Consumers, health care financing, external and internal competition are factors identified in the medical literature as prompting change within medicine. I test these factors to determine if they also prompt regular doctors to define themselves as ‘holistic MDs’ and align themselves with complementary and alternative medicine (CAM). State-level regression analyses on the number of MDs advertising in referral directories for CAM therapies find holistic practice a function of practice locale. The proportion of holistic MDs increases in states with an older population, where more patients survive despite serious disabilities, and where non-physician providers pose a competitive threat. Consumer demand, specialization and licensing do not significantly influence adoption of CAM treatments in these analyses. Health care financing has disparate effects. Indemnity insurance constrains holistic practice while HMO penetration enhances it. These results suggest that holistic practice may be an integral part of the regular profession's ongoing professionalization project.
Abbott, A. (1981). Status and strain in the professions . American Journal of Sociology, 86, 819–835 .
2.
Abbott, A. (1988). The system of professions: An essay on the division of expert labor. Chicago, IL: University of Chicago Press .
3.
American College for the Advancement of Medicine: Member referral. http://www.healthy.net/asp/Associations
4.
American Holistic Health Association: Practitioner Referral Sources. http://www.ahha.org
5.
American Holistic Medical Association. Directory of Practitioners. http://www.holisticmedicine.org
6.
Astin, J.A. (1998). Why patients use alternative medicine . Journal of American Medical Association, 279, 1548–1553 .
7.
Astin, J.A. , Marie, A. , Pelletier, K. , Hansen, E. and Haskell, W.L. (1998). A review of the incorporation of complementary and alternative medicine by mainstream physicians . Archives of Internal Medicine, 158, 2302–2310 .
8.
Baer, H.A. , Hays, J. , McClendon, N. , McGoldrick, N. and Vespucci, R. (1998). The holistic health movement in the San Francisco Bay area: Some preliminary observations . Social Science and Medicine, 47, 1495–1501 .
9.
Barrett, S. and Jarvis, W.T. (1993). The health robbers: A close look at quackery in America. Buffalo, NY: Prometheus Books .
10.
Bucher, R. (1988). On the natural history of health care occupations . Work and Occupations, 25, 131–147 .
11.
Bucher, R. and Strauss, A. (1961). Professions in process . American Journal of Sociology, 66, 325–334 .
12.
Cohen, M.H. (1998). Complementary and alternative medicine: Legal boundaries and regulatory perspectives. Baltimore, MD: The Johns Hopkins University Press .
13.
Conrad, P. (1992). Medicalization and social control . American Review of Sociology, 18, 209–232 .
14.
Cooper, R.A. and McKee, H.J. (2003). Chiropractic in the United States: Trends and issues . Milbank Quarterly, 81, 107–138 .
15.
Davis-Floyd, R. and St John, G. (1998). From doctor to healer: The transformative journey. New Brunswick, NJ: Rutgers University .
16.
Drivdah, C.E. and Miser, W.F. (1998). The use of alternative health care by a family practice population . Journal of the American Board of Family Practice, 11, 193–198 .
17.
Druss, B.G. and Rosenheck, R.A. (1999). Association between use of unconventional therapies and conventional medical services . Journal of American Medical Association, 282, 651–656 .
18.
Durkheim, E. (1958). Rules of sociological method. New York: Free Press .
19.
Eisenberg, D.M. , Kessler, R.C. , Foster, C. , Norlock, F.E. , Caulkins, D.R. and Delbanco, T.L. (1993). Unconventional medicine in the United States: Prevalence, costs, and patterns of use . New England Journal of Medicine, 328, 246–252 .
20.
Eisenberg, D.M. , Davis, R.B. , Ettner, S.L. , Appel, S. , Wilkey, S. , van Rompay, M. and Kessler, R.C. (1998). Trends in alternative medicine use in the United States, 1990–1997: Results of a follow-up national survey . Journal of American Medical Association, 280, 1569–1575 .
21.
Ernst, E. , Resch, K.L. and White, A.R. (1995). Complementary medicine: What physicians think of it . Archives of Internal Medicine, 155, 2405–2408 .
