Moving forward? Complementary and alternative practitioners seeking self‐regulation

Abstract

Complementary and alternative medicine (CAM) occupationscontinue to struggle towards achieving professional status, especially in the form of statutory regulation. Many consider professional status a worthwhile goal for CAM occupations, yet it is a process fraught with tensions. In this paper we present in-depth interview data from the leaders of three CAM groups (naturopaths, traditional Chinese medicine practitioners acupuncturists, and homeopaths) in Ontario, Canada that demonstrate four main strategies used by these groups to professionalize. The strategies discussed are related to how the knowledge base of each group is organised and transmitted. These strategies include: improving educational standards, improving practice standards, engaging in peer-reviewed research and increasing group cohesion. At the core of these strategies is the demarcation of who is qualified to practice, and a signalling to 'outsiders', such as medicine and the government, that practitioners are qualified and legitimate. Across the three groups, the leaders referred to the inclusion of medical science as a basis for distinguishing between 'science' and 'non-science' as well as who should practice and who should not. We highlight how internal battles over the infusion of medical science into the knowledge base are part of the process for establishing legitimacy for the three CAM groups in our study. We end with a brief discussion of the implications of these internal battles over medical science knowledge for the future of CAM groups.

Professional legitimacy claims in the multidisciplinary workplace: the case of heart failure care

“…All groups other than GPs employed a broadly similar expertise discourse, similar to that reported in Leonard's (2003) study. This, however, contrasts somewhat with the findings of earlier studies by Foley and Faircloth (2003) and Welsh et al (2004) discussed above; none of our respondents sought to legitimise their occupation in terms of a more overarching discourse of 'science'. The organisational efficiency discourse was employed only by our nurses and focused on claims that the specialist heart failure nursing role occupied a niche between the specialist work of cardiologists and the ongoing responsibility of GPs.…”

“…A number of empirical studies have examined the content of legitimation discourses, focusing mainly on interprofessional relationships in the context of practitioners of complementary and alternative medicine (Mizrachi et al 2005, Welsh et al 2004, Norris 2001, the nursing or midwifery boundary with medicine (Foley andFaircloth 2003, Leonard 2003) and the theatre nurse relationship to operating department practitioners (Timmons and Tanner 2004). Such research has suggested a number of recurring themes across a range of countries and of conventional and complementary health professions.…”

“…Such research has suggested a number of recurring themes across a range of countries and of conventional and complementary health professions. First, occupations may seek to legitimise their work with reference to 'science', for instance by stressing a common scientific basis of professional practice (Welsh et al 2004, Foley and Faircloth 2003, Mizrachi et al 2005. Secondly, occupations may stress the high level of skill and expertise that they possess (Leonard 2003).…”

Regulating Traditional Chinese Medicine Practitioners and Acupuncturists in Ontario, Canada

“…Western trained acupuncturists, on the other hand, declared that traditional training and education lacked the evidence-based scientific approach found in western medicine (Welsh et al 2004). Eventually, during the drafting of Bill 50, the government was able to serve as a mediator in order to give enough credibility to both forms of practice (The Canadian Press 2013).…”

“…Although TCM/A groups in Ontario had a history of lobbying for self-regulating status (Gilmour, Kelner, Wellman 2002;Welsh et al 2004), and various provincial governments had considered the issue since the 1990s, it was the timing of a combination of factors that gave the issue sufficient momentum to stay on the government's policy agenda long enough for action to be taken.…”