Alternative futures: Fields, boundaries, and divergent professionalisation strategies within the Chiropractic profession

Abstract

Sociological studies of the complementary and alternative medicine (CAM) occupations have documented the professionalisation strategies these groups use to establish boundaries between themselves and their competitors, including seeking educational accreditation and statutory regulation/licensure. Chiropractic has been particularly successful at professionalising and in Australia and the UK it is taught within public universities. Recent events have threatened chiropractic's university foothold, however, showing that professionalisation needs to be understood as an ongoing process of negotiation. Based on interviews with chiropractors in Australia and the UK, this paper examines the professionalisation strategies deployed by chiropractors within and outside of the university. Highly divergent strategies are identified across different sectors of the profession, relating to defining the chiropractic paradigm, directing education and constructing professional identity. In each domain, chiropractic academics tended to prioritise building the evidence base and becoming more aligned with medicine and other allied health professions. Although some practitioners supported this agenda, others strove to preserve chiropractic's vitalistic philosophy and professional distinction. Following Bourdieu, these intra-professional struggles are interpreted as occurring within a field in which chiropractors compete for different forms of capital, pulled by two opposing poles. The differing orientations and strategies pursued at the two poles of the field point to a number of possible futures for this CAM profession, including a potential split within the profession itself.

A Tale of Specialization in 2 Professions: Comparing the Development of Radiology in Chiropractic and Medicine

“…Halpern, in her study of American pediatrics, noted that specialties were dynamic and constantly changing. 125 Miller 126 and Brosnan 127 have also indicated that professional identity is negotiated with different constituencies, and is fluid over time. Chiropractic radiology will continue to negotiate its status within its larger profession, the community of patients, physicians, and the owners of independent imaging facilities.…”

Naturopathic Medicine for the Management of Endometriosis, Dysmenorrhea, and Menorrhagia: A Content Analysis

“…This could also be defined by the influence of professional elites or groups within naturopathy that steer or influence practice, as has occurred similarly in other CM professions. 137 Given that one of the common criticisms of traditional medicine systems is their fixed systems and that they do not evolve when faced with new evidence, 138 their research suggests that significant differences in common treatments over time have occurred; however, further scholarly work is needed to examine the evolution and factors that influence such changes.…”

The prevalence of the term subluxation in chiropractic degree program curricula throughout the world

“…This type of work is what is known in sociology as boundary-work. Boundary-work leads to a division within a profession where scientists exclude pseudoscience and thus excludes some as outsiders [ 2 ].…”

“…Boundary-work appears to be occurring in the chiropractic profession [ 2 , 3 ]. The boundary-work may be separating the scientific academics from the practicing field and more vitalistic academics [ 2 ].…”

“…Boundary-work appears to be occurring in the chiropractic profession [ 2 , 3 ]. The boundary-work may be separating the scientific academics from the practicing field and more vitalistic academics [ 2 ]. The developing boundary appears to be the often cited crossroads for the profession which centers on the issue of the subluxation [ 4 – 37 ].…”