australia’s health workforce series optometrists in...

HWA | Australia’s Health Workforce Series – Optometrists in Focus1

Australia’s Health Workforce SeriesOptometrists in FocusMarch 2014


© Health Workforce Australia.

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Suggested citation: Health Workforce Australia [2014]: Australia’s Health Workforce Series – Optometrists in Focus


Contents

Contents 3

Introduction 4

About HWA 4

What is an optometrist? 5

How are optometrists trained? 6

Associations 6

Regulatory and Accreditation bodies 6

What is known about this workforce? 7

Data sources and limitations 7

National Health Workforce Dataset: Optometrists 8

ABS Census of Population and Housing 19

Professional association 28

Workforce inflows 29

Students 29

Immigration 32

How can workforce activity be measured? 33

What issues have stakeholders identified for the optometrist workforce? 33

What were the jurisdiction views? 33

What were the Association views? 33

HWA’s assessment of this workforce 34

Existing workforce position assessment 34

Existing workforce position assessment scale 36

Existing workforce position assessment 36

Workforce dynamics indicator 37

Indicator range boundaries 38

How do optometrists compare with other registered health occupations? 39

What does the analysis show? 41

Appendix one – Optometrists by Medicare Local regions 42


Introduction

About HWA

Health Workforce Australia (HWA) is a Commonwealth statutory authority established to build a sustainable health workforce that meets Australia’s healthcare needs. HWA leads the implementation of national and large scale reform, working in collaboration with health and higher education sectors to address the critical priorities of planning, training and reforming Australia’s health workforce.

Australia’s health system is facing significant challenges, including an ageing population and an ageing health workforce; changing burden of disease, in particular a growing level of chronic disease; and increased demand for health services with higher numbers of people requiring complex and long-term care. To achieve HWA’s goal of building a sustainable health workforce that meets Australia’s healthcare needs, health workforce planning is essential – and in health workforce planning, understanding the number and characteristics of the existing health workforce is the essential first step.

Australia’s Health Workforce Series describes particular professions, settings and issues of interest to aid workforce planning. This issue of Australia’s Health Workforce Series examines optometrists, bringing together available information to describe the optometrist workforce, including number and characteristics, potential data sources to measure workforce activity, and an analysis based on information presented.

This publication is divided into four main parts:

1. What is an optometrist – a brief overview of the optometrist role and training pathway, and descriptions of the key regulatory bodies and peak associations.

2. What is known about the optometrist workforce – presentation of data from different sources, describing the number and characteristics of the workforce, student and migration inflows into the workforce, and potential data sources that could be used to measure workforce activity.

3. What issues are expected to impact supply and/or demand for optometrists – a summary of issues obtained through stakeholder consultation.

4. HWA’s assessment of the workforce – which includes an assessment of existing workforce position (whether workforce supply matches demand for services or not); presentation of a set of workforce dynamics indicators, used to highlight aspects of the current workforce that may be of concern into the future; and a comparison of the optometrist workforce’s key characteristics with other health workforces.


What is an optometrist?

Optometrists are commonly the first point of professional contact for people experiencing problems with their eyes or having difficulty seeing1.

Optometrists may perform the following tasks:

• Monitor patients’ vision and eye health, and determine the nature and extent of any eye and vision problems and abnormalities by examination using specialised instruments, techniques, procedures and tests.

• Correct vision defects by prescribing and dispensing glasses or contact lenses, special optical aids or vision therapy.

• Examine patients for signs of eye and systemic conditions, including glaucoma, diabetes, high blood pressure and multiple sclerosis.

• Treat some eye conditions by prescribing therapeutic drugs.

• Manage patients with relevant eye conditions, or refer patients to ophthalmologists and general medical practitioners upon indication.

• Participate in shared care arrangements with ophthalmologists and general medical practitioners for patients with conditions such as glaucoma and diabetes.

• Provide post-operative care in association with ophthalmologists for patients who have had eye surgery such as cataract extraction or laser vision correction.

• Conduct eye screenings to determine fitness to undertake sporting, leisure or occupational activities, as well as compulsory examinations to obtain commercial licenses (for example, flying or driving).

• Provide advice on environmental factors that impact visual comfort, for example lighting, posture.

• Undertake managerial, retail and administrative tasks.

Most Australian optometrists are either self-employed or work in private practice. Private practice settings include independent practice or as part of large optical companies. Optometrists may also work in public clinics, with ophthalmologists, or at health-care institutions such as hospitals, community health centres or special clinics.

Some optometrists continue their studies through research and teaching, and can work in universities, research organisations or companies involved in the manufacture of optical equipment and devices.

Optometry is a registered health profession under the National Registration and Accreditation Scheme (NRAS). Therefore a practitioner must be registered with the Optometry Board of Australia to practise as an optometrist. Currently, optometrists with qualifications in ocular therapeutics are entitled to endorsement on their registration to allow them to prescribe Schedule 4 medications for the treatment of eye conditions such as glaucoma. From December 2014 the entry level for new registrants will include therapeutics training and the ability to prescribe Schedule 4 medications. From this time, existing registrants will have a restriction on their registration if they have not been trained in therapeutics.2

1 Optometrists Association of Australia website http://www.optometrists.asn.au/AboutOptometry/tabid/76/language/en-US/Default.aspx. Accessed 15 October 2012.2 Optometry Board of Australia website http://www.optometryboard.gov.au/Registration-Standards.aspx. Accessed 22 October 2013.


How are optometrists trained?

Optometrists are university-trained professionals, and as optometry is a registered health profession, a person must generally have completed an accredited program of study to register and practise as an optometrist. Exceptions to this are overseas-trained optometrists who have been assessed as having equivalent qualifications and skills to an Australian-trained optometrist, and have obtained registration with the Optometry Board of Australia; and optometrists who completed their training prior to the implementation of the NRAS, and joined the register during transitional arrangements.

Currently accredited optometry programs are:

• A five-year Bachelor of Optometry/Bachelor of Science program at the University of New South Wales.

• A five-year Bachelor of Vision Science/Master of Optometry program at Queensland University of Technology.

• A five-year Bachelor of Science (Vision Sciences)/Master of Optometry program at Flinders University (at time of publication, this course held conditional accreditation).

• A four-year Doctor of Optometry program at the University of Melbourne (at time of publication, this course held conditional accreditation).

• A three and a half-year (fast track) Bachelor of Vision Science/Master of Optometry at Deakin University in Victoria (at time of publication, this course held conditional accreditation).

Associations

Optometrists Association Australia (OAA)

The OAA is the peak professional body for Australian optometrists. Services and resources provided by the OAA include representation of optometrists and their interests to government and other bodies, professional indemnity insurance, development and sharing of information regarding vision standards, legislation and regulatory matters affecting optometry, Medicare guidelines, practice management, financial, marketing and legal services and information and services to the public3.

Regulatory and Accreditation bodies

Optometry Board of Australia (the Board)

Responsibilities of the Board include registering optometrists and students, developing standards, codes and guidelines for the optometry profession, handling notifications, complaints, investigations and disciplinary hearings, assessing overseas-trained practitioners who wish to practise in Australia and approving accreditation standards and accredited courses of study4. Currently assessment of overseas-trained practitioners who wish to practise in Australia and accreditation of courses of study is delegated to the Optometry Council of Australia and New Zealand.

3 Optometrists Association Australia website http://www.optometrists.asn.au/about-us.aspx. Accessed 8 November 2013.4 Optometry Board of Australia website http://www.optometryboard.gov.au/About.aspx. Accessed 15 October 2012.


The Optometry Council of Australia and New Zealand (OCANZ)

OCANZ assess overseas optometry qualifications and conduct a competency-based examination for suitably qualified international optometrists. OCANZ also assess undergraduate and postgraduate optometry courses that can lead to registration as an optometrist and postgraduate courses in ocular therapeutics in Australia and New Zealand for accreditation purposes. An assessment process of overseas-trained optometrists for therapeutic prescribing is also available5.

What is known about this workforce?

In workforce planning, the first key step is to understand the existing workforce. In this section, information is presented from a range of sources to describe the existing size and characteristics of the optometrist workforce.

Data sources and limitations

National Health Workforce Dataset (NHWDS)

The NHWDS combines data from the NRAS with optometry workforce survey data collected at the time of annual registration renewal. The optometry workforce survey is administered through the national registration body, the Australian Health Practitioner Regulation Agency (AHPRA), on behalf of Health Workforce Australia. The optometry NHWDS was collected for the first time in 2011, with data for 2011 and 2012 presented in this report. The overall response rate to the optometry workforce survey was 92.4 per cent in 2011 and 94.9 per cent in 2012. As it is a new collection, the NHWDS shows the current characteristics of the optometry workforce.

