The allied health sector has experienced dramatic growth in recent years in response to increasing demand for health services and a shift towards greater recognition of the role that the sector can play in providing healthcare. As the allied health sector takes on a more significant role in the provision of health care services in Australia, it is increasingly important to have a more detailed understanding of its size and composition and how it fits into the broader Australian health landscape.
Historically there has been limited data available on the allied health professions. A sound fact base is essential for disaggregating the drivers and barriers of eHealth adoption amongst allied health practitioners, designing interventions to promote greater engagement with the national eHealth agenda and assessing the impact of policies once they have been implemented.
This chapter provides a profile of the allied health sector. As well as an overview of the size of the professions and the growth that they have experienced in recent years, it endeavours to give an insight into the work practices, funding and education of the sector. The information presented has been drawn from the eHealth readiness survey, detailed follow-up surveys and consultation sessions conducted for this report, as well as existing research on the professions.
Appendix 3 provides a high-level profile of each of the composition, role and eHealth position of each of the 15 allied health professions. The accompanying Annexure to this report, The eHealth Readiness of Australia’s Allied Health Sector, contains a detailed breakdown of results from the eHealth readiness survey for each profession.
Size and compositionBetween 2001 and 2006, the number of practitioners in each of the allied health professions grew by between 10 and 36 %. In that time, the total number of practitioners in the sector expanded by 22 %: see Exhibit 5. The number of recognised professions has also grown in line with technological advancements. For example, specialist sonographers have emerged as a separate discipline from traditional radiographers following the development of sophisticated ultrasound techniques.
EXHIBIT 5 – size of the allied health sector, by profession
Age and genderAllied health workers are a significantly younger workforce than those in the medical specialist, general practitioner and nursing professions, and are predominantly female: Exhibit 6 below. Further data on individual allied health profession demographics is presented in the detailed profiles of the professions in Appendix 3.
EXHIBIT 6 – Age and gender distribution
Work practicesThe allied health professions consist of practitioners with a wide variety of workflows, philosophies and professional cultures. Understanding the work practices of allied health practitioners is needed to help interpret their eHealth readiness. Exhibit 7 describes the high-level work practice profile of allied health practitioners.
EXHIBIT 7 – Overview of respondent attributes
Daily patient volumeThe significant variation between allied health professions in the number of patients a practitioner sees per day is shown in Exhibit 8. In three professions – social workers, psychologists and occupational therapists – more than 60% of respondents reported that they saw fewer than six patients per day. This reflects the type of work undertaken by these professions, as they spend more time understanding a patient’s perspective and behaviours. Other professions have much higher patient volumes. For example, over 3o% of radiographers and sonographers reported that they saw more than 25 patients per day.
EXHIBIT 8 – Daily patient volume by profession
Number of practice locationsAllied health practitioners work in a wide variety of settings, including hospitals, workplaces, sports organisations and clinics, community centres, women's health centres, rehabilitation centres, aged care facilities, mental health facilities, GP Superclinics and other multidisciplinary care centres, private practice, schools, universities, prisons and detention centres, and Government agencies (e.g. Workcover, Centrelink, Department of Veterans Affairs).
Most respondents (55%) reported that they work in only one practice location. However, this varies strongly with the profession of the practitioner: Exhibit 9 below. While over 70% of dentists, osteopaths and chiropractor responded that they worked from a single practice location, approximately 60% of audiologists and podiatrists work at two or more, and over 35% of dietitians, speech therapists and aboriginal health workers practice from three or more locations.
This distribution will have implications for the types of eHealth applications a practitioner is likely to use. Most practitioners working in multiple locations are likely to be either employees, or providing locum services – in either case they are unlikely to make the final adoption decision for eHealth solutions. As such, they must either adapt to the systems at each location or integrate them, highlighting the requirement for system commonality. Mobile eHealth applications and web-enabled interfaces are likely to be more attractive as practitioners can experience a more consistent experience across practice locations.
