Placement poverty has major implications for the future health and education workforce: a cross-sectional survey

Objective. 'Placement poverty' refers to the financial burdens imposed upon students by the completion of mandatory professional placement. We aimed to identify the financial implications of mandatory professional placements on student wellbeing. Methods. A cross-sectional online survey (August 2023 to January 2024) completed during students' most recent professional placement in the final year of their degree. Eligible participants were health or teaching students studying at Australian and New Zealand universities in degrees requiring mandatory professional placement. Questions included total and accommodation costs, financial support, impact of finances on placement preferences, presence of food insecurity, and implications for student wellbeing. Results. Participants (n = 530) were mostly health professional (65%) students (median, 25; interquartile range (IQR), 22-30 years, 95.3% domestic, 88.3% full time, 2.0% New Zealand). Health students had higher total costs (in Australian dollars) for the recent placement ($1500; IQR, 600-3453) compared to teaching students ($1200; IQR, 600-2757) (P = 0.02), likely due to longer placement duration (6 weeks for health students). A higher proportion of health students required financial support (P = 0.0001). Placement preferences were always or sometimes (63.8%) determined by cost rather than learning opportunity. Food insecurity was experienced by most students (70.2%) (10.4% marginal, 32.1% moderate, 27.7% severe), with no difference by degree type. Thematic analysis identified themes of burnout, emotional distress, inability to focus on learning, postponing care of oneself, urgent need for financial support, unanticipated family and other circumstances, and worsened societal inequity. Conclusions. Our study identified widespread financial difficulty in students undertaking placement that adversely impacted personal wellbeing. Strategies are needed to support wellbeing and ameliorate the financial burden.