Australian Bureau of Statistics (ABS) Census of Population and Housing

The census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. Its objective is to accurately measure the number and key characteristics of people who are in Australia on census night, and of the dwellings in which they live. Information in the census is self-reported, meaning information is dependent on individuals’ understanding and interpretation of the questions asked. In particular for information on occupation, a person may self-report as working in a particular occupation, but not necessarily be appropriately qualified/meet registration standards (where a registrable profession). However, the census is able to provide a picture of the changing size and characteristics of the reported optometry workforce, which is not currently available through the NHWDS.

Department of Education (DE)

The DE conducts the Higher Education Statistics Collection, which provides a range of information on the provision of higher education in all Australian universities. Information on higher education course enrolments and completions by field of education is presented in this publication.

Department of Immigration and Border Protection (DIBP)

DIBP information is administrative by-product data, reporting the number of temporary and permanent visa applications granted to optometrists.

5 Optometry Council of Australia and New Zealand website http://www.ocanz.org/about-us. Accessed 15 October 2012.


National Health Workforce Dataset: Optometrists

As noted earlier, the NHWDS for optometrists was first collected in 2011. Information is collected from optometrists at the time of their annual registration renewal (due in November). In this section, information focuses on describing the number and characteristics of employed optometrists in 2011 and 2012.

Please note, in the NHWDS, the term ‘employed’ means a practitioner who worked for a total of one hour or more in the week before the survey in a job or business (including own business) for pay, commission, payment in kind or profit; or usually worked but was on leave for less than three months, or on strike or locked out, or rostered off.

Data on gender were unavailable for a significant percentage of the South Australian optometry workforce. Where the percentage of females appears in tables, it was calculated excluding those where gender was unknown or not stated.

Labour force status

In 2012 there were 4,564 optometrists registered in Australia, with the majority (93 per cent) in the optometry labour force (either working, looking for work, or on extended leave). Of those in the optometry labour force most (96 per cent or 4,066 optometrists) were working at the time of the survey. Within this, the majority (95 per cent) of optometrists were working as clinicians, that is, practitioners who spend the majority of their time undertaking activities related to the diagnosis, care, and treatment, including recommending preventative action, of patients or clients (figure 1).


Total optometry registrations4,564

In optometry labour force4,230 (92.7%)

Employed in optometry4,066 (96.1%)

Employed elsewhere and not looking for work in optometry

64 (19.2%)

Clinician3,876 (95.3%)

Not employed and not looking for work

53 (15.9%)

Administrator60 (1.5%)

Overseas193 (57.8%)

Teacher/educator55 (1.4%)

Retired24 (7.2%)

Researcher56 (1.4%)

Other 19 (0.5%)

On extended leave148 (3.5%)

Looking for work in optometry16 (0.4%)

Not in optometry labour forcce334 (7.3%)

Figure 1: registered optometrists by labour force status, 2012

Source: NHWDS: allied health practitioners 2012


Age and gender

There was little change in the number of optometrists from 2011 to 2012, with an increase of less than one per cent (32 optometrists). Nearly half of all employed optometrists in both 2011 and 2012 were female (table 1).

Table 1: number of employed optometrists by gender, 2011 and 2012

2011 2012 % increase

Male 2,032 2,054 1.1

Female 1,860 1,909 2.6

Not stated/inadequately described

141 103 -27.0

Persons 4,034 4,066 0.8

% Female(a) 47.8 48.2 . .

(a) calculated excluding those where gender not stated or inadequately described

Source: NHWDS: allied health practitioners 2011 and 2012

The average age of employed optometrists in both 2011 and 2012 was approximately 41 years. Female optometrists have a substantially younger average age than male optometrists (a difference of seven years in 2012) and a much lower percentage aged 55 years and over than males.

Table 2: employed optometrists, age profile by gender, 2011 and 2012

Average age (years) Percentage aged 55 and over

2011 2012 2011 2012

Male 44.3 44.5 20.8 22.8

Female 37.1 37.4 6.7 7.0

Persons 41.0 41.2 14.3 15.4


Figures 2 and 3 show the number of optometrists in five-year age cohorts in 2011 and 2012. The figures show the different age profiles of male and female optometrists – in both years the largest age cohort of male optometrists was 50-54 years, while the largest age cohort for females was 25-29 years. The number of male optometrists is spread relatively evenly across the five-year age groups between 25 and 59 years, while the age distribution of female optometrists is skewed towards younger age cohorts.


Figure 2: Number of employed optometrists by age cohort and gender, 2011


Figure 3: number of employed optometrists by age cohort and gender, 2012

500 300 100 100 300 500

< 25

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65+

Number

Male Female

Age (yrs)


500 300 100 100 300 500

< 25

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65+

Number

Age (yrs)Male Female


Hours worked

Optometrists worked an average of approximately 36 hours per week in both 2011 and 2012 (table 3). In both years male optometrists had higher average weekly hours than female optometrists, a difference of 7.9 hours per week in 2011 and 7.5 hours in 2012.

Table 3: employed optometrists, average weekly hours worked and FTE by gender, 2011 and 2012

2011 2012

Average weekly hours Full-time equivalent(a) Average weekly hours Full-time equivalent(a)

Males 39.6 2,120 39.7 2,146

Females 31.7 1,554 32.2 1,616

Persons 35.9 3,810 36.1 3,859

(a) FTE calculated on a 38 hour week


Approximately two-thirds (67 per cent or 1,378) of male optometrists and just over half of female optometrists (52 per cent or 985) worked between 35-49 hours per week. A higher percentage of females than males worked part-time (less than 35 hours per week), and a higher percentage of males than females working more than 49 hours per week, can be seen in figure 4 (and is reflected in the average hours worked shown in table 3).

Figure 4: employed optometrists by total weekly hours worked, 2012

5.8 12

.9

67.1

13.4

0.9

19.2 24

.6

51.6

4.1

0.4

0

10

20

30

40

50

60

70

80

90

100

< 20 20-34 35-49 50-64 >65

Em

plo

yed

op

tom

etri

sts

(%)

Total weekly hours worked

Males

Females



Years worked

In 2012, optometrists had worked in optometry in Australia for 16 years on average. Optometrists employed as administrators and educators had the highest number of years in the workforce, at approximately 20 years each. This potentially reflects career pathways, with more experienced optometrists moving into administration and education. While average years worked by optometrists in administration and education were higher than clinicians’ average years worked, they represented less than three per cent of employed optometrists in both 2011 and 2012, so had little effect on the total average years worked.

There was little change in optometrists’ years worked between 2011 and 2012 (table 4). The largest changes between the two years occurred for researchers (an increase of 2.2 years) and optometrists in other roles (a decrease of 1.9 years).

Table 4: Employed optometrists, average years worked by principal role, 2011 and 2012

Principal role 2011 2012

Clinician 15.4 16.3

Administrator 19.9 20.4

Teacher or educator 18.6 19.7

Researcher 13.7 15.9

Other 12.7 10.8

Total 15.4 16.3


Aboriginal and Torres Strait Islander status

There are very few employed optometrists of Aboriginal and Torres Strait Islander status (table 5).

Table 5: number of employed optometrists reporting Aboriginal and Torres Strait Islander status, 2011 and 2012

2011 2012

Male 5 4

Female 7 3

Persons 12 7

% of all employed optometrists 0.3 0.2



Table 6 shows selected characteristics of those optometrists of Aboriginal and Torres Strait Islander status. Care should be taken when interpreting these figures due to the small number of Aboriginal and Torres Strait Islander practitioners.

Table 6: employed optometrists reporting Aboriginal and Torres Strait Islander status, average age and average hours worked, 2011 and 2012

Average age (years) Average hours worked

2011 2012 2011 2012

Male 40.9 43.9 41.2 41.7

Female 33.0 28.7 38.6 41.0

Persons 36.5 37.2 39.8 41.4


Country of first qualification

In 2012, most optometrists (85 per cent or 3,464) reported they earned their first optometry qualification in Australia. The characteristics of overseas-trained optometrists differed from those of Australian-trained optometrists. New Zealand trained optometrists had a substantially lower average age and much lower percentage aged over 55 than Australian-trained optometrists, and also had a higher percentage of females. In contrast, optometrists trained in countries other than New Zealand had a substantially older age profile, and a lower percentage of females than Australian-trained optometrists (table 7).

Table 7: selected characteristics of employed optometrists by country of first qualification, 2012

Country of initial qualification Number Average age % aged 55+ % female(a)

Average weekly hours

worked FTE(b)

Australia 3,464 41.1 15.3 48.5 36.1 3,288

New Zealand 219 33.0 5.7 55.4 37.4 215

Other country 362 46.7 22.1 41.2 35.5 338

Not stated/inadequately described

21 41.5 9.6 43.9 32.8 18

Total 4,066 41.2 15.4 48.2 36.1 3,859

(a) Calculated excluding those where gender not stated or inadequately described(b) FTE calculated on a 38 hour week



Sector and setting

Table 8 shows the number of optometrists undertaking clinical work in the public and private sectors in 2012. A higher number of optometrists worked in the private sector, which reflects the high percentage of the workforce employed in group or solo private practice (shown in Table 9).

