Making the Most of What You Have: Challenges and Opportunities from Funding Restrictions on Health Practitioners Professional Development
In the current climate driven by financial constraints there is an increased emphasis on high quality provision of healthcare and improved productivity. An important means of achieving this is to ensure health practitioners are provided with the opportunity to keep up to date with emerging knowledge (such as new research evidence), and increase skills and competence to be reflective and evidence-based in their practice. This is also important for ongoing registration purposes. This may be achieved through continuing professional development (CPD). Continuing professional development is an essential component of evidence-based and best practice. It has been shown to have many benefits to the practitioner, the patient, as well as the organisation. Also, a lack of engagement of health practitioners in CPD has been shown to result in risks to patients, to staff and to organisations.1
Over the past few months, I have had an opportunity to make linkages with fellow allied health professionals from another region of Australia, Queensland. During our wide ranging discussions about evidence-based practice, we stumbled upon the challenges that many allied health professionals’ face in accessing and effectively utilising CPD due to the current pressures within the health system. These challenges are even more acute in non-metropolitan areas. Geographical barriers, increased travel time and associated costs inherently predispose practitioners living and working in non-metropolitan areas such as rural Queensland to having limited opportunities to attend face-to-face training and CPD events.
As the discussions continued, in the true spirit of allied health, we focussed on how can we address these challenges and come up with creative opportunities in planning CPD and using innovative avenues and options. Therefore the purpose of this editorial is to outline the challenges currently faced by health practitioners (especially rural allied health professionals) in engaging with CPD activities due to pressures on healthcare, such as financial restrictions. Also, opportunities and innovative solutions for health practitioners to consider while planning and undertaking CPD activities are described.
Why is CPD Important?
Internationally, CPD has been acknowledged as that which provides the framework to ensure that health practitioners retain their capacity to practice safely, effectively and legally within their evolving scope of practice.2 CPD activities include a range of formal learning methods, such as attendance at conferences and courses, and non-formal learning gained through experience at work, interaction with other professionals, learning reflection, engagement in supervision, mentoring or coaching, involvement in communities of practice and evidence-based practice activities.3,4
Patients, staff and organisations are said to benefit from CPD as engagement in CPD results in increased skills and knowledge for practitioners, reduced waiting time for patients, well-informed and motivated workforce for the organisation. Lack of engagement in CPD can lead to compromised patient safety, staff shortages due to recruitment and retention issues, and difficulties for organisations in meeting national directives and guidelines.1 Another significant risk is that a lack of engagement with CPD may lead health practitioners to practice beyond their level of education, designated responsibility and competence.5 This in turn is likely to lead to poor patient outcomes and compromised patient safety.
Barriers in Accessing CPD
Lack of dedicated time and funding have been consistently shown to be the greatest barriers that impact on health practitioners’ ability to access CPD.1,4,6 Cuts in training budgets and shortages of staff to cover day to day activities make it difficult, if not impossible, to release staff to engage in CPD.1 A study of 180 allied health professionals by Gibbs identified that courses and workshops were personally funded by allied health practitioners themselves.1 In addition to this financial burden, the attendance at these events was undertaken at their own time, on weekends, or by using their annual leave from their paid employment. These findings are not unique to Australia. In a study conducted in the United Kingdom, which included 206 dieticians, shortage of staff to cover study leave and lack of management support were highlighted by participants as barriers in accessing CPD.4 Hill and Alexander note that other barriers to CPD access were hours of work (e.g., shift work), cost of travel, accommodation and time away from work and family.5 While such barriers affect health practitioners Australia-wide, those residing and practising in non-metropolitan areas are placed at a greater disadvantage.
