How Do I Choose a Job? Factors Influencing the Career and Employment Decisions of Physiotherapy Graduates in Canada

Abstract

Purpose: Physiotherapy is a diverse profession: there are many areas in which physiotherapists can practise. New graduates must decide in which area of physiotherapy they would like to work and with which organizations to seek employment. The purpose of this study was to describe the factors that influenced the career (area of practice, practice setting) and employment (organization) decisions of recent physiotherapy graduates. Method: Given Canada’s vast expanse, we used survey methodology. We invited English-speaking physiotherapists who had completed their physiotherapy education between October 2015 and December 2017 to participate in this study. The survey was emailed to 1,442 physiotherapists in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Nova Scotia. Results: We collected 351 responses (24%). Almost all respondents reported currently working as a physiotherapist, and the majority worked with patients with musculoskeletal conditions. Clinical education experiences were most influential in determining career decisions. Area of practice, practice setting, and mentorship were the most influential factors contributing to employment decisions. Conclusions: Clinical education experiences are influential in shaping physiotherapy students’ career and employment decisions. Employers who want to recruit physiotherapy graduates may consider partnering with physiotherapy programmes to offer clinical placement experiences and develop mentorship programmes that help build novice physiotherapists’ competence and confidence.

Physiotherapy practice involves providing health services for clients of all ages in a variety of settings and in many contexts: from wellness to health promotion and prevention, acute care and rehabilitation, and disability and disease management. The Canadian Physiotherapy Association (CPA) lists 14 specialty divisions (e.g., orthopaedic, cardiorespiratory) in which physiotherapists can practise, based on their special interest and expertise. In Canada, demand for physiotherapists and physiotherapy services is growing, particularly in the clinical areas needed to meet the needs of an aging population.¹

In this country, the entry-to-practice credential is a master’s degree; thus, students must complete an undergraduate degree before beginning their physiotherapy education. When students graduate from their programme and begin looking for a job, they must decide in which area of physiotherapy practice they would like to work (a career decision) and then decide with which organization to seek employment (an employment decision). Internationally, evidence has suggested that physiotherapy students are more likely to pursue a career in musculoskeletal and sports physiotherapy than in other areas of practice,^2–5 and the Canadian Institute for Health Information (CIHI) has confirmed that the majority of Canadian physiotherapists describe their area of practice as musculoskeletal.⁶

In Australia and New Zealand, Reeve and colleagues explored final-year physiotherapy students’ intentions to work in cardiorespiratory physiotherapy after graduation.³ They reported that most students were extremely interested in working in musculoskeletal physiotherapy, followed by neurological physiotherapy, and only a small percentage were interested in cardiorespiratory physiotherapy. On admission to their physiotherapy programme, approximately 37% of students reported knowing in which area of practice they intended to specialize, and for the majority, this area was musculoskeletal physiotherapy. An interesting finding was that 42% of the students reported changing their preferred specialty area during their physiotherapy education – mainly as a result of the influence of professors or clinicians and exposure to, and experience in, other areas of practice during their programme.³

Janaudis-Ferreira and colleagues conducted a similar study with a group of Canadian final-year physiotherapy students.⁵ Roughly one-third of them knew in which area of practice they wanted to work before starting their physiotherapy education, and the majority of them indicated that they wanted to work in musculoskeletal physiotherapy. At the end of their programme, this majority continued to report that they intended to specialize in musculoskeletal physiotherapy.⁵

Several studies have described the influence of clinical placement experiences on the career decisions of health sciences students.^4,7–10 In a small Canadian study, Öhman and colleagues reported that physiotherapy role models – in particular clinical instructors during placement – had a significant impact on the physiotherapy students’ career decisions.⁴ Students perceived the most desirable jobs to be in a general hospital or private practice, whereas jobs in home care and community-based care were considered the least desirable. These authors contended that many of the students had kinesiology degrees and that seeking employment in musculoskeletal physiotherapy was a pragmatic step in their career path.⁴

