Australian National Complementary Medicine Workforce Survey: A Profile of Practitioners and Their Practices

Abstract

Introduction:

Recent years have seen rapid changes to traditional, complementary, and integrative medicine (TCIM) practices in Australia associated with increased interest in TCIM during the COVID-19 pandemic and reorganization of practice delivery methods. This study aimed to update the understanding of the current TCIM workforce in Australia.

Methods:

Representatives of six TCIM professional organizations developed a survey for e-mail distribution to members. The anonymous online Qualtrics survey was based on previous surveys to identify workforce trends over time. Survey data were analyzed descriptively using Qualtrics and STATA statistical software (version 16).

Results:

Responses were recorded from 1921 participants. Respondents were predominantly female (79.7%); 71.8% were aged over 45 years. Remedial massage therapists represented 32.1% and naturopaths represented 23.7% of respondents. Highest qualifications were diplomas (37.7%), bachelor's degrees (28.9%), and advanced diplomas (21.8%). Metropolitan locations accounted for 68.1% of practices. Solo private practice was the main practice setting (59.8%); 13.8% practiced in group private practice with TCIM practitioners; and 10.6% practiced with allied health practitioners. Approximately three quarters of respondents (73.9%) saw 0–5 new clients per week; 42.2% had 0–5 follow-up consultations per week. Collaboration rates with TCIM practitioners, other non-TCIM practitioners, and general medical practitioners (GPs) were 68.7%, 24.4%, and 9.2%, respectively. A total of 93% did not suspect an adverse event from their treatment in the past year. Businesses of 75.9% of respondents were reportedly affected by the pandemic.

Discussion:

Comparisons with previous surveys show ongoing predominance of female practitioners, an aging workforce, a high proportion of remedial massage and naturopathy practitioners, and an increasingly qualified TCIM workforce. There was little change in the very low number of adverse events suspected by practitioners, number of consultations per week, and low levels of income of most TCIM practitioners compared with the average income in Australia. Respondents collaborated at similar rates as in the past; however, more with TCIM practitioners than with GPs.

Introduction

Traditional, complementary, and integrative medicine (TCIM) is thriving in Australia.¹ Approximately two thirds (63%) of Australians either consult TCIM practitioners or use TCIM remedies,^2
–4 and the population spends ∼$4.1 to $5.6 billion per year on TCIM with spending forecast to increase.⁵ This high demand has been identified in several studies over the past 30 years, which have provided the industry's demographic and professional practice profile.^6
–8

Key findings from these reports included female dominance and an aging workforce.⁹ A number of health professions, including acupuncture, Traditional Chinese Medicine, osteopathy, and chiropractic, are registered by the Australian Health Practitioner Regulation Agency.¹⁰ All other TCIM practitioners practice outside this registration system.

Consequently, there are no accurate data on the number of nonregistered TCIM practitioners in Australia. The Australian Bureau of Statistics¹¹ reported 8595 TCIM therapists in 2006, which was 80% higher than the figure in 1996. The 2018 Complementary Health Industry Forecast estimated that there were 19,900 massage therapists alone and 7200 other TCIM therapists.¹²

The past several years have seen rapid changes to the TCIM industry in Australia due, in part, to a global increase in the use and interest in TCIM during the COVID-19 pandemic, particularly for protecting against contracting COVID-19.^13
–15 The effectiveness of most TCIM interventions for COVID-19 still requires investigation.¹⁶

The pandemic also meant that TCIM practitioners worldwide had to reorganize their delivery methods, sometimes through telehealth consultations, and adjust their fees accordingly.¹⁷ In addition, a review of Australian government subsidies for private health insurance rebates saw the removal of subsidies for 19 natural therapies in 2019.¹⁸ Given these significant changes to the TCIM industry, this study set out to update the understanding of the current TCIM workforce in Australia.

Materials and Methods

Recruitment

Thirteen, leading, TCIM professional associations in Australia were invited to join the host organization, the Australian Traditional Medicine Society (ATMS), to form a Steering Committee and distribute the survey to members. One representative from each of five TCIM associations joined the Steering Committee. These associations e-mailed members, inviting their participation in an online anonymous Qualtrics survey (www.Qualtrics.com ).

