Abstract
Background: Approximately 36% of Australians consult complementary medicine (‘CM’) practitioners each year. Massage therapists and chiropractors are the most consulted CM practitioners. However, massage therapists and chiropractors are regulated very differently. Chiropractors, Chinese medicine practitioners and osteopaths are regulated under the National Registration and Accreditation Scheme (‘NRAS’). All other unregistered CM practitioners, including massage therapists, are regulated under State-based negative licensing schemes (‘NLSs’) or remain unregulated by legislation. While a paramount guiding principle underpinning the schemes is to protect the public, research analysing how the schemes regulate CM practitioners to protect the public is limited, unclear and potentially conflicted.Aims and Methods: This thesis analyses how three statutory schemes, the NRAS and the NLSs in New South Wales (‘NSW’) and Queensland, regulate CM practitioners to protect the public. It is informed by regulatory theory and mixed methods analyses. Based on key findings, recommendations are provided for future regulation of CM practitioners that may further protect the public.
Results: Despite broad similarities, these analyses found many differences, inconsistencies and gaps in the operation and public reporting of the schemes that may place the public at risk of harm. The doctrinal analysis found the NRAS has many more proactive regulatory mechanisms than the NLSs to minimise unacceptable risk or harm arising. The empirical analysis of NRAS complaints and disciplinary outcomes found differences in types of complaints and disciplinary outcomes received by registered CM professions compared to registered conventional professions. While removal from practice for misconduct was generally low, registered CM practitioners were removed at double the rate (2%) of registered conventional practitioners (1%). A retrospective case analysis found that the same number of registered CM practitioners were removed from practice under the NRAS across two six-year study periods despite increased registrant populations.
In contrast, under the NSW NLS, a 170% increase in unregistered CM practitioners were removed from practice in the second study period compared to the first. Under both NLSs, a higher percentage of complaints resulted in unregistered practitioner removal from practice than registered practitioner removal under the NRAS. Complaints against unregistered practitioners commonly involved professional conduct issues, whereas complaints against registered practitioners commonly involved treatment issues. These findings may be related to the lack of proactive regulatory mechanisms available under the NLSs.
Except for the second study period in NSW, across all schemes, sexual misconduct involving sexual assault of patients was the most common type of misconduct resulting in CM practitioner removal from practice. All cases of sexual assault of patients by CM practitioners were perpetrated by practitioners reported as male.
Conclusion: Recommendations are provided for future regulation of CM practitioners that may further protect the public. A primary recommendation is that unregistered CM occupations like massage therapy and others that pose significant risk of harm to the public may require stronger regulation in the form of statutory registration and inclusion in the NRAS. Findings and recommendations from this thesis may be useful to regulators and stakeholders to assist future research and regulation of CM practitioners in Australia and beyond.
| Date of Award | 12 Jun 2025 |
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| Original language | English |
| Supervisor | Michael Weir (Supervisor), Wendy Elizabeth Bonython (Supervisor) & Anne-Louise Carlton (Supervisor) |