Physicians providing alternative medicine: Boundary crossing and the emergence of integrative medicine.

摘要

Integrative medicine (IM) has organized as a new area of specialization in mainstream healthcare. The development of IM is widely attributed to popular demand for the range of therapies known collectively as Complementary and Alternative Medicine (CAM). During the 1990's the rate of acceptance of CAM accelerated among consumers, professions, financing and education. The Medical Expenditure Panel Survey (MEPS) measured CAM utilization and professional service provision during the years 1996 and 1998, but never since. These surveys were unique because they specifically inquired as to whether CAM was provided by a physician, among other types of professionals. This dissertation defines early integrative medicine (MDCAM) as CAM therapies provided by physicians. Because the MDCAM subpopulation is small, MEPS surveys for 1996 and 1998 were combined (N=39,314) to improve statistical power.;Nearly one million Americans received CAM therapies from their physicians during the period, and this professional behavior was found in every region of the country. Services provided by physicians included spiritual healing, massage and acupuncture; national population prevalence estimates are provided. This is meaningful because physicians, at the time, were at risk for disciplinary action for providing CAM.;The MDCAM subpopulation was similar to those who used both conventional and CAM services from other professional sources (BOTH), however, MDCAM reported much higher prescription medication use. The demographic profile of MDCAM was more similar to those who consume health care services frequently, compared to infrequent consumers. The MDCAM group is distinguished from those who use BOTH by increased utilization of the following services: nutritional advice, biofeedback and meditation. MDCAM is characterized by diagnoses of chronic illness. MDCAM recipients used mainstream medicine, yet employed disease management services offered by the CAM domain.;The theoretical approach employed Abbott's (1988) theory of a system of professions, in which MDCAM represents a professional strategy of client differentiation through the social boundary mechanism of borrowing (Tilly, 2004) specific CAM therapies to satisfy consumer demand. The utility of the theory of a system of professions is discussed for its ability to decouple conceptual-level claims from observable workplace-level behaviors.