Supportive but "worried": perceptions of naturopaths, homeopaths and Chinese medicine practitioners through a regulatory transition in Ontario, Canada.
BACKGROUND
In line with recent World Health Organization recommendations, many jurisdictions are taking steps to regulate practitioners of traditional, complementary and alternative medicine (TCAM). Previous studies have examined TCAM practitioners' generally-supportive views about professional regulation; however, little research has been conducted on TCAM practitioners' experiences and perspectives amidst an active regulatory process. In 2006 and 2007, the province of Ontario, Canada announced it would grant self-regulatory status to three TCAM practitioner groups--homeopaths, naturopaths and Chinese medicine practitioners/acupuncturists.


METHODS
In 2011 and 2012, part-way through each group's regulatory process, we surveyed all practitioners from these three groups (n=1047) that could be identified from public registries and professional associations. The data presented here are derived from the sub-sample of homeopaths (n=234), naturopaths (n=273) and Chinese medicine practitioners/acupuncturists (n=181) who provided answers to an open-ended question about their opinions of the regulatory process at the end of the survey. An inductive, thematic analysis of qualitative survey responses was conducted.


RESULTS
Survey responses affirmed a pro-regulatory stance across all groups, but revealed considerable 'worry' amongst practitioners as to how the regulations might be implemented. Four primary 'worry-related' themes emerged: a) regulation's potential administrative and financial burden on practitioners; b) scope-related concerns; c) implementation of fair registration standards; and d) whether regulation might erode the groups' distinctive worldviews. Some occupationally-specific concerns appeared related to each group's particular stage of professionalization. Other 'worries' may be related to the relative marginality of TCAM practitioner groups within biomedically-dominant national health care systems, and the possibility that inter-professional hierarchies may be emerging between particular TCAM groups. Specific concerns around overlapping practice scopes between TCAM and other professions raised questions about the implementation of non-monopolistic regulatory models such as Ontario's.


CONCLUSIONS
Overall, this study will help inform regulators and TCAM practitioner groups to navigate the unique challenge of regulating health care providers long excluded from national health care systems, who frequently work from within paradigms distinct from mainstream biomedicine.
Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St. (room 514), Toronto, ON, M5S 3M2, Canada.
Nadine
N
Ijaz
Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St. (room 514), Toronto, ON, M5S 3M2, Canada. heather.boon@utoronto.ca.
Heather
H
Boon
Department of Sociology, University of Toronto, Toronto, Canada.
Sandy
S
Welsh
Department of Sociology, University of Toronto, Toronto, Canada.
Allison
A
Meads
D000328:Adult; D001291:Attitude of Health Personnel; D000529:Complementary Therapies / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008516:Medicine, Chinese Traditional; D008875:Middle Aged; D009864:Ontario; D011795:Surveys and Questionnaires