An incentive of one continuing professional education point was awarded for completing the survey. Participants were those members of the five professional associations who responded to the survey. The response rate was calculated as the number of people who responded to the survey as a percentage of the total number of people who were invited to participate. It is not known how many invitees opened the link to the survey.

Survey development

The survey was developed from previous surveys distributed by the ATMS in 2002^19,20 and 2012^9,21 and by others^3,22 with the advice of the Steering Committee. The survey was piloted by members of the Steering Committee, the Directors of ATMS, and the ATMS Research Committee, and feedback was incorporated into the final version.

Changes included replacing “natural medicine” with “complementary medicine,” updating the options for gender, including new disciplines (e.g., lifestyle medicine) and salary ranges, including online as a practice setting option, and including questions on vaccination and the consequences of the COVID-19 pandemic on clinical practice.

The final survey contained 52 questions (Supplementary Data S1). The Centre for Evidence-Based Medicine Critical Appraisal of a Survey tool²³ guided survey development (Supplementary Data S2).

Data analysis

Survey data were analyzed descriptively using Qualtrics and STATA statistical software (version 16). All percentages were reported using valid percent, which excluded missing data. TCIM professions were clustered into the following groups for analysis:

Physical medicine—aromatherapy, Bowen therapy, hydrotherapy, kinesiology, myotherapy, osteopathy, reflexology, remedial massage, Shiatsu, sports massage, massage therapy/Swedish/relaxation massage, and yoga therapy.

Ingestive medicine—Ayurveda, homeopathy, naturopathy, nutrition, and Western herbal medicine.

Energetic medicine—energetic medicine, energetic healing, and Reiki.

Registered profession (i.e., registered by the Australian Government Health Practitioner Regulation Agency¹⁰)—acupuncture, Chinese herbal medicine, chiropractic, general medical practice, nursing, pharmacy, and physiotherapy.

Mind–body medicine—counseling, meditation/relaxation, psychology, and lifestyle medicine.

These clusters were originally informed by the Expert Committee on Complementary Medicines in the Health System²⁴ and decided (by consensus) by Steering Committees of this survey and previous iterations.

Participants were invited to provide detailed responses to questions about the consequences of COVID-19 (Q49) on their practices in an open text box. These were transferred to a word document and allocated codes that were later refined to form themes. This article reports those results deemed by the Steering Committee to be of interest to participating professional associations and for which longitudinal comparisons with previous workforce survey data could be made. The Southern Cross University Human Research Ethics Committee (Approval No.: 2022/026) approved the study.

Results

Responses were recorded from 1921 participants, an estimated response rate of 9.7%. A total of 810/1549 (52.3%) respondents reported ATMS membership, followed by 263/1549 (17.0%) from the Australian Natural Therapists Association, and 134/1549 (8.7%) from the Naturopaths and Herbalists Association of Australia. The remainder were from 18 other smaller associations (22.0%).

Practitioner profile

Gender

Respondents were predominantly female (1534/1915, 79.7%); 353/1915 (18.7%) respondents reported male gender; 6/1915 (0.3%) identified as nonbinary; and 1 (0.05%) preferred not to say.

Age

Approximately one third (602/1921, 31.3%) of respondents were 46–55 years old, followed by 526/1921 (27.4%) aged between 56 and 65 years, 386/1921 (20.1%) between 36 and 45 years, 149/1921 (7.8%) between 25 and 35 years, and 7/1921 (0.4%) younger than 25 years.

Primary discipline

A total of 588/1833 (32.1%) reported remedial massage as their primary discipline, 435/1833 (23.7%) reported naturopathy, 136/1833 (7.4%) reported acupuncture, 104/1833 (5.7%) reported nutrition, and 80/1833 (4.4%) reported homeopathy. Table 1 shows the total number of respondents who reported practicing each TCIM discipline and total number of practitioners reporting the TCIM discipline as their primary discipline.

Table 1.

