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      A cross-sectional workforce survey of three traditional and complementary medicine professions in Ontario, Canada

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          Abstract

          Background

          Workforce studies about traditional and complementary medicine (T&CM) occupations in industrialized countries are scant; and, these occupations’ position within the broader occupational workforce remains unclear. This study aims to address these gaps using a comparative approach.

          Methods

          Naturopaths, traditional Chinese medicine (TCM) / acupuncture practitioners, and homeopaths in Ontario, Canada were surveyed regarding their demographics, practice characteristics and self-reported income. Results were compared with parallel data from within and outside of Ontario.

          Results

          Study response rate: 23.3% (n = 1205). While predominantly female (57.9%), Ontario’s TCM/acupuncture profession was less feminized than the naturopathic (77.1%) and homeopathic (78.3%) groups. Naturopaths were significantly younger than, and reported fewer years of clinical experience than, the other two groups. About half of TCM/acupuncture practitioners, and almost one-third of homeopaths had trained outside of Canada, predominantly in East and South Asia, respectively. More TCM/acupuncture practitioners (58.9%) and homeopaths (57.6%) had multilingual clinical practices than naturopaths (19.1%). Homeopaths worked fewer hours and saw fewer patients per week than the other occupations. Self-reported mean incomes varied across groups, with naturopaths earning more on average ($63,834, SD $57,101) than did TCM/acupuncture practitioners ($45,624, SD $44,081) or homeopaths ($29,230, SD $41,645). Holding other variables constant, internationally-trained practitioners reported earning one-third less than their Canadian-trained counterparts.

          Discussion & conclusions

          Study findings echo occupationally-specific data from other industrialized jurisdictions; and, affirm that different T&CM occupations have distinctive demographic and practice characteristics. The demographic makeup of Ontario’s TCM/acupuncture and homeopathy occupations suggests a role for these groups in delivering culturally-responsive care within Asian ethnic communities. T&CM practitioner incomes, in particular for internationally-trained practitioners, fell below the provincial population income median, and in many cases below the poverty line. T&CM occupations’ relative socio-political marginality may be impacting clinicians’ ability to earn a viable living.

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          Most cited references33

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          A systematic literature review of complementary and alternative medicine prevalence in EU.

          Studies suggest that complementary and alternative medicine (CAM) is widely used in the European Union (EU). We systematically reviewed data, reporting research quality and the prevalence of CAM use by citizens in Europe; what it is used for, and why. We searched for general population surveys of CAM use by using Ovid MEDLINE (1948 to September 2010), Cochrane Library (1989 to September 2010), CINAHL (1989 to September 2010), EMBASE (1980 to September 2010), PsychINFO including PsychARTICLES (1989 to September 2010), Web of Science (1989 to September 2010), AMED (1985 to September 2010), and CISCOM (1989 to September 2010). Additional studies were identified through experts and grey literature. Cross-sectional, population-based or cohort studies reporting CAM use in any EU language were included. Data were extracted and reviewed by 2 authors using a pre-designed extraction protocol with quality assessment instrument. 87 studies were included. Inter-rater reliability was good (kappa = 0.8). Study methodology and quality of reporting were poor. The prevalence of CAM use varied widely within and across EU countries (0.3-86%). Prevalence data demonstrated substantial heterogeneity unrelated to report quality; therefore, we were unable to pool data for meta-analysis; our report is narrative and based on descriptive statistics. Herbal medicine was most commonly reported. CAM users were mainly women. The most common reason for use was dissatisfaction with conventional care; CAM was widely used for musculoskeletal problems. CAM prevalence across the EU is problematic to estimate because studies are generally poor and heterogeneous. A consistent definition of CAM, a core set of CAMs with country-specific variations and a standardised reporting strategy to enhance the accuracy of data pooling would improve reporting quality.
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            Complementary medicine use in the Australian population: Results of a nationally-representative cross-sectional survey

