Trends in retention and attrition in nine regulated health professions in Australia
Jade Tan A * , Rechu Divakar A , Lee Barclay A , Sunita Bayyavarapu Bapuji A , Sarah Anderson B C and Eva Saar A DA
B
C
D
Abstract
To identify factors associated with the retention and attrition of regulated health practitioners in Australia across nine health professions.
An online survey of practitioners and an analysis of 10 years of Australian Health Practitioner Regulation Agency (Ahpra) registration data were carried out.
Among surveyed health practitioners, 20,449 (79.4%) intended to stay, 1368 (5.3%) intended to leave, and 1759 (6.8%) were unsure. Most intending to leave planned to do so immediately or within 1-year (72.8%). Top reasons for leaving included mental burnout (32.9%), retirement (30.5%), feeling undervalued/unrecognised (28.5%), lack of professional satisfaction (27.9%), and work no longer being fulfilling (25.1%). Men, older practitioners, those working fewer than 20 h per week, and non-self-employed practitioners were more likely to consider not renewing or to be unsure. Analysis of Ahpra registration data from 2014 to 2023 showed that the number of registered practitioners per 100,000 population increased by 29.6%, but the replacement rate showed notable fluctuations over the observed period. Females consistently exhibited higher replacement rates compared to males, with exits from the workforce highest in those aged under 35 pre-2020 and highest in those aged 35–60 post-2020.
Although the overall number of health practitioners increased from 2014 to 2023, replacement rates have been fluctuating, highlighting concerns about workforce stability, particularly among males, older practitioners, those working fewer or greater than full-time hours, and non-self-employed practitioners. Addressing intrinsic and workplace factors such as mental burnout, lack of recognition, and job satisfaction may improve retention.
Keywords: attrition, Australia, health profession, health regulation, health workforce, regulated health workforce, retention.
References
1 Australian Health Practitioner Regulation Agency. Annual report 2022/23. 2023. Available at https://www.ahpra.gov.au/Publications/Annual-reports/Annual-report-2023.aspx
2 World Health Organization. Health workforce and labor market dynamics in OECD high-income countries: a synthesis of recent analyses and simulations of future supply and requirements. Available at https://apps.who.int/iris/handle/10665/259361 [accessed 12 September 2024].
3 Drennan VM, Ross F. Global nurse shortages: the facts, the impact and action for change. Br Med Bull 2019; 130(1): 25-37.
| Crossref | Google Scholar | PubMed |
5 McPake B, Mahal A. Addressing the needs of an aging population in the health system: the Australian case. Health Syst Reform 2017; 3(3): 236-247.
| Crossref | Google Scholar | PubMed |
6 Versace VL, Smith T, Sutton K. Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia. Med J Aust 2021; 215(3): 141.
| Crossref | Google Scholar | PubMed |
7 Gong CH, He X. Factors predicting voluntary and involuntary workforce transitions at mature ages: Evidence from HILDA in Australia. Int J Environ Res Public Health 2019; 16(19): 3769.
| Crossref | Google Scholar | PubMed |
8 AIHW. Australia’s health 2024: in brief. Australian Government; 2024. Available at https://www.aihw.gov.au/reports/australias-health/australias-health-2024-in-brief/summary
9 Russell DJ, McGrail MR, Humphreys JS. Determinants of rural Australian primary health care worker retention: a synthesis of key evidence and implications for policymaking. Aust J Rural Health 2017; 25(1): 5-14.
| Crossref | Google Scholar | PubMed |
10 Cosgrave C, Malatzky C, Gillespie J. Social determinants of rural health workforce retention: a scoping review. Int J Environ Res Public Health 2019; 16(3): 314.
| Crossref | Google Scholar | PubMed |
11 Australian Government, Jobs and Skills Australia (JSA). 2023 Skills Priority List – Key Findings Report. 2024. Available at https://www.jobsandskills.gov.au/data/skills-shortages-analysis/skills-priority-list
12 Ngugi AK, Nyaga LW, Lakhani A, et al. Prevalence, incidence and predictors of volunteer community health worker attrition in Kwale County, Kenya. BMJ Glob Health 2018; 3(4): e000750.
| Crossref | Google Scholar | PubMed |
13 Darbyshire D, Brewster L, Isba R, Body R, Basit U, Goodwin D. Retention of doctors in emergency medicine: a scoping review of the academic literature. Emerg Med J 2021; 38(9): 663-672.
| Crossref | Google Scholar | PubMed |
14 McDermid F, Mannix J, Peters K. Factors contributing to high turnover rates of emergency nurses: A review of the literature. Aust Crit Care 2020; 33(4): 390-396.
| Crossref | Google Scholar | PubMed |
15 Hallett E, Simeon E, Amba V, Howington D, McConnell KJ, Zhu JM. Factors influencing turnover and attrition in the public behavioral health system workforce: Qualitative study. Psychiatr Serv 2024; 75(1): 55-63.
| Crossref | Google Scholar | PubMed |
16 Halter M, Boiko O, Pelone F, et al. The determinants and consequences of adult nursing staff turnover: a systematic review of systematic reviews. BMC Health Serv Res 2017; 17: 824.
| Crossref | Google Scholar |
17 Hayes LJ, O’Brien-Pallas L, Duffield C, et al. Nurse turnover: a literature review – an update. Int J Nurs Stud 2012; 49(7): 887-905.
| Crossref | Google Scholar | PubMed |
18 Roche MA, Duffield CM, Homer C, Buchan J, Dimitrelis S. The rate and cost of nurse turnover in Australia. Collegian 2015; 22(4): 353-358.
| Crossref | Google Scholar | PubMed |
19 Australian Health Practitioner Regulation Agency. Annual report 2018/19. 2019. Available at https://www.ahpra.gov.au/Publications/Annual-reports/Annual-Report-2019.aspx
20 Australian Government, Department of Health and Aged Care. Modified Monash Model. 2024. Available at https://www.health.gov.au/topics/rural-health-workforce/classifications/mmm [accessed 17 May 2024].
