Characteristics and distribution of respiratory therapy practitioners in Saudi Arabia: national cross-sectional results

Abstract

Background

Respiratory therapy services commenced in Saudi Arabia (SA) in the mid-1970s. Since then, respiratory therapists have become integral members of the healthcare team. However, data about the characteristics and distribution of the respiratory therapy workforce in SA are limited. Therefore, the primary objective of this investigation is to examine the characteristics and distribution of respiratory therapy practitioners in SA.

Methods

This is a cross-sectional study. Data were obtained from the Saudi Commission for Health Specialties (SCFHS) database as of January 10, 2024. This includes all registered respiratory therapy practitioners. The available data include age, gender, highest qualification, professional ranking, geographical distribution, and employment status of respiratory therapy practitioners.

Results

The SCFHS database reveals that there are 5462 respiratory therapy practitioners registered with SCFHS. Females constitute 48% of respiratory therapy practitioners, and 85% of the entire workforce is under the age of 40. A Bachelor of Science degree is the highest academic qualification for 90% of these practitioners, with 75% professionally classified as specialists. The geographical distribution of the respiratory therapy workforce is uneven, with approximately 65% located in two regions: Riyadh and the Eastern province. Employment within this field is high, with 92% of practitioners currently employed.

Conclusion

The respiratory therapy workforce is witnessing steady growth, with the majority of respiratory therapy practitioners possessing a bachelor’s degree and classified as specialists professionally. Importantly, there is a clear imbalance in the distribution of these professionals across regions in SA.

Background

The profession of respiratory therapy, or respiratory care, originated in the United States (US) in the late 1930s [1]. Initially, individuals known as oxygen orderlies were responsible for handling oxygen delivery equipment. Over time, these individuals received training and transitioned into the role of inhalation therapists, which led to the establishment of formal education programs that graduated qualified respiratory technicians [1].

In Saudi Arabia (SA), the respiratory therapy profession was initiated in the mid-1970s [2]. At this time, cardiac surgeons in the Medical Services Division (MSD) at the Ministry of Defense acknowledged the importance of respiratory therapy services. As an outcome of this, in the early 1980s, the MSD recruited North American registered respiratory therapists to enhance services and train personnel [2]. In 1987, a cooperative agreement was established between the MSD and Loma Linda University to implement the first respiratory therapy program. Consequently, a year later, the MSD launched the first local respiratory therapy program. Both programs conferred an associate degree in respiratory therapy. A decade later, Imam Abdulrahman bin Faisal University, formerly known as King Faisal University, established the first Bachelor of Science degree program in respiratory therapy [2].

The first documentation of the respiratory therapy workforce in SA was reported in 2015 [3]. These data indicated a total of 1477 active respiratory therapy practitioners, with women constituting 53% of this figure. Approximately half of these practitioners were operating in the Riyadh region, whereas the remaining practitioners were distributed unevenly across other regions [3]. In addition, out of 411 hospitals, only 88 were reported to provide respiratory therapy services, leaving 323 hospitals without the presence of such practitioners [3]. However, the Central Board for Accreditation of Healthcare Institutions (CBAHI), started acknowledging the respiratory therapy profession in the late 2000s and incorporated it into its accreditation standards, marking a significant milestone for the field. As the sole governmental accreditation body for healthcare institutions, CBAHI mandates all healthcare institutions to receive accreditation [4]. This development led to a considerable expansion of respiratory therapy services, presumably escalating the demand for these practitioners.

Over the past 2 decades, the workforce in respiratory therapy has undergone significant changes, driven in part by an increase in educational institutions offering respiratory therapy programs [2, 5, 6]. A recent report reveals that currently there are 17 active programs offering academic degrees in the field of respiratory therapy [5]. In these established programs, all but one confer a Bachelor of Science degree, though none offer a postgraduate degree [7]. These programs are well-distributed across the country, with a notable exception in northern SA. Over the past 5 years, these institutions have produced over 1200 graduates in respiratory therapy, and it is projected that they will graduate another 1879 in the next 5 years [5].

