Summary of Findings

The popularity of Traditional Chinese Medicine is growing strongly, and a proliferation of Traditional Chinese Medicine practitioners, training courses and professional associations has occurred during the last decade. This growth is also relected in the four-fold increase in importation of Chinese herbal medicines since 1992.

The workforce

Traditional Chinese Medicine is practised as a principal health care practice and as an adjunct to other health care practices.

Currently, there are over 1,500 primary practitioners (those whose principal health occupation is Traditional Chinese Medicine), and 3,000 non-primary practitioners, who practise other disciplines such as medicine, nursing, osteopathy, and physiotherapy, and use Traditional Chinese Medicine predominantly in a part-time fashion.

By the year 2000, the number of primary practitioners is forecast to almost double, when over 1,100 students will graduate from Traditional Chinese Medicine qualifying programs.

Traditional Chinese Medicine accounts for an increasing percentage of total health care services. It is estimated there are at least 2.8 million consultations each year, representing an annual turnover of at least $84 million. Approximately twice as many consultations are performed each year by primary practitioners.

The mean age of the Traditional Chinese Medicine workforce is 44 years, and 68% are male. About 55% of practitioners practise predominantly acupuncture, 3% practise predominantly Chinese herbal medicine, and 28% combine both acupuncture and Chinese herbal medicine.

However, substantial differences exist between primary and non-primary practitioners. Primary practitioners more frequently combine acupuncture and Chinese herbal medicine, whilst non-primary practitioners are more likely to use acupuncture alone. Primary practitioners also use a variety of Traditional Chinese Medicine techniques that are less commonly used by allied health occupations. Some of these practices also carry distinct risks (for example, scarring moxibustion and point injection therapy).

Professional associations

There are now 23 professional associations represesenting different segments of the profession. However, there is no peak body which covers the entire profession, and the proliferation of groups makes it difficult to achieve uniform practice standards.

Full membership numbers vary from 40 to 764, with more than half of the associations having less than 150 members. Approximately 42% of practitioners are members of two or more asso ciations.

The membership criteria range from accepting applicants who are `interested' in using natural therapy in their clinical practice, to those associations that require over 2,500 hours of combined training in Traditional Chinese Medicine and western medicine. Eight associations require some continuing education in TCM in order to maintain membership.

Overall, there is strong support for government regulation of Traditional Chinese Medicine practice amongst the associations.

Another major finding is that not all TCM professional associations have substantive policies and procedures for:

  • record-keeping on accidents and injuries that occur in TCM practice;
  • dealing with complaints;
  • referral protocols to other health professionals;
  • peer review or quality assurance.

Education

There has been a recent expansion of Traditional Chinese Medicine education in universities and private colleges throughout Australia. However, there is significant variation in the delivery of education with award and non-award course lengths ranging from 50 hours to over 3000 hours. This has led to a very unevenly qualified workforce. Traditional Chinese Medicine courses for qualified medical practitioners range from 50 to 250 hours.

The academic component of education (which includes both acupuncture and Chinese herbal medicine) offered at some institutions appears similar to that in China, but clinical training in Australia is less substantial due to the lack of access to public hospitals for clinical experience. 50% of primary TCM practitioners have an average of 6 months clinical experience in China, predominantly within public hospitals.

There are 12 institutions (including three universities) which offer 13 major primary qualifying courses in Traditional Chinese Medicine. Ten of these are accredited by state education university authorities.

In addition, 10 short programs of study are offered to graduates of other health science disciplines, usually on a non-award basis and in acupuncture alone. The graduates receive limited recognition for membership by professional associations representing primary Traditional Chinese Medicine practitioners, although qualified practitioners of other health care occupations.

Undergraduate programs involve three to five years of full-time study. Standard four to five year programs are broadly recognised and favoured by professional associations. The average length of the first Traditional Chinese Medicine qualification for primary practitioners is 44 months, and for non-primary practitioners, eight months. About 10% of primary practitioners practise on the basis of apprenticeship training.

Some 45% of the total workforce stated they were involved in continuing Traditional Chinese Medicine education.

This is in contrast to the situation in China. China has dual systems and equivalent recognition of traditional Chinese and western medical education. There are 27 universities and colleges of Traditional Chinese Medicine, and 15 faculties in medical universities and colleges. The Bachelor of Medicine (TCM) program runs over five years full-time, with the fifth year as internship in a Traditional Chinese Medicine teaching hospital. Graduates have full practising rights within all public hospitals and are fully recognised by the State; that is, are on a State register and have prescribing rights for medications.

