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| ORIGINAL ARTICLE |
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| Year : 2019 | Volume
: 51
| Issue : 2 | Page : 45-51 |
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Occupational therapy workforce in India: A National survey
Karthik Mani1, Savitha Sundar2
1 External and Regulatory Affairs, NBCOT Inc., Gaithersburg, MD, USA
2 Santa Clara County Office of Education and Prime Rehab, San Jose, California, USA
| Date of Submission | 27-Feb-2019 |
| Date of Acceptance | 23-Mar-2019 |
| Date of Web Publication | 28-May-2019 |
Correspondence Address:
Dr. Karthik Mani
335, West Side Drive, Gaithersburg, MD 20878
USA
 Source of Support: None, Conflict of Interest: None  | 8 |
DOI: 10.4103/ijoth.ijoth_1_19
Background: Workforce data offer critical information to thrust a profession forward. The insights generated through workforce data provide foundations for benchmarking and advocacy initiatives pertaining to a given profession. Periodic salary surveys help professionals monitor trends and gauge the growth of their profession. Objectives: To determine the average compensation of occupational therapy practitioners in India and benchmark the profession's growth against 2015 workforce data. Study Design: The survey research design was used to conduct this study. Methods: The electronic survey used in 2015 salary survey study was modified and sent via e-mail and social media to Indian occupational therapy practitioners identified through convenience and snowball sampling. Data were collected from October 1, 2018, to October 27, 2018. Results: The number of responses received was 191. The average salary range of full-time OT practitioners in India was 35,001–45,000 Indian National Rupee/month. Gender, job title, level of OT education, practice area, years of experience, and geographical region influence the compensation received by OT practitioners in India. The profession has demonstrated a notable growth in multiple fronts. Conclusions: Occupational therapy in India is in growth trajectory. This workforce study points to the continuing demand for occupational therapists in India. Further, in-depth exploration is recommended.
Keywords: Benchmarking, Employment, Fringe Benefits, Occupational Therapists, Salary, Surveys and Questionnaires
How to cite this article:
Mani K, Sundar S. Occupational therapy workforce in India: A National survey. Indian J Occup Ther 2019;51:45-51 |
| Introduction | |  |
Workforce trends and compensation data offer critical information that helps professionals make informed career decisions.[1] They assist executives and human resource professionals of both start-up and established organizations in making business and recruitment decisions.[2] Further, workforce data provide key reference points for benchmarking.[3]
The occupational therapy (OT) profession in India, despite 68 years of existence, has gained momentum only in the recent years with increasing number of OT educational programs and practice settings. With more professionals entering the workforce, knowledge of compensation becomes crucial not only to negate salary discriminations but also to advance the profession in multiple fronts. The first workforce survey targeting occupational therapists (OTs) in India was conducted in 2015.[4] As periodic workforce surveys help professionals analyze and spot trends,[5] this study was conducted as a follow-up study to determine the current average compensation received by OTs in India and benchmark the status of the profession against the findings of the previous study.
| Methods | | |
This study was conducted adhering to the principles of Declaration of Helsinki guidelines. The guidelines were reviewed before the survey being sent to the participants. In addition, the survey invitation that was sent to and shared with participants clearly identified that participation in the survey was “strictly voluntary and the responses will be kept anonymous.”
Sample
The study's targeted population was OT practitioners in India. The participants of this study were identified through convenience and snowball sampling. The authors found 450 e-mail addresses belonging to OT practitioners in India through their e-mail archives. The possibility of two or more e-mail addresses belonging to the same practitioner cannot be ruled out. Further, the survey invitation was also shared on four different WhatsApp groups of Indian OT practitioners and with randomly selected practitioners via Facebook Messenger to achieve national representation. The practitioners who received the invitation via Facebook Messenger were found from authors' Facebook friends/networks. In addition, the authors communicated (e-mail/text message) with a few Indian OT professionals and requested them to share the survey link within their OT networks.
Instrumentation
The survey tool that was developed and used in the 2015 salary survey study was modified and used in this study [Appendix 1]. The following changes were made to the original survey tool based on anecdotal evidence. First, response options of the item on the salary range were revised. The lowest salary range was changed from <10,000 INR” to <15,000 INR” and the highest range was changed from >40,001 INR” to >65,001 INR.” Second, the item that requested participants' age range was replaced with the item on primary area of practice. This change was made since the “age range data” did not yield any meaningful finding and lack of information related to practice area was deemed as a limitation in the previous study. Third, the stem of the item that inquired the years of work experience was rephrased to reflect the years of experience in the field of OT rather than in the current position. Finally, the item that requested the respondents to identify their primary practice setting permitted the respondents to select only one response. The original survey tool allowed multiple selections.