Clinical placements are a significant component of physiotherapy students’ education. In Canada, physiotherapists graduate as generalists after having completed placements in the core areas of practice (musculoskeletal, neurological, and cardiorespiratory) and in varied clinical settings (e.g., acute hospital, private practice).¹¹ Clinical placements prepare students for general practice, and organizations often view them as opportunities to recruit future physiotherapy practitioners.⁸

Clinical placement experiences, and role models in the clinical and academic settings, appear to shape physiotherapy graduates’ career decisions. However, the extent to which these and other factors contribute to career decisions has not been fully explored with Canadian physiotherapy graduates. Therefore, the purpose of this study was to describe the factors that influenced the career and employment decisions of physiotherapists entering practice. We defined a career decision as relating to the specific area of practice (e.g., musculoskeletal or cardiorespiratory physiotherapy) or practice setting (e.g., acute care hospital or outpatient private practice clinic or home care) in which a physiotherapy graduate chose to work. An employment decision related to the specific organization with which a new graduate sought or accepted a job.

Methods

Creating the survey

We used a survey methodology. Because Canada is so vast, a survey allows researchers to collect large amounts of information economically and in a relatively short period of time, with the intention of generalizing the findings from the sample to the broader population.¹²

We obtained ethics approval to conduct this study from five institutions: the Health Research Ethics Board at the University of Alberta, the General Research Ethics Board at Queen’s University, the Human Research Ethics Program at the University of Toronto, the Research Ethics Board at the University of Saskatchewan, and the Human Research Ethics Board at the University of British Columbia.

We developed the survey using survey development methodology.^12–14 We first reviewed the literature on the career decisions of physiotherapy and other health sciences graduates to identify the survey items used in previous studies and the themes related to new graduates’ career and employment choices.^{2–5,9,15–17} We then used this review to formulate a set of interview questions to confirm our findings from the literature and identify any additional contributors to career and employment decisions. We conducted individual and group sessions with recent graduates from the four representative universities. The questions we prepared are provided in online Appendix 1.

We used convenience sampling to recruit interview participants. We sent an email invitation to recent physiotherapy graduates from the four institutions, and eight physiotherapists agreed to participate. Three worked in private practice, two in large urban hospitals, two in rehabilitation facilities, and one in an outpatient rehabilitation clinic. All worked in diverse areas of practice. They were aged 26–30 years, with between 3 months and 2 years of work experience.

The interview responses highlighted themes similar to those reported in other studies, such as a desire to work in a specific area of practice on graduation (and in some cases an open-mindedness to working in other areas), the influence of clinical education experiences on career and employment decisions, the desire for mentorship and a collegial work environment, the amount of pay being offered, and an employment location close to home.

We used these findings, together with themes and survey items identified from the literature,^{2–5,9,15–17} to develop new items and create a survey consisting of five sections:

• exposure to, and interest in, physiotherapy before beginning physiotherapy education;

• contributors (professional relationships, experiences) to career choices during physiotherapy education;

• contributors (professional relationships, experiences, geographical and other factors) to employment decisions;

• influence of clinical placement experiences on employment decisions; and

• respondent characteristics (e.g., current employment, location of physiotherapy education, gender, age).

The survey items explored the influence of experiences, coursework, and professional relationships on physiotherapy graduates’ career and employment decisions in the area of clinical practice (e.g., musculoskeletal, neurological) and practice setting (e.g., acute care hospital, home care), as well as the factors they considered regarding their first job. In Sections B, C, and D, respondents were asked to rank on a 5-point scale (ranging from 1 = not at all influential to 5 = extremely influential) how influential a number of factors were on their career and employment decisions. The survey is provided as online Appendix 2.

The survey, which consisted of open- and closed-ended items, used skip logic, allowing the respondents to progress through it on the basis of their answers; therefore, not all respondents answered all questions. We pre-tested the survey with a convenience sample of six students from the University of Alberta to ensure that the items were interpreted as we had intended (the responses from the pre-testing were not included in the final data set).^18,19 We then made minor revisions to the wording of the questions.

