This chapter summarises the findings of the Australian TCM Workforce Survey. Data was collected from all occupational groups, registered and unregistered, whose members practise TCM or one of its modalities. This survey provides the first comprehensive data on numbers of practitioners engaged in TCM, the nature of their qualifications, and profiles of their practice. Information was gathered through a written questionnaire, followed by a small number of face-to-face interviews with practitioners and a small follow-up telephone inquiry. The survey complements the surveys of TCM patients (Chapter 6), professional associations (Chapter 7) and of TCM teaching programs (Chapter 8).
This chapter presents an overview of findings from the survey. Relevant data on practitioner education, adverse events in TCM practice, and membership of professional associations is included in other relevant chapters.
5.2.1 The Mailing List
During 1996 professional associations representing practitioners of TCM or any of its modalities were approached for their mailing lists of members. All associations except those representing medical practitioners agreed to provide full mailing lists with names and addresses of members. A single non-medical master list was formed combining membership lists from all associations representing TCM practitioners who had members in the three States surveyed except for medical practitioners, and culling overlaps from the individual lists. TCM practitioners were included whether their primary practice was TCM or in another healthcare discipline. The latter group included physiotherapists, osteopaths, naturopaths, chiropractors, nurses, and shiatsu therapists. It is considered that TCM practitioners who are not members of any association form a very small percentage of the total TCM workforce.
This mailing list was held at the University of Western Sydney Macarthur (UWSM).
While the medical acupuncture associations had agreed to mail the TCM workforce survey di rectly to their members, the Health Insurance Commission (HIC) agreed to undertake the mailout. The HIC identified approximately 2,400 medical practitioners in Victoria, New South Wales and Queensland who had made claims in the previous 12 months on the Medicare item number for acupuncture. Distribution through the HIC ensured the most comprehensive identification of medical practitioners practising acupuncture, given that medical associations representing medical acupuncturists accounted for only one-third of claimants on Medicare. HIC distribution also avoided duplication from overlapping memberships of medical associations. The HIC mailing list consisted solely of medical practitioners.
5.2.2 The Questionnaire
A comprehensive questionnaire was designed to collect information on the characteristics of the TCM workforce. Consultation on the draft occurred on several occasions with the Victorian TCM Review Committee and executive representatives of TCM associations. The survey instrument was piloted with the associations' executive representatives. Ethics approval for the survey and follow-up interviews was obtained through the Victorian Department of Human Services Ethics Committee.
The survey instrument needed to be comprehensive (110 items distributed over eight pages), to address the lack of existing data. The overall response rate was adequate, and the database which has been established is accepted by the researchers as an accurate representation of the TCM workforce.
A bilingual letter (English and Chinese) was distributed with an English copy of the workforce survey to all practitioners on the two mailing lists. The letter provided contact names and numbers of Chinese speakers for each State who would forward a Chinese version of the survey if needed. The survey was translated into Chinese and verified independently by key bilingual staff including a teacher of Chinese language. The bilingual introductory letter further requested that readers nominate any other Chinese speaking TCM practitioners who had not yet been contacted. The letter advised that the survey was totally anonymous, and no identifying information was requested. Reply-paid envelopes were included.
Practitioners were invited to provide data on a number of important aspects of their practice. Information included:
- demographics of practitioners;
- the type of TCM services provided;
- years in TCM practice;
- number of consultations;
- adverse events related to their practice;
- referral systems;
- education and training;
- views on occupational regulation;
- membership of associations; and
- costs of treatment and income.
The same questionnaire was used for all practitioners of TCM, including those whose principal practice was in another form of health care. The questionnaire is attached as Appendix 15.
5.3.1 The UWSM Mailing List - Non-medical and Largely Primary TCM Practitioners
After culling of membership overlaps between associations, the UWSM mailing list consisted of 2,075 names. This was further reduced to 2,029 records when some surveys were returned to sender. This final number of 2,029 is taken as the identified total sample size of respondents. 1,073 (53%) practitioners had NSW addresses, 586 (29%) had Victorian addresses and 370 (18%) were in Queensland.
There were 621 responses by the due date, a response rate of 31%. However, verbal reports suggested that a number of practitioners, despite being on professional association mailing lists, were not currently in practice. Hence 100 names were randomly selected from the UWSM mailing list (via computerised random number generation), and efforts were made to make direct telephone contact with these practitioners. Over a two-week period of continuous attempted contact through various means (including at least six attempted calls during day, night and weekends), 83 were contacted: 63 (76%) were currently practising TCM, and 20 (24%) were no longer practising. Of the remaining practitioners who were not able to be contacted, it was assumed that 50% were out of practice. The adjusted rates are: 72% practising, 28% not practising.
Therefore, out of 2,029 members on the UWSM mailing list it has been assumed that 28% are not currently in TCM practice. This generates an active mailing list of 1,461 practitioners. 621 responses out of 1,461 active practitioners gives an adjusted response rate of 43%.
