Why placement poverty is a worry for the future workforce

Researchers from the University of Wollongong (UOW) are calling for impactful measures like greater access to scholarships and grants to reduce the financial burden caused by mandatory placements while students are completing their degrees.

Professional placements are a requirement for students in medicine, health and education-related fields with most of those who undertake unpaid placements experiencing ‘placement poverty’. This refers to the financial burden experienced due to compulsory training. 

Unpaid placement hours vary between fields, from 420 hours for postgraduate teaching, 700 hours for physiotherapy, 1,000 hours minimum in occupational therapy and psychology, and more than 2,300 hours in medicine. Nursing students must complete at least 800 hours of clinical placement which can include residential aged care. 

Dr Kelly Lambert, from UOW’s School of Medical, Indigenous and Health Sciences, led the project which was the first time researchers had sought to quantify the impact of placement on student wellbeing in the post-COVID-19 landscape. The research also examined the differences between health and education professions.

Dr Lambert said the urgency of the issue was exacerbated by the cost-of-living crisis.

“The study highlights that all students need support. There is a societal perspective that only nursing and teaching students are required to undertake placements, but it is much broader than that, particularly in the health professions,” Dr Lambert said. 

“We heard stories of students working 50 hours a week to save for their placements, on top of a full study load. Or students juggling full-time jobs on top of the full-time job of a placement.

“Burnout is very real and it has implications for the workforce. The known financial strain of professional placement may discourage students from entering these vital professions.”

The research found that health students had higher total costs for their placements, averaging $1,500. 

One medical student told the researchers that the burden of unpaid placements was too much on top of high study loads and personal responsibilities.  

“Medicine is a full-time gig and l am a high achieving student. But instead of my afternoons being a time of study they are filled with work to try and make ends meet.”

Food insecurity was also experienced by 70% of students, highlighting the real-world cost of poverty placement. Meanwhile, close to 50% relied on family or government support.

Students would often seek out placements that were better suited to their financial means rather than desired learning opportunities which could see key aged care placements ignored. Conversely, 60% said they had no chance to choose their placement location regardless of affordability. 

As part of the study, the students suggested several strategies to alleviate the impact of poverty placement. 

These included part-time placement options, flexibility for those with children, financial counselling, greater support for rural placements, access to emergency funds, subsidised parking for hospital placements, subsidised uniforms, financial counselling, discounted accommodation, access to bulk-billed medical care and counselling, and tools to recognise and manage burnout.

The proposed strategies outlined the practical, financial, academic, and well-being steps that could be taken to improve graduate outcomes and ensure that students do not begin their careers in these fields on the back foot.

A greater number of scholarships would also improve outcomes. The study found that only 10% of health students received a scholarship to help with the costs of placement.

Earlier this year, the government announced the introduction of the Commonwealth Prac Payment as part of its 2024 Budget. It will be available for nursing, teaching, midwifery, and social work students and will come into effect from July 2025.

Eligible students undertaking a mandatory placement can access $319.50 per week with the rate benchmarked to the single Austudy rate. 

Dr Anne McMahon, Senior Lecturer in UOW’s School of Medical, Indigenous and Health Sciences and co-author of the study, said the financial burden of unpaid, mandatory placement was a driving force of inequity among students and it would ultimately lead to a lack of diversity in the health and teaching professions.

“The fundamental diversity in our society will not be reflected in our professional groups in every discipline that requires placements as they cannot force their way through without an insane amount of personal and well-being cost,” Dr McMahon said.

“Our research showed that single parents, students with children, people living with a disability or from a lower socioeconomic background are less likely to begin and finish degrees that require mandatory professional placements.”

Dr Lambert said more must be done to attract students to health and education, professions that underpin society.

“Health and teaching are crying out for graduates, so why do we not reduce the financial and emotional burden of poverty placement in these disciplines?”

You can access the full report, Placement poverty has major implications for the future health and education workforce: a cross-sectional survey, here.