Recruiting the participants

The survey was formatted for online administration using an in-house online survey application (Gravic Inc., Malvern, PA) and hosted on an internal server at the University of Alberta. We recruited participants by email. An invitation with a link to the survey was emailed to English-speaking physiotherapists who had completed their programmes between October 2015 and December 2017 (three cohorts of graduates). We emailed the invitation link to a purposive sample of 1,442 physiotherapists in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Nova Scotia. We asked the physiotherapist regulatory college in each of these provinces to distribute the invitation along with the link. If the college was unable to do this, recent graduates were recruited through university contact lists. We timed the survey administration date to be close to each university’s 2017 graduation date.

We administered the survey between October 2017 and January 2018. We sent one reminder email 1–2 weeks after sending out the initial email invitation. Completing the survey implied consent to participate in the study, and responses were anonymous. As an incentive, the respondents who completed the survey were entered into a drawing to win one of six $50 gift cards. We collected contact information for the drawing separately from the survey data.

Analyzing the data

We analyzed the data using descriptive statistics and report our findings in frequencies and percentages. When questions required the respondents to rank items, we scored, summed, and then ranked them on the 5-point scale according to total score (first = 5 points and fifth = 1 point). The data were analyzed using IBM SPSS Statistics, Version 25.0 (IBM Corporation, Armonk, NY). We analyzed the open-ended responses using directed content analysis to identify any new factors not included in the survey.²⁰ One author (MH) initially reviewed the comments and completed the analysis, and another (BM) reviewed the findings. In the Results section, we include representative quotes from open-ended responses where they provide additional insight into the responses to closed-ended questions or highlight new factors.

Results

We present our results in five subsections: (1) a description of the respondents, including demographics, their experience of physiotherapy before entering their programme, and their current employment profile; (2) the influence of experiences and people during their academic training (in-class course work) on their career decisions; (3) factors contributing to their employment decisions; (4) the influence of their clinical placement experiences on those decisions; and (5) their satisfaction with physiotherapy as a career.

Respondents

Demographics

In total, 351 recent graduates responded to the survey (overall response rate 24%); half of them (50%) had completed their entry-level physiotherapy education in Ontario. The respondents’ mean age was 26.8 (SD 2.6) years (range, min-max, 23–42 years); 71% (248) identified as female, and 3% (9) identified as Indigenous. They were evenly distributed by year of graduation, and the majority (60%; 212) had previously completed an undergraduate degree in kinesiology. Approximately half (52%; 183) had grown up in a large population centre (≥100,000 people), and most (83%; 290) were members of CPA.

Table 1 .

Characteristics of Respondents (N = 351)

Characteristic	No. (%)
Undergraduate degree focus*
Kinesiology	212 (60)
Biology	34 (10)
Science	30 (9)
Physical education	15 (4)
Other health	8 (2)
Psychology	7 (2)
Arts	6 (2)
Commerce/business	3 (1)
Physiotherapy	2 (1)
Other	33 (9)
Size of population centre of childhood home
Large (≥ 100,000)	183 (52)
Medium (30,000–99,999)	57 (16)
Small (10,000–29,999)	34 (10)
Small town (1,000–9,999)	42 (12)
Rural (< 1,000)	35 (10)
Province of entry-to-practice education
British Columbia	42 (12)
Alberta	57 (16)
Saskatchewan	21 (6)
Manitoba	25 (7)
Ontario	174 (50)
Quebec	3 (1)
Nova Scotia	25 (7)
Outside Canada	4 (1)
Year of completion of physical therapy programme†
2015	115 (33)
2016	101 (29)
2017	130 (37)

^*One missing response.

^†Five missing responses.

Pre-university programme exposure to physiotherapy

Before starting their physiotherapy education, the respondents had varied exposure to physiotherapy. A total of 61% (216) had been treated by a physiotherapist, 37% (129) had a family member or friend who had been treated by a physiotherapist, and 59% (207) had volunteered in a context in which a physiotherapist worked. (The respondents could select multiple responses.)

