Strengths: A recent, multi-pronged scoping review synthesized the global occupational therapy workforce research: studies,17 findings,18 limitations & recommendations.19 Trend topics identified: attractiveness & retention for underserved areas - Australia; supply & demand - US; integration of international workers - Canada.18 Rural/remote areas identified as underserved in HICs and LMICs, with exploratory research on factors associated to recruitment/retention.18,21 Mental health (practice area) identified as underserved, but not in all contexts (e.g., easier to fill mental health vacancies in Sweden).18 A country-wide, service-level, cross-professional analysis in Saudi Arabia used international benchmarks, adapted them to a local context, and determined the requirements and costs for the required scale up of the occupational therapists for meeting the stroke rehabilitation needs.18,45 The WFOT has a monitoring mechanism in place since 2006, updated every two years, to ask for and collate national data from Member Organizations.8 Cross-professional studies with stratified data per occupations revealed findings (e.g., rates of turnover intention; private-public practice ratios; most significant factors leading to job satisfaction and retention; lack of diversity of the workforce) that are substantially different (i.e., with outstanding values, statistically different) for the occupational therapy profession relative to other professions, including rehabilitation professions; results reinforce the need for profession-specific developments in addition to strategies for the broader health workforce.18 Weaknesses: Only 57 publications (25 years, global), with little year to year growth of the occupational therapy workforce research.17 Many outdated findings (e.g., recruitment strategies decades ago, using dated information technologies).17-19 Overreliance on cross-sectional, descriptive, studies with no follow-up nor part of research programs.17,18 Small, convenience samples, often from single settings/regions; findings are: not easily generalizable, not representative of the workforce and their strata, and have limited subgroup analyses. 17,18 Lack of longitudinal studies and experimental approaches.17,18 Limited use of inferential statistics and standardized instruments. 17,18 Routine, administrative workforce data is often limited in availability and detail, scattered across sectors with unmergeable databases, sometimes not disaggregated for the profession, and varies in data collection requirements, procedures, and timings sometimes within one country.18 Large imbalances across nations (even among HICs) in the supply of occupational therapists; variations not justified by varying levels of population need.5,18 Few studies on LMICs (11%)17 and many such countries have no training programs or professional regulation.8,19 Studies on international mobility, compensation, human resources management, productivity, or task-shifting are rarely or not addressed.18 Few research-based, participatory processes to develop competency standards, with no impact evaluation.18 No situational analyses or other system-level, participatory analyses (e.g., co-created system dynamics modelling) of or including the occupational therapy workforce situation within or across jurisdictions. 18,27 No multi-year, data-based, deliberative (inter)national plans, their implementation, and evaluation.18,19 Requirements for continuous professional development of licensing bodies vary substantially, even across jurisdictions of a country with no underlying evidence base or specific population need identified. 19 Little research on diversity (ethnicity, gender) of the workforce compared to other professions.18 Lack of labor market or economic analyses (e.g., cost of scale ups; return-of-investment analyses).18 No research programs, hubs, teams, or networks (e.g., one-off studies conducted by master students).17-19
Opportunities: Global cross-stakeholders input (“Rehabilitation 2030”; World Rehabilitation Alliance) on strengthening rehabilitation services and human resources, within a global development agenda that increasingly includes the need to strengthen rehabilitation services28 and the health workforce overall.2 Global tools (e.g., WHO’s Rehabilitation Competency Framework; Guide for Rehabilitation Workforce Evaluation; National Health Workforce Accounts) recently developed for (cross-)professional developments.2,18,29 The WFOT is developing a global workforce strategy3,17-19 and has developed minimum education standards.46 The WFOT has observed a rise in membership from LMICs. Multi-year, multi-cycle health workforce and profession-specific workforce strategies exist (e.g., nursing & midwifery), providing development, implementation, and evaluation experiences.2,26 Licensing bodies can be positioned to collect and maintain key occupational therapy workforce data, otherwise coming from too many sectors and databases.19 Occupational therapists promote independence, societal participation and economic productivity – the societal return of scale up investments can be positive, if studied. Increasing numbers of occupational therapists trained at master or doctoral levels,8 possibly able to carry out workforce research with additional training or support. Preliminary findings from the occupational therapy workforce research, coupled with solid workforce evidence, can be used for more advanced study designs (e.g., discrete experimental choices; testing recruitment and retention packages).18,19 Threats: Rates of funding support for occupational therapy research (20%)17 less than health workforce research or rehabilitation research (>50%),30 which affects the quality of the scientific methods. Cross-professional workforce research sometimes does not differentiate or provide stratified results for the occupational therapy profession (e.g., aggregated for therapists or allied health professionals).19 Lack of capacity to scale up the occupational therapists supply in countries where training programs or occupational therapists are (nearly) absent.8,21 Lack of professional regulation, especially in many LMICs.19 Lower priority in the health agenda (e.g., not a large health workforce, without representation or training programs in many countries, and the focus on functional, well-being, and occupational outcomes versus survival or other medical outcomes). Underdeveloped rehabilitation systems of care, particularly in many LMICs, contrasting with the population ageing and growing rehabilitation needs.13-15 The lack of occupational therapy workforce data in major databases / repositoria (e.g., National Health Workforce Accounts only provide occupational profile information for Medical Doctors, Nurses, Midwiferies, Dentists, and Pharmacists; Global Health Workforce Statistics database provides data for multiple professions, including physiotherapists and their assistants but not for occupational therapists), impeding higher-levels analysis of the health workforce to be inclusive of the occupational therapy workforce.27,32,33 Occupational therapy is not described and classified as one discrete occupation within the International Standard Classification of Occupations31 and not mentioned in the global strategy for the human resources for health.2 Lack of a standard framework of data elements for the collection of occupational therapy workforce data 19