When eggs in the same basket are apples and oranges: length of stay for public sector allied health professionals in regional, rural and remote southern Queensland, 2010â2021

INTRODUCTION: Low retention of allied health professionals remains a major issue in regional, rural and remote areas of Australia. Professions in this catch-all label differ markedly in often fundamental ways. In most workforce research, however, low sample sizes often result in the combining of data from these diverse professions, potentially obscuring differences in employee retention. This study sought to assess employment retention patterns of public sector allied health professionals in regional, rural and remote regions of Southern Queensland, Australia, to determine retention time in location for various allied health professions, the impact of geographic location and other available demographic and employment covariates on risk of leaving location, and key exit times. METHODS: A retrospective quantitative longitudinal design used de-identified allied health employee records from two public health services from a 12-year observation period (January 2010 to December 2021). The critical time-based variable for survival analysis and Cox regression of employee retention was years employed in location, with profession and geographic remoteness of work location being primary covariates of interest. RESULTS: Analysis of records from 1454 allied health employees revealed a median retention time of 1.27 years (95%CI 1.15-1.46). Those working as anaesthetic technicians (hazard ratio (HR) 0.45, 95%CI 0.26-0.77), in radiography/sonography/medical imaging (HR 0.59, 95%CI 0.45-0.77), pharmacy (HR 0.61, 95%CI 0.48-0.78), social work (HR 0.66, 95%CI 0.52-0.83), psychology/mental health (HR 0.68, 95%CI 0.55-0.86) and other allied health positions (HR 0.81, 95%CI 0.62-1.07) were less at risk of leaving location than the physiotherapist reference group. Speech pathologists (HR 0.86, 95%CI 0.66-1.11), occupational therapists (HR 0.83, 95%CI 0.68-1.03) and dieticians (HR 0.81, 95%CI 0.62-1.07) were at no greater risk. Those working in rural (HR 1.61, 95%CI 1.41-1.84) and remote (HR 2.16, 95%CI 1.80-2.61) communities exhibited higher risk of leaving their location than those working in the regional cities, with these risks emerging within 3-6 months after starting a position. Type of employment, age when starting employment, and starting pay grade also had small but significant influences on risk of leaving location. DISCUSSION: Despite lower overall median retention time, possibly partly due to using a location-based, time-dependent variable, patterns observed in this study are largely consistent with previous research. Use of a location-based, time-dependent variable is advocated for future research - it most closely aligns with costs associated with replacing location-based positions, continuity of care and ultimately patient outcomes. The findings suggest prioritisation of interventions targeted towards allied health professions at highest risk of leaving location, and delivery of interventions in the first 12 months after starting employment in location. Cosgrave's Whole-of-Person Retention Improvement Framework is a potential framework for tailoring bespoke interventions to maximise allied health professional retention. CONCLUSION: The 'eggs' in the allied health basket are indeed 'apples and oranges' when it comes to length of stay in location across different allied health professions and work locations. Employees in four professions (physiotherapy, speech pathology, occupational therapy and dietetics) are at enhanced retention risk when compared with other allied health professions, as are those working in rural and remote areas, particularly within 6 months of commencing a role in location. These findings have important implications as to where and when interventions targeting retention might be most effective.