Before being admitted to their programme, 61% (214) of the respondents had wanted to work in a specific area of practice when they graduated. Of those, 40% (139) wanted to work in general musculoskeletal physiotherapy, 39% (137) in sports physiotherapy, 11% (37) in neurological physiotherapy, 3% (11) in cardiorespiratory physiotherapy, and the remainder in a variety of other practice areas. (The respondents could select more than one practice area.) Of the 61% of respondents who knew the area in which they wanted to work before admission, 47% (100) indicated that their desired area of practice had changed during the course of their program, the reasons for which are outlined in Table 2. (The respondents could select multiple responses.)

Table 2 .

Reason for Change in Desired Practice Area (N = 351)

Reason	No. (%)*
Experience or exposure to practice area on clinical placement	85 (24)
Exposure to new clinical area	82 (23)
Exposure to different patient population	67 (19)
An influential clinical role model	48 (14)
Experience/exposure to academic coursework	37 (11)
Realistic job expectations	31 (9)
An influential academic role model	23 (7)
Other	8 (2)

^*Respondents could select all that applied.

Employment profile

Almost all (97%; 339) of the respondents reported currently working as a physiotherapist; 75% (264) were working full time, the majority (80%; 211) at one job. On average, those working full time worked 39.5 (SD 4.6) hours per week. Of the 75 who worked part time, the majority (72%; 54) had worked for one employer an average of 22.9 (SD 7.2) hours per week. Of the 351 respondents, 68% (237) had a student loan when they completed their programme, 26% (92) had no loan, and 6% (22) preferred not to answer. After removing two outliers, the median amount of total student loan debt was $40,000 (inter-quartile range $36,000; range, min-max, $3,000–$180,000).

Table 3 shows the characteristics of respondents’ employ­ment: practice setting, practice area, age group of 80% of the patients they treated, and size of population centre, based on postal code.

Table 3 .

Characteristics of Graduates’ Employment (N = 351)

Characteristic	No. (%)
Practice setting*
Private practice (employee)	142 (41)
Private practice (contractor)	130 (37)
Large metropolitan acute care hospital	52 (15)
Small community general hospital	23 (7)
Rehabilitation facility	22 (6)
Ambulatory care (public practice)	21 (6)
Home care	10 (3)
Paediatric outpatient facility	9 (3)
Community health centre	7 (2)
Private practice (owner/part owner)	6 (2)
Long-term care	5 (1)
School division	4 (1)
Other	15 (4)
Practice area*
Musculoskeletal (general)	277 (79)
Musculoskeletal (sports medicine)	132 (38)
General rehabilitation	91 (26)
Multi-system	65 (19)
Musculoskeletal (arthritis care)	63 (18)
Neurology	57 (16)
Prevention, health promotion and wellness	56 (16)
Cardiorespiratory	53 (15)
Chronic disease management	38 (11)
Oncology	15 (4)
Developmental delay	13 (4)
Pelvic health	13 (4)
Hand therapy	8 (2)
Professional practice	7 (2)
Academia	5 (1)
Other	22 (6)
Age group of 80% of patients treated,† y
All	41 (12)
0–18	15 (4)
19–64	226 (67)
≥ 65	58 (17)
Size of population centre‡
Large
> 1.5 million	97 (28)
0.5–1.5 million	77 (22)
100,000–0.5 million	52 (15)
Medium (30,000–99,999)	34 (10)
Small (1,000–29,999)	42 (12)
Rural (< 1,000)	12 (3)
Missing§	36 (10)

^*Respondents could select all that applied.

^†Eleven responses are missing.

^‡One response is missing.

^§Respondents did not provide a postal code.

Of the respondents, 62% (218) reported securing an offer of employment before completing their physiotherapy programme, and 63% (220) found it easy or very easy to secure a job in their preferred area of practice or practice setting. A total of 19% (67) had taken a job in an area other than their preferred area of practice or practice setting because no jobs were available that matched their preference.

