Roles,workforce patterns,and concerns of psychologists working in New Zealand public hospitals: Findings from a national mixed-methods survey

Abstract

Unmet need for health psychologists is growing internationally. However, methodologically consistent and regular workforce data is lacking for long-term, evidence-based workforce planning. A two-armed, mixed-methods study (PsycH) of health psychologists was conducted across all 20 health districts in New Zealand (May 2022–January 2023). Arm 1 had 115 individual psychologists responding, while 17 professional leaders responded to Arm 2. Overall, PsycH found 126.14 full-time equivalent (FTE) psychologist positions across 34 categories of physical health services. The psychological workforce grew by 31.60 FTEs over the last 5 years, but 73 new positions worth 70.80 FTEs are needed to meet projected demand over the next 5 years. Psychologists reported high levels of job satisfaction but persistent systemic barriers to sustainable workforce development. PsycH highlighted the importance of robust and regular workforce data in facing growing levels of unmet need for psychologists in physical health settings in New Zealand, with similar challenges seen internationally.

Keywords

health psychology hospitals workforce development New Zealand unmet need

Introduction

Background

Public health systems in countries like New Zealand (NZ), Australia, Canada, and the United Kingdom (UK) have struggled to meet unmet need for health psychology (Busuttil et al., 2024; Psychology Workforce Task Group, 2016; Stokes et al., 2010). Yet, evidence suggests health psychologists―defined in this paper as psychologists (regardless of specialisation) working in physical health settings in hospitals―face barriers that hinder their ability to meet the rising demand, namely: (a) inadequate funding and resourcing of health psychology (Mental Health Commission, 2012); (b) inequitable access to health psychology services across patient populations (Paterson et al., 2018); and (c) inconsistent recognition of health psychologists’ clinical expertise and impact, particularly outside of patient-facing work (George and Webster, 2021; Stewart et al., 2017).

Alongside such challenges, there is evolving recognition of the critical value of developing a resilient, sustainable, and thriving psychological workforce (Health Education England, 2021; Psychology Workforce Task Group, 2016). However, there has been a paucity of international literature specifically on health psychologists across countries with publicly-funded health systems. Additionally, governance of health psychologists differs internationally, across countries like NZ (NZ Psychologists Board, 2022), Australia (Psychology Board of Australia, 2024), the UK (Health & Care Professions Council, 2025), and Canada (Demers and Cohen, 2023). Consequently, generating data-driven recommendations for staffing levels and long-term workforce planning in health psychology is challenging due to considerable methodological heterogeneity in the current literature; inconsistency in scope of data collection; and a lack of dedicated funding for regular, comprehensive, and methodologically-robust surveys (Lim, 2022).

Current population-based and needs-based recommendations for psychologist staffing levels are largely professional recommendations, rather than calculations from evidence-based formulae (Byrne and Branley, 2012; Department of Health & Children, 2006; Health & Social Care Integration Directorate, 2011). However, evidence suggests higher staff-to-patient ratios are predictive of greater mental health service quality and access (Boden et al., 2019; Smith et al., 2023). Thus, building a robust psychological workforce in physical health settings is crucial to mitigating the immense pressures on overburdened public health systems (Department of Health and Aged Care, 2022; Mental Health Commission, 2012; National Health Service [NHS] England, 2023). Regular collection of accurate, comparable, and targeted workforce data is critical to this effort, particularly given the diverse working conditions, organisational structures, and support needs across different workforces (Busuttil et al., 2024; Mathews et al., 2010). Hence, creating comprehensive and effective workforce surveys is imperative to generating tailored, evidence-based solutions to current and future challenges faced by health psychologists.

Current study

To this end, we conducted the National Survey of Psychologists in Public General Hospitals (PsycH), a two-armed, mixed methods survey of health psychologists in public general hospitals in NZ in 2022. The overarching aim of PsycH was to create a detailed descriptive snapshot of the NZ health psychology workforce, advocating for greater recognition of the value of health psychology and the need for workforce planning to meet future demand. By combining descriptive quantitative data on the health psychology workforce with qualitative perspectives on working conditions from individual health psychologists, we were able to contextualise our findings in the professional realities of the NZ workforce, allowing more nuanced and targeted analysis.

PsycH was designed to address three major weaknesses in the existing body of literature on the psychological workforce in NZ, namely: (a) a lack of specific focus on health psychologists and other psychologists working in physical health settings in public general hospitals; (b) a dearth of mixed-methods studies that combine quantitative and qualitative data; and (c) scant data on psychologist activities outside of direct clinical work, including in leadership and service development capacities. Thus, PsycH endeavoured to meaningfully expand understanding of the psychological workforce in physical health settings in NZ and establish a need for accurate, comprehensive, and consistent psychological workforce data.

Study context

PsycH was developed as an arm of the second national survey of consultation-liaison psychiatry services in NZ (CLPSNZ-2; Hopkins et al., 2023b). The previous iteration of the consultation-liaison psychiatry survey, CLPSNZ-1 (Hopkins et al., 2020), itself inspired by the annual Liaison Psychiatry Survey in England (Whalley et al., 2019), was crucial in establishing a baseline of service structure, coverage, and staff composition (Hopkins et al., 2022). This revealed that services in different hospitals had variable working relationships with psychological services in physical health outside of the core consultation-liaison psychiatry service. However, CLPSNZ-1 lacked direct measures of staffing levels or service activity, including for health psychologists. Thus, CLPSNZ-2 (Hopkins et al., 2023a, 2025) considerably expanded upon CLPSNZ-1 to provide a broader understanding of mental health support to patients in physical health settings (Nasim et al., 2024), including that provided by health psychologists.

Materials & methods

Research design overview

PsycH was designed as a descriptive, two-armed, mixed-methods survey targeting psychologists working in physical health settings in public general hospitals across all 20 health districts in NZ. Arm 1 comprised individual psychologists, while Arm 2 targeted professional leaders, senior psychologists with a leadership role across the entire psychological workforce in each district. In the absence of a professional leader, another person with an administerial overview of psychologists was recruited. For brevity, professional leaders refers to all Arm 2 participants, regardless of formal job title. The main purpose of using a two-armed approach was to add redundancy to data collection and maximise representation of different health districts and physical health settings. Additionally, by capturing similar data across two complementary sources, we aimed to enhance data validity by identifying notable points of discrepancy.