Patients

Traditional Chinese Medicine is provided to patients of all ages, including infants. Two in three patients are female, 50% tertiary educated, and over 80% have English as their first language.

A wide range of illnesses is treated, with 44% of cases being rheumatological or neurological in origin. Over 75% of patients are treated for a recurrent complaint of at least three months' duration.

On average, the cost of a consultation is $30, with the cost of a full course of treatment approximating $670 including Chinese herbs.

About 65% of patients are first-time users of Traditional Chinese Medicine. A large percentage are referred by word of mouth, which includes referral from other patients and through advertising.

Seven out of 10 had consulted another healthcare practitioner before starting Traditional Chinese Medicine treatment, and in six of the seven, this was a medical practitioner. Also 35% of patients taking Chinese herbal medicines take them concurrently with one or more of a broad range of pharmaceutical drugs (excluding vitamins and nutritional supplements).

Does Traditional Chinese Medicine work?

The report reviews international trials and studies examining the efficacy of Traditional Chinese Medicine and concludes:

  • There is a sufficiently strong case for the clinical use of acupuncture to manage pain, nausea and vomiting. Acupuncture also shows significant promise in other clinical areas, such as in hypertension and other cardiovascular disorders, digestive disorders, neurological problems, and drug addiction.
  • There are hundreds of clinical trials on Chinese herbal medicine, the majority of which have been undertaken in China. While these generally report favourable outcomes, they do not meet a sufficiently high methodological standard for broad acceptance in the West. There is some limited evidence in western countries for the efficacy of Chinese herbal medicine in a small number of clinical disorders.

What are the risks?

Although Traditional Chinese Medicine may be relatively safe compared to western medicine, it is not risk-free, and fatalities have occurred in Australia and overseas. Importantly, it appears to pose greater risks than some regulated health care practices, like chiropractic and osteopathy.

The report found that practitioners will experience one adverse event every eight months. These arise from:

  • The consumption of Chinese herbal medicines, leading to toxicity and allergic reactions.
  • The application of acupuncture, leading to infection, physical injury, fainting and convulsions.

A key finding is that the risk of adverse events is linked to the length of education of the practitioner, with practitioners graduating from extended Traditional Chinese Medicine education programs experiencing about half the adverse event rate of those practitioners who have graduated from short training programs.

Regulation of the profession

No provisions directly govern the practice of Traditional Chinese Medicine, although practitioners are regulated by State and/or Federal provisions of Medical Practice, Therapeutic Goods and Poisons legislation and by regulations and guidelines governing skin penetration. The dispensing of raw Chinese medicinal substances is not adequately regulated by current legislation.

Overseas trends

A number of overseas administrations have recently reviewed regulations concerning Traditional Chinese Medicine practice, and some have introduced occupational regulation.

Regulatory approaches to Traditional Chinese Medicine in different countries vary from a high degree of regulation, (where practitioners are licensed and supervising boards are established to maintain standards and oversee qualifications), to a virtual absence of regulation.

For example, in the United States, 27 states have enacted specific legislation to regulate the practice of acupuncture. A small number of states have adopted regulation similar to that applied to medical practitioners in Australia, restricting use of title to those with full Traditional Chinese Medicine qualifications. In these states medical and other health practitioners are required to obtain full Traditional Chinese Medicine qualifications to be able to call themselves Traditional Chinese Medicine practitioners or acupuncturists.

Australian Health Ministers' Advisory Council (AHMAC)

The policy and legislative framework for regulation of Traditional Chinese Medicine in Australia includes consideration of the Mutual Recognition legislation, the National Competition policy, and the AHMAC criteria for the regulation of unregulated occupations.

An assessment of Traditional Chinese Medicine against the AHMAC criteria has been made. The report concludes that:

  • It is appropriate for Health Ministers to exercise responsibility for regulating Traditional Chinese Medicine.
  • Some activities within the practice of Traditional Chinese Medicine pose a significant risk of harm.
  • Existing regulatory mechanisms are inadequate in safeguarding and protecting the public as consumers of Traditional Chinese Medicine (both acupuncture and Chinese herbal medicine).
  • Traditional Chinese Medicine is a defined profession for which regulation would be possible to implement.
  • Occupational regulation is practical to implement for currently unregulated Traditional Chinese Medicine practitioners.
  • The benefits of promoting public safety through occupational regulation of Traditional Chinese Medicine outweigh the potential negative impacts of such regulation.