As of 2022, the population of SA surpassed 32 million, growing annually at a rate of 2.4% [8]. The country boasts 493 hospitals, offering a total of 78,440 beds, signifying a 21% surge in the total hospital bed capacity over the past decade [9]. The medical staff, including physicians and dentists, witnessed a significant growth from 80,475 in 2013 to 129,229 in 2022. The number of nurses also escalated from 154,568 to 200,558. In a similar vein, the count of allied health professionals, consisting of clinical laboratory specialists, physical therapists, respiratory therapists and other similar specialities, jumped by 51% from 91,781 to 138,362 [9].

Currently, 1453 respiratory therapy practitioners are serving in the Ministry of Health hospitals, 45% of whom are female, and 78% are Saudi [9]. Al-otaibi’s 2015 study indicated that there were only 379 respiratory therapy practitioners in the Ministry of Health at that time, representing an impressive growth of 74% over nine years [3]. However, Al-otaibi emphasized that only 25% of the total respiratory therapy workforce is based in the Ministry of Health facilities, the primary healthcare provider in SA [3].

At the present time, reliable data on the respiratory therapy workforce across all healthcare sectors in SA remains unpublished. Information concerning the characteristics and distribution of this workforce is also lacking. Thus, this study aims to shed light on the salient features of SA’s respiratory therapy workforce.

Methods

This cross-sectional study aims to identify the key characteristics of respiratory therapy practitioners in SA. The current data were sourced from the Saudi Commission for Health Specialties (SCFHS) as of January 10, 2024. The SCFHS, a government organization, oversees the classification and registration of all healthcare providers in SA. It is a prerequisite for these providers to be classified and actively registered to practice within the healthcare system. Consequently, the SCFHS serves as one of the most reliable sources for acquiring accurate data on the respiratory therapy workforce.

The SCFHS categorizes respiratory therapy practitioners into five distinct levels based on their academic qualifications and clinical training. Practitioners who hold an associate degree or diploma are designated as respiratory therapy technicians. In contrast, those with a bachelor’s degree are classified as respiratory therapists (specialists), and those with a master’s degree or postgraduate diploma, along with relevant clinical experience, are classified as senior respiratory therapists. Practitioners who have a Ph.D. in respiratory therapy, coupled with specific clinical experience, are recognized as consultants.

In December 2023, a formal request was made to the data department of SCFHS for the sociodemographic data of respiratory therapy practitioners, including age, gender, and place of residence. We also gathered data concerning their highest academic qualifications and current professional classifications. We obtained information about the type of academic institution from which they earned their degrees, categorized as local governmental colleges, local private colleges, or international colleges outside of SA, referred to as “abroad”.

The data were analyzed by age group, gender, academic qualification, and professional classification. This analysis included an examination of the respiratory therapy workforce within each administrative region of SA. Further analysis was conducted based on employment type, which was categorized into three groups: public, private, or unemployed/unknown.

The study received approval from the research ethics committee of King Abdulaziz University Hospital, with the registration number HA-02-J-008.

The parametric data are presented as descriptive statistics. Percentages and frequencies were calculated using Microsoft® Excel 2017 (Microsoft Corporation, Redmond, WA, USA).

Results

As of January 10, 2024, the SCFHS database indicates a registry of 5462 respiratory therapy practitioners, of which 2607 are women, amounting to nearly 48% of the workforce in SA. The majority of these practitioners are relatively young, with around 85% under 40 years of age. In contrast, only about 2% are above 50 years of age. Furthermore, 65% of female respiratory therapy practitioners and 54% of male respiratory therapy practitioners are between the ages of 20–29. Figure 1 offers a comparative overview of male and female respiratory therapy practitioners across various age categories.

