists: Includes only employees where ANZSCO code =

‘252511’ / ‘Physiotherapist’.

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Physiotherapists Skill Mix (MECA Distribution)

The above graph and table below represents the breakdown of PSA MECA steps which reflects the

skill mix present within the Physiotherapy workforce steps 1-6 are for Graduate to Experienced

Clinicians and steps 7 to 15 are for Advanced Clinician/ Advanced Practitioner/ Designated Positions.

Under these categories graduate experienced physiotherapists make up 68% and advanced /

designated positions make up 32% of the workforce.

This information is derived from payroll data collected from PSA AHT MECAs as at 31 January 2015.

The PSA MECAs have been combined and the data comes from the PSA Auckland AHT MECA and PSA

Rest of New Zealand AHT MECA. The data excludes Northland, Waikato and BoP whose

Physiotherapists are covered by SECAs. The 5.2 component of the MECA step relates to the clause

number (5.2 covers other Allied Health professionals - not just physiotherapists). (Note that

Physiotherapist SECAs exist at Northland, Waikato and Bay of Plenty DHBs)

4. Non DHB Employed Workforce Information

Physiotherapy Board of New Zealand – Annual Report

The Physiotherapy Board of New Zealand is the regulatory body for Physiotherapists, established

under the Health Practitioners Competence Assurance Act 2003 (HPCA Act). The Physiotherapy Board

is the statutory body which sets standards, monitors and promotes competence, continuing

professional development and proper conduct for the practice of physiotherapy in the interests of

public health and safety.

The Board has four defined scope of practice:

1. General Scope of Practice: Physiotherapist

2. Specialist General Scope of Practice: Physiotherapist Specialist

3. Visiting Physiotherapist Presenter / Educator

0.0% 0.1% 0.0% 0.3% 0.5%1.9%

3.6%

9.8%

15.7%

30.9%

9.9%

5.3%

8.0%6.5% 7.3%

5.2 - 15 5.2 - 14 5.2 - 13 5.2 - 12 5.2 - 11 5.2 - 10 5.2 - 9 5.2 - 8 5.2 - 7 5.2 - 6 5.2 - 5 5.2 - 4 5.2 - 3 5.2 - 2 5.2 - 1

MEC

A S

tep

Dis

trib

uti

on

by

FTE

PSA MECA Step (1=Minimum, 15=Maximum)

PSA MECA Step distribution | Physiotherapists | National | 31 January 2015

Red = Graduate to ExperiencedBlue = Advanced Practitioner

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4. Postgraduate Physiotherapist Student

The number of Annual Practising Certificates issued

Source: Physiotherapy Board of New Zealand Annual Report 1 April 2015 to 31 March 2016

A total of 4,704 applications were received. Of the 4,703 APCs issued, 33 APCs were issued with

conditions on scope of practice, 25 were returners to practice.

As the chart demonstrates there has been a consistent increase in the number of scopes of practice issued. After a period of small increases between 2010 and 2012, the annual increases have been becoming greater each year.

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Number of Registrations Granted

Source: Physiotherapy Board of New Zealand Annual Report 1 April 2015 to 31 March 2016

The Trans-Tasman Mutual recognition Act 1997 (TTMR) allows physiotherapists who are registered

and currently eligible to practice in Australia or New Zealand to apply for registration in the other

country through a short-track process which exclude formal assessment. During the year a total of 370

physiotherapists gained registration with the General Scope of Practice: Physiotherapist There are

now 5 practitioners who are registered with the Scope: Physiotherapist Specialist.

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Country of Origin for Overseas Registrations

Source: Physiotherapy Board of New Zealand Annual Report 1 April 2015 to 31 March 2016

Almost 80% of overseas registrations for physiotherapists come from the United Kingdom and Ireland.

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Physiotherapist Board of New Zealand: Workforce Demographics

Physiotherapists complete a (voluntary) workforce survey when they apply for their Annual Practising

Certificates. The response rate for the 2015/16 survey was 56%.

Source: Physiotherapy Board of New Zealand Workforce Survey

The chart above shows that the United Kingdom and Ireland are the countries of origin receiving most

successful registration applications. The United Kingdom has seen a decrease in successful

applications in 2015 and 2016, relative to years prior to this. Since 2011, number of successful

applications from Ireland has been constantly increasing, with a slight reduction in 2016.

