Beyond Professional Licensure: A Statement of Principle on Culturally-Responsive Healthcare

Abstract

This work calls on healthcare institutions and organizations to move toward inclusive recognition and representation of healthcare practitioners whose credibility is established both inside and outside of professional licensure mechanisms. Despite professional licensure’s advantages, this credentialing mechanism has in many cases served to reinforce unjust sociocultural power relations in relation to ethnicity and race, class and gender. To foster health equity and the delivery of culturally-responsive care, it is essential that mechanisms other than licensure be recognized as legitimate pathways for community accountability, safety and quality assurance. Such mechanisms include certification with non-statutory occupational bodies, as well as community-based recognition pathways such as those engaged for Community Health Workers (including Promotores de Salud) and Indigenous healing practitioners. Implementation of this vision will require interdisciplinary dialogue and reconciliation, constructive collaboration, and shared decision making between healthcare institutions and organizations, practitioners and the communities they serve.

Governing therapeutic pluralism: An environmental scan of the statutory regulation and government reimbursement of traditional and complementary medicine practitioners in the United States

“…It is also important to note that there exist numerous T&CM practitioner communities across the US that are not presently licensed despite having implemented voluntary, non-statutory, and community-based governance mechanisms. Such practitioner communities include Indigenous healers, faith and energy healers, herbalists, yoga therapists, mindfulness educators and others, the governance of whom falls beyond the present work’s scope [ 27 ].…”

“…Other scholarly works address the historical and contemporary contexts of midwifery governance; a growing trend toward statutory governance and reimbursement of birth doulas [ 21 ]; chiropractic credentialing and scopes of practice [ 24 ]; licensed massage therapists’ vulnerability to sexual harassment and solicitation within a broader context wherein sex trafficking operations misrepresent themselves as massage therapy businesses [ 24 ] ; the potential for naturopathic doctors working as primary care providers to reduce health professional shortages [ 25 ]; legal issues surrounding medical doctors’ use of T&CM practices; and, ‘safe harbor’ state laws enabling the limited practice of T&CM therapies by unlicensed practitioners [ 26 ]. A few studies furthermore point to a broader context of unlicensed T&CM practitioners offering care across the US [ 27 ], whether as herbalists, yoga therapists, mindfulness educators, Ayurvedic practitioners or faith healers ; in the form of bodywork practices that fall outside of massage therapy’s legal boundaries [ 28 ]; or, with respect to the wide range of traditional/Indigenous therapeutic practitioners who offer care within ethno-specific communities [ 29 ]; at times in collaboration with biomedical professionals [ 30 ].…”