Optometrists may conduct clinical work in both the private and public sector, so may be counted in each sector. Full-time equivalent calculations account for hours worked in each sector, and show that almost all (96 per cent) of optometrists’ clinical work is in the private sector.

Table 8: employed optometrists undertaking clinical work by sector, 2012

Public Private

Number 362 3,791

Clinical FTE(a) 205 3,275

(a) FTE calculated on a 38 hour week


Almost four out of five optometrists (78 per cent or 3,187 optometrists) worked in group or solo private practice in 2012 (table 9).

Table 9: number of employed optometrists by work setting of main job, 2011 and 2012

Setting2011 2012 % change

2011 to 2012Number Number % of total

Group private practice 1,722 1,800 44.3 4.5

Solo private practice 1,352 1,387 34.1 2.6

Locum private practice 361 337 8.3 -6.6

Commercial/business services 158 186 4.6 17.7

Education facility 92 106 2.6 15.2

Community health services 46 41 1.0 -10.9

Hospital 17 17 0.4 0.0

Aboriginal health services 12 10 0.2 -16.7

Residential healthcare facility 8 10 0.2 25.0

Other 84 73 1.8 -13.1

Inadequately described/not stated/unknown 181 99 2.4 -45.3

Total 4,034 4,066 100.0 0.8



Employed optometrists’ average weekly hours worked varied by work setting, ranging from a low of 29 hours for locums in private practice to a high of 41 hours in educational facilities. Other settings where optometrists worked more than the national average included solo private practice (38 hours per week) and community healthcare services (37 weekly hours) (figure 5).

Figure 5: employed optometrists, average weekly hours worked by work setting, 2012

28.6

30.8

32.3

34.4

35.4

35.8

36.2

37.2

38.0

40.7

0 10 20 30 40 50

Locum private practice

Aboriginal health services

Hospital

Residential health care facility

Group private practice

Other

Commercial/business services

Community health care service

Solo private practice

Education facility

Average weekly hours worked

National average (36.1)


Distribution

Information from the NHWDS on the distribution of the optometrist workforce is based on survey respondents’ reported location of main job.

State and territory

In 2012, the majority of employed optometrists were located in the more highly populated states of New South Wales (35 per cent), Victoria (26 per cent), and Queensland (20 per cent). This distribution also correlates with the location of established accredited university courses for optometrists (while there is now a course offered in South Australia, the first cohort will not complete this course until 2014).

The number of optometrists per 100,000 population was lowest in the Northern Territory, a rate of 12.8 optometrists per 100,000 population, compared with the national average of 17.9.


Of all states and territories, Tasmania had the oldest age profile and the highest average weekly working hours, which may be a result of a low percentage of female optometrists (table 10).

Table 10: selected characteristics of employed optometrists by state and territory, 2011 and 2012

NSW VIC QLD SA WA TAS NT ACT AUS

2012

Number 1,416 1,044 825 243 354 87 30 68 4,066

No. per 100,000 population

19.4 18.5 18.1 14.7 14.6 17.0 12.8 18.1 17.9

Average age 42.0 39.7 41.2 41.1 42.1 44.8 41.7 37.0 41.2

% aged 55 and over 17.7 12.9 13.4 19.7 15.2 20.7 13.4 7.3 15.4

Average hours worked 36.2 35.9 35.3 37.0 36.3 37.7 41.2 34.9 36.1

% female(a) 51.5 50.2 45.8 41.4 40.5 33.3 49.6 48.3 48.2

2011

Number 1,391 1,054 843 225 340 82 31 65 4,034


19.3 19.0 18.8 13.7 14.4 16.0 13.4 17.7 18.1

% change in number 2011 to 2012

1.8 -0.9 -2.1 8.0 4.1 6.1 -3.2 4.6 0.8

(a) Calculated excluding those where gender not stated or inadequately described

Source: NHWDS: allied health practitioners 2011 and 2012, ABS, Australian Demographic Statistics, Dec 2012, cat. no. 3101.0

Remoteness area

The remoteness area (RA) structure is a geographic classification system produced by the ABS and is used to present regional data. The RA categories are defined in terms of the physical distance of a location from the nearest urban centre (access to goods and services) based on population size.

The optometry workforce is concentrated in major cities. In 2012, over three-quarters (78 per cent or 3,177) of optometrists were located in major cities (a rate of 19.9 optometrists per 100,000 population), a slight decrease from 2011 (79 per cent located in major cities, a rate of 20.2 per 100,000 population).

There were very few optometrists with their main job located in remote and very remote areas. As a predominantly private practice workforce, full-time practices in these areas are unlikely to be financially viable. Optometrists provide services to remote and very remote areas through the Visiting Optometrists Scheme and through privately funded secondary and visiting practices. Table 11 presents the location of the main place of work of optometrists, and does not account for secondary or multiple places of work.

Optometrists’ average weekly working hours were lowest in major cities, and increased with increasing remoteness. Optometrists located in outer regional areas had a higher average age, and higher percentage aged 55 and over, than the national average.


Table 11: selected characteristics of employed optometrists by remoteness area, 2011 and 2012

Major cities

Inner regional

Outer regional Remote(a)

Very remote(a) Australia

2012

Number 3,177 639 214 26 6 4,066


19.9 15.4 10.5 8.2 2.9 17.9

Average age 40.8 42.3 43.7 42.9 40.5 41.2

% aged 55 and over 14.7 15.6 24.9 19.3 0.0 15.4

Average hours worked 35.7 37.3 37.4 37.5 42.3 36.1

% female(b) 50.2 37.6 43.3 41.0 34.1 47.8

2011

Number 3,169 600 233 21 6 4,034


20.2 14.6 11.5 6.7 3.0 18.1


0.3 6.5 -8.2 23.8 0.0 0.8

(a) Care should be taken when interpreting the figures for remote and very remote areas due to the relatively small number of employed optometrists who reported their location of main job was in these regions.

(b) Calculated excluding those where gender not stated or inadequately described

Source: NHWDS: allied health practitioners 2011 and 2012, ABS, Regional Population Growth, Australia, 2012, cat. no. 3218.0.

Medicare Local regions

In 2011 the Australian government established 61 Medicare Locals across Australia. The Commonwealth government funds these organisations to plan, fund and deliver healthcare services at a local level, with each Medicare Local covering a defined geographic area.

Table 12 shows the Medicare Local regions with the highest and lowest rate of employed optometrists per 100,000 population, by primary place of work (a full list of Medicare Locals is included as appendix 1). Please note, data in this table shows the number of optometrists per 100,000 population working in the relevant Medicare Local region, and provides a useful refection of the geographical distribution of optometrists – it does not reflect optometrists employed by Medicare Local organisations.

As can be expected, Medicare Local regions with the highest rate of employed optometrists per 100,000 population were in capital cities, while most of the Medicare Local regions with the lowest rate of employed optometrists were located in regional and remote areas. The concentration of optometrists in capital cities reflects both population distribution and the location of major employers of optometrists.


Table 12: number of employed optometrists per 100,000 population by selected Medicare Local regions, 2012

Highest Lowest

State/Territory Medicare Local Rate State/

Territory Medicare Local Rate

NSW Eastern Sydney 61.0 NSW Far West NSW 5.2

VIC Inner North West Melbourne 48.1 WA Kimberley – Pilbara 6.9

QLD Metro North Brisbane 28.0 QLDCentral and North West Queensland

8.9

NSW Sydney North Shore and Beaches 27.2 VIC South Western Melbourne 9.3

NSW Northern Sydney 25.2 NSW Southern New South Wales 9.6

Source: NHWDS: allied health practitioners 2012, ABS, Australian Demographic Statistics, Dec 2012, cat. no. 3101.0

ABS Census of Population and Housing

While the NHWDS provides a picture of the number and characteristics of the current optometrist workforce, historical information showing trends in the optometrist workforce is not currently available from this source (although as it is an annual collection, this is a short-term issue only). Census information is self-reported, so people may report that they are an optometrist without being a registered practitioner. However, the census provides a picture of the changing number and characteristics of the reported optometrist workforce, which is not currently available through the NHWDS.

In the census, the Australian and New Zealand Standard Classification of Occupations (ANZSCO) is used to publish occupation statistics. In ANZSCO, an optometrist is defined as ‘someone who performs eye examinations and vision tests to determine the presence of visual, ocular, and other abnormalities, ocular diseases and systemic diseases with ocular manifestations, and prescribes lenses, other optical aids, therapy and medication to correct and manage vision problems and eye diseases’.

Please note, information is presented for people who self-reported as employed optometrists in the census (regardless of level of education). This includes those people working for an employer or conducting their own business, including those with their own incorporated company as well as sole traders, partnerships and contractors. Also, the ABS randomly adjusts cells to avoid the release of confidential data, so there can be slight discrepancies in totals when comparing census tables.