Influence of experiences and people on career decisions during academic training

As mentioned earlier, a career decision relates to the area of practice (e.g., musculoskeletal, neurological) or practice setting (e.g., acute care hospital, private practice, home care) in which a physiotherapist decides to work. The respondents were asked, “How influential were the following factors in contributing to your decisions about the area of practice or practice setting in which you wanted to work?” Figure 1 shows the influence of people and experiences during physiotherapy education on choice of practice area or practice setting.

Figure 1 .

Influence of people and experiences during physiotherapy education on choice of practice area or practice setting.

The respondents were then asked, “Please select the most important contributor to your decision about the area of practice or practice setting in which you wanted/where you preferred to work.” They could select only one response; the results are presented in Figure 2.

Figure 2 .

Most influential factor contributing to career decisions about area of practice or practice setting.

Our analysis of the participants’ open-ended responses regarding other factors that contributed to their career decisions did not result in any further influential factors. Participants confirmed the impact, both positive and negative, that clinical placements in particular had on their career decisions. Supportive clinical instructors who were passionate about their field and willing to teach, participants’ experiences and exposure during clinical placement, and the availability of jobs in specific sectors reinforced participants’ clinical areas of interest or sparked new interest in previously unknown clinical areas.

Clinical placement had the biggest impact on my decision to pursue the area that I’m in. Having a great mentor/clinical instructor who was passionate about her work rather than a clinical instructor who went to work to do their job and leave. (2017 graduate)

Clinical placements were extremely helpful in exposing me to the different areas of practice and being able to work in all of them. I was able to determine the areas that I liked and those that I did not, which helped guide me into the position I am working today. (2017 graduate)

Factors contributing to employment decisions

Employment decisions refers to the organization or organizations for which a graduate physiotherapist chose to work. The respondents were asked to rate how influential each of 38 factors were in the decisions they made about a specific job or organization with which they wanted to work. The five most and five least influential factors contributing to their employment decisions are listed here. A table of all the factors and their rank on the basis of the calculated score is presented in online Appendix 3.

Five most influential factors contributing to employment decisions

1. Desired practice setting (e.g., private clinic, hospital, other)

2. Desired area of practice (e.g., musculoskeletal, neurological, cardiac, other)

3. Mentorship from more experienced physiotherapists or health practitioners

4. Stability of income (hourly wage or fee for service, percentage of billing)

5. Pay – the amount they would be paid

Five least influential factors contributing to employment decisions

1. Payment of relocation expenses

2. A desire to work independently or be in sole charge (as the only physiotherapist in the facility)

3. Sign-on bonus

4. A desire to work in a community of a certain size

5. Advice from a physiotherapist who graduated before them, which tied with the ability to undertake educational or continuing professional development opportunities in the town of their employment

Directed content analysis of the respondents’ comments highlighted factors already addressed in our survey, including considerations for mentorship and work hours. New factors also emerged: the duration of patient appointments; the availability of jobs in their location, especially in smaller communities and rural areas; and the need to find a job to pay the bills (or pressure to start paying down their student debt).

Influence of clinical placement experiences on career decisions

Many graduates were influenced by clinical placement experiences when they sought employment. A total of 31% of the respondents (109) had completed a clinical placement with the organization at which they found their first job:

• For 90% (98), their experiences on placement were extremely or moderately influential in their employment decisions.

• For 78% (85), their clinical instructor was extremely or moderately influential in their employment decisions.

• For 84% (92), the general environment on placement was extremely or moderately influential in their employment decisions.

However, 69% (242) of the respondents did not obtain employment in an organization in which they had completed a placement:

• For 42% (101), there was no job available.

• For 36% (87), they moved to a different city or province than where their university was located.

• For 24% (58), they received a better job offer elsewhere.

• For 21% (51), they did not enjoy the facilities or did not want to work in any facilities in which they had completed their clinical placement.

Satisfaction with physiotherapy as a career

A total of 83% (291) of the respondents were very or somewhat satisfied with working in physiotherapy, and 90% (315) believed that they would be working as a physiotherapist in 5 years’ time. When asked whether they saw themselves working in the same area of practice or practice setting, 64% (226) thought they would be, 10% (35) said no, and 25% (89) were unsure. A total of 47% (164) aspired to take on leadership or management responsibilities in their organization, 31% (109) hoped to start their own business in physiotherapy, and 28% (99) were looking toward an academic or teaching career.