Arm 1 collected both quantitative and qualitative data on psychologists’ work and working conditions, while Arm 2 focussed on a quantitative overview of the psychological workforce in each respective district. As Arm 2 data was collected from a single representative for each district, qualitative data was not collected to avoid a biased perspective. Areas of focus across the two Arms included psychologists’ full-time equivalent (FTE) positions, roles, areas of clinical work, involvement in leadership opportunities, factors affecting work satisfaction, and perspectives on future workforce growth. All participants signed online consent forms to take part in the study. Ethics approval for PsycH was provided by the Auckland Health Research Ethics Committee (reference: AH1367) from 22 April 2022 to 27 May 2023. The survey was completed by participants between May 2022 and January 2023.

Survey design

PsycH was designed as an online survey containing multiple-choice and free-form answers, administered using REDCap, a secure web-based platform (Harris et al., 2009, 2019). The final form and structure of PsycH was approved by the listed authors, co-investigators, and an external advisor (clinical psychologist with experience conducting workforce surveys) following four rounds of consultation, pilot testing, and modification.

Participants

Organisational consent to conduct the survey was obtained from each district by contacting respective allied health directors or equivalent. For Arm 1, as no central registry of psychologists working in physical health settings in public general hospitals could be identified, professional leaders were contacted for a list of eligible psychologists in each district. Professional leaders were then invited to participate in Arm 2.

Inclusion and exclusion criteria

For Arm 1, participants were required to be a registered psychologist currently working in some capacity in physical health settings in a public general hospital. Participants working exclusively in private health or mental health settings were excluded. For Arm 2, participants were not restricted by profession, but were required to have an administerial overview of the psychological workforce in physical health settings within their respective district.

During initial consultation for PsycH, concerns were raised that no universal definition exists for the term physical health settings. It was then defined as, “a medical or surgical service, ward, or unit—such as cardiology, pain clinics, neurosurgery, general hospital liaison, and genetic counselling—in a public general hospital” within the study.

Statistical analysis plan

Quantitative analysis

Quantitative analyses focussed on providing descriptive statistics as PsycH was designed as a mixed-methods study to capture a snapshot of the psychological services. Relevant descriptive statistics are provided. Quantitative analysis was conducted with SPSS version 28.0 (IBM Corp, 2022).

Qualitative content analysis

The qualitative, open-ended sections of Arm 1 were interpreted using qualitative content analysis through an essentialist epistemology lens, meaning participants’ responses were regarded as representing their subjective reality, rather than universal truth (Chamberlain, 2014). Qualitative content analysis is a useful approach when exploring larger qualitative datasets with reported frequencies of themes across participants (Berelson, 1952; Lindgren et al., 2020). The lead author (DL) was assisted in the coding process by a co-author with experience in qualitative research methods (PR). Responses were individually coded in Nvivo version 13 (Lumivero, 2022) and then compared, with disagreements resolved through discussion and mutual agreement. Similar codes were organised into categories by agreement, which were then analysed to generate themes that encapsulated patterns and summative ideas across the dataset.

A combination of deductive and inductive approaches was used, in consideration of recent evidence suggesting effective qualitative content analysis utilises both (Graneheim et al., 2017). Firstly, using a top-down deductive process, the wording of the survey questions and the survey’s overarching research questions and prior literature guided the development of initial codes. Following this, a data-driven inductive approach guided the coding process, with categories and themes being refined or additionally generated from the data itself, as well as from the deductive codes.

Results

Response rate

In Arm 1, 115 of 185 eligible psychologists (62.2%) responded to the survey. Of the remainder, 65 (35.1%) did not respond to the survey invitation, and 5 (2.7%) declined participation (Figure 1). Thirteen districts were represented in the final participant pool, with no eligible psychologists identified in three districts (Mid Central, Tairāwhiti, and West Coast), no psychologists completing the survey in two districts (South Canterbury and Wairarapa), and one district (Taranaki) being unable to be included in final analyses due to delays in receiving the contact details of eligible participants. Demographic information of Arm 1 participants is presented in Supplemental Table 1.

Figure 1.

Total FTEs currently occupied by psychologists across physical health service categories, reported by professional leaders in Arm 2.

For Arm 2, one district did not respond within the timeframe of the study and was thus ineligible for participation, resulting in 19 of the 20 health districts being invited to complete the survey. Of these 19, one district completed the survey but did not return a signed consent form, and their response was excluded. Another district did not complete the survey following the initial consent process. Thus, a total of 17 out of 19 completed and eligible responses were received, representing an 89.5% response. A further district was excluded from some final analyses due to discrepancies in data reported in Arm 1 and Arm 2. For the purposes of Arm 1, this district provided details of a total of four psychologists working in physical health settings. However, in Arm 2, it reported having 18 psychologists working in physical health settings. As the professional leader could not be reached for clarification, the district was excluded from final analyses where relevant.

Current psychologist positions

Of the 115 respondents in Arm 1, 108 responses reported working in 119 psychologist positions across 28 categories of physical health services. In comparison, the 17 respondents in Arm 2 listed 114 psychologist roles worth 126.14 full-time equivalent (FTE) positions across 34 categories of physical health services (Figure 1).

Looking to the past, 11 of 17 districts in Arm 2 reported a 31.60 FTE total growth in psychologist positions in physical health settings in the previous 5 years, including 32 new positions worth 20.70 FTEs created across 17 physical health settings (Figure 2). Further, in Arm 2, while five positions totalling 2.90 FTEs across four clinical areas (diabetes; neurology and rehabilitation; renal; and paediatric services) in five districts were reported as having been stopped in the previous 5 years, no district reported an overall decrease in the psychological workforce in the previous 5 years.

Figure 2.

Total new psychologist FTEs created in previous 5 years by physical health service category, reported by professional leaders in Arm 2.

Shifting focus to the future, 13 of 17 districts in Arm 2 reported 73 new psychologist positions worth 70.80 FTEs would need to be created in 33 categories of physical health services in the next 5 years to meet projected demand (Figure 3). Thus, the projected rate of growth needed to meet future demand is estimated to be more than twice that of the previous 5 years. This data also shows different categories may have different future resourcing needs. For example, Neurology and rehabilitation has a relatively large allocation of current FTEs (Figure 1) and similarly has the highest projected need (Figure 3). In contrast, Cancer and blood has the highest allocation of current FTEs (Figure) but a relatively low level of projected need.