Age and gender

From 1996 to 2011, the number of employed optometrists increased by approximately 61 per cent (1,371 optometrists). This was largely the result of an increase in the number of female optometrists, which more than doubled over the period (an increase of 112 per cent, or 919 optometrists). This large increase in the number of female optometrists has changed the gender balance of the workforce – in 1996 approximately one-third (36 per cent) of the workforce was female, increasing to almost half (48 per cent) in 2011 (table 13).


Table 13: number of employed optometrists by gender, 1996 to 2011

1996 2001 2006 2011 % increase1996 to 2011

Males 1,439 1,603 1,709 1,891 31.4

Females 818 1,085 1,356 1,737 112.3

Persons 2,257 2,688 3,065 3,628 60.7

% female 36.2 40.4 44.2 47.9 . .

Source: ABS Census of Population and Housing, 1996 to 2011.

There is a substantial difference in the age profile of male and female optometrists (table 14). In 2011 almost one in five male optometrists was aged 55 and over, compared with less than one in ten females. In 1996, the age difference between male and female optometrists was even greater, with only two per cent of female optometrists aged 55 and over, compared with 12 per cent of male optometrists. The lower percentage of female optometrists aged 55 and over reflects the growing number of females entering the optometry workforce.

Table 14: employed optometrists, age profile by gender, 1996 and 2011

Per cent aged 55 and over

1996 2011

Males 12.0 19.4

Females 2.2 7.0

Persons 8.5 13.5

Source: ABS Census of Population and Housing, 1996 and 2011

Figures 6 to 9 show a detailed age and gender breakdown of employed optometrists for each selected census year. The ageing of the male optometry workforce between 1996 and 2011 can be seen. In 1996 the largest age cohort for male optometrists was 35-39 years, but by 2011 the largest age cohort was 50-54 years.

Strong growth in the number of females entering the profession is also shown in figures 6 through 9. In addition to the large increases in the younger age cohorts (in particular between 25 and 44 years) there were also smaller increases in each of the older age cohorts between 1996 and 2011.


400 300 200 100 0 100 200 300 400

<25

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Number


Figure 6: number of employed optometrists by age and gender, 1996




Source: ABS Census of Population and Housing, 1996





Hours worked

Average weekly hours worked for both males and females fell between 1996 and 2011 (figure 10). Male average weekly hours worked decreased by 4.3 hours (from 43.4 to 39.1) and female average weekly hours decreased by 3.6 hours (from 33.7 to 30.1). Figure 10: employed optometrists, average weekly hours worked, 1996 and 2011

Source: ABS Census of Population and Housing, 1996 and 2011

The fall in average weekly hours worked was not consistent across all age groups. Average weekly hours worked for males aged 55 and over increased from 1996 to 2011 (figure 11). Average weekly hours worked for females aged 55 and over also increased from 1996 to 2011 (figure 12). However it should be noted in 1996 there were small numbers of female optometrists aged 55 and over.

43.4

33.7

39.9

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1996 Females 2011 Females

Figure 11: employed male optometrists by age and average hours worked, 1996 and 2011

Figure 12: employed female optometrists by age and average hours worked, 1996 and 2011

Source: ABS Census of Population and Housing 1996 and 2011. Source: ABS Census of Population and Housing, 1996 and 2011.

Aboriginal and Torres Strait Islander Status

Over the four selected census years, there were very few employed optometrists of Aboriginal and Torres Strait Islander status (table 15).

Table 15: number of employed optometrists by Aboriginal and Torres Strait Islander status, 1996 to 2011

1996 2001 2006 2011

Aboriginal and Torres Strait Islander 3 6 7 4

Non-Aboriginal and Torres Strait Islander 2,244 2,679 3,047 3,603

Total(a) 2,254 2,694 3,066 3,626

(a) Includes Aboriginal and Torres Strait Islander status not stated


Country/region of birth

While most employed optometrists were born in Australia, the percentage of Australian-born optometrists fell between 1996 (74 per cent) and 2011 (60 per cent). Over the same period, the number of overseas-born optometrists from Chinese Asia increased sixfold, from 45 in 1996 to 289 in 2011 (table 16).


Table 16: employed optometrists – top five countries/regions of birth, 1996 and 2011

1996 2011

Country/region of birth Number % Country/region of birth Number %

Australia 1,653 73.9 Australia 2,164 59.7

United Kingdom 146 6.5 Chinese Asia 288 8.0

Maritime South-East Asia 87 3.9 United Kingdom 194 5.3

Southern and East Africa 62 2.8 Maritime South-East Asia 184 5.1

Chinese Asia 45 2.0 Southern and East Africa 175 4.8

Other countries(a) 245 10.9 Other countries(a) 622 17.1

Total 2,238 100.0 Total 3,627 100.0

(a) Includes country of birth not stated or inadequately described.

Source: ABS Census of Population and Housing, 1996 and 2011.

Education

While the NHWDS provides insight into the roles and work settings that registered optometrists are employed in, it does not provide information on the levels of qualification held by optometrists. Census data provides an indicator of the types of qualifications held by optometrists, and also provides information about the occupation of those who are qualified in optometry but not working as optometrists.

Table 17 shows the number of people who reported their highest level of qualification in optometry, by the type of qualification and the occupation they reported as working in at the time of the census.

Reflecting the current accredited training pathway, most people with their highest level of qualification in optometry reported a bachelor degree as their highest level of qualification (2,974). Those with their highest level of qualification in optometry most commonly reported an occupation of ‘professional’ (3,392), and within this, almost all reported an occupation of optometrist or orthoptist (3,252).

It should be noted current registration standards generally require an optometrist to have completed an accredited qualification in optometry (refer to ‘how are optometrists trained?’). Those people who self-reported as an optometrist with an advanced diploma or diploma (281) as their highest level of qualification may have gained registration under transitional arrangements during the implementation of the NRAS, or may not actually meet current registration standards to be recognised as an optometrist.


Table 17: employed persons, highest level of qualification in optometry, by type of qualification and occupation, 2011

Highest level of qualification

OccupationPostgraduate

degree

Graduate diploma and

graduate certificate

Bachelor degree

Advanced diploma and

diploma Total(a)

Managers 18 0 54 16 101

Professionals 290 66 2,756 186 3,392

Optometrists or orthoptist(b) 226 62 2,702 175 3,252

Technicians and trades workers 11 0 39 29 125

Other occupations 8 3 125 50 217

Total 327 69 2,974 281 3,835

(a) Includes level of education inadequately described and level of education not stated.(b) Includes 14 people employed as orthoptists who reported their highest level of qualification in optometry. It was not possible to remove the orthoptists from the

data available, and it is not known which qualification type they hold.

Source: ABS Census of Population and Housing, 2011.

Sector and industry of employment

Optometrists were almost exclusively employed in the private sector (table 18).

Table 18: number of employed optometrists by sector of employment, 1996 to 2011

Sector 1996 2001 2006 2011

Government sector(a) 25 15 18 34

Private sector 2,219 2,672 3,039 3,597

Total(b) 2,256 2,699 3,063 3,631

(a) includes Commonwealth, State and Territory and Local Government(b) includes not stated



Optometrists were also almost exclusively employed in the optometry and optical dispensing industry (table 19).

Table 19: number of employed optometrists by industry, 1996 to 2011

Industry 1996 2001 2006 2011

Healthcare and social assistance industries

Optometry and optical dispensing 2,121 2,518 2,903 3,344

Other healthcare and social assistance services 34 51 64 150

Total healthcare and social assistance 2,155 2,569 2,967 3,494

Other industries 110 162 98 134

Total 2,265 2,731 3,065 3,628


Distribution

Information from the census on the distribution of the optometrist workforce is based on place of usual residence (not place of work).

State and territory

In 2011, most employed optometrists were located in New South Wales (35 per cent), Victoria (26 per cent) and Queensland (22 per cent). As well as reflecting population size, this also reflects the location of the accredited education programs leading to registration as an optometrist (which are in New South Wales, Victoria and Queensland). A new optometry program in South Australia, with the first cohort due to graduate in 2014, may result in an increase in optometrists in that state in future.

In 2011, average weekly hours worked by optometrists were relatively consistent across states, varying from a minimum of 32.3 hours in the Australian Capital Territory to a maximum of 39.8 hours in the Northern Territory.

The largest percentage of female optometrists was in the Australian Capital Territory (62 per cent), while the lowest percentage was in Western Australia (36 per cent).

