Professional supervision and peer review: a strategic solution to boost demand and accommodate our growing professions
For referencing Arentz S. Professional supervision and peer review: a strategic solution to boost demand and accommodate our growing professions. AJHNM 2019;31(4):134-136
There is a significant difference between the size of the naturopathic profession and the number of graduates coming through the colleges, a difference that could inevitably lead to high rates of professional attrition. Diversification of career pathways is one solution, as is bolstering demand for naturopathic clinical services in healthcare and improving public access. There are barriers to the latter solution, however, including negative perceptions of naturopaths by conventional health providers. One way to overcome negative views is to demonstrate transparency, knowledge and accountability which could be achieved with greater engagement with professional supervision and peer review. It takes courage to face critics, but is a worthwhile pursuit for our professions, as it may translate to increased demand for our clinical services and, in turn, provide a supreme solution to the burgeoning growth of the profession.
During the Herbal Medicine Week celebrations I had the privilege of participating in the NHAA focus groups hosted by the new CEO Patricia Michel. The conversation turned to a familiar topic – the large number of naturopathic students and a lack of career capacity and opportunities for new graduates, an issue that seems at the forefront of established members as well as new graduates these days. And their concern is understandable.
The number of Australians listing their occupation as naturopath in 2017 was approximately 4,000; professional growth predicts space for 600 additional practitioners by the year 2022, bringing the total to 4,6001. However, this figure does not equate to the number of students currently enrolled in naturopathic degree programs. For example, in 2018, just one college had nearly 2,000 students of naturopathy enrolled2. This then equates to at least 400–500 new graduates each year, again from just that one college, meaning an estimated 2,000–2,500 new graduate members will join the profession between 2017 and 2022. This suggests that more than 75% of these graduates will not be accommodated in their chosen profession, despite having paid nearly $80,000 for their naturopathic degree qualification. Again, these figures are based on statistics just from one educational provider; however, in Australia at the moment we have a number of different pathways for students interested in this field, and therefore even more potential graduates.
While it can be argued that some established practitioners are likely to leave and buffer these rates, it is also worth noting that more than half of the current profession would need to retire in order to accommodate these new graduates and, considering most members are middle-aged women in part-time clinical practice3,4, this is very unlikely. I am referring to naturopaths only here because there are no undergraduate programs of herbal medicine in Australia at present. Indeed, if we add herbalists to the list, we need to further increase our estimates of the potential over-supply of students wanting to enter the profession, and therefore also consider the associated lack of professional opportunity.
Career diversity is a proposed solution and development of roles and jobs in areas other than clinical practice –such as community pharmacy, in the supplement industry, or in research – may offer career pathways for new graduates. Another strategy is to boost public demand and accessibility to naturopathic clinical health services, a strategy congruent with new graduates’ interests in clinical practice and professional values and goals.
However, there are significant barriers to increasing public demand for naturopathic services, including negative attitudes expressed by other conventional health professionals and providers. Over 48% of GPs cite that they would not refer to a naturopath under any circumstances5, and we are all familiar with the negative position statements of the Royal Australian College of General Practitioners (RACGP) in response to naturopaths’ referral of patients for pathology tests6. In addition, professional disunity and lack of regulation are often cited as growth barriers for our profession7. These factors underpin negative perceptions of naturopaths as having vested interests and a lack of knowledge.
Whilst we may not share these opinions, the most efficient and respectful way to challenge these views is to acknowledge they exist and respond with a counter argument of substance, relevance and transparency. A meaningful response requires internal collaboration, a harnessing of our resources and effectively working together, supporting one another to engage with the issues and problems, find logical solutions and respond to critics. It is important to defend our profession, as no response, or a non-coherent response, could confirm negative perceptions and biases expressed by our clinical healthcare peers and undermine growth in demand for our clinical services.
One of the main driving qualities of all clinicians is a desire to improve health, to make profound differences to people’s lives, and naturopaths are no exception. It means putting patients first and making decisions that genuinely help, using expert techniques – in our case, long consultations, specialised knowledge, effective communication and recommendations of relevant natural medicines. This person-centred approach is an intrinsic quality of ethical clinical practice, and a key definition of ethical healthcare8. Clinical roles are complex and require sophisticated meta-cognitive skills to plan, manage, meet patients’ expectations and appraise decisions.
In particular, self-reflection is a professional characteristic of ethical practice due to its facilitation of a practitioner’s recognition of their own impact on patients and clarification of their roles and boundaries. Many health professions support members with peer supervision programs that enable reflection and de-briefing in safe and non-judgemental settings, developing individual strengths, and identifying and positively addressing limitations. Formalised professional peer support programs can help identify overarching knowledge gaps and provide support that directly addresses the specific needs of professions without any agenda other than to enhance knowledge and function, cohesion and the profile of the profession.
Transparency in healthcare is often defined as a lack of hidden agendas and by the single intention to benefit recipients. It is closely linked to ethical practice when providing care for vulnerable and unwell people. An extra income stream for supervisors may be an incidental benefit for supervisors; however, financial gain should be accountable to the profession to ensure supervision aligns with cohesion of the profession objectives rather than developing another income stream or interest of supervisors
Another demonstration of transparency is members’ support of peer-reviewed scientific journals such as the NHAA members’ support of the AJHNM. Indeed, a significant factor that predicted GPs’ willingness to refer to naturopaths was their use of peer-reviewed literature5. A peer-reviewed journal containing articles written by naturopaths and herbalists can raise awareness. It shows specialised knowledge and expertise, capacity for self-reflection, and willingness to engage in critique. Peer review means articles are not published unless they have been reviewed by at least two peers with specific topical expertise and have been recommended for publication by the editorial board. Many clinical professions are not experienced in peer review and our profession is no exception. In this spirit, the AJHNM has introduced a peer mentor program for authors who lack experience in writing for publication and/or peer review.
