Primary care physicians and complementary-alternative medicine: training, attitudes, and practice patterns

Physician interest in complementary medicine is widely documented in many Western countries. The extent of level of training, attitudes toward legitimacy, and use of complementary therapies by US primary care physicians has not been extensively surveyed. We conducted a national mail survey of primary care physicians to explore these issues.

Primary care specialties represented were family and general practice, internal medicine, and pediatrics. A total of 783 physicians responded to the survey. For the multivariate analysis, sample weights were assigned based on specialty. Assessments were done for training, attitudes, and usage for complementary medicine. Additional data collected included years in practice, specialty, and type of medical degree.

Biofeedback and relaxation, counseling and psychotherapy, behavioral medicine, and diet and exercise were the therapies in which physicians most frequently indicated training, regarded as legitimate medical practice, and have used or would use in practice. Traditional Oriental medicine, Native American medicine, and electromagnetic applications were least accepted and used by physicians.

Many psychobehavioral and lifestyle therapies appear to have become accepted as part of mainstream medicine, with physicians in this study having training in and using them. Such therapies as chiropractic and acupuncture appear to be gaining in acceptance despite low training levels among physicians. Those in practice more than 22 years had the least positive attitudes toward and use of complementary therapies. Osteopathic physicians were more open than medical physicians to therapies that required administering medication or a procedural technique. In the multivariate analysis, attitude and training were the best predictors of use.