Total Number of Practitioners Reporting Practicing Traditional, Complementary, and Integrative Medicine (TCIM) Disciplines and Total Number of Practitioners Reporting the TCIM Discipline As Their Primary Discipline

TCIM discipline	Total number of practitioners reporting practicing the TCIM discipline ^a	Total number of practitioners reporting the TCIM discipline as their primary discipline, n (%)
Remedial massage	772	588 (32.1)
Naturopathy	566	435 (23.7)
Massage therapy/Swedish/relaxation	331	31 (1.7)
Nutrition	297	104 (5.7)
Western herbal medicine	236	50 (2.7)
Other	218	62 (3.4)
Sports massage	204	12 (.07)
Acupuncture	175	136 (7.4)
Homeopathy	139	80 (4.4)
Energy medicine/energetic healing	121	36 (2.0)
Chinese herbal medicine	99	5 (0.3)
Reflexology	93	13 (0.7)
Counseling	91	23 (1.3)
Aromatherapy	86	27 (1.5)
Reiki	85	4 (0.2)
Kinesiology	78	44 (2.4)
Bowen therapy	66	9 (0.5)
Myotherapy	52	25 (1.4)
Meditation–relaxation	50	5 (0.3)
Shiatsu	40	13 (0.7)
Yoga therapy	36	8 (0.4)
Lifestyle medicine	33	2 (0.1)
Nursing	33	16 (0.9)
Hypnotherapy	23	7 (0.4)
Ayurveda	15	6 (0.3)
Pharmacy	11	2 (0.1)
Osteopathy	9	3 (0.2)
Physiotherapy	6	3 (0.2)
Psychology	4	0 (0)
General medical practitioner	2	2 (0.1)
Hydrotherapy	1	2 (0.1)
Total	4111

Total number of respondents is 1833. Respondents were able to choose more than one TCIM discipline.

TCIM, traditional, complementary, and integrative medicine.

Years in clinical practice

Roughly one third (497/1588, 31.3%) of respondents reported practicing for >21 years, 248/1588 (15.6%) reported practicing between 16 and 20 years, 253/1588 (15.9%) for 11–15 years, 229/1588 (14.4%) for 6–10 years, and 361/1588 (22.7%) had been practicing for <5 years.

Practitioner qualifications

Using the Australian Qualifications Framework,²⁵ the main highest qualification types for respondents were diploma (661/1752, 37.7%), bachelor's degree (506/1752, 28.9%), and advanced diploma (382/1752, 21.8%) (Table 2). Registered practitioners had the highest percentage (101/159, 63.5%) of bachelor's degrees, followed by 21/159 (13.2%) with master's degrees.

Table 2.

Practitioner's Highest Qualification By Traditional, Complementary, and Integrative Medicine Discipline Cluster

Discipline		No formal qualifications	Certificate IV	Diploma	Advanced diploma	Bachelor's degree	Master's degree	PhD	Other	Total
Physical medicine	Count	2	31	496	99	56	6	4	11	705
Physical medicine	%	0.28	4.4	70.35	14.04	7.94	0.85	0.57	1.56	100
Ingestive medicine	Count	2	2	54	212	308	26	8	28	640
Ingestive medicine	%	0.31	0.31	8.44	33.13	48.13	4.06	1.25	4.38	100
Energetic medicine	Count	1	1	12	7	6	0	0	5	32
Energetic medicine	%	3.13	3.13	37.5	21.88	18.75	0	0	15.63	100
Registered profession	Count	0	1	13	20	101	21	1	2	159
Registered profession	%	0	0.63	8.18	12.58	63.52	13.21	0.63	1.26	100
Mind–body medicine	Count	0	1	7	6	3	2	2	1	22
Mind–body medicine	%	0	4.55	31.82	27.27	13.64	9.09	9.09	4.55	100
Other	Count	1	2	18	15	10	1	1	10	58
Other	%	1.72	3.45	31.03	25.86	17.24	1.72	1.72	17.24	100
Total		6	38	600	359	484	56	16	57	1616
Total		0.37	2.35	37.13	22.22	29.95	3.47	0.99	3.53	100

Practice profile

Main practice location

Table 3 depicts the main practice location and setting of respondents. Most (940/1571, 59.8%) practiced in a solo private practice and the majority (1305/1917, 68.1%) in a metropolitan setting. Geographic area was determined by the 1991 Australian Bureau of Statistics' geographical classification for area.²⁶

Table 3.

Main Practice Location and Setting

Location and setting	n (%)
Location
Metropolitan	1305 (68.1)
Rural	567 (29.6)
Remote	45 (2.4)
Total	1917 (100)
Main practice setting
Solo private practice	940 (59.8)
Group private practice with TCIM practitioners	216 (13.8)
Group private practice with other health practitioners^a	168 (10.6)
Online	69 (4.4)
Retail	52 (3.3)
Other	46 (2.9)
Mobile/house call	33 (2.1)
Group private practice with GP	25 (1.6)
Spa, gym, or resort facility	17 (1.1)
Corporate setting	5 (0.3)
Total	1571 (100)

Non-TCIM, non-GP.

