Date Presented 04/06/19
A survey of 225 OT practitioners living in rural states explored practice patterns and influences on employment choice. Rural and urban practitioner differences were noted in variability of hours spent working, number of work locations, and time spent in fieldwork education. Rural practice choice was influenced by fieldwork participation but not loan debt. Findings support the value of rural exposure in the curriculum and customized rural fieldwork educator support.
Primary Author and Speaker: Debra Hanson
Additional Authors and Speakers: Janet Jedlicka, Marilyn Klug, Nicole Harris
PURPOSE: The purpose of this study is to understand the practice patterns of occupational therapy practitioners in the rural states of North Dakota and Wyoming and the influence of the college experience, including fieldwork experience and loan debt on practice choice. Rural settings in the United States and other countries have a sparse distribution of OT practitioners, usually clustering in more urban/suburban areas (Playford, Larson & Wheatland, 2006). There is limited information about the nature of occupational therapy practice in rural versus urban areas and much of what is known comes from literature outside of the United States (Roots & Li, 2013). Australian and Canadian studies support the positive impact of undergraduate rural exposure to improving students’ perceptions towards and decisions to work in rural practice (Roots & Li, 2013; Winn, Chisolm & Hummelbrunner, 2014). Loan debt repayment has been found to influence the recruitment of healthcare providers to practice in rural practice areas, (Daniels, Vanleit, Skipper, Sanders & Rhyne, 2007) but the specific impact of loan debt and fieldwork experience on occupational therapy recruitment to rural areas in the US is unexplored.
DESIGN: A descriptive research design with cohort comparisons was employed to survey OT and OTA practitioners in ND and Wyoming. An initial email invitation was sent to all licensed OT practitioners in Wyoming (n = 515) and North Dakota (n = 735), followed up by invitations issued through program directors of OT and OTA programs within the states and through personal invitation at the ND and WY state conferences.
METHOD: A qualtrics survey including a total of 19 questions exploring background/demographic information, employment descriptions, educational and professional development experiences was piloted with 8 participants and then modified before it was emailed to licensed practitioners. Educational experiences were tested for association with rural status using chi-square analysis. A one-way Analysis of Variance (ANOVA) and independent t-tests were used to compare hours per week and percent patient care between urban, large rural and small/isolated rural areas. A non-parametric Kruskal-Wallis Chi-Square was used to test for distribution differences between rural status.
RESULTS: Findings show that rural practitioners have greater variability of hours spent working (5.5 more hours per week, p=.028), and one more work location on average (p=.006). Therapists in urban settings spent 15% more time in fieldwork education than their rural counterparts (p=.021). Rural practice choice was influenced by participation in Level I and Level II fieldwork (p=.002) but not by loan debt.
CONCLUSION: Findings have important implications for academic programs and rural employers. Given the variability of rural practice, academic programs are advised to prepare students by focusing on multiple areas of practice in the curriculum design, and frequent exposure to rural practitioners/rural practice examples/experiences. The positive influence of fieldwork juxtaposed with less time spent in the rural fieldwork educator role suggest that rural fieldwork educator recruitment include exploration of the benefits and drawbacks to rural fieldwork placement. In view of rural practice variability, educators are advised to collaborate with fieldwork educators and their rural employers to develop focal points for student learning in the level I and II fieldwork experience.
References
Daniels, Z.M., Vanleit, B.J., Skipper, B.J., Sanders, M.L., Rhyne, R.L. (2007). Factors in recruiting and retaining health professionals for rural practice. Journal of Rural Health, 23, 62 – 71.
Playford, D., Larson, A., & Wheatland, B. (2006). Going country: Rural student placement factors associated with future rural employment in nursing and allied health. Australian Journal of Rural Health, 14, 14-19.
Roots, R., & Li, L. (2013). Recruitment and retention of occupational therapists and physiotherapists in rural regions: A meta-synthesis. BMCV Health Services Research, 13, 59.
Winn, C. S., Chisolm, B. A., & Hummelbrunner, J. A. (2014). Factors affecting recruitment and retention of rehabilitation professionals in Northern Ontario, Canada: A cross-sectional study. Rural and Remote Health, 14, 2619-2626.