Rurality as a Barrier in Accessing CPD
As of 2009, 31.4% of the Australian population resided outside metropolitan areas.7 The number of health professionals is substantially lower per capita in non-metropolitan Australia compared to metropolitan areas.8 McLean noted that only 10% of physicians live and practice in these areas.9 Australian Institute of Health and Welfare report in 2009 highlighted the great disparity in numbers of health care practitioners between metropolitan and the most remote parts of the country. For example, there were only 64 allied health workers per 100,000 population in remote centres compared to 354 per 100,000 in major cities. This disparity has lead to a high demand for healthcare, while those living in these areas continue to have poor health outcomes. For example, a person living in rural Australia is 1.1 times more likely than his/her metropolitan counterpart to be diagnosed with a mental disorder at some point in life; a person between 55 and 74 years living in a rural area is nearly twice as likely to have no teeth compared to their city counterpart.7
This mismatch between the healthcare services and resources available, and the increased demand for healthcare due to poor health outcomes have meant that rural health practitioners need to be innovative, responsive and multi-skilled. The scope and nature of work of rural health practitioners require good generalist skills which may be obtained through participation in CPD. This is especially relevant for those who are new to rural practice as knowledge and skills with which a professional begins their career has a short ‘shelf-life’.4 Therefore, CPD in these instances provides an important opportunity and means of acquiring knowledge and skills consistent with recent, evidence-based and best practice.
In addition to organisational and resource limitations, allied health practitioners in rural and remote settings also face geographical barriers in accessing CPD. Much of the training for rural health practitioners are conducted in metropolitan locations or major centres. As highlighted before, time, financial and organisational policies act as barriers for occupational therapists to access such opportunities.1,4,6
While rural health professionals are expected to be multi-skilled, and practice with a broad scope, opportunities for these professionals to engage in learning activities are diminishing. This has lead to a need for health practitioners to be more strategic and innovative with CPD planning and engagement.
The Way Forward
While there are no simple solutions to these complex barriers, there are some enablers which health practitioners can tap into when accessing CPD. Technologies such as videoconferencing have been used for a long time by rural health practitioners to overcome issues such as professional isolation and reduced access to CPD.9-11 Other technologies cited in the literature include discussion boards, teleconferences, wikis, blogs, podcasting, vodcasting, virtual workspaces, email groups and listserves. With the recent advances in technology a range of possibilities exist for undertaking CPD through means other than face-to-face delivery. Although face-to-face delivery has been considered the most desirable option with activities such as supervision.12 there is a need in the current resource-constrained environment to consider alternative modes of engagement with CPD.
A survey study of 79 rural health practitioners conducted by Morey found that although all participants had access to internet, only two-thirds used it for CPD purposes.9 Furthermore, only less than one-third had used online CPD programs. Respondents of the survey also felt that personal contact was more useful than internet programs. The results of this study highlight the potential for increased use of web-based technology for CPD purposes. It also highlights the importance of the need for CPD programs to be interactive, possibly with a human element, even while delivered via technology. A review of the literature on online learning by healthcare professionals for CPD purposes by Sanders and Langlois, found that the use of computer-based technology has been limited by the user acceptability of the technology, as well as the lack of confidence and competence in use.11 They recommended that it is essential for online CPD program developers to adopt a user-centred approach while developing and implementing such programs to promote usability and uptake.
Organisations which employ allied health practitioners need to be encouraged to consider the impact of reduced support on staff retention as decreased educational support and limited access to continuing education have been shown to result in increased staff turnover in rural areas.13 This may ultimately impact the quality of health care provided. While organisational support and funding assistance for CPD continue to face challenges, health practitioners are encouraged to seek opportunities outside conventional venues for funding assistance. Avenues such as the Services for Australian Rural and Remote Allied Health CPD scholarships and grants through local Hospital Board Foundations or similar organisations can be sought to assist with CPD.14 Health practitioners can also make linkages with educational institutions, such as universities, and tap into those resources which can be made available through partnership in research projects, student supervision and clinical tutoring. As universities tend to have access to cutting-edge research and supporting resources (such as journals), linking with these organisations may provide a useful avenue to keep up-to-date with emerging science and technology.