Discussion

Our results paint a positive picture for physiotherapy graduates and for the profession. The majority of respondents reported being employed in their chosen practice area or practice setting, and many had already secured employment before completing their programme. They were satisfied working in physiotherapy, and most saw themselves working in the field for at least another 5 years. It is encouraging that many graduates aspired to start their own business or take on leadership responsibilities in their organization.

The respondents’ employment rate was high; 97% reported working as a physiotherapist. Unemployment in the field is lower than the national average of 6.9% for all occupations.¹ The majority were working in private practice, treating adults with musculoskeletal impairments. This is not unexpected given the employment data reported by CIHI and findings from other recent Canadian studies.^5,6 As with our study, Öhman and colleagues found that the majority of new Canadian-educated physiotherapists had a kinesiology background and that a pragmatic career choice was musculoskeletal physiotherapy.⁴ However, that study showed an equal preference for employment in private practice and general hospitals, followed by rehabilitation centres and children’s hospitals,⁴ whereas our results indicated a definite preference for private practice. These results may reflect changes in provincial funding for some physiotherapy outpatient services because service delivery is shifting from hospitals to community-based public sites and, more frequently, to private practice clinics, resulting in more employment opportunities in private practice.^21–25

A high proportion of students enter physiotherapy programmes with a desire to work in a specific area of practice. It is interesting that 46% of the respondents in our study changed their mind during their programme and decided to pursue a new area of practice or practice setting as a result of experiences on clinical placement and exposure to new clinical areas. This was comparable to the findings of Reeve and colleagues, who reported that a similar proportion of students changed their minds about their preferred practice area on graduating and for similar reasons.³

Clinical placement experiences appeared to have an impact on both career and employment decisions. Exposure to new clinical areas or patient populations, coupled with the influence of a clinical instructor, shaped some students’ decisions about the area of practice or practice setting in which they wanted to work and with whom. Roughly one-third obtained employment in an organization in which they had completed a placement; of those who did not, one-third reported no jobs available in their preferred area, and one-fourth had moved to a different city or province. Experiences while on placement, work environment, and clinical instructor appeared to influence the decision to work in a given organization. These findings are similar to those of Öhman and colleagues, who found that clinical instructors were influential role models in physiotherapy students’ career and professional choices.⁴

Our findings mirror those found for other professions. For occupational therapy, Crowe and Mackenzie reported that the clinical instructor was an important aspect of the clinical education experience and that this experience shaped students’ decisions about future practice areas.⁹ Students’ experiences with their clinical instructor and the overall work environment while on placement, both positive and negative, were influential in their decisions about their future job. In a study of nursing students, Andrews and colleagues highlighted the impact that placement experiences had on employment decisions for nursing graduates.¹⁰ Positive learning environments and supportive mentors while on placement were associated with students holding a more positive view of an organization as the first destination for employment. Andrews and colleagues also emphasized the need for organizations to partner with educational institutions to create a positive learning environment because of the impact that this partnership has on employment decisions.¹⁰

In our study, the most influential factor in making an employment decision was a graduate’s preferred practice setting and preferred area of practice. This was followed by mentorship, which speaks to the value that new graduates place on this important learning support. The respondents’ comments echoed the need for mentorship – not only having other physiotherapists in the workplace but also having them set aside time for mentorship and teaching. This is not always easy because of the fast pace and caseload in many workplaces. New graduate physiotherapists’ need for support and mentorship by senior physiotherapists and other health professionals was reported by Foster-Seargeant: new graduates who received good mentorship – feedback and support from senior physiotherapists – were more confident in their skills and acquired improved practical and clinical reasoning skills.²⁶

Stability of income and pay were also important factors in employment decisions. Because a master’s degree is required at entry level, graduates have a minimum of 6 years university education, and roughly two-thirds reported having student loans, so for some, the debt load was significant. The importance of pay in career decisions has also been reported in other research.^2,4 For example, Öhman and colleagues found that the potential to earn a good salary and job accessibility were the most frequently cited reasons for choosing physiotherapy as a career.⁴ Dodson and colleagues reported that having student loans limited the jobs that graduates considered because the amount they would be paid became more important.² This was evident in our study, too: respondents’ comments suggested that the need to find work and begin paying off loans superseded being selective about which job to take.

