Adams et al. BMC Health Services Research (2018) 18:352 https://doi.org/10.1186/s12913-018-3158-y RESEARCH ARTICLE Open Access A workforce survey of Australian osteopathy: analysis of a nationally- representative sample of osteopaths from the Osteopathy Research and Innovation Network (ORION) project Jon Adams* , David Sibbritt, Amie Steel and Wenbo Peng Abstract Background: Limited information is available regarding the profile and clinical practice characteristics of the osteopathy workforce in Australia. This paper reports such information by analysing data from a nationally- representative sample of Australian osteopaths. Methods: Data was obtained from a workforce survey of Australian osteopathy, investigating the characteristics of the practitioner, their practice, clinical management features and perceptions regarding research. The survey questionnaire was distributed to all registered osteopaths across Australia in 2016 as part of the Osteopathy Research and Innovation Network (ORION) project. Results: A total of 992 Australian osteopaths participated in this study representing a response rate of 49.1%. The average age of the participants was 38.0 years with 58.1% being female and the majority holding a Bachelor or higher degree qualification related to the osteopathy professional. Approximately 80.0% of the osteopaths were practicing in an urban area, with most osteopaths working in multi-practitioner locations, having referral relationships with a range of health care practitioners, managing patients a number of musculoskeletal disorders, and providing multi-model treatment options. Conclusions: A total of 3.9 million patients were estimated to consult with osteopaths every year and an average of approximate 3.0 million hours were spent delivering osteopathy services per year. Further research is required to provide rich, in-depth examination regarding a range of osteopathy workforce issues which will help ensure safe, effective patient care to all receiving and providing treatments as part of the broader Australian health system. Keywords: Osteopath, Osteopathy, Workforce, Practice-based research network Background countries with statutory regulation of osteopathy, there Osteopathy, with an emphasis on whole person care, is are two professional streams in the field of osteopathy – a health care system integrating physical examinations ‘osteopathic physicians’ in the US exclusively and ‘osteo- and manipulative treatments for a range of conditions paths’ in other countries [4]. Osteopathic physicians are [1–3]. Osteopathy has been developed in more than 50 qualified physicians with full medical practice rights countries and has been regulated in at least 15 coun- throughout the US and can perform surgery, while, out- tries, including US, UK, and Australia [4]. Amongst the side of the US, osteopaths are healthcare providers with practice rights who are not licensed to prescribe medica- * Correspondence: [email protected] tions or perform surgery [5]. As a government registered Australian Research Centre in Complementary and Integrative Medicine allied health profession in Australia, most private health (ARCCIM), Faculty of Health, University of Technology Sydney, Level 8, insurers provide partial reimbursement for osteopathic Building 10, 235-253 Jones St, Sydney, NSW 2007, Australia © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Adams et al. BMC Health Services Research (2018) 18:352 Page 2 of 7 services [6]. It is worth noting that Australian osteo- osteopaths in Australia. The invitation pack was dis- paths do provide a service under the government’s tributed to all registered osteopaths via OA networks Medicare Chronic Disease Management Plan [7]. The for OA members and via osteopathy-related confer- Australian osteopathic workforce continues to grow, ences/events and the ORION website for non-OA with 2115 registered practicing osteopaths in 2016, members. Participants were directed to the ORION compared to 1601 registered practicing osteopaths in website (containing the online practitioner questionnaire) 2012 [8]. National-scale studies have estimated that, and recruitment emails enclosed embedded links directly within a 12-month period, osteopaths provided 3.1 mil- to the questionnaire. Several email reminders were circu- lion patient consultations in Australia in 2005 and 3.4 lated following the initial invitation pack. The ORION million patient consultations in the US in 2006 [9, 10]. project is designed and conducted by senior researchers at Previous osteopathy workforce studies have largely the Faculty of Health, University of Technology Sydney examined educational issues [11, 12], treatment efficacy independent of OA who funded the project. This project for a number of musculoskeletal conditions [13, 14], and has been approved by the UTS Human Ethics Committee osteopathy use amongst either general populations or (approval # 2014000759). clinical subgroups across a range of countries including Participants were invited to complete the online prac- Australia [10, 15]. In addition to the online health work- titioner questionnaire and provide consent to be an force dataset (including osteopathy) (16), only three pre- ongoing member of the ORION PBRN project. The vious studies have examined the profile of Australian analyses presented in this article report data gathered osteopaths [16–18] and unfortunately all have been lim- from all participants who completed the questionnaire ited in sample size and/or sample focus. One such study regardless of whether the participant provided consent undertaken in 2004 restricted data collection to mem- or did not provide consent to be an ongoing member of bers of an osteopathy association [16], another 2010 the ORION PBRN database. study recruited only 54 osteopaths [17], and a third study conducted in 2012 only reported on the profile of Questionnaire osteopaths exiting practice [18]. As such, there is a sig- A questionnaire with 27 items was administered to nificant lack of analyses regarding the profile and clinical registered osteopaths in Australia (Additional file 1). practice characteristics of Australian osteopaths. The questionnaire examined osteopathic practitioner In direct response, this paper aims to provide an in- characteristics, practice characteristics, clinical manage- depth exploration of the practitioner and practice ment, and research engagement. Participants were ques- characteristics as well as the clinical practice manage- tioned about their age, gender, highest osteopathy ment characteristics of Australian osteopaths from a professional qualification, years in private osteopathy nationally-representative sample recruited as part of a practice, professional organization membership, and practice-based research network (PBRN) project. A roles they have been involved in as an osteopath in the PBRN refers to a collaboration of practitioners and previous 12 months. With regards to practice character- practices together with professional academic institu- istics the participants were questioned regarding their tions to facilitate research studies designed for answering average patient care hours per week, average patient clinical questions and to help translate research findings visits per week, number of practice locations, other into daily patient care (https://pbrn.ahrq.gov/). Therefore, health professionals working in the same practice loca- results reported here also provide sustainable opportun- tion, professional referral relationships (sending and re- ities for further nested sub-studies focusing upon the ceiving referrals separately), State/Territory of practice, efficacy and health services use of osteopathy practices. practice location (urban, rural, remote), use of diagnostic imaging and reason(s), techniques used to assist in clin- Methods ical diagnosis, use of electronic records and specified Recruitment and distribution software(s) for electronic records, and frequency of using The Osteopathy Research and Innovation Network eHealth system, HICAPs and Medicare Easyclaim. (ORION) project is the first national PBRN of osteopaths Osteopathic clinical management measures consisted of in Australia (http://www.orion-arccim.com/) and the re- the frequency of discussion with patients in their care/ cruitment of this project was conducted from July to management plan such as diet/nutrition, physical activity/ December 2016. The ORION recruitment invitation pack fitness, and medication, frequency of treating patients with included an online practitioner questionnaire (accessed a broad range of conditions (including musculoskeletal via SurveyGizmo™) as well as a consent form relating to disorders and non-musculoskeletal disorders), broader pa- joining the ORION PBRN database. tient subgroups (such as older people, people with sports- Osteopathy Australia (OA) is a national professional related injuries, and people with work-related injuries) of organization representing more than 85% of registered