Trends in retention and attrition in nine regulated health professions in Australia

Design

The study consisted of two components: an online survey of health practitioners and an analysis of 10 years (01 July 2014–30 June 2023) of Ahpra registration data.

Participants were recruited via email from Ahpra’s registration database and invited to complete the survey. Survey invitations were sent out by Ahpra. Participants were currently registered practitioners (as of 31 December 2023), and those who had been unregistered at any point in the preceding 5 years (1 January 2019–31 December 2023). Consent was obtained by participants clicking on ‘Next’ at the end of the survey introduction page.

Each profession had unique survey requirements, but a core set of questions related to intentions to stay or leave the profession was common to all surveys (Supplementary material file S1). The survey, administered through Qualtrics XM, was open for 1-month (12 February 2024–12 March 2024).

Data analysis

All data were extracted into Microsoft Excel for Windows (Microsoft, 2024), with statistical analysis conducted in Jamovi (version 2.6.13; The Jamovi Project, 2024), and visualisation in PowerBI (version 2.138.1452; Microsoft, 2024) and Python (version 3.10.1; Python, 2024). Prior to inferential statistical analysis, data were explored for normality.

Survey analysis

Of the 145,120 survey invitations sent, 29,464 health practitioners started the WRAP survey (20.3%) and 25,752 completed the survey in full (17.7% response rate) (Supplementary material Table S1). A total of 261 (0.2%) emails bounced and were not received by indented participants.

Demographics

Survey respondents were generally representative of Ahpra’s 2022–23 registered health practitioners, however, a higher proportion of participants were aged over 60 years (20.7%, n = 5304) compared with practitioners currently registered with Ahpra (9.0%, n = 11,399). Additionally, only 27.0% (n = 6951) of survey respondents were aged under 35, while this age group made up 42.3% (n = 53,628) of Ahpra’s registered cohort. Consistent with Ahpra’s workforce demographics, survey respondents were mostly female (survey, 60.6%; registrants, 61.4%), primarily from the 35–60 year age bracket (survey, 51.8%; registrants, 48.7%), predominantly from metropolitan areas (survey, 67.6%; registrants, 74.5%), and from the states of New South Wales, Victoria and Queensland (survey, 73.6%; registrants, 78.1%). A detailed breakdown of demographic data is provided at Supplementary material Table S2.

Reasons for staying, leaving, or being unsure of a future within their profession

Factors associated with intention to stay, leave or being unsure

An omnibus likelihood test performed as part of the multinomial logistic regression analysis (χ²(78) = 376, P < 0.001, R²_McF = 0.079) showed that profession, PPP, remoteness, years of experience, employment type, further qualifications, registration status, and Aboriginal and/or Torres Strait Islander status, did not significantly influence practitioners’ intentions to stay, leave, or to be unsure about staying in their profession (P > 0.05) (Supplementary material Table S3). The updated model was statistically significant (χ² (78) = 376, P < 0.001), with a McFadden’s R-squared value of 0.0786. Odds ratios from the regression analysis were used to explore factors influencing practitioners’ intentions (i.e. the likelihood of ‘leaving’ or being ‘unsure’ of a future in the profession), with ‘staying in profession’ used as the reference category. Detailed statistics are provided in Table 2.

Age and gender significantly influenced practitioners’ intentions. Male practitioners were nearly twice as likely to intend to leave compared with female practitioners. Practitioners over 60 years were nearly threefold more likely to leave and twice as likely to be unsure compared with those aged 35–60 years. They were also twice as likely to leave compared with practitioners under 35 years. The top five reasons for leaving by age group are presented in Fig. 1.

Fig. 1.

Top five reasons for leaving by age group: under 35, 35–60, and over 60.

Work hours also had a significant influence on intentions to stay or leave. Respondents working less than 20 h per week were nearly twice as likely to leave or be unsure compared with those working 29–40 h. Those working more than 50 h per week were twice as likely to be unsure about staying compared with those working less than 20 h.

