Associations play a key role in setting standards and in representing their members, and would be key players in future policy development processes. A survey instrument was developed to establish a comprehensive profile of associations that represent TCM practitioners in Victoria, New South Wales and Queensland. It was circulated to professional associations representing TCM practitioners and those who use TCM modalities within other healthcare practices. From discussions held with professional associations it is estimated that their membership in Victoria, New South Wales and Queensland represents approximately 90% of all TCM practitioners in Australia. This chapter summarises key findings related to these associations.
The professional associations in this report were identified by wide consultation with the TCM profession, government reports, communication with private health funds, and feedback from the TCM workforce survey. Only professional associations with members in NSW, Victoria or Queensland were surveyed. There were 23 associations identified. Table 7.1 lists these associations and also contains a key to the acronyms used throughout this chapter. Letters of invitation to participate in the TCM Review accompanied the survey instrument and were posted to the associations between 30 January 1996 and 20 February 1996. Associations who did not respond by the due date were followed up by telephone. Information requested included:
- the type of the association;
- a brief history;
- number and types of members in each State;
- criteria for membership;
- aim/purpose;
- continuing education programs conducted;
- continuing education requirements for continued membership;
- protocols for dealing with complaints, dealing with accidents;
- procedures for peer review and quality assurance;
- codes of ethics and practice guidelines (if available);
- affiliations with other associations; and
- views on the need for statutory regulation of TCM practitioners.
A copy of the survey instrument is included as Appendix 17. Some summative findings for each association are tabulated in Appendix 18. Findings summarised in this chapter and in Appendix 18 are based upon documentation provided by associations, which includes information on the number of voting members. These membership numbers have not been independently verified; however, the precise numbers would not affect the broad findings of this chapter.
Table 7.1: Professional associations representing TCM practitioners in Victoria, New South Wales and Queensland
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Responses were received from 23 associations, and data from 22 is presented here. The remaining one responded late to the survey; however it is a branch of the Federation of Chinese Medicine and Acupuncture Societies of Australia and has been included in data provided by the Federation.
7.4 Legal Status, Origins and Affiliations of TCM Associations
Associations generally represent their memberships through the election of officer bearers defined in the articles of association of each organisation. These office bearers have the power to run the day to day affairs of the association on behalf of the membership and have the mandate to act on policy directives voted for by their membership. Usually educational institutions and associations representing a profession are independent of each other, which allows for clearly defined boundaries of activity. However, in one case (ATMS) the association's executive is composed of members appointed predominantly by recognised colleges, and so is not currently directly elected by its membership.
There is a considerable diversity in the origins of these associations:
- 12 (55%) of the 22 were formed to represent practitioners whose main practice is TCM (including acupuncture) and do not represent other health occupations. Some of these were formed by TCM practitioners to represent specific interests. For example, practitioners who were refugees or migrants from South-East Asia or mainland China are in part represented by Australian Traditional Chinese Medicine Association. One (AESO) was formed as a result of the need of a private health fund to identify qualified acupuncture practitioners.
- A number of other associations were formed by health professionals from other health occupations who have adopted TCM as part of their practice:
- three (14%) (IMA, ACMA, AMAS) by medical practitioners;
- two associations (NSWHNA, ANAA) were established by nurses;
- one association (APA) by physiotherapists; and
- one by chiropractors (AAA).
- Two associations (ANTA, ATMS) have memberships from a variety of disciplines within complementary medicine including TCM.
- One association (STAA) did not claim to represent the interest of TCM practitioners although some of their practice principles were related to TCM.
Some associations (ANTA, ATMS) have adopted an `all-inclusive' approach, aiming to be the unifying force among all practitioners of non-conventional medicine. However, the proliferation of specialised TCM professional associations is evidence that the majority of TCM practitioners believe their interests are best served by other means. One association (AMAS) believes that acupuncture in Australia is best practised by graduates of western medicine with western medical diagnostic and assessment skills.
Other associations accept as members only graduates from two or three Australian courses. The Australian College of Acupuncturists Ltd currently recognises for membership graduates from two government accredited courses from amongst the 13 major qualifying programs in TCM in Australia (see Chapter 8); it does not recognise graduates from the eight other government accredited courses in Australia. Overseas trained practitioners constitute 5% of its membership. The executive of this association is composed of graduates from the two programs it recognises.
The Federation of Chinese Medicine and Acupuncture Societies of Australia is an umbrella body that represents a number of smaller state-based associations and organisations. These associations include a substantial proportion of Chinese speaking and Chinese trained practitioners. They are the:
- Society of Chinese Medicine and Acupuncture (Vic) Inc.;
- New South Wales Research Association of TCM Inc.;
- Australian Chinese Association of Australia (WA) Inc;
- Society of Chinese Medicine and Acupuncture (ACT) Inc.;
- Society of Chinese Medicine and Acupuncture (SA) Inc.; and
- Society of Chinese Pharmacotherapy, Australia Inc.