Table 20: selected characteristics of employed optometrists by state and territory, 2006 and 2011


2011

Number 1,265 935 786 190 302 80 17 52 3,627


17.5 16.9 17.6 11.6 12.8 15.6 7.4 14.1 16.2

Average hours worked 35.15 34.2 34.9 33.5 34.5 34.5 39.8 32.3 34.7

% female 50.0 51.6 46.6 40.0 35.8 45.0 41.2 61.5 48.0



2006

Number 1,110 726 650 173 269 69 24 44 3,065


16.5 14.3 16.2 11.1 13.1 14.1 11.5 13.1 15.0


14.0 28.8 20.9 9.8 12.3 15.9 -29.2 18.2 18.3

Source: ABS Census of Population and Housing, 2006 and 2011, ABS, Australian Demographic Statistics, Dec 2012, cat. no. 3101.0.

Remoteness area

In both 2006 and 2011, major cities had the highest rate of employed optometrists per 100,000 population (16.7 per 100,000 in 2006, and 18.6 per 100,000 in 2011).

From 2006 to 2011, the number of optometrists per 100,000 population increased across all remoteness areas, except outer regional (falling from 10.2 to 8.5 per 100,000 population) and very remote areas. While very remote areas had no employed optometrists in either year, and remote areas had very few, census data relates to the location of an optometrist’s main place of work only, and does not account for multiple places of work or visiting optometry services which service remote and very remote areas.

Two new courses that are underway at Deakin University in Victoria and Flinders University in South Australia, which both aim to educate optometrists for practise in rural and regional Australia, may result in an increase in optometrists in rural and remote Australia in future.

Table 21: selected characteristics of employed optometrists by remoteness area, 2006 and 2011

Major cities

Inner regional


Very remote(a) Australia(b)

2011

Number 2,923 501 172 10 0 3,627


18.6 12.2 8.5 3.2 0 16.2

Average hours worked 34.6 36.1 32.3 30.8 0 34.7

% female 50.2 36.1 43.0 70.0 0 48.0

2006

Number 2,374 489 196 6 0 3,065


16.7 12.8 10.2 2.0 0 15.0


23.1 2.5 -12.2 66.7 0 18.3

(a) Care should be taken when interpreting the figures for remote and very remote areas due to the relatively small number of employed optometrists who reported their usual residence was in these regions.

(b) Includes migratory and no usual residence.

Source: ABS Census of Population and Housing, 2006 and 2011, ABS, Regional Population Growth, Australia, 2012, cat. no. 3218.0.


Professional association

The OAA collects data on its members, periodically publishing formal studies to determine if the number of optometrists is sufficient to meet the eye care needs of the Australian community. OAA membership is open to all registered optometrists.

It should be noted when considering OAA data that information is provided voluntarily by members; not all registered optometrists are members of the OAA (the OAA has approximately 90 per cent membership from registered optometrists); and information recorded by the OAA in the past has not been time-stamped – which has particular implications for comparing age cohorts over time.

OAA information shows:

• The number of registered optometrists increased 30 per cent (858) from 2005 to 2009.

• The number of female optometrists increased at a greater rate (40 per cent) and number (475) than male optometrists (17 per cent or 356 optometrists) between 2005 and 2009.

• In 2009 approximately half (52 per cent) of optometrists were aged between 30 and 49, and within this, they were almost equally split between those aged 30-39 (28 per cent) and 40-49 (25 per cent).

Table 22: number of optometrists by age and gender, 2005 and 2009

2005 2009

Age group Males Females Persons Males Females Persons

20-29 175 291 466 217 422 639

30-39 446 477 923 465 569 1034

40-49 595 289 884 552 369 921

50-59 280 115 395 531 193 724

60+ 193 11 204 181 27 208

Total(a) 1,678 1,183 2,861 2,034 1,685 3,719

% female 58.7 41.3 . . 54.7 45.3 . .

(a) Includes age not stated

Source: Optometrists Association Australia, The Australian optometric workforce 2005 and 2009.

The OAA also collects information on the employment status of optometrists. This shows almost half of those reporting were salaried employees, followed by sole owners and partners/joint practice owners (table 23).


Table 23: number of optometrists by employment status, 2012

Number Per cent (%)

Partner/joint owner 583 19.3

Sole owner 958 31.7

Salaried employee 1,483 49.0

Total(a) 3,024 100.0

(a) Excludes those not reporting ownership status.

Source: Unpublished data 2012, Optometrists Association Australia

Workforce inflows

Information on workforce inflows is an important component of workforce planning, to understand how many people are entering the workforce. There are two primary streams to become an optometrist in Australia – through the education system and through immigration. Information available on both streams is presented in this section.

Students

There are currently two sources of information on optometry students in Australia – AHPRA and the DE. Information from both sources is presented below.

Registered optometry students

As outlined earlier, a person needs to complete an accredited program of study to become an optometrist in Australia. Students gaining a qualification that enables them to practise as a registered health professional usually undertake periods of clinical practice (involving direct patient contact) as a part of their course of study. In the interests of public safety, Health Ministers agreed that monitoring of students undertaking clinical practice is reasonable, and in line with the monitoring of fully qualified health professionals6.

Therefore, under the national registration laws, education providers provide AHPRA the details of people undertaking a Board approved program of study or clinical training. For students enrolled in approved programs of study, student registration commences from the first year of the program (except for psychology, which does not register students).

For students not enrolled in an approved program of study, registration occurs upon commencement of clinical training. Examples of this include:

• When an overseas student arranges a clinical placement as part of the course requirements set out by the education provider in their home country.

• When an education provider is running a course that is accredited by an accreditation authority but is not yet approved by a National Board.

• When an education provider is running a course that has not yet been accredited by an accreditation authority or approved by a National Board7.

6 Occupational Therapy Board website: http://www.occupationaltherapyboard.gov.au/Codes-Guidelines/FAQ.aspx#Whydostudentsneedtoberegistered. Accessed on 6 June 2013.

7 AHPRA Fact sheet for education providers: http://www.ahpra.gov.au/Registration/Student-Registrations/fact-sheet-for-education-providers.aspx. Accessed on 6 June 2013


Student registration numbers are cumulative and reflect the number of students who have an active registration on 30 June, based on the expected completion date supplied by the education provider8.

At 30 June 2013 there were 597 registered optometry students, with an additional 682 students undertaking clinical training that does not currently form part of an approved program of study.

Table 24: number of registered optometry students, 2011 to 2013

30 June 2011 30 June 2012 30 June 2013 % increase 2011 to 2013

Approved program of study(a) 214 524 597 179.0

Clinical training(b) 0 278 682 . .

(a) Students enrolled in a course approved by a National Board and leads to general registration.(b) Students undertaking any form of clinical experience that does not form part of an approved program of study and the person does not hold registration in the

health profession in which the clinical training is being undertaken.

Source: AHPRA Annual reports 2010-11, 2011-12, and 2012-13

The Department of Education student numbers

While the AHPRA student registration numbers show the number of students in accredited optometry courses, it is cumulative only and student characteristics are not published. The DE conducts the Higher Education Statistics Collection, which provides a range of information on the provision of higher education in all Australian universities. The following tables include data on student commencements and completions in all bachelor, masters, and doctorate level courses accredited by the Board (at time of publication). This includes data from Flinders University (first optometry student intake in 2010) and from Deakin University (first optometry student intake in 2012), which have conditional accreditation.

There are two Graduate Certificate in Ocular Therapeutics courses currently accredited by the Board, however these are accredited for the purpose of allowing registered optometrists to gain endorsement to prescribe Schedule 4 medicines. As entry to these courses is restricted to those who hold bachelor qualifications in optometry and completion of these courses does not lead to registration as an optometrist, data relating to these courses is not included in the following tables.

Student commencements

Table 25 shows the number of students commencing study in optometry increased from 208 in 2008 to 366 in 2012 (an increase of 76 per cent). There was a particularly large increase in student commencements between 2011 and 2012 – 62 per cent for those commencing bachelor courses and 235 per cent for those commencing postgraduate courses. These increases likely reflect the introduction of the Deakin University optometry program in 2012 and changes in courses offered by Queensland University of Technology (which changed its optometry program from a four year bachelor to a five year combined bachelor and masters in 2009).

In each of the selected years more than half of commencing students were female, indicating the increase in female participation in the workforce reflected in the census data is likely to continue into the future.

Overseas student commencements accounted for less than 13 per cent of all optometry commencements in each of the selected years.

8 Australian Health Practitioner Regulation Agency Annual Report 2012-13


Table 25: number of student commencements in accredited optometry courses by gender, 2008 to 2012

2008 2009 2010 2011 2012

Bachelor 183 196 158 156 252

Postgraduate 25 22 15 34 114

Total 208 218 173 190 366

% Female 62.5 68.8 59.5 65.3 65.8

% Overseas 12.5 11.9 9.2 10.5 4.4

Source: Department of Education

Student completions

Table 26 shows the number of students completing optometry courses rose between 2008 and 2011, before dropping sharply in 2012. Student completions at bachelor level fell by 20 per cent from 2011 to 2012; this is likely due in part to a change in courses offered by Queensland University of Technology, which changed from a four-year bachelor course to a combined three-year bachelor/two-year masters program in 2009.