The MACA program (Mentor an Author in return for Co-authorship or formal Acknowledgement) involves pairing manuscript authors with experienced, published authors for one-on-one support through to re-submission, peer review and acceptance for publication. The AJHNM is indexed on several databases and full texts can be accessed through membership of the NHAA and through library subscriptions such as university libraries. This means that articles published in the AJHNM are accessible and available to wide audiences, including the NHAA membership and to academic and conventional clinical communities. Alumni membership of university libraries is valued and embedded in conventional healthcare culture and access to peer-reviewed published literature is considered a primary avenue for reliable and robust information needed for clinical practice decisions.
Professional supervision and peer review demonstrate understanding, knowledge and courage, our openness to critique, and expression of our primary interests in patients which may all go some way in addressing the negative opinions held by other health practitioners. Considering and responding to criticisms may foster greater acceptance in Australian healthcare and pave the way for health service partnerships with more inclusion of naturopaths and herbalists. This could increase public demand for our services and help accommodate the rapid growth of new naturopathic graduates in a way that honours clinical practice values and preserves the integrity of our unique and growing professions. If you would like more information about the MACA program, please get in touch: firstname.lastname@example.org
This issue’s president’s report is by our newly elected NHAA president, David Casteleijn. In it, David outlines his vision for the NHAA, including continued endorsement of degree programs and statutory registration, including recognition of members with diploma and advanced diploma qualifications, expressed in the message “together, we can”.
On behalf of the editorial board and the AJHNM, I would like to thank the outgoing president Natalie Cook for her unwavering support and her astute and balanced contributions to the journal. We look forward to hearing and catching up on her new endeavours and achievements in and around naturopathy and herbal medicine. Thank you, Natalie; we gained significant ground under your leadership.
In case you are wondering about the private health insurance (PHI) rebates, this issue includes commentaries from two bodies. The first is a submission from the NHMRC Natural Therapies Working Committee, a background committee providing oversight and specialised methodological expertise for the Natural Therapies Review and evaluation of evidence of efficacy for naturopathy and western herbal medicine. The second is a report from the Australian Naturopathic Council (ANC), a newly created group representing naturopaths to government.
This issue also includes a review of the Fertility Society of Australia (FSA) conference. In the first invited presentation of naturopaths at this large reproductive medicine conference, our own naturopath Rhiannon Hardinger did us proud presenting naturopathy and describing effective outcome-focussed clinical partnerships between naturopaths and fertility specialists.
This issue of the journal also includes an article about diminished ovarian reserve (DOR), an often hidden condition that can cause a lot of grief and despair. The article outlines a case for research and the investigation of naturopathy for the management and treatment of women with DOR, to inform the author’s long-standing clinical practice specialty of women’s health and natural fertility.
Dr Wendy McLean has summarised the published evidence for herbal medicine and clinical practice in the MedJourn and MedPlant sections. Included in these you will find article summaries about mental health and stress disorders, including clinical trials investigating Withania somnifera for stress, Valeriana officinalis for anxiety and Crocus sativus for depression. There is also a summary of research investigating associated risk of infection in people diagnosed with stress disorders, and the associations between vitamin D deficiency in childhood with adolescent mood and behaviour, coeliac disease with young children’s behaviour and, in keeping with a paediatric theme, associations between mental health diagnoses and thyroid disorders in 10–18-year-olds. In addition, a summary of investigations of naturopathic and herbal interventions for chronic diseases characterised by inflammation include Sesamum indicum for rheumatoid arthritis, Curcumin longa for asthma, Glycyrrhiza sp. for Parkinson’s, omega-3 supplements for dry eye disorder and palmitoylethanolamide (PEA) for endometriosis. There is also an interesting study comparing vitamin D supplements against ultra violet light exposure for improved diversity of the digestive microbiome, which is my favourite in this issue. Which is your favourite study?
As 2019 comes to an end, I take this opportunity to wish you all a safe, happy and restful festive season and I look forward to catching up in the new year – I wonder what it will bring!
Susan Arentz PhD, BHSc(Hons)
Editor, Australian Journal of Herbal and Naturopathic Medicine
PO Box 696, Ashfield, NSW 2131
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- Endeavour College of Natural Health (ECNH) [Internet]. College profile; 2018. Available from: https://www.endeavour.edu.au/about-us/college-profile/.
- Australian Government [Internet]. Australian Government job outlook: naturopaths [ANZSCO ID 252213]; accessed 10th November 2019. Available from: https://joboutlook.gov.au/Occupation?search=Career&code=252213.
- Steel A, Leach M, Wardle J, Sibbritt D, Schloss J, Diezel H, et al. The Australian complementary medicine workforce: a profile of 1,306 practitioners from the PRACI study. J Altern Complement Med 2018;24(4):385–94.
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- Royal Australian College of General Practitioners (RACGP) [Internet]. Responding to patient requests for tests not considered clinically appropriate Australia; accessed 10th November 2019. Available from: https://www.racgp.org.au/advocacy/position-statements/view-all-position-statements/clinical-and-practice-management/responding-to-patient-requests-for-tests.
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