21 Australian Government Department of Education. Data from: A selection of findings from the Selected Higher Education Statistics: 2022 student data. 2023. Available at https://www.education.gov.au/higher-education-statistics/resources/selected-higher-education-statistics-2022-student-data-key-findings
22 Quality Indicators for Learning and Teaching (QILT). Data from: 2023 Graduate Outcomes Survey: National Report May 2024: Short-term graduate outcomes in Australia. 2024. Available at https://www.qilt.edu.au/docs/default-source/default-document-library/2023-gos-national-report.pdf
23 Australian Government National Skills Commission. Industry analysis: Health care and social assistance. 2023. Available at https://www.jobsandskills.gov.au/sites/default/files/2022-01/Health%20Care%20and%20Social%20Assistance%20Industry%20Analysis%20Special%20Topic%20Report.pdf
24 Universities Australia. Covid-19 Information for Higher Education. Universities Australia. https://universitiesaustralia.edu.au/policy-submissions/covid19/ (accessed 15 January 2025)
25 Australian Government, Department of Education. Coronvirus (COVID-19) Australian Government, Department of Education. https://www.education.gov.au/covid-19 (accessed 15 January 2025)
26 Hessels J, Arampatzi E, van der Zwan P, Burger M. Life satisfaction and self-employment in different types of occupations. Appl Econ Lett 2018; 25(11): 734-740.
| Crossref | Google Scholar |
27 Latzke M, Putz P, Kulnik ST, Schlegl C, Sorge M, Mériaux‐Kratochvila S. Physiotherapists’ job satisfaction according to employment situation: Findings from an online survey in Austria. Physiother Res Int 2021; 26(3): e1907.
| Crossref | Google Scholar | PubMed |
28 Dousin O, Collins N, Kler BK. Work–life balance, employee job performance and satisfaction among doctors and nurses in Malaysia. Int J Hum Resource Stud 2019; 9(4): 306-319.
| Crossref | Google Scholar |
29 Schmit Jongbloed LJ, Schönrock-Adema J, Borleffs JC, Stewart RE, Cohen-Schotanus J. The influence of achievement before, during and after medical school on physician job satisfaction. Adv Health Sci Educ Theory Pract 2014; 19: 581-595.
| Crossref | Google Scholar | PubMed |
30 Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002; 288(16): 1987-1993.
| Crossref | Google Scholar | PubMed |
31 Wu H, Liu L, Wang Y, Gao F, Zhao X, Wang L. Factors associated with burnout among Chinese hospital doctors: a cross-sectional study. BMC Public Health 2013; 13: 786.
| Crossref | Google Scholar |
32 Smallwood N, Bismark M, Willis K. Burn-out in the health workforce during the COVID-19 pandemic: opportunities for workplace and leadership approaches to improve well-being. BMJ Lead 2023; 7: 178-181.
| Crossref | Google Scholar | PubMed |
33 Curtis L, Robinson S, Netten A. Changing patterns of male and female nurses’ participation in the workforce. J Nurs Manag 2009; 17(7): 843-852.
| Crossref | Google Scholar | PubMed |
34 Hjalager AM, Houman Sørensen J, Juul Møberg R. Who cares? Male and female careers in the health‐and eldercare sector in Denmark. Equal Oppor Int 2005; 24(3/4): 27-45.
| Crossref | Google Scholar |
35 Schofield DJ, Fletcher SL. The physiotherapy workforce is ageing, becoming more masculinised, and is working longer hours: a demographic study. Aust J Physiother 2007; 53(2): 121-126.
| Crossref | Google Scholar | PubMed |
37 Horner DK. Mentoring: Positively influencing job satisfaction and retention of new hire nurse practitioners. Plast Surg Nurs 2017; 37(1): 7-22.
| Crossref | Google Scholar | PubMed |
38 Kroezen M, Dussault G, Craveiro I, et al. Recruitment and retention of health professionals across Europe: A literature review and multiple case study research. Health Policy 2015; 119(12): 1517-1528.
| Crossref | Google Scholar | PubMed |
39 Aust B, Møller JL, Nordentoft M, et al. How effective are organizational-level interventions in improving the psychosocial work environment, health, and retention of workers? A systematic overview of systematic reviews. Scand J Work Environ Health 2023; 49(5): 315-329.
| Crossref | Google Scholar | PubMed |
40 Australian Government, Prime Minister of Australia. The Hon Anthony Albanese MP. Meeting of National Cabinet; 2022. Available at https://www.pm.gov.au/media/meeting-national-cabinet-1
41 Australian Government, Health and Aged Care. Health Ministers Meeting (HMM) – Communique 14 June 2024. 2024. Available at https://www.health.gov.au/resources/publications/health-ministers-meeting-hmm-communique-14-june-2024?language=en
42 Australian Government, Department of Finance. Final report of the Independent Review of Overseas Health Practitioner Regulatory Settings. 06 December 2023. Available at https://www.regulatoryreform.gov.au/news-and-events/2023-12-06-final-report-independent-review-overseas-health-practitioner-regulatory-settings
43 Australian Capital Territory Current Acts. Health Practitioner Regulation National Law (Act) - Section 3. Objectives. Australian Government; 2024. Available at https://www8.austlii.edu.au/cgi-bin/viewdoc/au/legis/act/consol_act/hprnl428/s3.html