Finally, practitioners who were not self-employed were nearly twice as likely to be unsure about staying in their profession compared with those who were self-employed.

Registration data analysis – trends from 2014 to 2023

Paramedicine was not included in this analysis as paramedics only joined the Scheme in 2019. The results for paramedicine are provided separately in the last paragraph of the Results section. The number of practitioners per 100,000 population increased by 29.6% from 2014 to 2023, rising from 400.6 to 519.4 with an average annual increase of 3.0% (Fig. 2a). The replacement rate showed notable fluctuations over the observed period, peaking in 2020 before declining significantly in 2021, but a partial recovery was observed in 2022 and 2023 (Fig. 2b). Female practitioners consistently exhibited higher replacement rates compared to males, highlighting their stronger contribution to workforce sustainability (Fig. 2c).

Fig. 2.

Analysis of Ahpra registration data showing retention and attrition trends (excluding the addition of Paramedicine to Ahpra in 2018). (a) Number of practitioners per 100,000 population. (b) Overall replacement rate. (c) Replacement rates by gender: female and male.

The sharp increase of the replacement rate in 2020 was related to a decrease in exits among practitioners across all age groups (Fig. 3). For paramedicine, which was not included in Fig. 2, the number of practitioners per 100,000 population increased by 29.2% from 2019 (68.0) to 2023 (87.9). Meanwhile, the replacement rate dropped from 4.6 to 2.0 during the same period. The male replacement rate declined by 65.8%, from 3.8 to 1.3, while the female replacement rate fell by 49.1%, from 5.5 to 2.8.

Fig. 3.

Number of exits per year by age group: under 35, 35–60, and over 60.

Potential strategies to retain practising health practitioners

Consistent with research across multiple health professions,^28,29 this study highlights the importance of job satisfaction, professional fulfilment, work–life balance, and a sense of achievement in motivating health practitioners to remain in their professions. These factors fall outside the regulatory context and primarily relate to personal and workplace factors.

This study identifies specific target groups that should be the focus of retention strategies and future research. For practitioners working fewer than 20 h per week, further research could identify incentives to keep them practising. These practitioners may be reducing their hours as part of their career exit plans or seeking more hours but are unable to secure them. Providing support or targeted employment assistance could help with retention. Conversely, for practitioners working more than 50 h per week, initiatives to reduce burnout and improve work–life balance are likely to be relevant.

Working long hours can increase the risk of burnout.^30,31 A survey of more than 9500 healthcare workers identified 12 organisational, leadership and individual support approaches, including the need for active, authentic and visible leadership, safe working environments, clear communication, and teamwork.³² Further research taking a qualitative approach including interviews with health practitioners, health service managers and policymakers, will provide richer insights into addressing burnout.

Understanding why male practitioners, who comprise just over a third of these professions, are more likely to leave than female practitioners and have a lower replacement rate, is important. While this finding does align with some previous studies of allied health professions,^33,34 other data have suggested the opposite.^35,36

Older practitioners, who may be considering early retirement or beginning to struggle with the physical demands of their profession, could benefit from pathways to less physically demanding roles, such as mentoring and supervision. Mentoring has been observed to increase job satisfaction among health professionals and may also help to retain newer graduates.³⁷

Empirical research on interventions to improve retention in health professions is limited, however, it has been noted that most interventions targeting a single aspect of a role have little impact.³⁸ A systematic overview of organisation-level interventions, including but not limited to the health professions, found strong evidence for interventions that introduced changes to working hours, and moderate evidence for interventions that allowed for greater influence on work tasks or organisation, and improvements in the psychosocial work environment.³⁹

Currently, the Australian government,⁴⁰ health departments and Ministers,⁴¹ through implementation of the Kruk review,⁴² are focused on workforce and internationally qualified practitioners. In conjunction with section 3(f) of the National Law,⁴³ Ahpra, although not directly part of its regulatory role, may be able to support the health workforce through contributing to research to develop and share a better understanding of the workforce climate.