The purpose of this study was to identify the key motivations, sources of influence and barriers to choosing a podiatry career for students, and whether this differed between people who had (not) previously engaged in an alternative first career (Pre-FC and Post-FC). Altruistic reasons were the key motivations for choosing podiatry. Personal sources of influence, such as seeing a podiatrist at work, someone in the profession I saw/met who was a really good role model for me or my own research, were the most important sources of influence. Overall, educational, media and marketing sources scored low in terms of influence. On the whole, potential barriers to the profession scored low perhaps owing to the fact that the participants had overcome these barriers to enable their engagement with the podiatry profession. Nevertheless, a lack of awareness of the podiatry profession and what it entails remains problematic. Although the study demonstrated many similarities between Pre-FC and Post-FC respondents across the main themes to the study, there were distinct differences between groups when considering some of the motivations (i.e., intellectually stimulating, student bursaries), sources of influence (i.e., own patient experience) and barriers (i.e., financial, job availability) associated with engaging in the podiatry profession. As this is the first national questionnaire to explore these topics in England, these findings have important implications for recruitment of podiatrists both at the national level, (e.g. NHS and HEE), but also at a local level for universities advertising podiatry courses, and school and colleges providing satisfactory information on podiatry for it to be seen as a viable career option for both Pre-FC and Post-FC students.
Post-FC participants reported intellectually stimulating, challenging role and student bursaries as three motivations that were of greater importance to them compared to Pre-FC. The two former motivations are likely related to Post-FC participants wanting to commit to a career change that may ultimately lead to job satisfaction (14). In promoting podiatry, the importance of these motivations suggests that there needs to be a greater focus on the seriousness and medical emphasis of podiatry work and the level of skills and knowledge required (15).
Our study complements research exploring occupational therapy career choice motivation for mature students where financial pressure was identified as the key factor deterring students choosing this career (16). The loss of the NHS bursary was seen as the likely reason that accelerated the decline in undergraduate applications to podiatry courses (10) (15). Podiatry was greatly affected because of the high proportion of mature students (4) (15) (17) who are more ‘debt-adverse’ than younger students and are more likely to have responsibilities which require funding (18). Therefore, our finding relating to the importance of student bursaries among the Post-FC group is unsurprising. Minority ethnic students particularly from lower income groups are more averse to taking out loans (17) and therefore the bursary removal was likely to affect these students more. The Saks report confirmed that there had been an increase in student recruitment to podiatry courses in the current academic year and highlighted the ‘welcome reinstatement of the bursaries’ (4). From September 2020, students starting or continuing an undergraduate or postgraduate podiatry course could apply for the NHS Learning Support Fund allowance. Our research took place in early 2021, and as such, public awareness of the fund may still be growing. That there has been an increase in student recruitment (4) suggests that awareness of the fund has improved since we undertook data collection, in addition to the vast HEE and Office for Students funded careers activity in recent years. Nevertheless, it is critical that public awareness of this fund is widespread so that different population groups (e.g., mature students; minority ethnic groups) do not see financial challenges as a barrier to choosing podiatry as their career.
There is a synonymous link between mature students and Post-FC participants, as in our study, 94% of our Post-FC group were older than 25 years of age. Interestingly, although the Office for Students stated that older podiatry students have a greater interest in private practice and potentially earning a large salary (15), such findings were not evident in our study (Table 4). For example, 86.1% of our Post-FC respondents agreed/strongly agreed that working in the NHS was a key reason for choosing podiatry. With there being a minimum of a 19% NHS vacancy rate predicted in England for podiatry by 2025 (19) and with 60% of members of the Royal College of Podiatry working in the private sector (4), it may be prudent for NHS recruitment campaigns to either: i) increase recruitment of Post-FC podiatrists as they may want to work in the NHS, or ii) develop strategies to encourage Pre-FC podiatrists to be motivated to work in the public sector.
Post-FC participants recognised own patient experiences (their own experience or that of a relative receiving care from the profession) as a more important personal influence than the Pre-FC group. In the study by Byrne (20), mature students reported a proportionally higher amount of exposure to occupational therapy through personal life experiences than the rest of the cohort. More generally, in accordance with recent research (10) (21), a high proportion of our study sample (46% and 50.1% for Pre-FC and Post-FC, respectively) were influenced by their own personal (or relatives) podiatry treatment. These findings highlight the opportunity for qualified podiatrists; they can take on the role of career ambassador when meeting patients. This message needs to be conveyed to all podiatrists through the NHS, private practice, HEE and the Royal College of Podiatry. Activating this extensive workforce to be the ambassadors for the profession so that they see every patient and relative as a future podiatrist and to overtly prioritise work experience and university clinics opening doors for work experience.