Figure 3.

Total FTEs projected to need to be filled by psychologists in the next 5 years grouped by physical health service category, reported by professional leaders in Arm 2.

Scopes of psychologists

In Arm 1, of 114 responses providing demographic information, 43.3% (n = 58) reported being registered as a clinical psychologist, while 35.8% (n = 48) reported being registered as a general psychologist (which includes those with health psychology qualifications). In Arm 2, of a total of 185 psychologists identified by professional leaders as working in physical health settings, 57.8% (n = 107) were identified as having clinical psychology-related qualifications while 26.5% (n = 49) were identified as having health psychology-related qualifications. However, when asked how many psychologists would consider themselves health psychologists, Arm 2 respondents reported 35.3% of all psychologist FTEs (42.70 of 120.85 FTEs) as being filled by such people. The number of psychologists comprising this category cannot be reported due to missing data. However, as highlighted in the Introduction, this discrepancy suggests some psychologists may consider themselves to be health psychologists by virtue of working in physical health settings, despite lacking formal health psychology qualifications.

Distribution of psychologists

PsycH found a wide variation in the number of psychologists and psychologist FTEs in physical health settings across different districts in Arm 2 (Figure 4). Using projected population data (Te Pou, 2021), Waitematā stood out with the lowest allocation of psychologists (1.1 psychologists) and psychologist FTEs (0.8 psychologist FTEs) per 100,000 inhabitants despite being the largest district in terms of population (653,740 inhabitants). In contrast, less populated districts such as Southern (354,170 inhabitants) and South Canterbury (62,595 inhabitants) had comparable or greater numbers of psychologists per 100,000 inhabitants to more populated districts like Canterbury (591,930 inhabitants) and Counties Manukau (609,350 inhabitants), although psychologist FTEs per 100,000 inhabitants were lesser. Overall, Arm 2 found an average allocation of 3.6 psychologists and 2.3 psychologist FTEs per 100,000 inhabitants in physical health settings across the country.

Figure 4.

Number of psychologists and psychologist FTEs in physical health settings per 100,000 people in each district.

Inpatient versus outpatient settings

PsycH found more psychologists were involved in outpatient than inpatient work. Across the 17 Arm 2 respondents, 57.6% (n = 99) of psychologists were listed as working mainly with outpatients, 7.9% (n = 16) were identified as working mainly with inpatients, while 42.9% (n = 87) were marked as mainly working with a combination of both. In contrast, of the 119 roles identified in Arm 1, 95.0% (n = 113) included outpatient work in some capacity, while 63.0% (n = 75) involved inpatient work in some capacity. A further 7.6% (n = 9) of roles involved working in an emergency department in some capacity.

Clinical and non-clinical leadership activities

Of the 119 psychologist positions reported in Arm 1, many were marked as carrying out quality improvement (n = 84, 70.6%) or teaching and training activities (n = 93, 78.2%) for their service. Many of these activities demonstrated elements of clinical and non-clinical leadership, such as being involved in hospital governance; developing hospital policies and clinical procedures; presenting at grand rounds, conferences, or community organisations; and being involved in regional (i.e. beyond local catchment) and national service development. At the same time, in Arm 2, three respondents only listed three leadership positions totalling 1.40 FTEs as being held by psychologists, including a “Clinical Lead Health Psychology” role with no formal FTE allocation.

Overall satisfaction with work

Work satisfaction, perceptions of support at work, and satisfaction with resourcing at work were measured by four-item Likert scales (Table 1). Of 98 responses received in Arm 1 to the question of work satisfaction in the public health system, an overwhelming majority indicated they were moderately (n = 45, 45.9%) or very satisfied (n = 47, 48.0%). Relatedly, of 96 responses to being asked about feeling supported by colleagues and managers, participants generally indicated feeling moderately (n = 33, 34.4%) or very (n = 47, 49.0%) well-supported. However, the opposite was true with regard to resourcing for positions, with the majority of 97 responses to this question indicating their roles were “Only a little (n = 33, 49.5%)” or “Not at all (n = 9, 34.0%)” well-resourced. Overall, over 80% (n = 77) of 96 applicable responses reported wanting to change their work environment (Table 1).

Table 1.

Frequency and percentage of psychologists’ perceptions of the adequateness of their working conditions and work environment.

Question	n	%
Overall, how satisfied are you with your role as a psychologist in public general hospitals? (n = 98)
Not at all	0	0.0
A little	6	6.1
Moderately	45	45.9
Very	47	48.0
How well resourced do you consider your position to be? (n = 97)
Not at all	9	9.3
A little	33	34.0
Moderately	48	49.5
Very	7	7.2
How well supported by colleagues and managers do you consider your position to be? (n = 96)
Not at all	1	1.0
A little	15	15.6
Moderately	33	34.4
Very	47	49.0
If you could, would you change anything about your working environment? (n = 96)
Yes	77	80.2
No	19	19.8

Qualitative findings

Factors affecting working conditions

Finally, Arm 1 participants were prompted on their working conditions (Table 2).

Table 2.

Qualitative questions on working conditions.

Qualitative questions
What are the three things that you enjoy most about your role as a psychologist in public general hospitals?
What are the three things that frustrate you the most about your role as a psychologist in public general hospitals?
What do you find most satisfying about your role as a psychologist in public general hospitals?
What are the greatest barriers that make it difficult for you to do your job well?
What are the most important resources that help make it easier for you to do your job well?
What are the key things that would make you feel more supported in your role?

Qualitative content analysis was used to generate two broad categories of responses grouped under Enablers and Inhibitors (Table 3). Enablers refer to factors that enhance job satisfaction, making psychologists’ jobs enjoyable and supporting them to be productive. In contrast, Inhibitors refer to those factors that diminish job satisfaction, making work difficult and stressful.

Table 3.

Summary of psychologists’ perspectives on working in physical health settings in public general hospitals.