            In order to describe the prevalence and characteristics of complementary medicine (CM) practice and product use by Australians, we conducted a cross-sectional online survey with Australian adults aged 18 and over. Rates of consultation with CM practitioners, and use of CM products and practices were assessed. The sample (n = 2,019) was broadly representative of the Australian population. Prevalence of any CM use was 63.1%, with 36% consulting a CM practitioner and 52.8% using any CM product or practice. Bodywork therapists were the most commonly consulted CM practitioners (massage therapists 20.7%, chiropractors 12.6%, yoga teachers 8.9%) and homeopaths were the least commonly consulted (3.4%). Almost half of respondents (47.8%) used vitamin/mineral supplements, while relaxation techniques/meditation were the most common practice (15.8%). CM users were more likely to be female, have a chronic disease diagnosis, no private health insurance, a higher education level, and not be looking for work. Prevalence of CM use in Australia has remained consistently high, demonstrating that CM is an established part of contemporary health management practices within the general population. It is critical that health policy makers and health care providers acknowledge CM in their attempts to ensure optimal public health and patient outcomes.
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              Characteristics of chiropractors and their patients in Belgium.

              The purpose of this study is to describe the characteristics, practice characteristics, and opinions of chiropractors and the sociodemographic characteristics and the type of complaint of patients presenting to chiropractors in Belgium. In 2008, all doctors of chiropractic in Belgium (N = 101) were asked to provide personal sociodemographic and practice-specific information via postal questionnaires. The participating practitioners presented written questionnaires to a maximum of 10 consecutive patients to collect sociodemographic and clinical data on the patients. Descriptive analyses were used. In total, 80 doctors of chiropractic (79.2%, n = 80/101) participated, providing information on 517 patients. Belgian doctors of chiropractic are predominantly male (75%), have a mean age of 44 (SD = 14) years, and have been in practice for 18 years on average. They typically treat neck and/or low back pain with or without radiating pain (85% of all complaints). Patients have a mean age of 43 (SD = 16.4) years, 54% are female, and most patients are employed (70%). Patients present with musculoskeletal complaints of moderate intensity, averaging 5 on a 0 to 10 numeric rating scale. Chiropractors spend, on average, 36 minutes on a new patient and 15 minutes on follow-up consultations. Diversified technique (93%) is the most often used technique, followed by mechanical-assisted (Activator) spinal manipulative therapy (41%). Ergonomic advice and instruction in exercise therapy are most often used in conjunction with spinal manipulative therapy. Most chiropractors would like to have the legal authority to request diagnostic imaging (87%). This is the first study describing doctors of chiropractic and their patients in Belgium. Chiropractors in Belgium primarily focus on the treatment of neuromusculoskeletal complaints in adults, with emphasis on the spine. Patients presenting to the chiropractor consult with musculoskeletal complaints of moderate intensity that moderately affect their activities of daily living. Copyright © 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                13 May 2021
                2021
                : 16
                : 5
                : e0250223
                Affiliations
                [1 ] Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
                [2 ] Department of Sociology, Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
                [3 ] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
                Endeavour College of Natural Health, AUSTRALIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-5826-5699
                https://orcid.org/0000-0002-9439-8456
                Article
                PONE-D-20-35806
                10.1371/journal.pone.0250223
                8118255
                33983955
                23702df1-4e01-48dd-ad00-45f6722e591f
                © 2021 Ijaz et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 16 November 2020
                : 2 April 2021
                Page count
                Figures: 0, Tables: 6, Pages: 16
                Funding
                Funded by: Canadian Institutes of Health Research
                Award ID: 503 255 - 4
                Award Recipient :
                This study was funded by the Canadian Institutes of Health Research (HB, SW, NI), Fund 503 255 - 4, https://cihr-irsc.gc.ca/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                People and Places
                Population Groupings
                Professions
                People and places
                Geographical locations
                North America
                Canada
                Ontario
                People and places
                Geographical locations
                North America
                Canada
                Social Sciences
                Linguistics
                Languages
                People and Places
                Geographical Locations
                Oceania
                Australia
                People and Places
                Geographical Locations
                Europe
                Switzerland
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Allied Health Care Professionals
                Medicine and Health Sciences
                Complementary and Alternative Medicine
                Acupuncture
                Custom metadata
                The ethics protocol for this study indicates presentation of aggregate data only, with no practitioner being identified or identifiable. This was due to the study datasets being small and containing many identifying factors, with a high risk of anonymity being breached with data sharing. The authors' university ethics board has confirmed that the deidentified dataset may therefore not be shared publicly. Daniel Gweyu, d.gweyu@ 123456utoronto.ca may be contacted directly at the University of Toronto Research Ethics Board for additional information.

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