Unsurprisingly, and similar to Craik et al (22), we found differences between groups relating to school or college sources of influence: these sources were more important for the Pre-FC group. However, career advisors lack of awareness of the profession was reported to be a substantial barrier for the Pre-FC group. In accordance with past research, careers advisors, and to a lesser extent, teachers, were reported to not have a strong influence on Pre-FC’s choice to engage in podiatry (23) (24) (25). However, previous employment in healthcare was perceived to be an important influence for the Post-FC group to engage with the profession. This was a similar finding to Craik et al (22), who suggested that the higher number of mature students in occupational therapy may be partly owing to students only hearing about the profession through their work in health care settings and not when they first make their career choice at school or college. Career advisors are a vital conduit to the successful recruitment of students to AHPs (23), and therefore, they need to have a good level of knowledge and understanding about the podiatry profession. With medicine and nursing still primarily promoted as the key healthcare careers in schools (9), career advisors can use the familiarity of these careers to introduce students to AHPs, including podiatry.
For Pre-FC participants, someone in the profession I saw/met who was a really good role model for me and my own research were considered more important than school or college sources. The importance of seeing AHP role models and the impact on career choice, has been explored in the literature, especially the lack of role models for minority ethnic individuals in particular professions, such as physiotherapy (26) (27). Despite increases in the ethnic diversity of podiatry students in recent years (6), the Saks report (4) recommended improving efforts to recruit a more diverse (including ethnicity and gender) podiatry student population. In our study, the majority of the sample were white (85% and 62% for Post-FC and Pre-FC participants, respectively) and the importance of seeing role models in the profession suggests that more ethnic minority role models in podiatry are needed to support student recruitment.
Job availability was perceived to be an important barrier for the Post-FC group and careers advisors lack of awareness of the profession and misconception of profession were reported to be more important barriers for the Pre-FC group. Previous research has shown that podiatry is an attractive career path to mature students as it leads to ‘almost certain employment’ following completion of undergraduate podiatry courses (4) (9, 10). The importance of employment for Post-FC participants was shown in our study as the more mature students reported this to be of greater importance than Pre-FC participants. Job availability is not considered a pertinent reason for selecting different AHP careers (28) (29). However, although it may not be a key motivation, ensuring that job availability is viewed positively, is important, especially for the Post-FC group.
Misconceptions around the profession suggests that marketing needs to emphasise the ‘extensive, diverse and interesting’ scope of practice (4). The Saks report (4) also suggested that podiatry is not portrayed sufficiently as an appealing or important career. Our study was unable to determine why individuals working as an AHP overlooked the opportunity to engage in podiatry. Despite noting that there is an opportunity to maximise on the territory of the foot (30) once invested in the profession (31), the perceived status of the profession may lead to this never being actualised. Through addressing the perceived status of the podiatry profession by contemporary research, it may be possible to target marketing to attract applicants. The Saks report (4) highlighted the image of podiatry as a profession being perceived negatively by the public. Tollafield (32) highlights overcoming the ‘ugh factor’ associated with working with feet with an emphasis on function not condition; podiatrists help return people to activity and occupation as a slogan, not podiatrists’ work with ingrowing toenails and ulcers. Further research is needed to understand the relationship of profession status, ‘ugh factor’ and podiatry as a career choice. In addition, a media marketing strategy should be implemented that not only increases the public awareness of the profession, but also enhances the government and other health professionals’ understanding of podiatry (4).
Strengths and limitations
It is important to contextualise our findings in light of the strengths and limitations to the study. The study was conducted prior to the publication of the Podiatry Career Framework (33) and Standards for the Foot Health Workforce (34). These frameworks may influence the decision to study podiatry among podiatry associate professions in future years. Although conducting the study in February and March 2021 provided a fascinating insight into views of podiatry students during the COVID-19 pandemic, participant responses will have been influenced by the unique academic and professional conditions which participants experienced (35).
Despite the questionnaire being piloted, it had not been validated. Furthermore, recall ability is a limitation of questionnaires (36), and this is likely to have affected the participants in our study owing to new impressions formed on the course influencing perceptions of podiatry. The study sample lacked ethnic diversity as 75% of respondents were white. However, our sample was fairly representative of qualified podiatrists in the UK registered with the HCPC (37), with minority ethnic males, for example, comprising 3.5% of the study sample. Our sample was a relatively small self-selecting proportion of all podiatry students in England. Therefore, the findings cannot be seen to represent the views of the wider podiatry student population (38). There are a number of existing studies exploring career choice motivations in other AHPs but they focus on one university or geographical area (for example, Craik et al (22)). A real strength of our study was that it was a first national questionnaire about podiatry students, the results of which provide a data set for future studies exploring podiatry as a career choice.