Abstract
Background
The lack of information on public and private physiotherapy supply in Ireland makes current and future resource allocation decisions difficult.
Aim
This paper estimates the supply of physiotherapists in Ireland and profiles physiotherapists across acute and non-acute sectors, and across public and private practice. It examines geographic variation in physiotherapist supply, examining the implications of controlling for healthcare need.
Methods
Physiotherapist headcounts are estimated using Health Service Personnel Census (HSPC) and Irish Society of Chartered Physiotherapists (ISCP) Register data. Headcounts are converted to whole-time equivalents (WTEs) using the HSPC and a survey of ISCP members to account for full- and part-time working practices. Non-acute supply per 10,000 population in each county is estimated to examine geographic inequalities and the raw population is adjusted in turn for a range of need indicators.
Results
An estimated 3172 physiotherapists were practising in Ireland in 2015; 6.8 physiotherapists per 10,000, providing an estimated 2620 WTEs. Females accounted for 74% of supply. Supply was greater in the non-acute sector; 1774 WTEs versus 846 WTEs in the acute sector. Physiotherapists in the acute sector were located mainly in publicly financed institutions (89%) with an even public/private split observed in the non-acute sector. Non-acute physiotherapist supply is unequally distributed across Ireland (Gini coefficient = 0.12; 95% CI 0.08–0.15), and inequalities remain after controlling for variations in healthcare needs across counties.
Conclusion
The supply of physiotherapists in Ireland is 30% lower than the EU-28 average. Substantial inequality in the distribution of physiotherapists across counties is observed.
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Notes
Includes those employed in organisations where the HSE pays staff salaries under Section 38 of the Health Act 2005.
Since 30 September 2016, all physiotherapists have been obliged to register by 30/09/2018 with the new professional regulator, the Health and Social Care Professionals Council (CORU): http://www.coru.ie/en/about_us/what_is_coru [last accessed 12/03/2018].
The HSE provides these organisations with block grant funding under Section 39 of the Health Act 2005.
Physiotherapists who worked in the acute setting are defined as those who worked in acute hospitals (“acute hospital services” in the HSPC; those who worked in acute private hospitals in the ISCP register), while the non-acute setting is defined as physiotherapy work that is conducted in the community (e.g. local health offices, local health centres), private practices, long-term care facilities, intermediate care facilities, hospices, children’s and disabled people’s services and sports facilities. In the HSPC, these were classified as working in “disabilities”, “mental health”, “older people”, “palliative care” and “primary care”.
A sensitivity scenario using a 50:50 ratio was also undertaken, with results consistent with those reported due to the small number of physiotherapists (n = 84) impacted. A small number of physiotherapists who worked in both an Irish and a foreign practice (assumed to be Northern Ireland) were allocated a WTE of 0.5, as data on cross-border working patterns were unavailable.
Hospitals could not be identified due to confidentiality issues—in some counties, there is only one acute hospital which would be identified where the acute supply is to be geographically profiled.
For example, access to physiotherapy in a primary care team in Dublin South is prioritised for Medical Card holders and for clients living in the catchment area of the health centre:
http://www.hse.ie/eng/services/list/2/PrimaryCare/pcteams/dublinsouthpcts/blackrockpct/physio.html [Last accessed 02/08/2017]. While access to publicly employed or financed physiotherapy services professionals is free at the point of use for medical card holders, this often depends upon availability in local areas [10].
e.g. a data point in the upper left quadrant indicates a county where per-capita supply is higher than the national value based on the unadjusted population (e.g. location quotient 1.5), and lower than the national value based on a needs-adjusted population (e.g. location quotient 0.85).
The number for Dublin South includes 32.5 WTEs employed in a facility which also covers individuals from outside Dublin South. If these are excluded from the geographic analysis, Dublin South has a total WTE of 4.77 per 10,000 population (second behind Leitrim) under the baseline scenario and 5.21 per 10,000 people (first in the ranking) in the sensitivity scenario.
In this Australian study, part-time was defined as working less than 30 hours per week [20].
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Acknowledgements
The authors thank Des Williams (Health Service Executive), and the Irish Society of Chartered Physiotherapists for provision, support, and advice in using the data. The views expressed are those of the authors and not necessarily of the Health Research Board.
Funding
The work was supported by the Health Research Board grant (Grant No. 4644727) for project number HRA-2014-HSR-659.
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Fig. 5 Distribution of hours worked by private only physiotherapists, ESRI/ISCP Physiotherapy Survey (2015) (PDF 384 kb)
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Fig. 6 Sensitivity scenario WTE numbers of acute and non-acute physiotherapists in Ireland by sector (2014-2015) (PDF 331 kb)
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Table 2 Headcount of acute and non-acute physiotherapists in Ireland by sector and gender (2014/2015) (DOCX 31 kb)
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Table 3 Acute and non-acute sensitivity scenario WTE physiotherapists in Ireland by sector and gender (2014/2015) (DOCX 31.3 kb)
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Eighan, J., Walsh, B., Smith, S. et al. A profile of physiotherapy supply in Ireland. Ir J Med Sci 188, 19–27 (2019). https://doi.org/10.1007/s11845-018-1806-1
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DOI: https://doi.org/10.1007/s11845-018-1806-1