Category	Themes	Frequency^a	Example quotes
Enablers: Factors that add to job satisfaction, enjoyment, and productivity	1. The professional satisfaction of working in a physical health setting	144 of 538	“The fact that I’m constantly learning—from patients’ own experiences or up-skilling myself in therapy techniques” (Participant 14) “I enjoy the fast-paced, changing environment. No two days or cases are the same.” (Participant 69) “Autonomy and independence to do what works best for patients” (Participant 8)
	2. Having a positive impact on people’s lives	134 of 538	“Psychology is at its best, patients are very grateful for the psychology input and the difference it makes for them” (Participant 80) “I can offer [support] in some of the most vulnerable times of [patients’] lives” (Participant 6) “I enjoy being able to provide a psychological service to people who would otherwise not be able to access it for financial reasons” (Participant 35)
	3. Working as a team with supportive colleagues and managers	212 of 538	“Working with colleagues/teams who share the same values [and] want to do the best for patients [and] whānau” (Participant 23)“People. We have a small team but such great colleagues.” (Participant 81)“A supportive supervisor and team, who I can discuss complex cases, other work issues, etc.,” (Participant 36)
Inhibitors: Factors that make work difficult, unfulfilling, and stressful	1. Lack of funding and resources to deliver highest quality care	257 of 538	“Poor funding and resourcing make it impossible to offer the highest quality care” (Participant 50)“No chance of expanding [the] workforce in order to deliver a more comprehensive service” (Participant 58)“[Not having] a clinic room or therapeutic space where patients would feel safe and comfortable to engage in therapy” (Participant 17)
	2. Lack of organisational support for psychologists	211 of 538	“[Hospitals] can sometimes be very inflexible–in an MDT, processes are not necessarily set up for psychologists” (Participant 14)“[I would feel supported] if all of the leaders understood and valued our role and allocated us the [administrative] support, we require” (Participant 35)“Having more of a voice [and] being included in management discussions” (Participant 64)
	3. Being undervalued as a competent clinician	110 of 538	“The lack of understanding of a psychologist’s role by other medical practitioners, and as a result being undervalued” (Participant 18)“I would feel more supported if I was not micro-managed and treated and considered as a well experienced professional that can be trusted” (Participant 80)
			“The discounting of the significance of psychological intervention” (Participant 40)
	4. Feeling overwhelmed by work demands without adequate support or reward	61 of 538	“Insufficient time to meet expectations to my satisfaction” (Participant 65)“Poor salary for the training and competencies required” (Participant 85)“High caseloads and feeling rushed to see the next person/pick up more cases” (Participant 79)

For each frequency, X of Y, X denotes the number of responses coded to the relevant theme. Y denotes the total number of responses given across all qualitative questions in Table 2. As a single response could have multiple codes corresponding to several themes, the total sum of X across all themes exceeds Y.

Enablers: Factors that add to job satisfaction, enjoyment, and productivity

Three themes were identified from 39 codes generated in the Enablers category.

The professional satisfaction of working in a physical health setting

In this theme, 144 of 538 responses described the satisfaction derived from professional growth and development. Psychologists―as much as they work to improve patient well-being―also derive professional satisfaction and joy from working with patients. The theme also served to deepen the professional identity of psychologists, showing they not only gain meaning and enjoyment from working with patients, but also from being challenged to grow professionally.

Participant 24 referred to the “professional challenge of working with patients with complex physical health conditions,” while Participant 41 found patients offered “other perspectives to [their] training manuals.” Similarly, Participant 79 said “working at the intersection of mental and physical health [was] very interesting and rewarding.” Additionally, Participant 87 appreciated the unique opportunity to “[work] in a specialist field.”

Relatedly, participants also spoke of the innate joy and satisfaction of working holistically with clients and their families. Participant 69 described being “most passionate about. . .biopsychosocial care,” while other participants listed “client interactions” (Participant 13), “working with children and their families” (Participant 36) and “client[-focused] work” (Participant 83) being enjoyable.

Having a positive impact on people’s lives

Adding to the previous theme (134 of 538 responses), this theme served to solidify psychologists’ dedication to producing observable and relevant clinical outcomes, including collaborating with other clinicians to provide patient-centred care. Furthermore, it underpinned the holistic perspective of psychologists working in physical health settings, revealing their concern with not only achieving clinical excellence, but doing it in a way that is fair and equitable.

Participants pointed out the value of “feeling like [they’re] contributing to [the] well-being of patients” (Participant 27) in order to “make meaningful difference to patient outcomes” (Participant 8). Participants also highlighted their ability to make a significant difference in often short clinical engagements” (Participant 19), which helped not only the patient, but also improved the “effectiveness of other professions’ interventions” (Participant 28). Alongside clinical interventions, participants also noted the benefits of “[providing] a service [for] free” (Participant 81) with a focus on “equity and hard-to-reach populations” (Participant 80) as part of the public health system, allowing them to “work with people who otherwise may never get the help.” (Participant 6)

Working as a team with supportive colleagues and managers

In conjunction with the previous themes, this final theme (212 of 538 responses) further revealed psychologists’ collaborative and humanistic focus in physical health settings. It highlighted the clinical competency and flexibility of psychologists, showcasing their involvement in multidisciplinary settings. Finally, it made plain the value of having a supportive network of colleagues and superiors in creating a safe, effective, and enjoyable work environment.

Participants highlighted “working in both interdisciplinary and multidisciplinary teams” (Participant 47) enabled psychologists to “discuss [patients] with relevant clinicians of other disciplines” (Participant 21), leading to more “robust and holistic assessments” (Participant 78). Further, participants explained they enjoyed “participating in a successful client-centred multidisciplinary team” (Participant 16) and “working with a variety of different cases in a multidisciplinary team” (Participant 34).

Similarly, participants expounded on the benefits of “being part of a larger collective of psychologists” (Participant 10), reporting a sense of “team spirit” (Participant 11). Participant 97 highlighted the achievement of “putting together and retaining a motivated and competent team despite operating in an underfunded and difficult context.” Supporting this notion, participants also highlighted the crucial role of “an amazing manager who is very supportive” (Participant 63) in making “the role work.” (Participant 50)

Inhibitors: Factors that make work difficult, unfulfilling, and stressful

Four themes were identified from 61 codes in the Inhibitors category.

