Canadian Family Physicians and Complementary/alternative Medicine: The Role of Practice Setting, Medical Training, and Province of Practice

By Hirschkorn, Kristine A.; Andersen, Robert et al. | Canadian Review of Sociology, May 2009 | Go to article overview

Canadian Family Physicians and Complementary/alternative Medicine: The Role of Practice Setting, Medical Training, and Province of Practice


Hirschkorn, Kristine A., Andersen, Robert, Bourgeault, Ivy L., Canadian Review of Sociology


ATTEMPTS AT CATEGORIZING PRACTICES/PRACTITIONERS AS COMPLEMENTARY and alternative medicine (CAM) are contested and vary according to political context, point of view and study design (Achilles 2001; Astin et al. 1998; Kelner and Wellman 2000; NCCAM 2008). CAM is typically defined "residually" as therapeutic approaches that fall outside of orthodox biomedicine in the West (Achilles 2001; Hirschkorn and Bourgeault 2007; Saks 2003; Sharma 2000). It has also been defined positively as a group of practices/practitioners embodying the characteristics of holism, vitalism, and individualized care (Kelner and Wellman 2000; Micozzi 2001). Nonetheless, an internationally facilitated consensus process identifies the following as core practitioner-based or self-care CAM therapies/modalities: acupuncture, Traditional Chinese Medicine, homeopathy, herbal supplements, and nutrition therapy (Lachance et al. 2006). In Canada, the definition is extended to include chiropractic medicine.

In recent decades, there has been a large increase in the consumption of CAM in the Western world (Eisenberg et al. 1998; Goldner 2004; Goldstein 2000), including Canada (Kelner and Wellman 2000; Northcott 1994; Simpson 2003). Concomitantly, many recent surveys have measured physicians' attitudes and behaviors related to CAM use (i.e., providing a CAM service or referring for CAM services). While Ernst, Resch, and White (1995) argue that there is no noticeable increase in physician referral for CAM over time, other findings are less conclusive (Astin et al. 1998; Botting and Cook 2000; Ernst et al. 1995; Hirschkorn and Bourgeault 2005). Attitudinal measures feature prominently in these studies, and although they consistently explain some of the variation in physician behavior (Astin et al. 1998; Visser and Peters 1990), explanations for physician provision of or referral for CAM remain unclear (Astin et al. 1998; Botting and Cook 2000; Ernst et al. 1995; Hirschkorn and Bourgeault 2005).

The present study sheds some light on the reasons why Canadian family physicians offer CAM services to their patients. Using survey data collected by the College of Family Physicians of Canada (CFPC)--the 2001 National Family Physician Workforce Survey (NFPWS)--we focus on the influence of practice setting, location of medical training, and province of practice. Our findings suggest that organizational practice setting, a hitherto underinvestigated influence, has significant negative effects on provision of CAM services. We also show that location of training and practice are both important factors related to a physician's probability of offering CAM services.

LITERATURE REVIEW

The most common factors thought to affect physicians' behavior with respect to CAM are individual-level sociodemographic variables, measures of attitudes about knowledge of safety and effectiveness of CAM therapies, training in or familiarity with CAM, and locality of practice (region/country, urban/rural) (Astin et al. 1998; Aziz 2004; Botting and Cook 2000; Clement et al. 2005; Ekins-Daukes et al. 2004; Ernst et al. 1995; Gardner and Ogden 2005; Hinkka et al. 2004; Hirschkorn and Bourgeault 2005; Hsiao et al. 2005; Milden and Stokols 2004; Schneider, Hanisch, and Weiser 2004; Suter, Verhoef, and O'Beirne 2004; van Haselen et al. 2004). Other factors, albeit less so, that are also considered important are the area of specialization of the physician (family practice, oncology, etc.), personal or familial use, disease/illness characteristics, work setting (e.g., clinic/hospital, public/ private), years of professional experience, locality (e.g., urban versus rural, regional/country comparisons), size of clinical practice, patient request or interest, and ethnicity or nationality.

Specialization and Family Physicians

Given the focus of our analysis on Canadian family physicians, it is worth noting how family physicians compare with other physicians with respect to CAM. …

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