Fig. 1

Comparison between male and female respiratory therapy practitioners based on age category. Data are presented as a percentage of respiratory therapy practitioners within a specific age category to the total number of respiratory therapy practitioners of each gender

The academic qualifications of respiratory therapy practitioners vary significantly, with an uneven distribution acrnoss all degree categories. Current data reveal that 90% of these practitioners hold a Bachelor of Science degree, while only 5% possess a diploma or associate degree. In terms of professional classification, the specialist category is dominant, with about 75% of practitioners under this designation, while 22% are classified as technicians. Table 1 provides a detailed overview of the demographic statistics and professional characteristics of respiratory therapy practitioners in SA.

Table 1 Demographics and characteristics of respiratory therapy practitioners in Saudi Arabia (n = 5462)

The geographical distribution of respiratory therapy practitioners is uneven; approximately 65% are located in two administrative regions: Riyadh and Eastern province. Conversely, fewer than 1% of these practitioners operate in Al Jawf, Al Bahah, and the Northern Borders regions. Figure 2 displays a comparison of the number of male and female practitioners in these administrative regions.

Fig. 2

Gender of respiratory therapy practitioners across administrative regions of Saudi Arabia

Nearly 62% of respiratory therapy practitioners have graduated from local colleges, while about 34% obtained their academic degrees from colleges outside of SA. Of these practitioners, approximately 91% are employed, predominantly in governmental sectors. Table 2 shows the geographical location, the educational institutions, and the employment status of these respiratory therapy practitioners.

Table 2 Geographical location and educational institutions of respiratory therapy practitioners

Discussion

The current study reveals a nearly threefold increase in the respiratory therapy workforce over the past decade. The distribution of respiratory therapy practitioners is nearly gender-balanced. The majority of these practitioners are under 40 years old. Even though 90% of practitioners possess a bachelor’s degree as their highest qualification, 75% of them are classified as specialists. Notably, current data suggest that more than 80% of the respiratory therapy workforce is located in just 3 out of the 13 administrative regions in SA. Approximately 62% of these practitioners are graduates from local colleges. Moreover, over 90% of them are employed in either government or private institutions.

According to the American Association of Respiratory Care (AARC) human resources survey conducted in 2020, the average age of a respiratory therapist in the US is 46 years [10]. In contrast, in India, the average age is calculated to be 28 years [11]. However, this estimate from India is drawn from a cross-sectional study with a small sample size, which may not accurately reflect the populace. In Minnesota, the age distribution among different categories is relatively balanced. Specifically, the recorded distribution is 27% for those 35 years and under, 23% for ages 36–44, 22% for ages 45–54, and 23% for those aged 55 to 64 years old [12]. On the other hand, in Oregon, 51% of respiratory therapists fall within the 35–54 years age range [13]. Current data suggest that nearly 85% of respiratory therapy practitioners are under 40 years old, and 59% are younger than 29 years old. The age distributions among male and female respiratory therapy practitioners are strikingly similar.

The respiratory therapy profession is predominantly female. In the US, according to the AARC human resources survey of respiratory therapists in 2020, females make up 70% of the profession [10]. In Canada, they represent 75% of this workforce [14], while in Minnesota, the percentage stands at 65% [12]. As of 2015, 53% of respiratory therapy practitioners in SA were female [3]. Similarly, a cross-sectional study conducted in India in 2021 revealed that 55% of respiratory therapy practitioners were females [11]. According to the Ministry of Health’s annual report published in 2022, female physicians and dentists make up 37% of the total workforce, with female pharmacists constituting 23% [9]. This report also stated that females account for 37% of the total allied health professions’ workforce. Our findings, along with those of other authors [9], suggest a minor decrease in the number of female respiratory therapy practitioners in SA, from 53 to 48%. Yet, this is still a significant percentage compared to other allied health professions in SA.