Procedure
The survey was conducted through SurveyMonkey™.[6] In October 2018, all identified participants were sent an e-mail invitation to participate in the survey. The survey link was also shared via social media channels (Facebook Messenger and WhatsApp groups) with October 27, 2018, as the response deadline. Four reminder e-mails were sent to 450 e-mail addresses during the open survey period.[7] The reminder e-mail message with the link was also posted on the WhatsApp groups. However, those who received the survey invitation via Facebook Messenger did not receive the reminders. It is important to note that the survey invitation was sent via Facebook Messenger over several weeks, and hence, the recipients may not have had the same survey response period as other recipients. At the end of survey response period, all data were exported and tabulated for statistical analysis.
Data Analysis
The average compensation range was identified by calculating the median. Chi-square analyses were used to determine the association between salary and workforce variables. When Chi-square tests yielded significant results (P< 0.05), odds ratio (OR) analyses and/or examination of percentage values were performed to determine the direction of association. All analyses were conducted using Microsoft Excel. During the Chi-square and OR analyses, the frequency data were merged to create categories as appropriate. Further, during the analysis, job titles identified by the respondents were grouped into clinical titles (occupational therapist, senior occupational therapist, etc.,), academic titles (lecturer, assistant professor, etc.,), and management titles (director, manager, etc.) [Table 1]. Similarly, the states identified by the respondents were grouped into zones based on the administrative zonal classification system identified in the State Reorganization Act of 1956.[8] Data are reported as percentages and aggregate numbers to protect the identity of respondents.
| Results | | |
By the response deadline, 191 responses were received. Of 191 respondents, 52% (n = 99) were female OTs and 48% (n = 92) were male OTs; 83% (n = 158) work full-time and 17% work part-time (n = 33); 77% (n = 148) work in practice settings located in urban areas, 17% (n = 32) work in practice settings located in suburban areas, and 6% (n = 11) work in rural areas. Forty-three percent (n = 82) of the respondents reported that they are in the field of OT for > 10 years, 28% (n = 53) reported 5–10 years, 19% reported 2–5 years (n = 36), 5% reported 1–2 years (n = 9), and 6% (n = 11) reported <1 year.
Respondents identified themselves with a variety of job titles. The most common titles identified by the respondents were “occupational therapist” (n = 98), senior occupational therapist (n = 23), and consultant occupational therapist (n = 16). Outpatient clinic, special school/school, and subacute rehabilitation center were the top three practice settings identified by the respondents. [Figure 1] presents the practice settings of the respondents.
The survey yielded more responses from Tamil Nadu (TN, 42%; n = 81), Delhi–National Capital Region (Delhi-NCR, 20%; n = 38), and Karnataka (KA, 9%; n = 17). Only 12 responses were received from Maharashtra (MH). [Figure 2] identifies the number of responses by states and union territories (UTs). The survey failed to generate responses from 13 states and four UTs. In response to the item on highest level of OT education attained, 1% (n = 2) reported that they have a diploma, 47% (n = 89) reported a baccalaureate level degree, 48% (n = 92) reported a master's level degree, and 4% (n = 8) indicated that they attained doctoral level education.
Pediatrics was identified as the primary practice area by most respondents (72%; n = 137). Thirteen percent (n = 25) of the respondents indicated their primary practice area as neurology, 7% (n = 13) indicated mental health, and 6% (n = 11) indicated orthopedics. Geriatrics and oncology were identified as the primary practice area by one respondent each. Three respondents chose the “other” option and identified public health, rehabilitation, and burns/plastic surgery as their primary area of practice.
The monthly salary of OTs in India ranges from <15,000 Indian National Rupee (INR) to >65,001 INR. Of 191 respondents, 6% (n = 12) reported their monthly income as <15,000 INR, 16% (n = 30) reported 15,001–25,000 INR, 22% (n = 42) reported 25,001–35,000 INR, 21% (n = 40) reported 35,001–45,000 INR, 10% (n = 20) reported 45,001–55,000 INR, 6% (n = 11) reported 55,001–65,000 INR, and 19% (n = 36) 2 reported >65,001 INR.
| Discussion | | |
The results estimated the monthly median salary range as 35,001–45,000 INR for full-time practitioners [Figure 3] and 25,001–35,000 INR for part-time practitioners. The monthly median salary has increased notably (almost 60%) since 2015 as the previous study identified the median salary range as 20,000–30,000 INR.[4] There is also a 1% increase in the number of full-time practitioners since 2015.