Implications

Our results have several implications, particularly for employers looking to recruit new graduate physiotherapists. As the Canadian population continue to age, the need for rehabilitation services will continue to grow, as will the demand for physiotherapists.¹ Demand for physiotherapists currently exceeds supply; the vacancy rate is approximately 2%, and this rate is higher in non-urban areas.¹ Physiotherapist shortages in non-urban areas have also been identified in other countries, for example in Australia, a country whose vast land mass is similar to Canada’s.²⁷

Internationally, many physiotherapy education programmes struggle to secure enough clinical placement experiences to educate their students.^28–32 Our results highlight the impact that clinical placement experiences, in particular, have in shaping the career decisions of physiotherapy students, as well as the likelihood that graduates will seek employment with an organization with which they have completed a clinical placement. Employers seeking to hire physiotherapy graduates may want to forge closer ties with academic institutions to build clinical education capacity and develop robust clinical education programmes that encourage teaching and student supervision; this background, together with structured mentorship experiences, may persuade physiotherapy graduates to seek employment with these organizations.

Limitations

Our study had several limitations related to generalisability, representativeness, and recall bias. First, the overall response rate was 24%, which is lower than that of comparable studies but consistent with other recent surveys of physiotherapists conducted in Canada.^3,5,33,34 We sent out only one reminder email to complete the survey; two or more reminders may have resulted in a higher response rate.^34,35 Some of our partners were unwilling to send out additional reminder emails to their members. Instead of varying the number of reminder emails we sent to different groups, we elected to maintain consistency and send out just one email reminder.

Respondents who self-selected to complete our survey may have had a particular interest in this topic; therefore, the results must be interpreted with caution because the views of non-responders may vary from those of responders, and this may call into question the generalisability of our findings.

Second, we did not reach the full number of potential Canadian physiotherapists because some regulatory colleges were not willing or able to participate in the study; thus, we did not have access to their most up-to-date email contact information. Also, some university graduates may not have been using or checking their university email accounts, so they would have been unaware of the survey. Therefore, our denominator of 1,442 potential respondents is likely an overestimate of the number of people who received the invitation, and thus our calculated response rate of 24% is likely lower than the actual percentage of those who responded.

Finally, our study surveyed physiotherapy graduates up to 2 years after graduation, and they may not have correctly remembered the factors that informed their career and employment decisions.

Conclusion

The demand for physiotherapists and physiotherapy services in Canada is growing. As a result, most physiotherapy graduates are able to secure jobs in their chosen practice area and setting, working with the patient populations that bring them fulfilment. Newly qualified physiotherapists are generally satisfied with working in physiotherapy and see themselves continuing to work as physiotherapists. Clinical education experiences are extremely influential in shaping physiotherapy students’ career and employment decisions. Employers who want to hire physiotherapy graduates may consider partnering with physiotherapy programmes to offer clinical placement experiences in an attempt to increase recruitment and develop mentorship programmes that help build novice physiotherapists’ competence and confidence.

Key Messages

What is already known on this topic

Physiotherapy graduates are more likely to pursue careers in musculoskeletal and sports physiotherapy than in other areas of practice. Clinical placement experiences and role models in clinical and academic settings appear to shape physiotherapy graduates’ career decisions.

What this study adds

This study provides further evidence of the influence of clinical education experiences in shaping the career and employment decisions of Canadian physiotherapy graduates. Our findings highlight the multiple factors considered by new graduates when deciding on employment; however, their preferred area of practice and practice setting and the availability of mentorship appear to be the most influential factors.