Clinician’s Commentary on Hall et al.

Considering changing demographics with an increasingly aging population and a move toward conservative management, all amid the current health crisis, timely access to physiotherapy has become an ever-growing need and issue. In 2017, the Conference Board of Canada published a briefing that indicated a national unemployment rate of just 0.3% in 2014 for physiotherapists seeking professional opportunities,² a rate considerably lower than the overall national unemployment rate of 6.9%. The briefing also suggested that the demand for physiotherapy consultation and service would continue to increase but would not be matched by the growth rate of physiotherapists available to provide these services. Although the Canadian Institute for Health Information shows that the supply of physiotherapists is increasing in specific regions,³ this discrepancy in supply and demand may result in shortages of service on the basis of geography. This information shows, then, that it is imperative to explore the factors that influence the decisions of physiotherapists (the supply) about where they choose to provide service.

Hall and colleagues¹ conducted a qualitative analysis to determine the factors that influenced the decisions of new graduate physiotherapists (NGPs) with respect to practice setting, practice area, and employment. The authors conducted this study in two phases: by developing and distributing a survey and then collecting and analyzing the data from that survey. They presented the results in five subsections, three of which discussed the influence of experiences during academic training, contributors to employment decisions, and influence of clinical placement experiences on employment decisions.

Many students begin their physiotherapy training with predetermined notions, primarily based on expectations and experience, of their desired setting and areas of practice on completion. Despite this, Hall and colleagues¹ found supporting evidence to suggest that students were malleable and shaped by the interactions they had during both their academic and their clinical education. The authors reported that the two most influential factors that contributed to students’ decisions were (1) exposure to a practice area or setting during clinical placement and (2) interaction with a clinical instructor (CI). Harman and colleagues explored the factors that contributed to physiotherapy students’ development of professional identity throughout their training.⁴ Their study supported the idea that physiotherapy students’ perspective was non-linear and influenced by several factors, including clinical placements, that were critical and meaningful to students’ views on desired practice setting and area.

Regarding contributors to NGPs’ employment decisions, Hall and colleagues identified desired practice setting and area as the two most influential factors.¹ Given the evidence that supports the influence of clinical placement experiences on students’ perceptions of practice area and setting, it appears that clinical placement experiences may have a direct impact on employment decisions.

Hall and colleagues found that clinical placement experiences had an influence on employment decisions:¹ of the 351 survey respondents, 31% had secured employment with an organization at which they had completed a clinical placement; of those who had not, 42% said that the reason was that no job was available. Mentorship from a more experienced physiotherapist was the third most influential factor in employment decisions.¹ Students place significant value on the opportunity to be mentored in their chosen place of employment.⁵ If students have a positive experience being mentored by a CI, it may increase the likelihood that they will consider a professional opportunity in that organization.

If clinical placement experiences can shift and shape students’ preference for practising in a specific setting or area and hence have an impact on their employment decision, physiotherapy programmes and employers should pay attention to the potential opportunities that can develop from these linkages. It has been proposed in the literature that NGPs may feel unprepared when entering the physiotherapy workforce because of the caseload and complexity of patients. If clinical placements do not reflect what NGPs expect in an employment setting, it can decrease their confidence in their ability to fulfill a prospective role.⁶ Given that nearly one-third of Hall and colleagues’ survey respondents identified having secured employment opportunities at previous clinical placement sites,¹ NGPs seem to feel more prepared to take on roles at sites where they have previously worked.

Considering the rising demand for physiotherapy services,² it is important to analyze the factors that influence NGPs’ employment decisions as well as organizations’ recruitment strategies for satisfying their need for these services. In physiotherapy programmes, the demand for clinical placements is often not met by the supply of offers; thus, providing clinical placements can help fill these organizational service gaps.⁷ The findings of Hall and colleagues suggest that it may be mutually beneficial to consider collaborative efforts between organizations looking to fill physiotherapy positions and physiotherapy programmes looking to secure offers.¹ Both parties should consider exploring opportunities to serve both needs so that they can close the gap between supply and demand.