As with student commencements, female students accounted for more than half of all graduating students in each of the selected years.

The percentage of overseas optometry student completions varied during this period, ranging from a low of 11 per cent (16 students) in 2012 to a high of 27 per cent (28 students) in 2009.

Table 26: number of student completions in accredited optometry courses by gender, 2008 to 2012

2008 2009 2010 2011 2012

Bachelor 150 78 117 188 151

Postgraduate 5 27 13 15 0

Total 155 105 130 203 151

% Female 68.4 63.8 61.5 73.4 63.6

% Overseas 11.6 26.7 16.2 12.3 10.6

Source: Department of Education


Immigration

Optometrists are currently included on the skilled occupation list and the consolidated sponsored occupation list. This means overseas-trained optometrists are eligible for permanent migration through the skilled independent pathway, or through sponsored pathways including state and territory, regional and employer sponsored. They are also eligible for temporary migration through the business (long stay) (subclass 457) visa.

Before migrating to Australia, the skills and qualifications of an overseas-trained optometrist are assessed for equivalency to Australian standards. If the qualifications are assessed as effectively equivalent, the optometrist is permitted to sit the Competency in Optometry Examination, administered by the OCANZ. Upon passing the exam, overseas-trained optometrists are eligible to apply for registration with the Optometry Board of Australia. Registration is required before a visa can be granted.

Temporary visa grants

The number of temporary visas granted to optometrists over the period 2005-06 to 2012-13 has varied year on year (table 27).

Table 27: temporary visa grants by subclass, 2005-06 to 2012-13

Visa category 2005 -06 2006 -07 2007 -08 2008 -09 2009 -10 2010 -11 2011 -12 2012-13

457 temporary work (skilled)

14 9 17 15 13 26 30 22

Source: Department of Immigration and Border Protection administrative data.

Permanent visa grants

Permanent visas granted to optometrists over the period 2005-06 to 2012-13 have varied from a low of nine in 2009-10 to a high of 44 in 2010-11 (table 28). Most permanent visas are granted under the general skilled migration pathway.

Table 28: permanent visa grants(a) by visa type, 2005-06 to 2012-13

Visa category 2005 -06 2006 -07 2007 -08 2008 -09 2009 -10 2010 -11 2011 -12 2012-13

Employer sponsored

9 4 6 10 5 13 5 9

General skilled migration(b) 17 11 14 17 4 31 13 17

Total 26 15 20 27 9 44 18 26

(a) Includes provisional visas(b) Includes skilled independent, skilled regional and state/territory nominated visas

Source: Department of Immigration and Border Protection administrative data.

On 1 July 2012, SkillSelect was implemented, a process where a person wanting to migrate to Australia first completes an expression of interest (EOI); and an invitation to apply for a visa is extended to people with an EOI, in order of those who scored the most points. Caps on the number of visa grants allowed for each occupation have been implemented from 1 July 2012. This is in contrast to the previous process where there were no caps, and anyone could submit an application without being invited to apply. The impact of these changes on skilled independent immigration numbers is yet to be seen.


How can workforce activity be measured?

As well as understanding the existing workforce stock and having an indication of how many people are entering the workforce, understanding workforce demand also forms an integral component of workforce planning. Potential data sources that could be used to measure demand for the optometrist workforce are outlined in this section.

Many optometry clinical services to Australian residents are generally subsidised by Medicare, and consultations to veterans are subsidised by the Department of Veterans’ Affairs. Information from Medicare and the Department of Veterans’ Affairs could therefore be used as a basis for measuring clinical services provided through these two sources.

The ABS National Health Survey is another potential source of optometry information, and was used by AIHW in generating optometry workforce projections in 1998-99. Few optometry clinical services are covered by private health, so the Private Health Insurance Administration Council information is not a useful source of information for this workforce.

What issues have stakeholders identified for the optometrist workforce?

Considerations that may impact future workforce supply or demand are important in providing a real world context for interpreting the historical trends presented in this report, and developing an understanding of future workforce requirements. Consultation was conducted with employers and the profession to obtain their views on such considerations, which are summarised in this section.

What were the jurisdiction views?

The optometry workforce in Australia is predominately private. Those jurisdictions employing optometrists provided mixed comments; some reported that current workforce supply is sufficient, while others reported difficulties in recruiting experienced optometrists or recruiting to rural and regional areas.

It was noted the possibility of future expansion of the optometrist scope of practice to assist with ophthalmology workforce shortages would lead to expanded training needs for the optometrist workforce.

What were the Association views?

In relation to workforce supply, the OAA highlighted clinical training capacity as a particular issue, with limited support for private optometry practices to host students undertaking clinical training, and limitations in the diversity of clinical settings available to train the workforce. This can result in training blockages in some jurisdictions and limited student exposure to different training experiences.

Concerns also exist that with no restriction on the ability of Australian universities to open new optometry schools, increasing numbers of students may further increase pressure on the sector’s largely unfunded clinical training capacity.

Other factors highlighted as impacting future workforce supply included:

• The increasing number of females entering the workforce, which is likely to influence hours worked and increase the need for flexible work practices.

• Remuneration, with the OAA noting that Medicare fees do not adequately compensate optometrists for clinical services and current arrangements do not enable optometrists to charge above the Medicare scheduled fee when working under Medicare; this may potentially detract people wanting to enter the profession.


In relation to workforce demand, the key factors highlighted were:

• Technological advances and research progress into the treatment and cure of eye diseases may also impact demand for optometry services.

• Increasing rates of chronic disease and an ageing population create the opportunity for increased collaboration between optometrists and ophthalmologists.

The OAA noted that changes in service delivery models, continuing assessment of the regulatory settings governing optometry’s scope of practice, and awareness and support at government level can support and facilitate increased collaboration between these two roles in future.

The geographic distribution of the optometry workforce was also highlighted as a workforce issue. The OAA advised there are currently no government funded programs specifically focused on increasing the number of optometrists working in regional and remote areas or supporting those who currently work in these areas, other than the Visiting Optometrists Scheme (VOS). Ongoing support for the VOS, which provides financial support to optometrists delivering outreach services in communities unable to support a full time optometry service, is required.

HWA’s assessment of this workforce

HWA’s assessment of the optometry workforce comprises three components:

1. An assessment of existing workforce position – used to assess whether workforce supply matches demand for services (whether the workforce is in balance or not) at this point in time.

2. A set of indicators – collectively called the workforce dynamics indicator – used to highlight aspects of the current workforce that may be of concern into the future.

3. Comparison with other occupations – NHWDS data is used to compare key characteristics of the optometry workforce with other registered health occupations.

Existing workforce position assessment

Ideally, quantitative evidence should be used to determine whether a workforce is in balance or not at a point in time. However, there is a lack of such evidence. Therefore, to provide an understanding of the existing workforce position for the health workforces, HWA conducted an assessment using a range of partial measures. These measures were:

• Assessment by key stakeholders.

• Waiting times.

• Vacancy rates.

Each of these measures is discussed below.

Assessment by key stakeholders

HWA consulted with jurisdictions, the peak association, and employers to obtain their assessment of the existing workforce position of the optometry workforce. Where provided, these views are incorporated within the existing workforce position assessment.


Waiting times

Waiting times are a measure of access to a health professional – not specifically a measure of workforce imbalance. It is for this primary reason that waiting times can only be used as a partial measure to demonstrate existing workforce position. Factors aside from workforce availability influence waiting times and affect its use as an indicator, including the length of time someone has to wait, as this influences their likelihood to wait, and demand for a particular health profession.

Budget can also strongly influence waiting times for health professions primarily based in the public sector. Budget constraints influence supply by limiting the availability of staff, which impacts waiting times.

Vacancy rates

Vacancy rates and duration of vacancies are often used to assess potential workforce imbalances. Vacancies can imply there is an insufficient sized workforce as there are not enough people to fill positions available. However there are a range of cautions to note with using vacancy rates as a measure of workforce shortage:

• Vacancies occur as part of normal operations due to turnover and lags in filling positions.

• There is no single level of vacancy rate considered to reflect a workforce shortage.

• Vacancies can occur for reasons other than shortage, for example: the vacancy could be in an unattractive location; an employer may choose not to fill a vacancy for reasons such as budget constraints; or, applicants for a position may not have sufficient experience the employer is looking for.

• Vacancy rates may also understate workforce shortage, for example positions may not be advertised if they are not expected to be filled.

The sector in which this measure is being applied also determines its usefulness. In the public health sector, positions are salaried so vacancy rates can be an appropriate indicator. However in the private sector, private practitioners often deliver services so there may be minimal identified vacancies. Other indicators such as waiting times for a first appointment may be more appropriate for the private sector. For the reasons above, vacancy rates can also only be used as a partial indicator – they should not solely be considered as a measure of workforce shortage.