The results indicate that OTs in India continue to earn slightly more than other allied health professionals such as physiotherapists and staff nurses and less than physicians.[9],[10],[11] However, it is important to note that the upper end of the median salary range identified in this study falls only 10% short of the average salary reported for general physicians in India. Caution must be exerted when interpreting these comparisons as different sources report different numbers as the average salary of a given healthcare profession.[12] The identified median salary range of full-time practitioners also aligns with the pay band 2 of the seventh Central Pay Commission of India.[4],[13]
The compensation received by OTs in India was influenced by several factors such as gender, job title, practice area, years of work experience, geographical region, location of practice setting, and highest degree held within the profession. The following section examines these influences while comparing the data pertaining to these variables with that of the previous study to spot trends.
Workforce Trends
Gender
The male-to-female ratio of respondents in this study is 1:1.08, compared with 1:1.17 in 2015. It appears like India continues to produce more male OTs in a globally female dominated profession.[14],[15] Data analysis examining the association between the gender and salary revealed a statistically significant association (χ2 P = 0.0012) revealing a gender–wage gap. Further examination of the percentage values indicated that the female gender was associated with low salary ranges. This finding aligns with the general trend prevailing in India and within the OT profession in other countries.[14],[16] Some of the reasons behind the gender–pay gap could be the perceived low bargaining power of women and their preference toward less competitive jobs so that they can fulfill their family responsibilities (domestic chores, child care, etc.,) per cultural expectations.
Job titles
The comparative analysis of job title categories with the 2015 data showed a 6% increase in academic titles and 1% increase in management titles. The statistical analysis revealed a significant association between job title categories and salary (χ2 P = 0.0061). The OR analysis confirmed that respondents with clinical job titles reported a higher salary range than the ones with academic/management titles (OR: 2.84; 95% confidence interval [CI]: 1.32, 6.12). This finding is in contrast with the findings reported in the United States workforce surveys.[14],[17] One could also interpret this finding as the increase in demand for clinicians over the years as increase in wages is typically associated with increasing demand for workforce. However, any interpretations related to this finding must be made with caution as this survey did not yield information about other benefits such as bonus, allowances, leave, and flexibility in hours.
Practice setting
More than half of the respondents worked at one of the three primary settings: 21% worked at outpatient clinics, according to the 2018 results, compared with 20% in 2015; 17% worked at schools, down from 29% in 2015; and 17% worked at subacute rehabilitation centers, down from down from 29% in 2015. Although special school/school and subacute rehabilitation center continue to remain as two of the top three practice settings of respondents in 2015 and 2018, it is evident from the current data that these settings suffered a 12% decline. The current data also indicated a decline in the number of practitioners in acute-care settings (down by 7%), nongovernmental organizations (down by 5%), and home health/private practice (down by 17.5%) since 2015.
These findings indicate the increased preponderance toward outpatient clinic and decreased proclivity toward home care/private practice among OTs in India. Although Chi-square analysis did not reveal significant association between the variables, the obtained P value was very close to the level of significance (χ2 P = 0.0602).
Geographical region
The data indicate that TN, Delhi-NCR, KA, and MH continue to be the four states/UTs with more number of OT practitioners when compared to other parts of India. However, the current study yielded less responses from MH (down by 11.5%) and KA (down by 3%) and more responses from TN (up by 22%) and Delhi-NCR (up by 9%) than the previous study. This could be due to sampling bias. Both the authors were from TN and identified participants who received the survey invitation via e-mail from their e-mail archives. Further, the e-mail recipients also received multiple survey reminders.
