This is the first study to provide insight into the NZ podiatry profession through analysis of workforce data between 2015 to 2019. Although the profession has experienced modest growth during the study period the number of practising podiatrists in NZ remains relatively small. The data highlights concerning trends surrounding the current and future growth of the workforce. Areas of concern include the number of podiatrists currently practising, the limited number of new graduates entering the workforce, the limited opportunities for podiatrists to work in secondary care settings, and the small number of podiatrists working outside major cities.
Whilst the number of NZ podiatrists grew by approximately 20% over the study period, the number of NZ podiatrists per capita remains small. The NZ population was estimated at 5.04 million in 2019, with 430 podiatrists holding an APC, this equates to approximately 8.5 podiatrists per 100,000 people. Comparably, Australian statistics for March 2019 indicate there were 5215 podiatrists registered in Australia, representing approximately 20 podiatrists per 100,000 people (4). In the UK, reports estimate figures on par with Australian data for 2019, with approximately 20 podiatrists per 100,000 people. For NZ to achieve a per capita ratio equivalent to that of the UK and Australia (approximately 20/100,000) a total of 1008 practising podiatrists would have been required in 2019, an increase of 578 podiatrists on reported figures. This data signals evidence of a significant workforce shortage of NZ podiatrists.
One solution to remedy this issue is to increase the number of graduates entering the profession. However, NZ has only one tertiary provider of undergraduate podiatric education, and as shown in Fig. 1 only a small number of NZ graduates were available to enter the NZ workforce during the study period. Building on this issue is that post-graduation, not all graduates move on to enter NZ practice with only 61% of graduates issued an APC in 2019. Unless graduate numbers significantly increase, the workforce shortage will only continue to escalate in the future. Further evidence of a growing workforce shortage is revealed by examination of the relationship between total numbers of podiatrists leaving the profession and the number of new graduates entering the profession. Over the study period 136 new graduates entered the profession, however, this figure has not been reflected in the total number of podiatrists holding an APC which grew by only 73, indicating a loss of 63 practitioners within the NZ profession between 2015 to 2019.
Interconnected with the small number of graduates entering the profession and the relatively small overall growth in the profession is the type of work that NZ podiatrists can access. The number of podiatrists in private practice increased during the study period. However, this may be a situation driven out of necessity due to the limited work opportunities for podiatrists, particularly in the public health sector. While data indicates there has been an increase in work for NZ podiatrists in the public health sector, there were only 32 podiatrists (8% of the 2019 practitioners) who declared themselves as employed in the public health sector. When compared to other countries this number is again low. The 2014 Australian workforce data indicated that 19.5% of podiatrists were working in a hospital or community healthcare service, with 65% employed in private practice (5). UK workforce data from 2016 indicated that 35% of podiatrists worked in the National Health Service (NHS), 23% a mixture of NHS and private practice and 41% in private practice only (6). This also raises the question why podiatry is not a profession that is embedded in the NZ public health sector.
Further compounding the growing workforce issue is the small number of podiatrists located outside of the major cities. 2019 data indicated most practitioners were in the North Island with approximately half of those located in the Auckland region. This is not unexpected as the Auckland population accounted for approximately 40% of the North Island population in 2019. However, whilst Auckland is the most densely populated area, there is still a low per capita ratio of podiatrists in Auckland (approximately 10 podiatrists per 100,000 people). Data for the South Island also demonstrated a similar per capita ratio (approximately 10 podiatrists per 100,000 people) as Auckland, however, with more podiatrists in the Auckland region than the entire South Island and 45% of South Island practitioners located in a similar geographical location (Canterbury) workforce concerns are raised. Concerns specifically related to the ability of podiatrists to service remote and rural communities.
The issues described raise questions around the value, impact, profile, and sustainability of the NZ podiatry profession. With relatively few practising podiatrists and a slow rate of growth, the ability of the profession to demonstrate an impact on the health care system is limited. This is emphasised by the small number of podiatrists practising in the public health sector. Further insight is required to understand the barriers to employment and underlying reasons for limited opportunities in the public sector. Perhaps the greatest threat to the future of the profession is the small number of NZ graduates entering the workforce. Further work is required surrounding the visibility of the profession and whether the profile of podiatry must be lifted to attract and retain more people into the profession. The low profile raises questions as to whether there is an understanding of what a podiatrist does and the scope of work in they can do; both from the perspective of potential students and from other health professionals. The effect of locality warrants further investigation. Specifically, we may be starting to see the long-term effects of having only one podiatry training programme, which has been located in Auckland for 20 years. Further, this North Island based programme may be limiting the ability to draw people from the South Island into the profession.
Although this is the first study to examine the NZ podiatry workforce there are some limitations that require consideration. Regarding locality, podiatrists were asked to name their location in relation to their nearest DHB which does not provide an accurate depiction of their exact geographic location. Also, many of the questions in the survey do not require practitioners to respond. Consequently, there are numerous questions where there are non-responders. Finally, practitioners were able to select multiple answers for the work type questions, subsequently it is difficult to obtain an accurate trend related to this data.