Lack of funding and resources to deliver highest quality care

This theme (257 of 538 responses) revealed the challenges faced in providing psychological care within a health system that lacks adequate funding and resources, in stark contrast with the themes of synergistic collaboration and collegial support explored previously. Participants voiced frustration, concern, and exasperation around the impacts on both quality of care and perceptions of collegiality as a result of such challenges. These concerns highlighted the critical need for specific support and investment in psychological services in physical health settings.

Participant 6 spoke of the “lack of funding for the obvious patient need” that compromised the quality and delivery of psychological care within the public health system, with participant 88 noting the “chronic neglect of psychology services. . .leading to a crisis point” In a similar vein, participants portrayed the “competition for scarce resources” (Participant 58), especially for “suitable clinic space” (Participant 52). Participant 35 reported feeling “frequently [pressured] to vacate [their] assigned spaces” by other clinicians resulting in seeing patients in “physical spaces. . .not set up for [psychological] services” such as “medical clinic rooms full of medical equipment” (Participant 17). Participant 33 noted such spaces are “not very conducive to [patients] feeling relaxed and able to open up,” supporting participant 76 describing inadequate resourcing “an impediment” to the safe and effective delivery of psychological services.

Lack of organisational support for psychologists

This theme (211 of 538 responses) highlighted the hazards faced by psychologists who feel unsupported to deliver high-quality psychological services. Beyond the practical challenges with staffing, resourcing, and remuneration, participants pointed towards an underlying organisational reluctance to prioritise supporting psychological services. Thus, despite recognising and advocating the need for more investment and development of psychological services, participants also depicted the challenges of rallying support for psychological services in the first place.

Participants spoke of an “absence of workforce planning” (Participant 85), scarce “long-term planning or bigger picture thinking” (Participant 53), and a “lack of direction and planning around future services, workforce training, and retention” (Participant 96). Thus, participants called for “investment in the delivery of [psychological] services to be the best that it can be” (Participant 78), namely “more psychologists” (Participant 79), “more training/service improvement” (Participant 54), “dedicated [administrative] support” (Participant 47), and “more competitive pay rates” (Participant 86).

Relatedly, participants expressed the demoralising effects of inadequate support. Participant 49 lamented feeling like they were “helping too late, [like an] ambulance at the bottom of the cliff,” while Participant 6 detailed the “moral distress of not being able to see every patient.” Further, Participant 6 expounded the frustrations of “trying to make [changes] within [their] service when so many road blocks are put in the way,” with Participant 91 pointed out that “while medical professionals can have new hours added, [psychologists cannot].”

Being undervalued as a competent clinician

Supporting the previous theme, participants (110 of 538 responses) expanded on the moral hazards of working in environments not equipped to support the delivery of high-quality psychological care. In contrast to the professional satisfaction, pride, and meaning psychologists expressed feeling from seeing the real clinical impact of their work, participants highlighted the vexations of feeling undervalued and misunderstood. Thus, this theme revealed support for psychologists’ needs to encompass both material (e.g. funding and clinic rooms) and perceptual (e.g. feeling valued, heard, and supported) factors.

Illustrating this idea, participant 18 spoke of the frustrations of “working in a system that is so strongly medically focused, and doesn’t provide enough [for] or value the importance of psychosocial support.” This was exemplified by participants “feeling like a small cog in a big wheel and possibly not having a voice” (Participant 27) or feeling “severely undervalued” (Participant 30). This was reflected in relationships with managers, with Participant 41 describing their manager as “unapproachable and difficult to contact” while Participant 63 bluntly expressed their “dislike and distrust” for their non-psychologically-minded manager.

On the other hand, participants also specified ways to feel appreciated and valued in physical health settings, such as having “autonomy” (Participant 22), having managerial support for “endeavours [psychologists] want to pursue, such as. . .further study” (Participant 36), and being offered “better pay and conditions” (Participant 61). Summarily, participants wished for a “better understanding of health psychology and its place” (Participant 30) as more than a mere “addition to core work” (Participant 98) in physical health settings.

Feeling overwhelmed by work demands without adequate support or reward

This final theme (61 of 538 responses) encapsulated the emotional toll of psychologists feeling stretched and overworked in a demanding and unsupportive environment, drawing attention to psychologists’ humanity. Participants critiqued the medical hegemony “where doctors/consultants are at the top but don’t lead as a team” (Participant 18), leading to “an underlying sense of a lack of cohesion” (Participant 63). Further, participants plainly spoke of “personal tiredness” (Participant 14), expressing they felt “overwhelmed by workload and demands, [and] therefore [unable] to work as effectively or efficiently” (Participant 18). Participant 41 explained this extended beyond their own well-being, laying out the distress of “seeing [their] colleagues crumble under the pressures the health service is under, with and without COVID-19.”

Discussion

Overall, PsycH created a detailed snapshot of the NZ health psychologists in public hospitals by combining descriptive quantitative data from both individual psychologists and professional leaders. By using a mixed-methods approach, PsycH was able to integrate qualitative data with descriptive quantitative data to ground and contextualise our findings in the subjective experiences of individual psychologists. Further, by basing the definition of physical health settings on whether a psychologist works in a physical health service (as opposed to basing it on their qualifications or scope of practice), PsycH endeavoured to keep the pool of eligible psychologists consistent across different districts and hospitals with variable service structures. This targeted focus enhanced the richness of our understanding of the workforce challenges faced specifically by health psychologists, including poor resourcing of psychological services, undervaluation of psychologists as clinicians, and work-related stress. Similar obstacles to the growth and development of a robust and effective health psychology workforce have been noted for several decades internationally (e.g. Harvey and Hodgson, 1995; Litwin et al., 1991; Matarazzo et al., 1978; Stewart et al., 2017). However, despite such difficulties, qualitative analyses revealed a high proportion of psychologists also felt satisfied in their roles, describing opportunities for professional growth, robust collegial support, and meaningful patient interactions. These contrasting attitudes have been widely echoed in recent surveys from countries with comparable public health systems like Australia (Stokes et al., 2010), Canada (Drapeau et al., 2016), South Africa (Bantjes et al., 2016), and the UK (Busuttil et al., 2024). Such complexity highlights the value of mixed-methods approaches in adding interpretive depth.

