Limited registration physiotherapists – understanding the problems and looking for solutions

As a clinical managing director actively working in the aged care sector, I am reminded daily of the desperate short of high-calibre clinicians that exists. This mass shortage is not limited to regional or rural areas, but equally occurs in large metro areas Australia wide. This extreme shortage is in part due to the increased demand required to adequately meet the January 2017 ACFI funding changes related to the time requirements for the pain management program and the other is a declining interest amongst qualified physiotherapist and occupational therapists to work within the sector under the current ACFI approved scope of practice. Coupled with increasing wage pressures due to high labour demands have placed the ability to provide a high quality of care for our elderly clients under extreme pressure.

Amongst physiotherapists and similar health professionals, there appears to be a distinct lack of understanding of the opportunities that exists in aged care, not only skill development wise and possible career progression available, but also the value in which high quality allied health service can improve current industry service and implementation of best practice. Compounding the shortage of qualified clinicians is the lack of recognition and need by our major Universities and the existing national undergraduate physiotherapy/ occupational therapy syllabus, that fails to adequately expose, promote and educates new members entering the profession to the wide range of specialist skills required, complex clinical reasoning and demand that exists servicing the aging population, meaning too few Australian-trained therapist are being attracted to work in the industry.

As a direct result of this we’ve, as a sector, had to become reliant on importing clinicians from overseas to meet the sector needs and resultantly being subjected to the horrors of what is our Australian Physiotherapy Council/ AHPRA’s limited registration process. As it currently stands, the Australian limited registration process for Physiotherapists is a very long winded, arduous and inconsistent method of helping to train and upskill those graduating from other nations, meet our registration standards and requirements. The process involves copious paperwork, long processing wait times, frequently up to 4 months to get a possible outcome from AHPRA, governing program requirements that limit the numbers of supervisees per registered therapist and the requirement for direct supervision for months, all in which places a huge strain on what is already an overstretched workforce. The process of limited-registration requires an experienced practitioner to have no least than five-years post-graduate experience to qualify to supervise no more than three overseas physios, which places an upper limit on how useful this program is given the cap on number of seniors available within any one organisation that can meet the supervisor requirements and ultimately the extent in which we can utilise this avenue to expand the workforce to meet the growing demands for service.

Whilst it is true that some other countries offer less thorough training and not as rigorous qualification requirements, there are equally as many overseas physios bound by the requirements of limited registration that are trained in countries such as the UK, America and Europe, often colleagues that we look to as a profession for best practice and cutting edge research in our sector, particularly dementia. It doesn’t seem right that these clinicians are subject to the same process as those imposed on 3rd world countries where educational institutions are not deemed to be at as a higher standard. It’s ludicrous, that someone trained in some of the best institutions in the world can’t have their qualification, skills or experience recognised without going through the limited registration process or going through an even more tedious and very expensive process of equivalence which requires the evidencing of 4-years worth of course content and justification of equality of quality in training.

Even within the limited registration process there is huge disparity between the requirements for an overseas trained Occupational Therapist (OT) v’s a similarly trained Physiotherapist, both of whom have registration granted by the same governing registration body AHPRA. Currently the only requirements that exist for an overseas OT is a supervision period of 6 months then they are eligible for full registration under AHPRA. Whereas a Physio must undergo a written exam and 3 clinical exams, plus the extensive requirement for direct supervision and progression reports. It’s a frustrating and the problems are multiple beyond application approval: There are too few approved clinical assessors, this means that it can take two years before people can take even their first clinical exams, with similar wait periods for subsequent ones. There are also insufficient patient volunteers for the examinations, which leads to sessions being delayed or cancelled. The simple truth is that there aren’t enough centres at the moment offering the required testing of those registered under the limited registration process and there is no solution being offered. In fact most people aren’t aware of this even being a problem, except those of us that are required to deal with the inefficiencies on a daily basis.

We need a solution, fast! Currently the process is not fit for purpose. I know of a British-registered and trained physiotherapist who started the process of limited registration but realised that it would be quicker to just redo the whole 4 years here in Australia from scratch. Sad thing is she was correct! It took her four years to complete her Undergraduate Bachelor course and some of her other limited registration colleagues that started the process either before or at the same time, still remain hamstrung by the process and under limited registration. How can that be right?

Something has to change. I believe there are a few ways in which we could improve the process:

1. We could develop intensive, university-based bridging courses to train overseas physiotherapists to Australian standards of care and aid understanding of our national systems within an 18 month – 2 year period. Many of these overseas trained therapists need further development of essential clinical reasoning skills and familiarity with equipment use and approaches to care that are not available in their nation.

2. To assist in relieving the backlog of existing limited registration physio’s, perhaps we could streamline things by increasing the number of accredited assessors and centres and using simulation technology to avoid delays due to lack of patient volunteers and offered bulk written examinations in capital cities that test the clinical knowledge and safe application to practice, similar to what occurs in undergraduate courses already.

3. The introduction of a compulsory, post-entry, two-year clinical secondment in aged care for every limited-registration physiotherapist. It would be a way of increasing staff supply in a sector that is struggling at the moment. Aged care offers physios a wealth of experience in all aspects of management of acute and chronic disease.

Now for those of you that maybe worried that we’re using elderly Australians as guinea pigs, that absolutely wouldn’t be the case. These are physios that have been trained and are subject to ongoing supervision similar to undergraduate students. Equally this model is comparable to the international registration requirements that overseas doctors have when commencing practice in Australia, and its an opportunity to work in a challenging and interesting sector with support, supervision and a fair but fixed-rate of pay until they achieve full registration. My final proposal is perhaps the most controversial, but it has the potential to be a game-changer.


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