GP, general medical practitioner; TCIM, traditional, complementary, and integrative medicine.

Number of consultations

The highest number of respondents reported seeing 0–5 clients per week: just under three quarters (1172/1587, 73.9%) reported 0–5 new clients per week and 667/1582 (42.2%) reported 0–5 follow-up consultations per week. Table 4 provides details of the number and duration of consultations reported by respondents.

Table 4.

Initial Consultation, Follow-Up Consultation, and Consultation Time

	n (%)
Initial consultations per week
0–5	1172 (73.9)
6–10	210 (13.2)
11–20	121 (7.6)
21–30	46 (2.9)
31–40	18 (1.1)
41–50	13 (0.8)
>51	7 (0.4)
Total	1587 (100)
Follow-up consultations per week
0–5	667 (42.2)
6–10	390 (24.7)
11–15	324 (20.5)
21–30	139 (8.8)
31–40	42 (27.0)
41–50	12 (0.8)
Over 51	8 (0.5)
Total	1582 (100)
Initial consultation time
15 min or less	138 (8.8)
Between 15 and 30 min	124 (7.9)
Between 31 and 45 min	88 (5.6)
Between 46 and 60 min	569 (36.4)
Longer than 60 min	645 (41.2)
Total	1564 (100)

Practice income

The question about practice income was answered by 1388/1921 (72.3%) respondents (Table 5). Three quarters of respondents (1043/1388, 75.1%) reported a average gross annual income of AUD 60,000 or less (in the same year, the gross annual income of Australians was AUD 90,800²⁷).

Table 5.

Practitioners' Gross Income

Gross income in AUD	n (%)
<$5,000	156 (11.2)
$5,001–$10,000	144 (10.4)
$10,001–$20,000	189 (13.6)
$20,001–$40,001	303 (21.8)
$40,001–$60,000	251 (18.1)
$60,001–$80,000	146 (10.5)
$80,001–$100,000	77 (5.6)
$100,000–$120,000	52 (3.8)
>$120,000	70 (5.0)
Total	1388 (100)

Use of digital technologies

More than half (855/1569, 54.5%) of respondents used digital technologies to operate and/or manage their TCIM practice (e.g., online booking system, practice management software). Ingestive medicine practitioners reported the highest use (350/525, 66.7%). Digital technologies were not used by 714/1569 (45.5%) respondents.

Referrals and collaboration

Respondents were asked about referral rates to and from other health practitioners and responded on a 6-point Likert scale (never, rarely, very rarely, frequently, or very frequently/always). A total of 616/1407 (43.8%) respondents reported referring clients to general medical practitioners (GPs) for medical diagnostic testing (e.g., blood tests, X-rays) occasionally, 316/1407 (22.5%) reported frequently, 64/1407 (4.6%) reported very frequently, and 72/1407 (5.1%) said they never referred for these tests.

Respondents also reported referring clients for functional pathology tests (e.g., hair analysis, saliva, stool tests, urine, gene mapping): 160/1409 (11.4%) reported frequently, 33/1409 (2.4%) reported very frequently, 335/1409 (23.8%) reported occasionally, and about a third (464/1409, 32.9%) reported never.

Almost two thirds of respondents (868/1408, 61.7%) said they very frequently, frequently, or occasionally used some kind of mainstream medical diagnostic test (e.g., blood tests, X-ray) to inform their assessment of clients. A total of 1329/1408 (94.4%) respondents reported receiving referrals from other health practitioners: 35/1408 (2.5%) very frequently/always, 307/1408 (21.8%) frequently, 656/1408 (46.6%) occasionally, 180/1408 (12.8%) rarely, and 151/1408 (10.7%) very rarely.

Table 6 shows referrals from other health practitioners by TCIM discipline cluster. Approximately a quarter of physical medicine practitioners (153/598, 25.6%), registered TCIM practitioners (30/84, 22.4%), and mind–body practitioners (3/14, 21.42%) reported frequently receiving referrals from other health practitioners.

Table 6.