22.
Escarce, J.J. , Polsky, D. , Wozniak, G.D. , Pauly, M.V. and Kletke, P.R. (1998). Health maintenance organization penetration and the practice locations of new physicians . Medical Care, 36, 1555–1566 .
23.
Frank, R. (2002). Integrating homeopathy and biomedicine: Medical practice and knowledge production among German homeopathic physicians . Sociology of Health and Illness, 24, 796–819 .
24.
Frech, H.E., III . (1996). Competition and monopoly in medical care. Washington, DC: AIE .
25.
Freidson, E. (1970). Professional dominance: The social structure of medical care. New York: Atherton .
26.
Freidson, E. (1994). Professionalism reborn: Theory, prophecy and policy. Chicago, IL: University of Chicago Press .
27.
Frenk, J. and Duran-Arenas, L. (1993). The medical profession and the state. In F.W. Hafferty and J.B. McKinlay (Eds.), The changing medical profession, pp. 25–42. New York: Oxford University Press .
28.
Gevitz, N. (1988). Other healers: Unorthodox medicine in America. Baltimore, MD: The Johns Hopkins University Press .
29.
Gieryn, T.F. (1999). Cultural boundaries of science: Credibility on the line. Chicago, IL: University of Chicago .
30.
Goldner, M. (2000). Integrative medicine: Issues to consider in this emerging form of health care . Research in the Sociology of Health Care, 17, 213–233 .
31.
Goldstein, M. (1998). Alternative health care: Medicine, miracle, or mirage. Philadelphia, PA: Temple University .
32.
Guadagnoli, E. and Ward, P. (1998). Patient participation in decision making . Social Science and Medicine, 47, 329–339 .
33.
Hafferty, F.W. and McKinlay, J.B. (1993). The changing medical profession. New York: Oxford University .
34.
Haug, M. (1973). Deprofessionalization: An alternative hypothesis for the future . Sociological Review Monograph, 20, 195–211 .
35.
Haug, M. (1988). A re-examination of the hypothesis of physician deprofessionalization . Milbank Quarterly, 66, 48–55 .
36.
Haug, M. and Lavin, B. (1983). Consumerism in medicine: Challenging physician authority. Beverly Hills, CA: Sage .
37.
Health Insurance Association of America (1999). Source book of health insurance data. Annapolis, MD: Health Insurance Association of America .
38.
Herzlinger, R.E. (1997). Market-driven health care: Who wins, who loses in the transformation of America's largest service industry. Reading, MA: Addison-Wesley .
39.
Kuhn, T.S. (1970). The structure of scientific revolutions. Chicago, IL: University of Chicago .
40.
Larson, M.S. (1977). The rise of professionalism. Berkeley, CA: University of California .
41.
Light, D. (1988). Turf battles and the theory of professional dominance . Research in the Sociology of Health Care, 7, 203–225 .
42.
Light, D.W. (1991). Professionalism as a countervailing power . Journal of Health Politics, 16, 499–506 .
43.
Light, D.W. (2000). The medical profession and organizational change: From professional dominance to countervailing power. In C. Bird , P. Conrad and A.M. Freemont (Eds.), Handbook of medical sociology, 5th edn, pp. 201–216. Upper Saddle River, NJ: Prentice Hall .
44.
MacDonald, K. (1995). The sociology of the professions. London: Sage .
45.
McKinlay, J.B. and Arches, J. (1985). Towards the proletarianization of physicians . International Journal of Health Services, 15, 161–195 .
46.
McKinlay, J.B. and Marceau, L.D. (2002). The end of the golden age of doctoring . International Journal of Health Services, 32, 379–416 .
47.
McKinlay, J.B. and Stoeckle, J. (1988). Corporatization and social transformation of doctoring . International Journal of Health Services, 18, 191–206 .
48.
Mayer, T.R. and Mayer, G.G. (1985). HMO's origins and development . New England Journal of Medicine, 312, 590–594 .
49.
Menninger, R.W. (1976). Psychiatry 1976: Time for holistic medicine . Annals of Internal Medicine, 84, 603–604 .