Half of the associations have been formed since 1985. This parallels the growth in numbers of TCM practitioners in Australia. Only one association (ANTA) was formed before 1970. More than half (55%) are affiliated with other TCM associations, while almost one third (32%) are directly affiliated with at least one TCM teaching institution, demonstrating a significant relationship between teaching institutions and professional associations. The growth in TCM associations in Australia parallels the growth in TCM teaching programs (see Figures 7.1 and 7.2).
Figure 7.1: Growth in number of TCM associations between 1955 and 1995. Columns represent the number of new associations established for each 5 year period.
| Number of TCM Associations Established Between 1955 to 1995 | |||||||||
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1955 | 1960 | 1965 | 1970 | 1975 | 1980 | 1985 | 1990 | 1995 |
| 5 year period ending | |||||||||
Figure 7.2: Growth in number of TCM programs between 1970 and 1995. Columns represent the number of new courses established for each 5 year period.
| Number of New Courses Established Between 1970 to 1995 | |||||
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| 1975 | 1980 | 1985 | 1990 | 1995 | |
The types of membership offered by each association varies. Two associations (AAcA/AESO, STAA) have five types of membership ranging from provisional to life members. Eight associations (44%) offer full membership only. Less than a quarter of associations explicitly state that members are required to be current TCM practitioners.
There is a wide variation in the membership numbers:
- The number of full members (members assumed to be engaged in practice) ranges from 40 to 764.
- More than half the associations have less than 150 members (excluding associate and stu dent members).
- One association (AAcA/AESO) has a full membership exceeding seven hundred. It represents practitioners whose sole practice is TCM.
Membership numbers as listed in Appendix 18 have not been independently verified. Some associations also act as `umbrella groups' for other associations and some members of these associations may be counted twice. Overlapping membership is discussed in Chapter 5. In addition, the membership lists are not necessarily up to date, given that random telephone survey of practitioners selected from these lists (see Chapter 5) suggested that 28% were not currently in practice.
Of the 14 associations (64%) that indicated the distribution of their members by States or Territories, 46% of members were located in NSW, 32% in Victoria, 14% in Queensland, and 5% in Western Australia. The remaining 3% were distributed throughout South Australia, Tasmania and the Territories. Counts of individual practitioners by State (excluding dual membership of associations) are provided in Chapter 5.
7.6 Full Membership Eligibility
The eligibility criteria for full membership varies widely. One association (NSWHNA) accepts applicants who are `interested in using natural therapy' in their clinical practice, while others (for example, ACAc) require approximately 2,500 hours of combined training in TCM and western medical sciences. The Australian Medical Acupuncture Society requires registration as a medical practitioner and 100 hours of TCM training for full membership. Only 50% of the associations require members to have a formal TCM qualification. The standard for this qualification is set by the association itself.
Five associations (23%) conduct entry examinations for applicants who are unable to fulfil other membership criteria. Competency in the English language was identified by two as a criterion for membership (AAcA/AESO and ACAc).
7.7 Continuing Professional Education
There is significant variation in continuing professional education (CPE) requirements:
- 10 associations state that continuing education is not a requirement for continued membership.
- 5 do not state their policy on CPE.
- 8 (36%) require continuing professional education in TCM in order for practitioners to maintain membership. The extent of CPE required is summarised in Table 7.2.
Table 7.2: Some stated continuing professional education (CPE) requirements in TCM
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7.8 Purpose of the Association
All associations identified a number of purposes. They are:
- To enhance the knowledge and skills of association members (96%).
- To conduct conferences, seminars or symposia for their members (73%).
- To set a proper standard of practice amongst TCM practitioners (60%). Professional conduct and standards is addressed in the policies and procedures of 14% of the associations.
- To distribute up-to-date information on TCM in their own publications. Twelve associations (55%) have their own publications, comprising eight that publish a journal and four that publish quarterly or biannual newsletters.
- To promote academic exchange or liaison between members and teaching institutions of TCM (46%).
- To protect members' interests and provide a register of qualified TCM practitioners (32%).
- To act as a political voice on behalf of their membership (23%).
Not all TCM professional associations have comprehensive procedures to deal with issues related to public safety. The areas reviewed include:
- Dealing with complaints: 15 (68%) of the 22 associations stated that they have a procedure for dealing with complaints and 14 identified their disciplinary procedures (see Appendix 18).
- Record-keeping on accidents and injuries in TCM practice: 8 (36%) have procedures for collecting and recording information on accidents or injuries resulting from treatment administered by their members.
- Referral protocols to health professionals: 11 (50%) have a referral protocol.
- Peer review or quality assurance: 4 (18%) have a peer review or quality assurance process available to their members.
Sixteen associations (73%) stated that they have a code of ethics. Nine (41%) forwarded a copy with their response. The codes sampled were comprehensive. Most cover issues related to the treatment of patients, relationships with colleagues and other TCM practice issues.
7.10 Position on Occupational Regulation
The survey requested information on the attitude of the professional associations to government regulation of the profession. Four associations did not respond to this component (ACMA, IMA, NSWHNA, STAA). Of the 18 associations which responded, 16 (89%) were in favour of government regulation. These 16 associations represent the majority of currently unregulated TCM practitioners represented by the 22 associations. Some of the reasons given for supporting occupational regulation were:
- Regulation will improve patient safety and quality of service.