In the US, the population count of respiratory therapy practitioners was rated at 145,117 in 2015, indicating a practitioner-to-population ratio of 1:2136 [3]. By 2022, the number of respiratory therapy practitioners had escalated to 191,457 [10], showcasing a ratio of 1:1,749. Contrastingly, in 2015, in Canada and SA, the ratios were 1:3,365 and 1:17,692, respectively [3]. Furthermore, the population of Texas, for instance, mimics that of SA, with Texas having roughly 30.5 million inhabitants as of 2023, and SA documenting approximately 32 million people in 2022 [9, 15]. Nevertheless, according to the SCFHS database, there are 5,462 respiratory therapy practitioners in SA, while Texas has 14,176 actively licensed respiratory therapy practitioners [16]. Therefore, the respiratory therapy practitioner-to-population ratio stands at 1:2,151 in Texas and 1:5,895 in SA. The statistics dictate that the count of respiratory therapy practitioners would need to swell to around 15,000 to be on par with Texas. Similarly, records from Minnesota reveal that there were 2,069 respiratory therapy practitioners as of 2019 [12], accompanied by a population nearing 5.8 million [17], causing a ratio of 1:1,772. In Oregon, there are 1,902 licensed respiratory therapy practitioners, rendering the ratio 1:2,213 [13]. Collectively, these data suggest that the ideal ratio of respiratory therapy practitioners per population is around 1:2,000.

There has been a subtle shift in the distribution of respiratory therapy practitioners across the country over the last decade. In 2015, approximately 95% of these practitioners were stationed within three geographical regions: the central region, eastern region, and western region [3]. According to recent data, however, roughly 80% of these practitioners are now situated within three administrative regions: Riyadh, Eastern province, and Makkah. This indicates a modest rise in the number of practitioners located outside of the principal cities. Nonetheless, our current data reveals that under 10% of the total respiratory therapy workforce is distributed across eight regions. This workforce distribution is likely influenced by factors such as population density, the number of hospitals, and the quantity of available hospital beds. Hence, it is logical that major cities host a higher percentage of respiratory therapy practitioners compared to smaller and medium-sized cities.

Emergency Medical Services (EMS) is a health profession closely related to respiratory therapy. A recent report indicated that the SCFHS database registered 18,336 EMS providers [18], contributing to a ratio of 1 EMS provider per 1,756 individuals. However, female EMS providers make up just 3% of the total workforce. Notably, the majority (76%) of these providers are professionally categorized as technicians, while only 24% are specialists. Our data show that among respiratory therapy practitioners, 75% are classified as specialists, with approximately 22% identified as technicians. The distribution of EMS providers and respiratory therapy practitioners across administrative regions is relatively similar, with both groups primarily situated in the Riyadh region, Eastern province, and Makkah region. These three regions represent 68% of EMS providers and 82% of respiratory therapy practitioners, most likely due to their high population densities [9].

The population-to-practitioner ratio in these regions varied: In Riyadh, it was 1:4334 for respiratory therapy practitioners and 1:1131 for EMS providers. In Eastern province, these ratios were 1:3229 and 1:2159, respectively, while in Makkah, they were 1:8185 and 1:3141. However, these ratios significantly differed in Al Jouf region, where it stood at 1: 28,372 for respiratory therapy practitioners and 1:1535 for EMS providers. The distribution of these two professional groups exhibited similarities across the 13 regions of SA, though the number of registered EMS providers was markedly higher than that of respiratory therapy practitioners.

This study presents certain limitations. Firstly, it utilizes cross-sectional data retrieved from the SCFHS database as of January 2024. As such, the figures may have marginally fluctuated at the time of publication. Moreover, it remains uncertain if practitioners maintain active registration. Secondly, our dataset excludes the ratio of Saudi to non-Saudi respiratory therapy practitioners. Our third limitation is that our data indicate that 33% of respiratory therapy practitioners have obtained their academic degrees from international universities and colleges, but we are unable to confirm whether they are Saudi or non-Saudi. Nonetheless, we assume the majority are non-Saudi.

In conclusion, although the respiratory therapy workforce is consistently expanding, demand still outpaces supply. The distribution of respiratory therapy practitioners across different regions in SA is noticeably imbalanced. Key performance indicators such as the ratio of respiratory therapists to the population or critical care beds, can help track the needs and growth of respiratory therapy practitioners. Furthermore, the current data are beneficial to readers from SA and beyond, as it provides insights into this rapidly developing profession, including the characteristics of the respiratory therapy workforce, and the challenges and opportunities within the profession.