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Based on the data from the ‘Snapshot of Workforce Demographic Data’ above the following further

analysis has been produced.

Headcount

As the chart below demonstrates, in both 2015 and 2016, around 28% of workforce survey

respondents indicated they worked in a ‘DHB and PHO’ practice setting. Around 57% of workforce

respondents indicated they worked in Private Practice settings (both employed and self-employed and

in hospitals or rest homes) in 2015, and 58% in 2016.

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Female %

As the chart below demonstrates, in 2015 and 2016, on average, 89% of workforce survey respondents

indicated they were female and employed in DHBs/PHOs, the highest of all the Practice Setting

categories.

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Age profile of Physiotherapy practitioners

The chart below shows the age profile of physiotherapy practitioners by gender and demonstrates a

higher percentage of females present in the workforce with a large proportion of employees aged 44

and under.

Ethnicity

Number of Physiotherapists per 10,000 population by DHB area

The table below demonstrates the number of physiotherapists per 10,000 resident population. Large

DHBs appear to have the most DHBs per resident population, with the exception of Counties Manukau

and Waikato DHBs

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Number of hours worked per week

The chart below shows the number of hours worked per week. The majority (around 35%) work

between 40 and 49 hours per week and an estimated 92% works 49 hours a week or less.

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When observing how the average hours compares across different practice settings (see chart below)

the ‘DHB and PHO’ category worked around 33 hours per week in both 2015 and 2016.

Work type and hours worked per week

The chart below shows the work type and how many hours per week worked in each category.

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Workforce Supply Projections, 2014-2035: The Physiotherapy Workforce (August 2014)

Overseas comparators

In 2014 Business and Economic Research Limited (BERL) produced a report for the Physiotherapy

Board of New Zealand and used a snapshot of the physiotherapy workforce which enabled BERL to

produce economic modelling scenarios to project the potential changes that could occur in the supply

of physiotherapists towards 2035. Whilst the scenario model findings of the report are not included

here, the report did include some useful facts regarding overseas comparators shown here:

“In 2012, approximately 20,081 physiotherapists were employed in Australia and the majority

were females. The average age was 38.6 years old, and one third of physiotherapists worked part-

time.2

The ratio of physiotherapists to the total population was one physiotherapist for every 1,082

people. The supply of physiotherapists into the Australian workforce is steadily growing, with an

increase in the number of physiotherapy schools. In 2012, approximately 1,550 people completed

a physiotherapy qualification, while 2,500 students enrolled to begin. Approximately 85 percent of

the total workforce in Australia trained in Australia. New Zealand physiotherapists were 3.7

percent of the workforce in 2012, but comprised almost 25 percent of all internationally qualified

physiotherapists working in Australia.3

Workforce data on physiotherapists in Canada is for the 2011 year. This data indicates that in

2011, approximately 17,653 people were employed as physiotherapists. This means the ratio of

physiotherapists to the total population is higher in Canada than Australia or New Zealand, with

one physiotherapist for every 1,896 people in 2011.4

The average age of physiotherapists in Canada was 41.9 years old in 2011 and this workforce is

also predominantly female, but this varies between provinces. Nearly 90 percent of

physiotherapists in Canada work in urban areas, and equal numbers work in hospitals and private

practice. One third of physiotherapists work part-time, and the majority of the workforce work for

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a single employer. Approximately 12 percent of Canadian physiotherapists are internationally

qualified, with 20 percent of these physiotherapists coming from the United Kingdom, 15 percent

from India and 10 percent from the United States.5”1

Tertiary Education Commission: Education Counts

Total Student Enrolment

To become a physiotherapist in New Zealand, students will have successfully completed one

of the following qualifications:

Bachelor of Health Science (Physiotherapy) at Auckland University of Technology

Bachelor of Physiotherapy at the University of Otago

Bachelor of Physiotherapy with Honours at the University of Otago

Domestic and international students enrolled in a physiotherapy degree 2008-2015

Notes:

1. Data relates to any student enrolled in a Bachelor of Health Science (Physiotherapy) at Auckland University of

Technology) or in a Bachelor of Physiotherapy at the University of Otago or in a Bachelor of Physiotherapy with

Honours at the University of Otago.

2. Data relates to students enrolled at any time during the year with a tertiary education provider in formal

qualifications of greater than 0.03 EFTS (more than one week's full-time duration).