EXHIBIT 9 – Number of practice locations by profession
Frequency of rural or remote serviceLike other health professions, allied health practitioners are largely concentrated in urban areas with considerable workforce shortages relative to demand in rural and regional Australia. Almost two-thirds (57%) of practitioners responded that they never visit rural or remote locations: Exhibit 10 below. However, three professions are much more likely to do so: Aboriginal and Torres Strait Islander Health (ATSIH) workers, social workers and occupational therapists. 54% of ATSIH workers reported visiting rural or remote areas daily, reflecting the role these practitioners play in engaging with Aboriginal communities in these areas. 34% of social workers said that they visited rural or remote areas weekly or fortnightly, with many employed by Centrelink throughout its rural and regional branch network. 34% of occupational therapists also responded that they visited rural or remote areas weekly or fortnightly.
EXHIBIT 10 – Frequency of rural or remote practice by profession
FundingAlthough more mixed funding models are emerging, there remains a clear division between allied health practitioners employed in salaried positions in the public sector, and those in private practice.
Practitioners most likely to work in the private sector are chiropractors, dentists, osteopaths and optometrists: see Exhibit 11. Other professions derive a significant proportion of their income from the public sector. For example, 70% of dietitians reported earning less than 25% private income (although private income is growing as a result of the Medicare Chronic Disease Management items, see below). 55% of ATSIH workers and 38 % of speech pathologists also reported earning less than 25% of their income from private sources, with many employed by Aboriginal Medical Services, community health services and schools.
In professions with a more established history of working in the private sector – such as chiropractors, osteopaths, dentists and optometrists – over 80% of respondents reported that they earned more than 75% of their income from the private sector. Most practitioners in private practice have relied on fee-for-service or benefits provided under private health insurance. While some professions such as optometrists have access to subsidised services through the Medicare Benefits Schedule, most do not.
EXHIBIT 11 – Private sector income, by profession
Structural changes are allowing more public sector-based practitioners to increase the proportion of income they derive from the private sector. The introduction of the Medicare Chronic Disease Management (CDM) items (formerly known as the ‘Enhanced Primary Care program’) in 2004, and the Better Access to psychiatrists, psychologists and General Practitioners through the MBS, in 2006, gave access to Medicare rebates for certain allied health services following referral from a general practitioner: see Accessing Medicare funding below. This has made small private practice a much more viable option for many practitioners who would previously have worked on a salary in an institutional environment. They now have significant incentives to build a practice through strong relationships with GPs, specialists and other health professionals, as well as marketing and improving services to patients.
Other government or universal insurance schemes exist to fund allied health delivery. For instance, the Department of Veterans Affairs provides health benefits for veterans that may be delivered through allied health practitioners. Workcover also funds significant levels of service from occupational therapists or physiotherapists.
Accessing Medicare fundingAn example of the way the items work is provided by the individual allied health items for people with a chronic or terminal medical condition and complex care needs – MBS items 10950 to 10970
- Patients must have a chronic or terminal medical condition and complex care needs and be managed by their GP under a GP Management Plan (GPMP, MBS item 721) and Team Care Arrangements (TCAs, MBS item 723), or be Commonwealth-funded residents of a residential aged care facility who are managed under a multidisciplinary care plan (MBS item 731)
- GP refers to allied health practitioner
- A Medicare rebate is available for a maximum of five (5) allied health services per patient each calendar year. (Note, however, that allied health providers may set their own fees)
- Allied health practitioners must report back to the referring GP
Patients may be eligible for individual allied health services under Medicare if their GP has provided the following MBS Chronic Disease Management services:
- A GP Management Plan (GPMP) - item 721 (or review item 732); and
- Team Care Arrangements (TCAs) - item 723 (or review item 732); or
- A multidisciplinary care plan prepared by a residential aged care facility involving GP contribution- item 731
For psychologists, social workers and occupational therapists, Medicare rebates are currently available for patients with an assessed mental disorder to receive up to 12 (in exceptional circumstances up to 18) individual, and up to 12 group allied mental health services per calendar year. The psychologist or other allied mental health professionals can provide one or more courses of treatment, with each course of treatment involving up to six services (but may involve less depending on the referral). At the conclusion of each course of treatment, the allied mental health professional reports back to the referring medical practitioner on the patient’s progress and the referring practitioner assesses the patient’s need for further services. Changes in the 2011-12 Budget mean that from 1 November 2011 the maximum number of sessions that can be received in a calendar year will be 10 individual and 10 group sessions.