Referral from Other Health Practitioners

Discipline		Never	Very rarely	Rarely	Occasionally	Frequently	Very frequently	Total
Physical medicine	Count	18	61	58	288	153	20	598
Physical medicine	%	3.01	10.2	9.7	48.16	25.59	3.34	100
Ingestive medicine	Count	41	62	76	214	89	9	491
Ingestive medicine	%	8.35	12.63	15.48	43.58	18.13	1.83	100
Energetic medicine	Count	2	1	4	10	2	0	19
Energetic medicine	%	10.53	5.26	21.05	52.63	10.53	0	100
Registered profession	Count	9	8	22	62	30	3	134
Registered profession	%	6.72	5.97	16.42	46.27	22.39	2.24	100
Mind–body medicine	Count	0	2	1	7	3	1	14
Mind–body medicine	%	0	14.29	7.14	50	21.43	7.14	100
Other	Count	6	5	4	18	8	1	42
Other	%	14.29	11.9	9.52	42.86	19.05	2.38	100
Total		76	139	165	599	285	34	1298
Total		5.86	10.71	12.71	46.15	21.96	2.62	100

Respondents were also asked if they collaborated with other health practitioners to discuss clients' conditions. Over three quarters of respondents (1065/1407, 75.7%) said they collaborated with other health practitioners and 654/1061 (59.5%) reported collaborating about treatment options occasionally (499/1061, 47%), frequently (117/1061, 11.1%), or very frequently/always (18/1061, 1.8%). A total of 68.7% reported collaborating with other TCIM practitioners, 24.4% with other health practitioners, and 9.2% with GPs.

Adverse reactions

Respondents were asked whether they had suspected that an adverse reaction may have occurred due to their treatment in the past 12 months. Those who responded yes were asked about the type of adverse reaction and its severity. A small proportion (99/1421, 7.0%) of respondents reported suspecting an adverse reaction in the past year, while 1322/1421 (93.0%) reported no suspected adverse reactions.

A total of 24/1322 (25.5%) of these reactions were reported as aggravation of symptoms, 17/1322 (18.1%) as gastrointestinal reactions, and 10/1322 (10.6%) as bruising. Only three (0.2%) of the 1421 respondents reported referring their client to a medical practitioner due to an adverse reaction.

Consequences of the COVID-19 pandemic on TCIM practice

Over three quarters of respondents (1044/1376, 75.9%) said their businesses were affected by the pandemic. Many reported loss of clients throughout the pandemic, while others said that demand for their services increased substantially. Some who lost clients initially reported that these clients eventually returned with easing of restrictions. Others reported their clients never returning, giving such reasons as clients no longer being able to afford treatments or being frightened of contracting COVID-19.

Loss of vaccinated clients was also frequently reported as they were unwilling to visit a clinic that also treated unvaccinated clients. According to respondents, negative impacts came from the extra time required to clean thoroughly between clients and the difficulties associated with working with masks. However, for some, the shift to online delivery had long-term benefits, including being able to reach more clients or reduced overhead costs.

Discussion

This survey, the latest in a series of similar surveys of the Australian TCIM workforce over the past 25 years,^{9,19
–21,28,29} confirms long-term characterizations, including predominantly female and increasingly qualified practitioners, private practice setting, long consultation times (77.6% over 45 min), and few suspected adverse reactions (93.2% reported no suspected adverse reactions in the past year). However, it is important to note that respondents' reports about adverse reactions may differ from the true number. The results also provide an updated understanding of current issues facing TCIM professions in Australia, including decreasing rates of collaboration with GPs, challenges establishing a full-time practice, and consequences of vaccine mandates and pandemic lockdowns.

Practitioner profile

Gender and age

The TCIM workforce in Australia in 2022 had increased its female dominance from 73% in 2012³⁰ to 79.7% in the present survey. The trend toward an aging TCIM workforce demographic also continues. In 2000–2002 surveys,²⁸ age ranges for remedial massage therapists were fairly evenly distributed between 26 and 55 years; naturopaths, Western medical herbalists, and acupuncturists were slightly older (34–45 years).

In the 2012 survey, however, only 15% of respondents were 35 years or younger.³⁰ In the present survey, only 8.1% of respondents were 35 years or younger. It appears that a future shortage of TCIM practitioners may be anticipated.