3. International students are those studying here without New Zealand/Australian citizenship or permanent

residence status. Students studying off-shore at tertiary education providers that are registered in New Zealand

are considered international students unless they hold New Zealand citizenship.

4. Totals also include those students with unknown values.

5. Data in this table, including totals, have been rounded to the nearest 5 to protect the privacy of individuals, so the

sum of individual counts may not add to the total.

2 Health Workforce Australia. (2013). Health Workforce by Numbers – Issue 2. (www.hwa.gov.au). 3 Health Workforce Australia. (2013). Health Workforce by Numbers – Issue 2. (www.hwa.gov.au). 4 Canadian Institute for Health Information. (2011). Physiotherapists in Canada, 2011 – National and Jurisdictional Highlights. (www.cihi.ca). 5 Canadian Institute for Health Information. (2011). Physiotherapists in Canada, 2011 – National and Jurisdictional Highlights. (www.cihi.ca).>

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The chart above demonstrates the number of International students has remained stable since 2008,

the number of domestic students seen in 2016 was the highest since 2008.

Domestic students enrolled in a physiotherapy degree by ethnic group 2008-2015

With ethnicity distribution of all ethnicities has remained constant between 2008 and 2015, with the

exception of Asian ethnicity which has increase from 16% in 2014, to 20% in 2015.

Domestic and international students completing a qualification in physiotherapy 2008-2015

The chart above demonstrates since 2009 the number of students completing a qualification in

physiotherapy has remained 210 on average. Given the increase in recent years in enrolments, and

the fact that a bachelor’s degree in physiotherapy taken four years to complete, it would be

reasonable to expect to see an increase in the number of completions from 2019.

Domestic students completing a qualification in physiotherapy by ethnic group 2008-2015

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The ethnic distribution of domestic students completing a qualification in physiotherapy has on

average remained unchanged since 2008.

Immigration New Zealand Information

Skill Shortage List

The Ministry of Business, Innovation and Employment maintains three lists consisting of; the Long-

term Skill Shortage List, the Immediate Skill Shortage List and the Canterbury Skill Shortage List. The

lists help to ensure that New Zealand’s skills needs are met by facilitating the entry of appropriately

skilled migrants to fill shortages. However, this objective must be balanced by the need to ensure that

there are no suitably qualified New Zealand citizens or resident workers available to undertake the

work. The Immediate Skill Shortage List (ISSL) includes occupations where skilled workers are

immediately required in New Zealand and indicates that there are no New Zealand citizens or

residents available to take up the position. The Long Term Skill Shortage List (LTSSL) identifies

occupations where there is a sustained and on-going shortage of highly skilled workers both globally

and throughout New Zealand.

Physiotherapists are contained in the Long Term Skill Shortage List (LTSSL). In the table below are

extracts from the Long Skill Shortage List, effective from 11 April 2016.

Occupational

Group

Occupation

Occupations are listed

by ANZSCO (Australian

and New Zealand

Standard Classification

of Occupations) code.

Long Term Skill Shortage List

Requirements Qualifications must

be comparable to the standard of the

New Zealand qualification listed. Also see

Note 1 at the end of this list.

Bonus point requirements

In order to claim bonus points for

qualifications in an area of absolute

skill shortage under the Skilled Migrant

Category, applicants must meet the

following specifications.

Health and Social Services

Physiotherapist (252511)

NZ registration as a physiotherapist in the general scope of practice or the specialist scope of practice with the Physiotherapy Board of New Zealand (Qualifications in this area of absolute skill shortage are: Bachelor of Physiotherapy (NZQF Level 7), or Bachelor of Physiotherapy with Honours (NZQF Level 8), or Bachelor of Health Science (Physiotherapy) (NZQF Level 7) – see Note 5)

NZ registration as a physiotherapist in the general scope of practice or the specialist scope of practice with the Physiotherapy Board of New Zealand

Ethnic Group 2008 2009 2010 2011 2012 2013 2014 2015

European 81% 76% 77% 84% 87% 79% 85% 77%

Maori 8% 10% 8% 7% 8% 7% 10% 8%

Pasifkia 2% 0% 0% 5% 3% 2% 3% 3%

Asian 13% 17% 15% 12% 13% 14% 8% 18%

Other 4% 7% 3% 5% 3% 5% 8% 5%

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5. Appendices

Health Workforce Classification Scoring Matrix

Appendices