The allied health services under Medicare can only be claimed by allied health professionals who meet specific eligibility criteria, are registered with Medicare Australia, and are in private practice. In addition, the providers must be registered and meet the requirements of their professional organisation. From 1 July 2011, additional continuing professional development requirements will be in place for allied health providers of focussed psychological strategies under Medicare.
National registration and accreditationParticipating in Australia’s national health registration scheme has increased the recognition of allied health professions within Australia’s health sector, strengthened the role of its national professional bodies, and made Medicare funding more accessible.
In 2006, the Council of Australian Governments (COAG) agreed to establish a single national registration scheme for health professionals and a single national accreditation scheme for health education and training. On 26 March 2008, the Australian Government and the governments of all states and territories signed an intergovernmental agreement to establish a single National Registration and Accreditation Scheme for health practitioners (the National Scheme) to commence on 1 July 2010. This process has allowed for uniform and consistent regulation of health professions across Australia, with the associated benefits of reducing red tape, increasing the mobility of health professionals and increasing transparency around the level of registration a health professional has through a online searchable register. The Australian Health Practitioner Regulation Agency (AHPRA) was established as the organisation responsible for the implementation of the National Registration and Accreditation Scheme across Australia.
Of the ten health professions that are currently regulated under the National Registration and Accreditation Scheme (NRAS), eight are allied health professions.4 Four more allied health professions are due to join the national scheme from 1 July 2012 – Aboriginal and Torres Strait Islander Health workers, Chinese medicine practitioners, medical radiation practitioners and occupational therapists.5
EducationAlong with the changes in funding and registration, the education required to practice in allied health is being set at a higher tertiary level and is becoming more technically complex, though it has not yet been extended to eHealth.
Allied health practitioners are generally required to have university qualifications in order to be registered or to qualify for membership of their professional bodies. These requirements flow from the process of the profession’s national registration, with its emphasis on professional (university-delivered) qualifications, and standardised accreditation for university courses that are overseen by independent profession-based bodies.
As both technological solutions and clinical understanding is advancing in most professions, most have continuing professional development (CPD) programs in place to ensure that the skills and knowledge of practitioners remain up-to-date.
Professional bodies are increasingly responding to member demands for online registration, CPD and other service delivery. CPD and other professional development activities are being provided online and in electronic formats, particularly for those professions with a large percentage of rural members and those with a younger membership base. In some cases this has extended to providing business development support. For example, the Optometrists Association Australia provides assistance to members in developing their websites.
Formal training and accreditation programs in eHealth applications are not yet widespread, which is in keeping with the rest of the health industry. However the strong education and training structures that exist in the allied health professions – both at university and through CPD programs – provide a platform for further engagement on eHealth applications.
SummaryUnderlying demand for health services in Australia is growing, driven by an ageing population and an increasingly health-conscious population. A substantial portion of this demand for health services is being met by the allied health sector. Participating in Australia’s national health registration scheme has correspondingly increased the recognition of allied health professions within Australia’s health sector, strengthened the role of its national professional bodies, and made Medicare funding more accessible.
Such structural changes are allowing more public sector-based practitioners to increase the proportion of income they derive from the private sector, and for those in the private sector to be more secure in their funding. Nonetheless, there remains a clear division between allied health practitioners employed in salaried positions in the public sector, and those in private practice.
The education required to practice in allied health is being set at a higher tertiary level, is becoming more technically complex (though not yet extended to eHealth), and tied to professional accreditation. Allied health workers are a significantly younger workforce than the medical specialist, general practitioner and nursing professions, and like other non-medical health professions are predominantly female.
Significant variation in practitioners’ type of work leads to significant variation in their workflow and patient rate. Most social workers, psychologists and occupational therapists see fewer than six patients per day, while over 30 % of radiographers and sonographers see more than 25 patients per day.
Though most practitioners (55%) work in only one practice location, over 35% of dietitians, speech therapists and aboriginal health workers practice from three or more locations. Setting up equipment and software at multiple sites is a barrier to eHealth adoption, so mobile eHealth applications and web-enabled interfaces are likely to be more attractive. This will also assist those practitioners with a strong rural and regional practice. Allied health practitioners are largely concentrated in urban areas, with over 68 % never visiting rural or remote locations. However, 54% of Aboriginal and Torres Strait Islander Health (ATSIH) workers visit rural or remote areas daily, while 34% of both social workers and occupational therapists visit those areas weekly or fortnightly.