Primary discipline

About a third (32.1%) of the respondents in the present survey reported remedial massage as their primary discipline and 23.7% reported naturopathy. The same primary disciplines were prevalent in 2012,³⁰ with 25.7% of respondents reporting remedial massage and 17.7% reporting naturopathy as their primary discipline.³⁰

Years in clinical practice

A total of 63.3% of respondents reported practicing for >10 years, with almost a third (31.5%) of those reporting practicing for >20 years; 22.8% had been practicing for <5 years. In 2012, 23% of respondents had been in practice for >16 years and 33% had been in practice for <5 years.³⁰ It appears that TCIM practitioners are remaining in practice longer than in the past.

Practitioner qualifications

In Hale's 2002 survey¹⁹ of acupuncturists, naturopaths, and Western herbal medicine practitioners, 10.5% of respondents had a bachelor's degree. In 2012, the number of respondents with a bachelor's degree increased slightly to 14%.³¹ The present survey demonstrated a more than doubling of the number of TCIM practitioners with a bachelor's degree (28.9%), suggesting an increasingly qualified TCIM workforce.

Practice profile

Practice location

TCIM practitioners' practice locations in 2022 are similar to those reported 20 years earlier, with approximately two thirds (68.9%) practicing in metropolitan locations and one third (32.1%) in nonmetropolitan locations. Earlier surveys reported 44% of massage therapists and 67% of acupuncturists, Western medical herbalists, and naturopaths working in metropolitan locations.^19,20

Practice setting

There has been little change in TCIM practice settings. In the present study, solo private practice was the main practice setting for 59.8% of respondents; 13.8% reported practicing with other TCIM practitioners and 10.6% with allied health practitioners. Earlier surveys reported that solo practices accounted for 64% of remedial massage practices and 59% of naturopathy, Western herbal medicine, and acupuncture practices.^19,20 Up to 30% reported working in group practices. By 2012, there had been little change, with 58.9% of TCIM practitioners working in solo practices.³⁰

Number of consultations/gross income

Low numbers of TCIM consultations continue to be reported, with 73.9% of respondents seeing 0–5 new clients per week and 42.2% reporting 0–5 follow-up consultations per week. In the 2012 survey,³⁰ 54% of practitioners conducted an average of 10 consultations per week and this was reflected in levels of gross incomes derived from TCIM practice, which were below the national average for the same year. Further research is required to investigate reasons for this low income.

The present survey asked respondents to nominate their preferred number of consultations per week; 42.7% selected 11–20 consultations per week and 31.7% chose 0–10. This suggests that many TCIM practitioners choose to work part-time and may have other sources of income. However, it appears to be challenging to establish financially viable practices for those who want to work full-time in TCIM in Australia.

Other health practitioners' perceptions of inadequate levels of education and competence may play a role.^32,33 It is also possible that some graduates lack the business skills required for establishing successful small businesses and/or receive a limited welcome from mainstream health care.^33
–35

Referrals and collaboration

A total of 70.5% of respondents reported occasionally, frequently, or very frequently referring clients to GPs for medical diagnostic testing (e.g., blood tests, X-rays). This is a slight increase from the comparable referral rate (69%) reported in the 2012 survey.³¹ With regard to referral from other health practitioners, 70.7% of respondents in the present survey reported occasionally, frequently, or very frequently/always receiving referrals from other health practitioners.

This is very similar to responses in the 2012 survey (71%).³¹ A total of 61.5% of respondents in the 2022 survey said they occasionally, frequently, or very frequently used mainstream diagnostic tests to inform their clinical decision-making. This is a slight increase from the 58% reported in 2012.³¹

Collaboration rates (75.6%) in 2022 are similar to those reported in 2012, although the trend appears to be toward more collaboration with TCIM practitioners (68.7%); 31.6% collaborated with other health practitioners, 9.2% of whom collaborated with GPs. In 2012, more than a third of respondents reported collaborating with TCIM practitioners (37%), 37% reported collaborating with allied health practitioners, and 25% reported collaborating with GPs.³¹

Given the low levels of patient disclosure of the use of TCIM to medical practitioners,^36
–38 such collaborations could contribute to patient safety and patient-centered care. The trend toward decreasing collaboration with GPs needs further investigation. Given the well-recognized importance of participating in health care teams for optimal client outcomes,³⁹ it is important that TCIM practitioners, who are already highly popular with the Australian population, are not excluded from multidisciplinary health care teams.

