Podiatry workforce which is facing a serious national crisis!

Foot care assistants;

• A foot care assistant role and job description was created for Te Whatu Ora in Te Tai Tokerau this year and enabled the part-time employment of a 3^rd year student for four weeks while on placement – learn & earn.
• Enable more part-time employment opportunities for all podiatry students as FCAs to earn and learn while contributing to building capacity and gaining additional clinical experiences and hours.
• Create cadetships through Mana in Mahi (MSD) to employ job seekers to FCA roles throughout Te Whatu Ora to create additional pipelines of workforce with supplemented salary and training support.
• Create other employment opportunities for FCAs via the transition of HCAs to FCAs, career changers, school leavers or return to work seekers.
• Create opportunities to staircase cadets and FCAs into the tertiary podiatry programme.
• Utilise and employ the Calderdale Framework as a safe process of delegating clinical task instructions to FCAs.
• Implement the Fundamentals of Foot Care (PODY401) programme that was approved by AUT this year (30 point, level 5 paper) to coincide with on-the-job FCA training.
• Recognise the learning outcomes of PODY401 towards the under-graduate programme with credits for learning outcomes and clinical hours.
• Develop micro-credentialing options as part of the PODY401 programme and post-graduate High Risk Foot programme (PODY801).

• Scholarships – create Hauora Māori Scholarships specifically for Podiatry.
• Voluntary bonding scheme – create a scheme specifically for Podiatry for hard to fill districts.

• Prioritise podiatrists onto the long-term skills shortage list due to the forecasted and expected long-term workforce shortages.

• Replicate the satellite learning hub model to deliver the AUT podiatry programme at Northtec, Whangārei to other regions;
  • To remove barriers to tertiary training.
  • To train, develop and retain a locally trained workforce.  

• Roll out the model for FCA training as outlined above for adoption in the private sector. 

27 likely graduates this year and 18 next year will not meet patient and health system needs, particularly if there are already unfilled vacancies and districts not providing podiatry services. 

Creating capacity for a workforce in crisis can be achieved with immediate effect and with minimal time and effort with FCAs than traditional means of waiting three-years for qualified podiatrists.  The FCA  workforce enables practitioners to work at top of scope while also maintaining and delivering more patient care by delegation.  

The consultations have already been had and the solutions and enablers have already been designed, discussed and/or actioned.

Just waiting for some co-ordination, support and a national plan for adoption.

The above title has emerged for a considerable period of time and there has been many hui in the past 12-months.  As such, discussions at various meetings and communications in the media ora have sought to address this impending workforce crisis and the likely impact on diabetes management, and diabetic foot complications such as lower limb amputations and associated mortality.  While there has been heaps of hui and kōrero, little doey or actions have resulted from the all the talking in relation to a nationwide response.

Why are the ideas important?

• There are approximately 471 registered podiatrists currently practicing with APCs in NZ (Te Whatu Ora, private practice & tertiary education).
• There are approximately 45 podiatrists employed by Te Whatu Ora who are providing 36.40 FTE of secondary podiatry services in 16 districts (as at 12/09/2022). 
• There is approximately 7.35 FTE which are vacant positions in nine districts and many are long-standing vacancies(as at 12/09/2022).

• AUT Podiatry school anticipates that there will be;
  • 27 graduates this year (2022)
  • 18 graduates next year (2023)
  • 39 graduates who are currently enrolled in year one this year (2024)

• The employment of graduates and prospective employees to Te Whatu Ora roles are facing immense competition from Australia and the private sector with higher remuneration packages and this has resulted in recent recruitment challenges.
• Similarly, the private sector in NZ is also facing workforce pressures due to an ever increasing demand of private and community podiatry services and a dwindling workforce pool of prospective employees.

• It has been forecasted that the podiatry profession (numbers) will only increase from 471 this year to 527 in 2032 (10-years) – Emmanuel Jo: Manager, Analytics and Intelligence, Health workforce, Te Whatu Ora.
• Yes, an increase of only 56 additional podiatrists in the next 10-years due to an ageing workforce, attrition, and aggressive Australian recruitment marketing.

• It is also forecasted that the number of podiatrists per 100K patients with diabetes will also decrease over the next 10-years  - Emmanuel Jo: Manager, Analytics and Intelligence, Health workforce, Te Whatu Ora.
• Yes, the forecasted headcount of podiatrists per 100K patients with diabetes will decrease by 19 podiatrists and a reduction of 15 FTE positions in 10-years.
• Concerningly, while the prevalence rate for diabetes is increasing, an important podiatry workforce that provides specialist services for the management of diabetic foot complications is decreasing.

• The current and forecasted shortage of podiatrists who are employed by Te Whatu Ora or those who are engaged to provide community podiatry services will have an immediate and catastrophic effect on diabetes management and the prevention of diabetes related amputations.
• The annual inpatient costs for diabetes related amputations is increasing and with a significant sharp increase in the past three-years – Steve York: Podiatry Professional Lead, Te Whatu Ora – Te Tai Tokerau.
• During the past 10-years, the number of patients, admissions, amputations and costs have increased by nearly 100% or doubled.

• While podiatrtric management for diabetic foot complications is critical and crucial, there are many other high risk foot pathologies and complications which are also impacted by an aging population such as rheumatological and arthritic conditions, gout, vascular disease, biomechanical deformities as well as nail and skin care management.