Statistical analyses that attempted to determine the association between geographical region and salary revealed some interesting trends. Due to low frequency values, Central, East, and West Zones were merged into “other zones” during the analyses. [Table 2] presents the various analyses. The findings suggest that practitioners in North Zone earn relatively more than their counterparts in other regions. One possible reason behind this finding could be the relatively higher cost of living associated with living in the Delhi-NCR region.[18] Another reason could be the equal proportion of male and female practitioners in the North Zone than the South Zone. | Table 2: Geographical Region Versus Salary of Occupational Therapists in India
Click here to view |
Location of practice setting
The data indicate that the percentage of practitioners in rural areas continues to remain at 6% in 2018. However, the percentage of practitioners in urban areas rose by 6%, from 71% in 2015 to 77% in 2018, with a corresponding decline in the percentage of practitioners in suburban areas. This could be due to the rise of urbanization in India.[19] Surprisingly, the statistical analysis did not identify a significant association between the location of practice setting and salary (χ2 P = 0.197).
Years of work experience
The current data show more experienced practitioners in India with 70% of the respondents reporting >5 years of experience. In the current study, 43% of respondents reported that they have >10 years of work experience, up from 10% in 2015; 28% reported 5–10 years of experience, up from 16% in 2015; 19% reported 2–5 years of experience, down from 29%; 5% reported 1–2 years of experience, down from 23%; and 6% reported <1 year of experience, down from 22%.
The statistical analysis revealed a significant association between years of work experience and salary (χ2 P = 0.001). As expected, low salary was associated with < 5 years of experience (OR: 2.9, 95% CI: 1.38, 6.09).
Area of practice
As 72% of the respondents reported that they practice in pediatrics and number of respondents identified other practice areas were low, the frequency data of all other practice areas were combined to create an “other area” category during the statistical analysis. The Chi-square analysis that examined the association between area of practice and salary revealed significant results (χ2 P = 0.011). Surprisingly, the OR analysis revealed that the odds of earning higher salary is high in the “other area” category than pediatrics (OR: 2.42, 95% CI: 1.27, 4.64).
Level of education
The comparative analysis revealed a 9% increase in the number of practitioners with a master's level degree and 3% increase in practitioners with a doctoral degree. The Chi-square analysis confirmed the association between level of education and salary (χ2 P = 0.00007). The OR analysis also confirmed that that individuals with a baccalaureate degree receive average or less than average salary when compared to individuals with a master's/doctoral level OT degree (OR: 3.03, 95% CI: 1.57, 5.88). It is important to note that 75% of respondents with a doctoral degree identified the highest salary range (>65,001 INR) as their salary range.
Implications for the profession in India
From this study, it is evident that there is notable shift in the OT workforce between 2015 and 2018. Several trends that emerged from comparative analysis were positive for the profession such as the notable increase in the (a) average monthly salary of OT practitioners, (b) number of experienced practitioners, (c) number of practitioners with master's/doctoral degrees, and (d) demand for clinicians. Further, the analyses disclose the migration of practitioners toward urban areas and outpatient practice, reduction in rural–urban wage gap, and emergence of geographical and gender disparity in wages.
Although several of the findings emerged from this study appear promising for the profession, there exists several issues that need attention. First, the profession is still an unregulated profession, except in Delhi and MH. Recently, the cabinet approved the Allied and Healthcare Professions Bill 2018, which awaits passing in the Indian Parliament at the time of this writing.[20] Hence, Indian OTs must continue their efforts in this front.
Second, practitioners' convergence in urban locales and pediatric practice area. Professional organizations and educational institutions must take efforts to redistribute the workforce to extend the access of OT services in suburban and rural regions. The first step in this process would be gaining increased knowledge of the realities of rural OT practice as it is essential to reduce the inequities in therapist distribution.[21] Similarly, more efforts are needed to redistribute the workforce across practice areas to serve the adult and geriatric population with functional needs. Student internship postings and establishment of OT departments/schools in suburban/rural areas, use of innovative and need-based service delivery models, and skill development initiatives to enhance practitioners' skills in other practice areas may assist with redistribution of OT workforce.
Third, reduced access to OT services due to the lack of practitioners in many states and UTs. Indian OT practitioners may explore opportunities for OTs in state-level programs/schemes and engage in advocacy efforts to create OT posts in states where OT is barely existent. Aside from the workforce issues examined in this survey, inadequacy of research/documentation and issues related to reimbursement for OT services are other major professional issues that need attention.[22]
Limitations
The major limitation of this study is the low number of responses. Furthermore, the study yielded more responses from the southern region when compared to other regions. These study-traits may limit the generalizability of the findings across the nation. A mail or telephone survey may have increased the number of responses.
