ReviewRegistration factors that limit international mobility of people holding physiotherapy qualifications: A systematic review
Introduction
The past decade has seen a rapid increase in global health workforce migration [1], including rising migration amongst physiotherapists [2]. The World Confederation for Physical Therapy (WCPT), the sole international voice for physiotherapy, recognises 111 member organisation countries in which physiotherapy is practiced. While both the WCPT and International Labour Organization have provided guidelines around the definition of physiotherapy, adherance to these guidelines are not enforced and are not a requirement of being a WCPT member [3], [4]. As a result, physiotherapists from one country are not necessarily the same as physiotherapists from another country, with potential variation in education, scope of practice, and professional title [5]. For the purpose of this review, the term physiotherapy will encompass all terms used to describe the professions represented by the WCPT and defined as professionals who provide services to maximise movement and functional ability [4].
Recent migration has been driven by an increase in globalisation, coupled with an undersupply of human resources for delivering health services [6]. It should be noted that the World Health Organization (WHO) discourages the recruitment of health personnel from countries with workforce shortages, and rather, places an emphasis on sustainability through staff retention and workforce planning [7], [8]. When conducted in a responsible manner, skilled migration is not only useful for meeting workforce shortages, but also distributes knowledge and increases per capita productivity [9], [10], [11]. Skilled migration is an attractive proposition for many health workers, and may present new job opportunities, higher wages, and increased professional recognition [10]. In addition to career and economic incentives, other influences include social, political, and environmental factors. These are often referred to as ‘push and pull’ factors, and have been extensively studied [10], [12], [13].
In the absence of internationally recognised standards, professional regulation by local regulatory authorities should aim to protect the public through maintaining standards of care [14]. Regulation is characterised by four key elements – registration, standards of professional competence or proficiency, standards of education and accreditation processes, and standards of professional ethics and conduct [15]. Registration refers to being placed on a list of suitably qualified individuals who are permitted to use the physiotherapy professional title and perform physiotherapy specific duties [14]. The process for obtaining registration may include an assessment of professional competence, either through an evaluation of formal education documents or direct assessment using examinations. When combined with standards of ethics and conduct, this process should determine ‘fitness to practice’, defined by Parker [16] as clinical competence, acceptable professional behaviour, and freedom from impairment.
While sensible, the WCPT notes with concern that some of these processes appear to limit worldwide professional mobility [17]. The lack of understanding and authority on the international regulation of physiotherapy has led to the recent inception of the International Network of Physiotherapy Regulatory Authorities (INPTRA). The INPTRA aims to facilitate international cooperation and collaboration, furthering understanding of regulatory systems in physiotherapy [18]. In their 2015 report, ‘Rethinking Regulation’, the Professional Standards Authority admits that despite best efforts, current health regulatory processes in the United Kingdom are increasingly unfit to deal with modern regulation issues [19]. The report identifies the lack of a proper mechanism for assessing regulation needs and risks as contributing to the development of multiple, overly-complex layers of regulation which have become inefficient and wasteful. Despite this rising cost, there is little evidence for the effectiveness or impact of these regulatory processes [20]. Ineffective and inefficient registration processes not only pose a threat to regulatory bodies, but may also result in additional financial, psychic, and time costs borne by migrating physiotherapists, creating potential barriers to global workforce mobility. Thus, in order to better understand the registration process, and how it may limit workforce mobility, this systematic review was conducted.
The research question was: “What is known about the professional registration factors that may limit the international mobility of people holding physiotherapy qualifications?”
Section snippets
Inclusion and exclusion criteria
Any peer reviewed article, or website, or document found on a website, that referred to processes applied to the registration of international physiotherapists, was eligible for inclusion in the review. Reports that dealt only with student mobility were excluded, as student specific requirements differ from requirements for those holding full qualifications.
For currency, we excluded reports published before 1995. This was the year the WCPT began to facilitate the movement of physiotherapists
Flow of studies through the review
A total of 819 articles were identified from the initial database search. After deletion of duplicates and screening based on title and abstract, 22 articles were read in full. Seven articles met the inclusion criteria [2], [18], [23], [24], [25], [26], [27]. From the search of the WCPT and INPTRA websites, respectively, one article [28] and two articles [15], [29] were included. Through the subsequent snowballing strategy, an additional eight websites were included, see Table 2 for a summary
Discussion
Consideration of context of practice, recognition of a substantially equivalent qualification, and verification of fitness to practice are components of the registration process designed to protect the public. These features of the registration process are inextricably linked, and together, should limit the mobility of physiotherapists who do not meet local standards of practice. Shortcomings in any one of these three areas may negatively impact service delivery, posing a potential risk to the
Conclusion
Registration plays an essential role in the protection of the public. Migrating physiotherapists must be able to meet the required competencies in destination countries, as well as be able to apply these competencies in a new practice context. However, further research is required to determine whether these processes are operating effectively and efficiently, without placing undue burden on regulatory systems and migrating physiotherapists. Due to the nature of the registration process, there
Ethics approval
Not applicable as systematic review of published data.
Conflict of interest
The authors report no conflict of interest arising from this paper.
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