"We're stuck in recruitment, because we can't retain": an interview study exploring physiotherapy recruitment and retention in rural Australia.

Background: Physiotherapy workforce shortages in rural Australia limit the profession's ability to meet community needs, resulting in the rationing of services. Recent research on recruitment and retention has primarily focused on medicine, nursing and allied health as a collective, leaving physiotherapy-specific factors underexplored.

Objective: To investigate what factors are perceived to influence the recruitment and retention of physiotherapists in rural Victoria, Australia.

Methods: Qualitative design using in-depth semi-structured interviews, analysed using reflexive thematic analysis. Methods: Fifteen participants currently working in the Hume region of Victoria, including physiotherapists, their employers, and managers.

Results: Three themes were identified as key influences on recruitment and retention in Victoria's rural physiotherapy workforce. The first theme, 'a chronically stressed and tired workforce', reflected participants' perceptions of how persistent shortages perpetuate workforce instability, creating a vicious cycle. The second theme, 'the concrete clinical ceiling', highlighted limited career progression opportunities in rural areas, leading physiotherapists to seek opportunities in non-clinical roles. The third theme, 'unrecognised and undervalued', described how physiotherapists feel undervalued by the health system and society as clinicians.

Conclusions: The findings highlight a vicious cycle in which poor retention increases recruitment needs, placing further strain on the existing workforce. Breaking this vicious cycle requires stronger pathways for vertical career progression in clinical practice, including formal recognition of specialist generalist physiotherapists. Supporting senior physiotherapists in supervising students and new graduates is also crucial for effective recruitment. These targeted, discipline-specific strategies may help address the complex and interrelated issues impacting Australia's rural physiotherapy workforce. CONTRIBUTION OF THE PAPER.