PsycH also used a two-armed approach to combine quantitative workforce data from two different sources to enhance data completeness and validity. However, due to differences in sample size, the number of health districts represented, and survey design, direct comparisons across the two arms is difficult. Further, full representation of all health districts was unable to be reached across the two arms. Thus, it is likely that PsycH underestimates aspects such as the total number of psychologist positions; the range of physical health settings in which psychologists work; and the types of clinical and non-clinical leadership activities psychologists carry out. Additionally, as quantitative analysis was limited to descriptive statistics, PsycH is not designed to explain differences across factors like psychologists’ scopes, categories of physical health services, or health districts. For example, Figure 2 shows in total, there are approximately two times more psychologists per capita and over two times more psychologist FTE per capita in northern health districts compared to southern ones (NZ Health, 2025). Further research is required to examine the potential drivers of these discrepancies, such as differences in funding, staffing composition, service accessibility, and local demand. Thus, while PsycH fulfilled its objectives as a descriptive survey of the psychological workforce, more data is required to be able to benchmark psychological services for the purposes of evidence-based health psychology workforce planning, in accordance with the broader aims of CLPSNZ-2 (Hopkins et al., 2023b).

Nonetheless, our findings suggest a growing number of psychologists may consider themselves health psychologists when working in physical health settings, even without formal qualifications in the field. Previously, a survey (Stewart, 2008) showed only 3% of psychologists in the NZ public health system were identified by their managers as being health psychologists. In Arm 2 of PsycH, 26.5% of participants were identified as having health psychology qualifications, while 35.3% of all psychology FTEs were reported as being held by those who consider themselves health psychologists. PsycH does not report on the proportion of these FTEs held by psychologists with health psychology qualifications due to missing data. However, in NZ, health psychology does not exist as a standalone scope of practice, unlike clinical psychology, counselling psychology, or neuropsychology (NZ Psychologists Board, 2022). This lack of regulatory protection arguably inhibits accurate public and professional recognition of the unique clinical value of health psychologists. Within a regulatory model which confers legal protection to vocational scopes in psychology, the absence of a health psychology scope may also imply a lower level of specialist skills and training (NZ Psychologists Board, 2008), especially when the title is adopted by psychologists without appropriate training. Moreover, there are significant differences internationally in the governance of health psychology. As an example, Australia (Psychology Board of Australia, 2024) and the UK (Health & Care Professions Council, 2025) offer specific endorsements for health psychology, while regulatory variations exist across states and provinces in Canada (Demers and Cohen, 2023). Thus, the lack of a unified scope of health psychology internationally—which would distinguish psychologists with health psychology qualifications from psychologists broadly working in physical health settings—adds complexity to the interpretation of workforce data.

Notably, PsycH showed a substantial 31.60 FTE growth in psychologist positions across 11 districts between 2017 and 2022, in line with trends of sustained growth in the psychological workforce shown in previous surveys in NZ (Psychology Workforce Task Group, 2016; Stewart, 2008; Tuck, 2007). Similarly, in the UK, a survey found a 104% increase in psychology posts in physical health care in the NHS between 2015 and 2022 (Busuttil et al., 2024). Yet, PsycH also estimated the rate of workforce growth in NZ would need to more than double in order to meet projected need for the future, with 13 districts saying 70.80 psychologist FTEs will need to be filled across 33 physical health settings in the next 5 years. This narrative is also reflected in the NHS, where the current supply of psychological professions is needed to be almost tripled to meet projected need in 2037 (NHS England, 2023). In Australia, the number of psychologist FTEs across the public and private sectors in 2021 had only reached 35% of targets set in 2019, with shortfalls expected to increase even more by 2030 (Department of Health and Aged Care, 2022). Thus, in spite of continued growth in the existing workforce, projected need may be accelerating, although PsycH does not compare the rate of change in the health psychology workforce year-on-year. Contributing factors might include generally increased demand for mental health services (NZ Health, 2024), increased recognition of the value of psychologists in physical health settings (Stewart et al., 2014), and greater policy-based targeting of psychological workforce expansion (NZ Health, 2024; NHS England, 2023).

On the other hand, there is widespread recognition of the challenges posed by the lack of consistent and reliable workforce data to meaningfully growing the health psychology workforce to meet current and projected demand (Busuttil et al., 2024; Department of Health and Aged Care, 2022; Mathews et al., 2010; Psychology Workforce Task Group, 2016). PsycH also uncovered significant disparities in the regional distribution of the psychological workforce in NZ, suggesting focussed research is needed to understand how to grow the psychological workforce not only in absolute terms, but also in a way that equitably leads to improved health outcomes. In both NZ and the UK, serious attempts are ongoing to reform public health systems to improve health outcomes (Department of Health & Social Care, 2025; Te Whatu Ora Health NZ & Te Aka Whai Ora Māori Health Authority, 2022). Thus, PsycH provides a timely opportunity to build a consistent lineage of targeted psychological workforce data that will enable proactive planning, development, and maintenance of the valuable work of health psychologists.

PsycH showed that by and large, the health psychology workforce was highly satisfied with their work in physical health settings, despite material shortcomings with resourcing and funding. Importantly, participants’ responses showed psychologists’ commitment to clinical excellence, relishing opportunities to grow professionally and demonstrate clinical value. Participants also highlighted the importance of multidisciplinary work, not only to enhance patient outcomes but also as evidence of their acceptance and integration into clinical teams. Indeed, advocating for and promoting the clinical competencies of psychologists may be important not only to facilitate better patient outcomes, but also to enhance representation of health psychologists in leadership capacities. From this perspective, the challenge with resourcing for health psychology might be interpreted as a systemic issue that requires a fundamental shift in the way health psychology is valued and managed, rather than as an issue of scarcity.

Conclusions

PsycH provides the first national survey that psychologists working in physical health settings in New Zealand public hospitals are a substantial, valued, and growing workforce, yet one that remains under-recognised and insufficiently resourced. Across both survey arms, findings point to clear and increasing demand for health psychology input across a wide range of hospital services, alongside major projected workforce needs over the coming 5 years. These findings make a compelling case for strategic workforce planning, sustained investment, and clearer integration of psychologists within physical health services. Although psychologists reported high job satisfaction and strong commitment to their roles, this goodwill should not obscure the systemic barriers they continue to face, particularly inadequate resourcing and persistent misunderstandings about the scope and value of psychological practice in hospital settings. Without coordinated action, these barriers are likely to constrain service development and limit the ability of public hospitals to meet growing patient need.