5.3.2 The HIC Mailing List - Medical and Largely Non-primary TCM Practitioners
The HIC mailing list consisted of 2,408 medical practitioners. Based on 1995 data, State distribution of medical practitioners claiming for acupuncture on the HIC list was NSW (36%), Victoria (22%), Queensland (20%).
There were 426 responses by the due date, a response rate of 18%. However, as with the UWSM list, there were concerns that a number of the medical practitioners who were sent survey forms may no longer be in practice or may have made only a few claims for acupuncture on Medicare. Based on 1995 HIC data, 2% of medical practitioners claiming for acupuncture account for 22% of consultations.
The HIC was not able to release names and telephone numbers of medical practitioners for a random telephone survey. If the UWSM adjustment of 28% is made, this generates an active HIC list of 1,734 medical practitioners. 453 responses (including some unallocated responses - see below) out of 1,734 gives an adjusted response rate of 26%. Calculations are presented based on both response rates, 18% and 26%, for this cohort of practitioners.
The HIC also provided figures on the total number of acupuncture consultations per year provided by medical practitioners for the years up to and including 1995, which have been used to estimate consultations for 1996 (see Table 5.7). The figures provided in Table 5.7 indicate that responses to the Workforce Survey are the equivalent of 39% of the total acupuncture consultations claimed for on Medicare. This would support the view that the medical response rates quoted above are conservative.
5.3.3 Total Responses
A number of practitioners (69 out of 1,074) chose not to identify their primary practice. This cohort has been allocated as respondents to the UWS and HIC mailing lists in a similar proportion to overall responses.
Twenty-seven copies of the Chinese version of the TCM workforce survey were distributed.
A total of 1,074 practitioners responded to the survey by the due date.
Final adjusted response rates were:
- UWSM mailing list - 43%.
- HIC mailing list - 18% (or 26%).
Practitioners were asked whether TCM was their primary health care practice:
- 433 (40%) identified TCM as their primary health care practice: these are referred to below as primary TCM practitioners.
- 571 (53%) stated their main health care practice was in another discipline, indicating a substantial cohort of allied health practitioners use TCM as an adjunct to their practice: these are referred to below as non-primary TCM practitioners. Of these, 426 were medical practitioners (40% of total respondents).
Table 5.1 and Figure 5.1 summarise the range of allied health practitioners utilising some modality of TCM. A number of practitioners (6.5%) chose not to identify their primary practice or had more than one occupation.
Table 5.1: Health practitioners using some modality of TCM in their practice
|
Table 5.2: Percentage of practice allocated to TCM by principal
practitioner occupation (number of practitioners in the occupational group in brackets)
* consists predominantly of shiatsu therapists.
|
Figure 5.1: Graphical distribution of health occupations using some modality of TCM in their practice
 |
Figure 5.2: Percentage of practice allocated to TCM by principal practitioner occupation (`other' consists predominantly of shiatsu therapists)
 |
There were significant differences in the amount of time allocated to TCM by each health occupation. The average (mean) percentage of TCM practice for each occupational group is given in Table 5.2 and Figure 5.2.
Practitioners who identified themselves as primary TCM practitioners devoted more of their clinical time to TCM practice than other health practitioners. Of practitioners identifying themselves as primary TCM trained, 12% spent less than 50% of their practice using TCM.
Whilst TCM is utilised by a wide range of health occupations, it is used as an adjunct to their primary practices. Only 1% of general practitioners using TCM do so for 90% or more of their practice. 75% of general practitioners use TCM for 10% or less of their practice time. For all other allied health occupations the pattern of TCM/non-TCM practice is similar to medical practitioners.
5.5 Basic Demographics of Practitioners
The average (mean) age of the TCM workforce was 44 years (standard deviation +10.5 years), with little difference between those identifying themselves as primary or non-primary TCM practitioners. Males made up 63% of primary TCM practitioners and 73% of the non-primary TCM workforce.
Distribution of practitioners
Table 5.3 and Figure 5.3 present the distribution of practitioners by State. Metropolitan and country distribution is summarised in Table 5.4. More than twice the number of primary TCM practitioners practise in metropolitan as opposed to country regions in the three States surveyed (Table 5.4). Non-primary TCM practitioners are more widely distributed than primary TCM practitioners, with approximately 40% of the former group practising in country regions.
Table 5.3: Number of practitioners by state, country or metropolitan location, and nature of main practice (69 practitioners did not identify themselves as primary or non-primary TCM practitioners)
|
Figure 5.3: Number of practitioners by state, country or metropolitan location, and nature of main practice.
| Sydney metrop. |  |
| NSW country | |
| Total NSW & ACT | |
| Melbourne metrop | |
| VIC country | |
| Total Victoria | |
| Brisbane metrop | |
| QLD country | |
| Total Queensland | |
 Primary  Non-Primary |
Table 5.4: Number of practitioners by country or metropolitan location and nature of main practice
|