Recommendations
The survey tool could be elaborated with additional questions to collect more comprehensive data pertaining to the Indian OT workforce. In addition, providing narrow salary ranges (5000 INR increments) as response options to the item on salary may yield additional insights. It may also be beneficial to repeat this survey every 3–5 years to continue to monitor OT workforce trends in India.
| Conclusions | | |
Occupational therapists' salary in India has grown notably in the past few years. Gender, geographical region of practice, area of practice, years of work experience, and level of education influence the salary. Although the job outlook for OT professionals in India appears positive, multiple professional issues need attention to augment the growth of the profession.
Financial Support and Sponsorship
Nil.
Conflicts of Interest
There are no conflicts of interest.
| Appeendix | | |
Appendix 1: Indian OT Workforce Salary Survey 2018
Instructions
This survey aims to determine the average compensation received by occupational therapists in India. Please complete this survey relevant to your current position. If you have more than one job, please consider your primary or full-time job related to the profession of occupational therapy (OT). If you are not currently working/practicing in the field of OT, complete this survey with relevance to your latest OT position. Please DO NOT complete this survey if:
- Your current job is not related to the field of occupational therapy
- You are working outside India
- You are working outside India
Please do not provide your name or contact details anywhere on this survey.
Should you have any queries or comments regarding this survey, you are welcome to contact us k[email protected] or [email protected]
Glossary: INR: Indian Rupee
- Gender
- Do you work full-time or part-time? (If you have more than one job of which one is a full-time job, please check full-time)
- Full-time (35 or more h/week)
- Part-time (Less than 35 h/week)
- What is your job title?
(Textbox)- What type of practice setting (s) do you work in?
- Acute care hospital
- Subacute care/Rehabilitation center
- School/Special School
- Nongovernmental organization
- Outpatient clinic
- Academic Institution
- Academic Institution
- Other
- Please identify the state/union territory in which you currently practice OT
(Drop down menu listing the states/union territories of India)- Which of the following best describes the location of your practice setting?
- How long have you been working in the field of OT?
- <1 year
- 1-2 years
- 2-5 years
- 5-10 years
- More than 10 years
- Identify your primary area of practice
- Pediatrics
- Neurology
- Orthopedics
- Orthopedics
- Geriatrics
- Oncology
- Other (please specify)
- What is the highest level of occupational therapy education you have completed?
- Diploma
- Bachelor's degree
- Master's degree
- Doctoral degree
- What is your monthly salary, not including bonuses? (If you are self-employed, select the response that best represents your monthly income)
- <15,000 INR
- 15,001-25,000 INR
- 25,001-35,000 INR
- 35,001-45,000 INR
- 45,001-55,000 INR
- 55,001-65,000 INR
- >65,000 INR
| References | | |
| 1. | |
| 2. | |
| 3. | |
| 4. | Mani K, Provident I. Compensation received by occupational therapists in India: A national survey. Indian J Occup Ther 2017;49:22-28.  |
| 5. | |
| 6. | SurveyMonkey Inc. Online Survey Development Software. San Mateo, CA: SurveyMonkey Inc. Available from: https://www.surveymonkey.com. [Last accessed on 2018 Dec 25]. |
| 7. | Dillman DA, Smyth DJ, Christian LM. Internet, Mail, and Mixed-Mode Surveys: The Tailored Design Method. 3 rd ed. New Jersey: John Wiley and Sons; 2009. |
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| 13. | |
| 14. | American Occupational Therapy Association. Surveying the profession. OT Pract 2015;20:7-11. |
| 15. | Maxim AJM, Rice MS. Men in occupational therapy: Issues, factors, and perceptions. Am J Occup Ther 2018;72:7201205050p1-7201205050p7. |
| 16. | |
| 17. | American Occupational Therapy Association. Surveying the profession. OT Pract 2010;15:8-11. |
| 18. | |
| 19. | |
| 20. | Press Information Bureau. Cabinet Approves the Allied and Healthcare Professions Bill, 2018 for Regulation and Standardization of Education and Services by Allied and Healthcare Professionals. Government of India; 22 November, 2018. Available from: http://www.pib.nic.in/newsite/PrintRelease.aspx?relid=185894. [Last accessed on 2018 Dec 25]. |
| 21. | |
| 22. | Mani K. R2D – A three-pronged approach to develop OT in India. VOTC Ther Newsl 2017;97:1-5. |
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]
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