Supplemental Material

sj-docx-1-hpq-10.1177_13591053261448153 – Supplemental material for Roles, workforce patterns, and concerns of psychologists working in New Zealand public hospitals: Findings from a national mixed-methods survey

Supplemental material, sj-docx-1-hpq-10.1177_13591053261448153 for Roles, workforce patterns, and concerns of psychologists working in New Zealand public hospitals: Findings from a national mixed-methods survey by David Lim, Frederick Sundram, John Hopkins, Lisa M. Reynolds, Lisa Hoyle, Phoebe Ross and Anna Serlachius in Journal of Health Psychology

Footnotes

Acknowledgements

The authors would like to thank co-investigator Dr Sarah Fortune for her contributions to this study. Special thanks also to Dr Malcolm Stewart for his expertise as external advisor.

ORCID iDs

David Lim

Frederick Sundram

John Hopkins

Lisa M. Reynolds

Lisa Hoyle

Phoebe Ross

Anna Serlachius

Ethical considerations

Ethics approval was provided by the Auckland Health Research Ethics Committee (reference: AH1367) on 22 April 2022 to 27 May 2023. Organisational approval was obtained from all participating health districts prior to recruitment.

Consent to participate

All participants provided written or digital informed consent prior to undertaking the survey.

Consent for publication

Consent for publication is not applicable to this article as it does not contain any identifiable data

Author contributions

David Lim: Original draft preparation, review & editing; formal analysis; data curation; visualisation; investigation. Frederick Sundram: conceptualisation; project administration; supervision; review & editing. John Hopkins: conceptualisation; project administration; review & editing. Lisa M. Reynolds: conceptualisation; review & editing. Lisa Hoyle: conceptualisation; review & editing. Phoebe Ross: formal analysis; review & editing. Anna Serlachius: supervision; conceptualisation, project administration; methodology; review & editing.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.*

Supplemental material

Supplemental material for this article is available online.

References

Bantjes

Kagee

Young

(2016) Counselling psychology in South Africa. Counselling Psychology Quarterly 29(2): 171–183. https://doi.org/10.1080/09515070.2015.1128401

Berelson

(1952) Content Analysis in Communication Research. Free Press.

Boden

Smith

Klocek

, et al. (2019) Mental health treatment quality, access, and satisfaction: Optimizing staffing in an era of fiscal accountability. Psychiatric Services 70(3): 168–175. https://doi.org/10.1176/appi.ps.201800229

Busuttil

Lavendar

Allez

, et al. (2024) Survey of clinical psychology and practitioner psychology posts in physical health care 2022. The British Psychological Society. Available at: https://explore.bps.org.uk/binary/bpsworks/2552801aba6b5099/aaef35676cdf7683bce6255925ee0115a3503e1d2deb8089adbe6bc460540ad2/9781854338631.pdf

Byrne

Branley

(2012) How many psychologists do we need? The Irish Psychologist. Available at: http://hdl.handle.net/10147/216129

Chamberlain

(2014) Epistemology and qualitative research. In: Rohleder

Lyons

(eds) Qualitative Research in Clinical and Health Psychology. Palgrave Macmillan, pp.9–28.

Demers

Cohen

(2023) Introduction to the health workforce in Canada: Psychologist. Report for the Canadian Health Workforce Network, Canada. Available at: https://tools.hhr-rhs.ca/en/details/2/11694.html

Department of Health & Children (2006) A vision for change: Report of the expert group on mental health policy. Report for the Government of Ireland. Available at: https://www.hse.ie/eng/services/publications/mentalhealth/mental-health-a-vision-for-change.pdf

Department of Health & Social Care (2025) Road to recovery: The government’s 2025 mandate to NHS England. Report for the UK Government. Available at: https://www.gov.uk/government/publications/road-to-recovery-the-governments-2025-mandate-to-nhs-england/road-to-recovery-the-governments-2025-mandate-to-nhs-england

10.

Department of Health & Aged Care (2022) National mental health workforce strategy 2022-2032. Report for the Commonwealth of Australia. Available at: https://www.health.gov.au/sites/default/files/2023-10/national-mental-health-workforce-strategy-2022-2032.pdf

11.

Drapeau

Holmqvist

Piotrowski

(2016) Psychology in Canada: Opportunities and challenges. Canadian Psychology/Psychologie Canadienne 57: 143–148. https://doi.org/10.1037/cap0000062

12.

George

Webster

(2021) The future of allied health leadership in New Zealand-Aotearoa: A literature review. Asia Pacific Journal of Health Management 16(2): 16–27.

13.

Graneheim

Lindgren

Lundman

(2017) Methodological challenges in qualitative content analysis: A discussion paper. Nurse Education Today 56: 29–34. https://doi.org/10.1016/j.nedt.2017.06.002

14.

Harris

Taylor

Minor

, et al. (2019) The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics 95: 103208. https://doi.org/10.1016/j.jbi.2019.103208

15.

Harris

Taylor

Thielke

, et al. (2009) Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics 42(2): 377–381. https://doi.org/10.1016/j.jbi.2008.08.010

16.

Harvey

Hodgson

(1995) New directions for research and practice in psychology in rural areas. Australian Psychologist 30(3): 196–199. https://doi.org/10.1080/00050069508258933

17.

Health & Care Professions Council (2025) Professions and protected titles. Available at: https://www.hcpc-uk.org/about-us/who-we-regulate/the-professions/

18.

Health & Social Care Integration Directorate (2011) Applied psychologists and psychology in NHS Scotland: Working group discussion paper. Report, NHS Scotland. Available at: https://www.publications.scot.nhs.uk/files/cel2011-10.pdf

19.

Health Education England (2021) Psychological professions workforce plan for England. Report, Health Education England. Available at: https://www.hee.nhs.uk/sites/default/files/documents/Psychological%20Professions%20Workforce%20Plan%20for%20England%20-%20Final.pdf

20.

Hopkins

Cullum

Sundram

(2020) The state of play - The first national survey of consultation-liaison psychiatry services in New Zealand. Australasian Psychiatry 28(4): 448–453. https://doi.org/10.1177/1039856220908174

21.