While the impact of the current widespread austerity in health systems on direct health services are continuing to be minimised, the adverse effects of the austerity measures are beginning to impact at the non-clinical, and yet often mandated, tasks such as ongoing CPD. Reduction in opportunities to participate in formal training and other CPD activities conflicts with the requirements for documented evidence of CPD for maintaining national registration.1 This has created a need for health practitioners in Australia to take a more strategic view of their training needs while planning their CPD goals and activities. Innovation and search for alternative solutions are paramount in the current climate. Use of web-based technologies, as well as strategies to maximise the benefits of using such technologies are to be considered while planning CPD. Alternate funding sources and overt linkages with educational institutions may provide access to untapped resources. Being a lifelong learner is an important trait for any health practitioner and the 21st century provides challenges and opportunities in achieving and maintaining this unique trait.
- Gibbs V. An investigation into the challenges facing the future provision of continuing professional development for allied health professionals in a changing healthcare environment. Radiography. 2011;17:152-57. doi: 10.1016/j.radi.2011.01.005.
- Health Professions Council. Your Guide to Our Standards for Continuing Professional Development. London: HPC; 2008
- Occupational Therapy Board of Australia [Internet]. ACT: c2010-2013 [updated 2013 Feb 25; cited 2013 May 29] Available from: http://www.occupationaltherapyboard.gov.au/ .
- Sturrock JBE, Lennie SC. Compulsory continuing professional development: a questionnaire-based survey of the UK dietetic profession. Journal of Human Nutrition and Dietetics. 2009;22:12-20. doi: 10.1111/j.1365-277X.2008.00935.x.
- Hill P, Alexander T. Continuing professional education: a challenge for rural health practitioners. The Australian Journal of Rural Health. 1996;4(4):275-79.
- Townsend E, Le-May S, Stadnyk R, Beagan B. Effects of workplace policy on continuing professional development: the case of occupational therapy in Nova Scotia, Canada. Canadian Journal of Occupational Therapy. 2006;73: 98-108. doi: 10.1177/000841740607300202.
- National Strategic Framework for Rural and Remote Health [Internet]. Rural and Regional Health Australia. ACT: 2012 [cited 2013 May 29] Available from: http://www.ruralhealthaustralia.gov.au/internet/rha/publishing.nsf/Content/NSFRRH-homepage.
- DOHA, Department of Health and Ageing Australia. Report on the Audit of Health Workforce in Rural and Regional Australia, April 2008. Canberra: Commonwealth of Australia. Publications Number: P3-3656
- McLean R. Continuing professional development for rural physicians: an oxymoron or just non-existent? Internal Medicine Journal. 2006;36:661-64.
- Greenwood J, Williams R. Continuing professional development for Australian rural psychiatrists by videoconference. Australian Psychiatry. 2008;16:273-76. doi: 10.1080/10398560801982994.
- Sanders J, Langlois M. Online collaborative learning for healthcare continuing professional development: lessons from the recent literature. Education for Primary Care. 2006;17:584-92.
- Kavanagh DJ, Spence SH, Strong J, Wilson H, Sturk H, Crow N. Supervision practices in Allied Mental Health: relationships of supervision characteristics to perceived impact and job satisfaction. Mental Health Services Research. 2003;5(4):187–95.
- Steenbergen K, Mackenzie L. Professional support in rural New South Wales: Perceptions of new graduate occupational therapists. Australian Journal of Rural Health. 2004;12:160-65.
- SARRAH, Services for Australian Rural and Remote Allied Health [Internet]. ACT: c2013 [cited 2013May 29] Available from: http://www.sarrah.org.au/site/index.cfm?display=231520.
Kumar S. Making the Most of What You Have: Challenges and Opportunities from Funding Restrictions on Health Practitioners Professional Development. The Internet Journal of Allied Health Sciences and Practice. 2013 Oct 01;11(4), Article 3.