Characteristics and distribution of respiratory therapy practitioners in Saudi Arabia: national cross-sectional results | Human Resources for Health

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.