Hopkins

Skudder

Sundram

, et al. (2023a) A survey of the psychiatric care provided for medically ill older adults in general hospitals in New Zealand. Australasian Psychiatry 31(4): 485–493. https://doi.org/10.1177/10398562231186132

22.

Hopkins

Skudder

Sundram

, et al. (2025) A survey of the psychiatric care provided for children and young people in general hospital settings in New Zealand. Australasian Psychiatry 33(1): 64–75. https://doi.org/10.1177/10398562241282743

23.

Hopkins

Skudder

Vroegop

, et al. (2023b) Broadening the state of play - The second national survey of consultation-liaison psychiatry services in New Zealand, 2021. Australasian Psychiatry 31(5): 635–645. https://doi.org/10.1177/10398562231191689

24.

Hopkins

Sundram

de Beer

(2022) Consultation-liaison psychiatry in Aotearoa New Zealand – Past, present and a blueprint for the future. Report, Committee of the Aotearoa New Zealand Faculty of Consultation-Liaison Psychiatry. Available at: https://www.ranzcp.org/getmedia/0dbd7975-4cee-458b-b550-87a20de4becb/occassional-paper-from-nz-fclp-about-clp-in-nz.pdf

25.

IBM Corp (2022) IBM SPSS statistics for windows (28.0) [Computer software]. IBM Corp. Available at: https://www.ibm.com/products/spss-statistics

26.

Lim

(2022) Is there a psychologist in the house? The national survey of psychologists in general hospitals (PsycH). Master’s Thesis, University of Auckland, NZ.

27.

Lindgren

Lundman

Graneheim

(2020) Abstraction and interpretation during the qualitative content analysis process. International Journal of Nursing Studies 108: 103632. https://doi.org/10.1016/j.ijnurstu.2020.103632

28.

Litwin

Boswell

Kraft

(1991) Medical staff membership and clinical privileges: A survey of hospital-affiliated psychologists. Professional Psychology Research and Practice 22: 322–327. https://doi.org/10.1037/0735-7028.22.4.322

29.

Lumivero (2022) NVivo (13) [Computer software]. Available at: https://lumivero.com/products/nvivo/

30.

Matarazzo

Lubin

Nathan

(1978) Psychologists’ membership on the medical staffs of university teaching hospitals. American Psychologist 33: 23–29. https://doi.org/10.1037/0003-066X.33.1.23

31.

Mathews

Stokes

Crea

, et al. (2010) The Australian psychology workforce 1: A national profile of psychologists in practice. Australian Psychologist 45(3): 154–167. https://doi.org/10.1080/00050067.2010.489911

32.

Mental Health Commission (2012) Blueprint II: How things need to be. Report, Mental Health Commission, NZ.

33.

Nasim

Jayasundaram

Sundram

(2024) Understanding the scope of consultation-liaison psychiatry referrals in a general hospital setting in New Zealand. The New Zealand Medical Student Journal 0(38): 12–16. https://doi.org/10.57129/001c.127908

34.

NHS England (2023) NHS long term workforce plan. Report, NHS England, UK. Available at: https://www.england.nhs.uk/wp-content/uploads/2023/06/nhs-long-term-workforce-plan-v1.21.pdf

35.

NZ Health (2024) Health New Zealand Te Whatu Ora mental health & addiction workforce plan 2024-2027. Report, Health NZ. Available at: https://www.tewhatuora.govt.nz/publications/mental-health-and-addiction-workforce-plan-2024-2027

36.

NZ Health (2025) Map. Available at: https://www.tewhatuora.govt.nz/corporate-information/about-us/map

37.

NZ Psychologists Board (2008) Review of scopes of practice 2008. Report, NZ Psychologists Board, NZ. Available at: https://www.psychology.org.nz/journal-archive/Submission-on-the-review-of-the-scopes-of-practice-for-psychologists-May-2008.pdf

38.

NZ Psychologists Board (2022) Scopes of practice. Available at: https://psychologistsboard.org.nz/looking-to-register/scopes-of-practice/

39.

Paterson

Durie

Disley

, et al. (2018) He Ara Oranga: Report of the Government Inquiry Into Mental Health and Addiction. Report for Government Inquiry into Mental Health and Addiction.

40.

Psychology Board of Australia (2024) Endorsement. Available at: https://www.psychologyboard.gov.au/Endorsement.aspx

41.

Psychology Workforce Task Group (2016) The Aotearoa New Zealand psychology workforce survey. Report, Ministry of Health, NZ.

42.

Smith

Boden

Trafton

(2023) Outpatient provider staffing ratios: Binary recursive models associated with quality, access, and satisfaction. Psychological Services 20(1): 137–143. https://doi.org/10.1037/ser0000449

43.

Stewart

Bushnell

Hauraki

, et al. (2014) Evidence and wisdom: The role and value of psychologists in healthcare. Journal of the New Zealand College of Clinical Psychologists 24(1): 3–14.

44.

Stewart

Butcher

Garstang

, et al. (2017) Leadership by psychologists in the secondary healthcare system: A stocktake in New Zealand district health boards. Journal of the New Zealand College of Clinical Psychologists 27(2): 36–44.

45.

Stewart

(2008) Psychologists in physical health services in New Zealand. New Zealand Journal of Psychology 37: 50–55.

46.

Stokes

Mathews

Grenyer

BFS

, et al. (2010) The Australian psychology workforce 3: A national profile of psychologists in salaried employment or in independent private practice. Australian Psychologist 45(3): 178–188. https://doi.org/10.1080/00050061003777126

47.

Te Pou (2021) DHB population profiles 2021–2031: Statistics New Zealand projections 2020 update. Report, Te Pou.

48.

Te Whatu Ora Health NZ & Te Aka Whai Ora Māori Health Authority (2022) Te pae tata: Interim New Zealand health plan 2022. Report for Te Kāwantanga o Aotearoa NZ Government.

49.

Tuck

(2007) Psychologists working in district health boards in New Zealand: A survey. Bulletin of the New Zealand Psychological Society 108: 11–19.

50.

Whalley

Aitken

Lee

(2019) Report of the 4th survey of liaison psychiatry in England (LPSE-4). Report, NHS England. Available at: https://www.england.nhs.uk/wp-content/uploads/2019/07/fourth-annual-survey-liaison-psychiatry-england-report.pdf

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