A number of other partial indicators can also be used to provide a picture of the existing workforce position, including overtime rates, salaries and predicted employment growth. However for this publication, the measures described above were focused on.


Existing workforce position assessment scale

Using available information from the measures outlined above, the following scale was used to assess the existing workforce position of optometrists.

White Current perceived excess supply – current aggregate workforce exceeds existing expressed service demand, including across geographic areas

Green No current perceived shortage – sufficient workforce for existing expressed service demand, minimal number of vacancies, no difficulty filling positions, and short waiting times

YellowPerceived maldistribution: localised excess supply and localised shortages – existing workforce supply exceeds existing expressed service demand in some locations, while in other locations expressed service demand exceeds existing workforce.

OrangePerceived maldistribution: localised adequate supply and localised shortages – existing sufficient workforce for existing expressed service demand is some locations, however expressed service demand exceeds existing workforce in other locations

RedPerceived current shortage – that is, expressed service demand in excess of existing workforce, ongoing vacancies exist, difficult/unable to fill positions, and extended waiting times across geographic areas

Existing workforce position assessment

Reflecting the fact allied health professionals are employed and deployed differently across jurisdictions, the range of stakeholder views received and the difficulty in assigning weightings to stakeholders to generate a national assessment, a single existing workforce position assessment has not been assigned for optometrists.

However from information obtained, the optometrist existing workforce position assessment is clearly in the yellow to orange scale – few stakeholders rated this workforce as ‘green’ (no perceived shortage). The reasons behind this rating are reflected in the workforce issues section of this report, and reflect:

• Difficulties in recruiting to rural and regional areas.

• Difficulties in recruiting to special interest areas.

The existing workforce position information obtained by HWA is consistent with the Department of Employment research. The Department of Employment conduct research to identify skill shortages in the Australian labour market, and publish the results of their research in individual occupation reports. The skill shortage research methodology is based on a sample survey of employers who had recently advertised vacancies, examining whether they were able to find suitable workers for the advertised position(s). Employers are identified through sources including national and regional newspapers, online job boards, association websites, professional journals and specialist publications. The labour market rating for optometry (at April 2013) was ‘shortage’. It was noted that employers filled less than half of surveyed vacancies, and more than one in three employers did not attract any suitable applicants. The labour market rating also notes that this difficulty in attracting suitable applicants is particularly evident in regional areas, although employers in some states experienced little difficulty in recruiting suitable applicants9.

9 Department of Employment occupational skills shortage information: employment.gov.au/occupational-skill-shortages-information#health-and-social-assistance-occupations. Accessed 22 October 2013.


Workforce dynamics indicator

The workforce dynamics indicator is used to highlight aspects of the current workforce that may be of concern into the future. The workforce dynamics indicator was adapted from Health Workforce New Zealand’s (HWNZ) medical discipline vulnerability ranking method10, where a traffic light approach is used to score workforces against the selected indicators.

HWA selected the following indicators for scoring.

• Average age – workforces with a higher average age are more susceptible to higher exit rates (through retirement) with lower entry rates.

• Percentage aged 55 and over – this can be a useful indicator of those potentially retiring or reducing working hours within the next 10 years.

• Change in average hours worked – workforces with falling average weekly hours worked can be an indicator of sufficient workforce supply, or supply exceeding demand; while workforces with increasing hours of work can indicate supply pressures.

• Replacement rate – this item is designed to calculate the ratio of newly registered professionals to workforce exits in a given year. This indicates whether the number currently completing training is sufficient to replace those presently leaving the workforce.

• Dependence on internationally trained professionals (ITPs) – workforces with high percentages of ITPs are of greater concern due to their dependence on a less reliable supply stream (for example, changes in immigration policy may impact on supply).

• Duration of training program – the greater the duration of training, the longer it takes to train a replacement workforce.

The WDI provides a visual summary of the key dynamics of workforce recruitment, retention and retirement. They provide an easily understood presentation of health workforce planning information.

Workforce dynamic indicator assessment

NHWDS data was used to calculate the WDI, except for duration of training. For duration of training, the assessment is based on the shortest accredited training pathway to general registration. Given the maldistribution of the health workforce is one of the key findings across a number of HWA consultations, the WDI has also been calculated by remoteness area. This visually shows any differences in the characteristics of the employed optometrist workforce by remoteness area.

Table 29 shows the WDI assessment for employed optometrists by remoteness area. The value used to determine the WDI assessment is shown in the table, and shaded according to the assessment scale (table 30).

10 Prioritisation of Medical Disciplines for Funding by Health Workforce New Zealand. www.rnzcgp.org.nz. Accessed 3 May 2012


Table 29: optometrists – workforce dynamics indicators

Major cities

Inner regional


Very remote(a) Australia

Average age 40.8 42.3 43.7 42.9 40.5 41.2

Percentage aged 55+ 14.7 15.6 24.9 19.3 0.0 15.4

Change in average hours

0.0 0.6 0.5 2.9 -6.9 0.2

Replacement rate(b) not assessed

Dependence on ITPs 14.5 12.4 14.5 31.5 17.3 14.3

Duration of training (years)(c) 5 5 5 5 5 5

(a) Care should be taken when interpreting the figures for remote and very remote areas due to the relatively small number of employed practitioners who reported their location of main job in these regions.

(b) As the NHWDS is a longitudinal dataset, replacement rate will be able to be calculated in the future.(c) At time of publication, the minimum duration of programs with full accreditation is 5 years. A 3.5 year fast track program, offered by Deakin University, holds

conditional accreditation. n.a. not assessed.


Indicator range boundaries

The range boundaries for most indicators were selected as an extension of the HWNZ ranking method. In this development of the WDI, the ranges for each indicator were set to be relatively equal, rather than being established using a statistical base.

To be able to score against the WDIs, an extensive range of data is required. Where a score cannot be allocated due to insufficient data, the indicator is not assessed.

The indicators used are basic measures only – ideally as data availability improves, more sophisticated measures can be developed. Table 30 summarises the indicators and their score ranges.


Table 30: workforce dynamics indicators

Indicator Minimal concern Significant concern

Average age <40 40–44 45–49 50–54 55+

Percentage aged 55+ <20% 20% – <30% 30% – <40% 40% – <50% 50%+

Annual change in average hours

± <0.3 hrs ±(0.3 –<0.6) hrs ±(0.6 –<0.9) hrs ±(0.9 –<1.2) hrs ±1.2 hrs+

Replacement rate 95% – 105%90% – <95%

105% – <110%80% – <90%

110% – <120%70% – <90%

120% – <130%<70%130%+

Dependence on internationally trained professionals

<12% 12% – 24% 25% – 37% 37% – 49% 50%+

Duration of training <4 4 5 6 7+

How do optometrists compare with other registered health occupations?

Table 31 shows the key characteristics of those employed in registered health occupations using NHWDS data. Compared with the other workforces, the optometry workforce has:

• The approximate median average age (41.2 years) and median percentage aged 55 years and over (15.4 per cent) within the registered health occupations – with approximately half of the other occupations having values for these two characteristics above the optometry workforce’s, and half below.

• A relatively low percentage of females – optometry is one of the few registered occupations with less than half female.

• A slightly higher average weekly working hours than many of the other registered occupations.

• A geographic distribution consistent with most of the selected workforces.

Table 31: registered health occupations, WDI ratings and selected characteristics

WDI ratings(a) Other selected characteristics

OccupationAve. Age

% aged 55+

Annual change

in ave hrs(b)

Dependence on ITPs

Duration of

trainingNumber

employed

Average weekly

hours worked

% female(c)

Remoteness distribution(d)

Medical practitioner

46.0 26.6 -0.5 35.1 5 79,653 42.7 37.9 79: 13: 6: 1

Nurse(e) 44.6 23.1 n.a. n.a. 3 288,236 31.6 89.7 71: 18: 9: 2

Midwife(f) 49.5 34.9 n.a. n.a. 3 30,792 19.0 98.2 68: 19: 10: 3

Dentist 43.4 23.4 -0.3 28.5 5 13,266 37.0 36.5 80: 14: 6: <1

Dental therapist

46.4 20.4 0.2 7.5 3 1,117 29.4 96.9 63: 21: 13: 3

Dental hygienist

37.4 5.7 0.7 15.2 2 1,425 29.4 94.6 84: 10: 5: <1


WDI ratings(a) Other selected characteristics

OccupationAve. Age

% aged 55+

Annual change

in ave hrs(b)

Dependence on ITPs

Duration of

trainingNumber

employed

Average weekly

hours worked

% female(c)

Remoteness distribution(d)

Oral health therapist

31.0 1.9 1.0 1.7 3 675 33.7 84.7 71: 19: 9: 1

Dental prosthetist

49.1 31.3 0.0 5.9 4 1,100 42.7 14.7 73: 21: 6: <1

Aboriginal and Torres Strait Islander health practitioner

44.4 18.8 n.a. - 2 233 40.5 71.9 3: 4: 31: 61

Chiropractor 41.2 15.2 -0.2 14.4 5 4,029 33.3 34.8 75: 18: 6: <1

Medical radiation practitioner

39.1 14.7 n.a. 14.0 3 7,806 34.4 66.7 83: 13: 3: <1

Occupational therapist

36.8 8.0 n.a. 7.5 4 7,231 33.1 91.5 76: 19: 4: <1

Optometrist(g) 41.2 15.4 0.2 14.3 5 4,066 36.1 48.2 78: 16: 5: <1

Osteopath 38.8 13.2 -0.5 11.1 5 1,543 35.7 46.582: 15: n.p.:

n.p.