- Concerns over complaints received by the associations regarding unsafe TCM practitioners.
- Ineffectiveness of current self-regulatory systems in protecting the public from unsafe or unethical TCM practitioners.
- The inability under the current self-regulatory system to influence or discipline substandard TCM practitioners who are not members of the particular, or any, TCM association.
- The inability to ensure TCM courses are taught to an adequate standard.
The Australian Traditional Medicine Society (ATMS) is the only non-medical association which advocates self-regulation and does not currently believe that government regulation is necessary. It also believes that the government regulatory body of TCM could be dominated by orthodox medical practitioners. These views do not, however, reflect the views of the respondents to the TCM workforce survey, who identified themselves as principally ATMS members (43 out of 1074):
- 77% of these stated that government regulation would have a positive effect on professional status;
- 79% stated that government regulation would have a positive effect on standards of practice;
- 63% felt positively about the effects of regulation on standards of education; and
- 70% thought it would have a positive benefit on access to research infrastructure.
The Australian Medical Acupuncture Society (AMAS) does not support occupational regulation until mechanisms are in place to ensure adequate medical and clinical sciences training of undergraduates.
Australian Natural Therapist Association (ANTA) believes that the introduction of government regulation of TCM would result in:
- narrower and restrictive practice of TCM;
- restriction of Chinese herbal medicine imports; and
- undue pressure on TCM to conform to a scientific paradigm that might compromise TCM practice.
7.11 Cross-membership between Associations
In the TCM workforce survey practitioners were asked to list the TCM associations they were members of, in order of importance to themselves. Table 7.3 lists respondents by number of associations to which they belonged.
Approximately 42% of the respondents to the workforce survey are members of two or more TCM associations. Respondents were asked to identify their primary association. The number of respondents for each association is listed in Table 7.4.
Table 7.3: Summary of patterns of membership of TCM associations as identified in the TCM workforce survey
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Table 7.4: Primary associations identified by respondents
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Chapter 7: Professional Associations
- Peak body: There is no peak body that represents the entire TCM profession.
- Numbers of associations: There is a large number (23) of professional associations each representing segments of the TCM profession, with 50% of these associations formed since 1985. The growth in TCM associations parallels both the upsurge in numbers of TCM practitioners in Australia, and the growth in TCM teaching programs.
- Objectives: There is considerable diversity in the origins of these associations. The reasons for their development include:
- to represent TCM practitioners' interests;
- to deal with interests relevant to specific subgroups;
- to represent specific medical and allied health groups who have adopted TCM as one treatment modality;
- as a consequence of discontent amongst members of other associations;
- to represent the interests of graduates of particular courses. Almost one third (32%) of associations are directly affiliated with at least one TCM teaching institution.
- Membership: There is a wide variation in membership numbers amongst associations. Full membership numbers vary from 40 to 764. More than half of the associations have membership of less than 150. Approximately 42% of the practitioners responding to the TCM workforce survey are members of two or more TCM associations.
- Entry requirements: Eligibility criteria for full membership varies between associations. The 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 TCM and western medicine. Fifty percent of associations require members to have a formal TCM qualification recognised by that association. Less than one-quarter (seven) of associations conduct their own entry examinations for applicants who do not fulfil qualifying criteria for membership. Competency in the English language was identified as a requirement by two associations.
- Continuing education: Eight associations (36%) require some continuing professional education in TCM in order to maintain membership. CPE requirements vary considerably between associations.
- Professional quality assurance: Not all TCM professional associations have substantive 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.
There are difficulties in achieving uniform practice standards given the diversity of associations and the factional interest groups they represent. Approximately 25% of associations do not have a published code of ethics.
- Views on regulation: Overall, there is strong (89% of respondents to this item) support for government regulation of TCM practice amongst the associations. The main reasons given by associations for supporting occupational regulation are:
- the belief that regulation will improve patient safety and quality of service;
- concern over complaints received by the associations regarding unsafe TCM practices;
- ineffectiveness of current self-regulatory systems in protecting the public from unsafe and unethical TCM practitioners;
- the inability under the current self-regulatory system to influence or discipline substandard TCM practitioners who are not members of the particular, or any, TCM association;
- the inability to ensure TCM courses are taught to an adequate standard.
Chapter 7: Professional Associations
- That the self-regulatory mechanisms of professional associations be strengthened, regardless of whether the establishment of state based occupational regulation proceeds.
- That TCM associations cooperate to standardise continuing education requirements, codes of conduct, disciplinary procedures and other matters related to standards of clinical practice for the TCM profession.
- That TCM associations establish standard record-keeping procedures for recording adverse incidents, and educate their members on professional and community responsibilities regarding notification to a central body of adverse incidents arising from their treatment.
- That government ensure that consultation and policy development with regard to TCM involve associations representing Chinese-speaking practitioners and Australian-trained practitioners, most particularly those where executive representives have been democratically elected by their membership.
