An Investigation into Attrition and Retention of Rehabilitation Professionals
Bibliographic record
Abstract
Introduction: Health human resources are scarce worldwide. In occupational therapy (OT), physical therapy (PT), and speech-language pathology (S-LP), attrition and retention issues amplify this situation and contribute to the precarity of health systems. The overarching objective of this doctoral research was to investigate why OTs, PTs and S-LPs stayed in, or left their profession. Specific aims were to: 1) understand how educational and health care environments influence professionals’ decisions to stay in, or leave their profession; 2) investigate reasons for attrition across the three professions; 3) explore stakeholder perspectives on attrition and retention; and 4) explore stakeholder-informed retention strategies for OTs, PTs and S-LPs in Quebec (Canada). Methods: The research included three phases. Phase 1 was a scoping review to map the literature on attrition and retention in OT, PT and S-LP. Guided by cultural-historical activity theory (CHAT) as a theoretical scaffolding, phases 2 and 3 used interpretive description (ID) methodology including inductive and deductive analytical approaches and constant comparative techniques. Phase 2 involved interviews with 51 Quebec OTs, PTs and S-LPs. Phase 3 consisted of focus groups with 16 participants from 4 stakeholder groups: employers, professional educational programs, associations, and regulatory bodies. Results: Fifty-nine papers were included in the scoping review. Main findings highlighted push, pull, and stay factors that shaped professionals’ decisions to leave their profession. Based on the interviews, six themes related to professionals’ perceived factors contributing to attrition and retention, were developed: 1) characteristics of work that make it meaningful; 2) aspects of work that practitioners appreciate; 3) factors of daily work that weigh on a practitioner; 4) factors that contribute to managing work; 5) relationships with different stakeholders that shape daily work; and 6) perceptions of the profession. Through a combined analysis of phase 2 and 3 data, five sets of retention strategies were generated: 1) offering informal and formal benefits; 2) ensuring that work aligns with values; 3) improving alignment of work parameters with professionals’ needs and interests; 4) modifying physical, social, cultural, and structural aspects of a workplace; and 5) addressing how the profession is governed. Discussion: Push, pull and stay factors shape professionals’ decisions in terms of leaving their profession. Push factors (e.g., unsupportive environments) drive professionals out of their profession. Pull factors (e.g., career change) draw professionals away from their profession. In contrast, stay factors (e.g., positive impact on clients) support professionals to remain in their chosen profession. System-level factors (e.g., regulatory bodies’ expectations) influenced participants’ decision to stay in or leave their profession. Regarding retention strategies, professionals focused on improving public awareness of their profession while managers targeted individual-level retention strategies (e.g., providing support). Broader solutions were identified by professional educational programs (e.g., mentorship), associations and regulatory bodies (e.g., scope of practice). The data demonstrate that stakeholders need to adopt an intersectoral approach to designing multi-system retention strategies. Conclusion: This doctoral research makes an original and important contribution to knowledge around attrition and retention in OT, PT and S-LP. Using CHAT and ID, the research enriches concepts of attrition and retention, highlights the multi-level, contributing factors to attrition and retention and provides the first set of stakeholder-informed retention strategies. Designing multi-level strategies will be especially important to ensure the availability of professionals for present and future rehabilitation needs
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.036 | 0.091 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.007 | 0.011 |
| Science and technology studies | 0.008 | 0.004 |
| Scholarly communication | 0.006 | 0.003 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".