Adverse reactions

In the present survey, 93.0% of respondents reported not suspecting any adverse reactions from their consultations over the past year. This is comparable with the 92% reported in the 2012 survey.^31,40 However, these surveys asked for practitioners' perceptions and may not be an accurate measure of adverse reactions. There are real risks associated with TCIM use and accurate measures are required. Registered professions are governed by the Australian Health Practitioner Regulation Agency that provides annual reports on complaints.⁴¹ No such register exists for nonregistered TCIM practitioners in Australia. However, members of the public experiencing suspected adverse reactions to TCIM products are advised to report the reaction to the Therapeutic Goods Administration (TGA).⁴² Sponsors of traditional and complementary medicines are required to report all suspected adverse reactions to the TGA.

Consequences of COVID-19 on TCIM practice

Globally, interest in TCIM therapies remained high throughout the COVID pandemic^13,43,44; however, government mandates may have left some practitioners in Australia feeling uncertain about their future as TCIM providers. This survey found that most TCIM practitioners in Australia were affected by the pandemic in some way, although not all negatively. For example, many who switched to online consultations were able to increase the number of clients they could consult and reduce overhead costs.

Similarly, a Norwegian study by Stub et al.¹⁷ found that practitioners who reorganized their delivery to include online consultations held higher hopes for the future of their practice. The reorganization in delivery of some TCIM practices appears to have created an opportunity for some, although others reported financial distress and losing clients who had not returned. Further research is required to identify the consequences of the COVID-19 pandemic and other external forces (e.g., cost of living increases) on the TCIM workforce in Australia and globally.

TCIM practitioners have a long history of providing services for the Australian public.⁴⁵ However, restructuring of the vocational education sector⁴⁶ and closure of a number of high-profile, TCIM tertiary education courses in recent years^47,48 have led to a decline in the number of TCIM education providers in Australia. The results of the current survey suggest that strategies to increase student enrollment in TCIM courses and to secure the financial viability of their practices are required to secure the future TCIM workforce in Australia.

Limitations

Limitations of this survey are its response rate (9.7%) and potential selection bias (i.e., failure to reach cohorts of Australian TCIM practitioners with different views). However, respondents were similar to the whole membership of the ATMS (∼10,000 members) in age, practice location distribution, and primary discipline (Supplementary Data S3). The consistency of results over three iterations of similar surveys over more than two decades is also noteworthy.

However, the results may not represent the profiles and practice characteristics of all TCIM practitioners in Australia. Social desirability bias (i.e., if answers were chosen to be perceived favorably by others) could have also influenced the results. A further limitation is clustering of TCIM disciplines as there are pragmatic and theoretical overlaps between several clusters, and other researchers may have chosen different clusters.

Conclusions

Comparisons with previous surveys conducted over the past 25 years show an increasing predominance of female practitioners, an aging workforce, continued dominance of remedial massage therapy and naturopathy, increasing years in clinical practice, and an increasingly qualified TCIM workforce.

There appears to be little change in the very low number of suspected adverse events reported by respondents, the number of consultations per week, and the low level of income of most TCIM practitioners in Australia, two thirds of whom work 20 h per week or less. Collaboration rates with GPs have also declined.

If these trends are confirmed by future research, strategies will be required to boost student enrollment in TCIM courses and to increase the financial viability of practice.

Footnotes

Acknowledgments

The authors would like to acknowledge the generous support of the funding body, the ATMS, and the participating TCIM professional associations who guided development of the survey and its distribution to their members. The authors would also like to acknowledge Dr. Alison Bowling for her statistical analysis of the data.

Authors' Contributions

S.G. was responsible for conceptualization, formal analysis, funding acquisition, methodology, project administration, writing—original draft, and writing—reviewing and editing. K.B. was responsible for data curation, formal analysis, project administration, writing—original draft, and writing—reviewing and editing.

Author Disclosure Statement

S.G. is a Director of the Board of the ATMS, who sponsored this project. The sponsor had no involvement in collection, analysis, or reporting of data. S.G. has no other competing, personal financial, funding, or employment interests to declare. K.B. has no competing, personal financial, funding, or employment interests to declare.

Funding Information

This project was sponsored by the ATMS.

Supplementary Material

Supplementary Data S1

Supplementary Data S2

Supplementary Data S3

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