Pharmacist 39.7 16.7 0 12.7 5 21,331 35.9 58.2 76: 15: 7: 1

Physiotherapist 38.6 12.4 -0.3 14.5 4 20,081 34.2 68.8 80: 13: 5: 1

Podiatrist 37.6 8.2 -0.2 11.7 3 3,491 36.4 58.0 76: 17: 6: <1

Psychologist 45.6 26.9 -0.6 7.5 6 22,404 32.6 76.7 82: 12: 5: <1

Traditional Chinese medicine practitioner

47.0 28.5 n.a. 31.8 4 3,580 31.8 52.3 88: 9: 3: <1

n.a. not available. n.p. not publishable.(a) Replacement rate not included as this has not been assessed for any registered occupations at this point in time.(b) Aboriginal and Torres Strait Islander health practitioners, medical radiation practitioners, occupational therapists and traditional Chinese medicine practitioners

joined the NRAS from 1 July 2012, so NHWDS data not available for 2011 for these occupations. Therefore annual change in average hours worked was not calculated for these occupations.

(c) For osteopaths, optometrists, physiotherapists and podiatrists, calculated excluding those where gender not stated or inadequately described.(d) Percentage of workforce located in major cities : inner regional : outer regional : remote or very remote areas.(e) Includes registered and enrolled nurses plus dual registered nurses and midwives. The duration of training WDI indicator for nurses was based on registered nurse

training time. (f) Includes those registered as midwives only plus dual registered nurses and midwives.(g) For optometrists, the minimum duration of programs with full accreditation at time of publication is 5 years. A 3.5 year fast track program offered by Deakin

University holds conditional accreditation at time of publication.

Sources: NHWDS: medical practitioners 2011 and 2012, NHWDS: nurses and midwives 2012, NHWDS: dental practitioners 2011 and 2012, NHWDS: allied health practitioners, 2011 and 2012


What does the analysis show?

In terms of workforce characteristics, despite different collection methodologies, information from the three sources presented in this report (NHWDS, Census and the OAA) shows the optometry workforce:

• Has experienced substantial growth over the last fifteen years.

• Has different age and hours worked profiles for male and female optometrists.

• Is predominately located in major cities and eastern states.

The WDI assessment shows no real areas of concern for this workforce; most indicators are between the minimal concern range and the middle of the scale. The WDI assessment shows the annual change in average hours for optometrists working in remote and very remote areas is rated as significant concern. However very low numbers of optometrists reported their main job location in these areas, so the analysis needs to be treated with caution. Additionally, optometrists can provide services in regional areas through the Visiting Optometrists Scheme and through secondary practice locations, which is not currently shown in the NHWDS data. Despite this, the OAA highlighted the ability to offer optometry services to regional communities as a concern, along with the lack of a national program specifically addressing workforce distribution.

Both the NHWDS and Census data highlights consistent differences in the characteristics of male and female optometrists – with females having a younger age profile and working fewer hours. Census data also highlights the fall in male average weekly hours from 1996 to 2011 (4.3 hours) was the major contributor to the overall fall in average weekly hours over the same period (5.1 hours). However with greater numbers of females now entering the workforce, and working fewer hours, this may result in a continued reduction of working hours in future and a need to focus on flexible work practices.

The number of temporary and permanent visas granted between 2005-06 and 2012-13 indicates that immigration is not a significant supply source for the Australian optometry profession. This is supported by the NHWDS data, which shows that 85 per cent of employed optometrists obtained their first optometry qualification in Australia. Optometry’s inclusion on the skilled occupation list has not resulted in large numbers of optometrists migrating to Australia, and education within Australia remains the major supply source for the profession.

The impacts of recent changes within the education sector, notably the introduction of new optometry programs, is yet to be seen in the number of employed optometrists (the first cohorts to complete the Flinders University and Deakin University courses will graduate in 2014 and 2015 respectively). However, the impact of these new courses on student numbers can already be seen – with the number of students entering optometry courses almost doubling from 2011 to 2012. The increased student commencements will increase the need for clinical placements, and pressure on the ability of the optometry sector to provide clinical training was highlighted as an area of concern by the OAA. If the increased number of student commencements translate into greater numbers of graduates entering the workforce in the next five years, this will have impacts for the industry in terms of the availability of jobs at levels suited to graduates and early career optometrists.


Appendix one – Optometrists by Medicare Local regions

Table 32 shows the number of employed optometrists per 100,000 population across all Medicare Local regions. Data in this table shows the number of optometrists per 100,000 population working in the relevant Medicare Local region, and provides a useful refection of the geographical distribution of optometrists – it does not reflect optometrists employed by Medicare Local organisations.

Table 32: number of employed optometrists per 100,000 population by Medicare Local regions, 2012

Medicare Local State/Territory Rate Area (km2)

Eastern Sydney NSW 61.0 106

Inner North West Melbourne VIC 48.1 149

Metro North Brisbane QLD 28.0 3,999

Sydney North Shore and Beaches NSW 27.2 307

Northern Sydney NSW 25.2 592

Perth Central and East Metro WA 23.8 2,149

Inner East Melbourne VIC 23.1 319

South Eastern Sydney NSW 21.1 400

Bayside VIC 20.9 215

Central Adelaide and Hills SA 20.7 1,657

Inner West Sydney NSW 19.0 126

Barwon VIC 18.2 7,913

Australian Capital Territory ACT 18.1 2,352

Gold Coast QLD 18.0 1,843

Sunshine Coast QLD 17.5 9,968

Greater Metro South Brisbane QLD 17.4 3,775

Tasmania TAS 17.0 68,018

Western Sydney NSW 16.9 775

North Coast NSW NSW 16.9 32,767

Wide Bay QLD 16.8 36,974

Gippsland VIC 16.4 41,557

Lower Murray VIC 16.4 75,172

Eastern Melbourne VIC 16.3 2,641



Loddon - Mallee - Murray VIC 16.0 49,202

Western NSW NSW 16.0 117,845

Fremantle WA 15.8 243

Darling Downs - South West Queensland QLD 15.8 407,815

South Western Sydney NSW 15.7 6,241

Goulburn Valley VIC 15.3 16,519

Central Coast NSW NSW 15.1 1,680

Perth North Metro WA 14.9 880

Grampians VIC 14.8 47,885

Illawarra - Shoalhaven NSW 14.7 5,687

Northern Melbourne VIC 14.5 1,304

Southern Adelaide - Fleurieu - Kangaroo Island SA 14.4 8,027

New England NSW 14.2 98,905

Frankston - Mornington Peninsula VIC 13.8 854

Great South Coast VIC 13.8 22,885

Hunter NSW 13.7 32,747

Far North Queensland QLD 13.5 270,956

West Moreton - Oxley QLD 13.5 9,596

South Eastern Melbourne VIC 13.4 1,821

Hume VIC 12.9 39,200

Northern Territory NT 12.8 1,348,190

Nepean - Blue Mountains NSW 12.2 9,122

Townsville - Mackay QLD 12.2 239,180

Murrumbidgee NSW 11.8 89,471

Perth South Coastal WA 11.5 3,093

Northern Adelaide SA 11.4 1,605

South West WA WA 11.0 219,939

Macedon Ranges and North Western Melbourne VIC 10.5 3,275

Central Queensland QLD 10.2 110,959



Country North SA SA 10.1 903,379

Bentley - Armadale WA 10.0 1,734

Goldfields - Midwest WA 10.0 1,373,296

Country South SA SA 9.7 69,522

Southern NSW NSW 9.6 4,534

South Western Melbourne VIC 9.3 606

Central and North West Queensland QLD 8.9 634,891

Kimberley - Pilbara WA 6.9 925,390

Far West NSW NSW 5.2 275,512

Source: NHWDS allied health practitioners 2012


Enquiries concerning this report and its reproduction should be directed to:

Health Workforce Australia Post | GPO Box 2098, Adelaide SA 5001Telephone | 1800 707 351 Email | [email protected] Internet | www.hwa.gov.au

© Health Workforce Australia 2014HWA14IAP001.3 Published March 2014ISBN: 978-1-925070-15-6

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