50.
Miller, K. (1998). The evolution of professional identity: The case of osteopathic medicine . Social Science and Medicine, 47, 1739–1748 .
51.
Mitchell, B.B. (1999). Acupuncture and oriental medicine Laws. Gig Harbor, Washington: National Acupuncture Foundation .
52.
Morgan, K.O. , Morgan, S. and Uhlig, M.A. (Eds.). (1993–9). Health care state rankings. Lawrence, KS: Morgan Quitno .
53.
National Center for Health Statistics . (1981, 1999). Health, United States: 1980; 1998. Hyattsville, MD: Public Health Service .
54.
National Center for Homeopathy . (1998). National Center for Homeopathy 1998 Directory: Practitioners, study groups, pharmacies, resources. Alexandria, VA: National Center for Homeopathy .
55.
Navarro, V. (1988). Professional dominance or proletarianization? Neither . Milbank Quarterly, 66, 57–73 .
56.
Omran, A.R. (1971). The epidemiological transition: A theory of epidemiology of population change . Milbank Memorial Fund Quarterly, 49, 509–538 .
57.
Parsons, T. (1954). Professions and social structure. Essays in sociological theory. Glencoe, IL: Free Press .
58.
Parsons, T. (1966). Societies: Evolutionary and comparative. Englewood Cliffs, NJ: Prentice-Hall .
59.
Pescosolido, B. , McLeod, J. and Allegra, M. (2000). Confronting the second social contract: The place of medical sociology in research and policy for the twenty-first century. In C. Bird , P. Conrad and A. Freemont (Eds.), Handbook of medical sociology, 5th edn, pp. 411–426. Upper Saddle River, NJ: Prentice-Hall .
60.
Pescosolido, B. , Tuch, S.A. and Martin, J.A. (2001). The profession of medicine and the public: Examining America's changing confidence from the beginning of the ‘health care crisis’ to the era of ‘health care reform’ . Journal of Health and Social Behavior, 42, 1–16 .
61.
Reeder, L.G. (1972). The patient as a consumer: Some observations on the changing professional–client relationship . Journal of Health and Social Behavior, 13, 406–412 .
62.
Rothstein, W.G. (1972). American physicians in the nineteenth century: From sects to science. Baltimore, MD: Johns Hopkins University Press .
63.
Shuval, J.T. , Mizrachi, N. and Smetannikov, E. (2002). Entering the well-guarded fortress: Alternative practitioners in hospital settings . Social Science and Medicine, 55, 1745–1755 .
64.
Simon, C.J. , White, W.D. , Born, P. and Dranove, D. (1998). Managed care and the physician marketplace. In M. Morrisey (Ed.), Managed care and changing health care markets, pp. 95–120. Washington, DC: AEI .
65.
Starr, P. (1982). The social transformation of American medicine. New York: Basic Books .
66.
US Bureau of the Census . (1998). Statistical abstracts of the United States: 1998, 118th edn.Washington, DC: US Bureau of the Census .
67.
Verhoef, M.J. and Sutherland, L.R. (1995). General practitioners’ assessment of and interest in alternative medicine in Canada . Social Science and Medicine, 41, 511–515 .
68.
Wardwell, W. (1992). Chiropractic: History and evolution of a new profession. St Louis: Mosby Year Book .
69.
Weil, A. (2000). The future of integrative medicine. Self-healing, 200, December, 1, 6–7.
70.
Winnick, T.A. (2005). From quackery to ‘complementary’ medicine: The American medical profession confronts alternative therapies . Social Problems, 52, 38–61 .
71.
Wolinsky, F.D. (1993). The professional dominance, deprofessionalization, proletarianization, and corportization perspectives: An overview and synthesis. In F.W. Hafferty and J.B. McKinlay (Eds.), The changing medical profession, pp. 11–24. New York: Oxford University Press .
72.
Wolpe, P.R. (1990). The holistic heresy: Strategies of ideological challenge in the medical profession . Social Science and Medicine, 31, 913–923 .
