The lockdown of society resulted in many healthcare workers having to close their practice or comply with a requirement of two meters distance between patients and providers, and consultations of a maximum of 15 minutes. This also applied to the CAM providers. In collaboration with 35 CAM organizations, we forwarded a survey to 2,215 CAM providers at the start of the COVID-19 pandemic (March-May 2020). We wanted to investigate how the pandemic affected their financial situation, patient consultations, how they perceived their future practice, and which advice they gave their patients about staying healthy.
What did we find?
Participants
The providers in our study practiced several CAM modalities. The most frequently practiced was psychological treatment such as conversation therapies (33.7%), including gestalt therapy (19.6%), psychotherapy (10%), and coaching (11.5%). Many also practiced acupuncture (30.1%), massage (24.6%), reflexology (19.6%), and music therapy (11.7%).
Organization of their practice
The majority of the participants had a sole proprietorship (Altinn.no definition) (84.3%) or a private limited company (Altinn.no definition) (12%). 1.2% were employed by others or had other modes of operation (1.7%). Only 38% of the providers we asked had kept the practice open and provided treatments to patients during this period. Virtually all (96.4%) implemented the new hygiene regulations imposed by the Norwegian authorities. Of these, less than half (43.5%) had retained physical consultations, the others had reorganized their practice to video consultations (57.4%) or consultations via telephone (43.5%). One participant explained:
I have used telephone consultations. This has worked well and is one of the reasons why I consider the future quite bright. I have expanded my practice. Previously I only had local patients, now I treat patients from all over the country.
Consequences for the economy
Almost all (96%) reported that their income was reduced during the lockdown. To manage financially, 46% spent their private savings, male providers (60%) to a higher degree than females (46%). A third of the participants were supported financially by a partner and 26% received compensation from the state. Others (26%) had other paid work that provided them with income. A fifth of the participants borrowed money from friends and family, took out a new bank loan, or changed the loan terms of an existing loan.
The youngest CAM providers (25-39 years) had fewer consultations with patients compared to the older age groups during the lockdown. They also took out loans to a greater extent and used more of their private savings compared to the middle or older age groups. The older providers, on the other hand, were less likely to have other paid work compared to the youngest respondents. This suggests that the youngest providers appeared to be most affected by the lockdown. One describes it like this:
I think that this period has been difficult financially. I don't have money to pay my bills because of the lockdown even though I have an agreement with the bank to only pay interest on the loan.
Thoughts about the future
Most of the CAM providers (63%) were unsure of what the future would bring and what would happen to their practice. A minority (7.6%) were downright pessimistic. About 1 in 3 providers still had faith and were optimistic about the future. This particularly applied to those who could treat patients using video or telephone consultations.
Recommendations for patients related to COVID-19
To prevent COVID-19, these providers recommended their patients vitamin C (6.9%) (high dose or recommended daily dose), relaxation techniques (3.1%), prayer for own health (2.1%) psychological treatment (1.9%), Ginger (1.9%) and Omega 3,6 and 9 (1.9%). In addition, several participants expressed that they recommended the patients exercise, eat healthily, and get enough sleep during this period.
Nearly half of the participants (42%) believed that a COVID-19 infection would be more serious than the usual flu, yet only 57% were worried about getting infected themselves. However, several wrote that they were more worried about infecting others. They were particularly worried about infecting others when they were at work, illustrated by this statement: I am most worried that someone will be infected in my practice even if all rules about hygiene have been followed.
Consequences for the industry
CAM, like other public health services, has been exempt from VAT if the provider was a member of a practitioner organization and registered in the Public Registry for CAM practitioners. From 1.1.21, VAT was introduced to these services regardless of whether the providers were registered in the registry or not. In the period 2021 to 2022, the number of members in the public registry fell by as much as 18%. This may be explained by the fact that membership in the register no longer gives VAT exemption, but the decline may also be because many CAM providers have had to close their practices after the COVID-19 lockdown and have applied for other jobs. Whatever the reason, we believe, that the decline in providers who choose to be in the public registry, has a great negative impact on patient safety. The reason for this increased risk is that members of the practitioner organizations have minimum requirements for training in medical subjects, CAM modalities, and requirements for liability insurance. These are measures that reduce risks for patients who want to use CAM.
Interpretation of the results
The lockdown of society during the first wave of COVID-19 has had serious consequences for CAM providers in Norway. Several got financial problems when they had to close their practices and their view of the future became less optimistic. These findings are in line with findings from other studies showing that visits to CAM providers during the pandemic decreased from 14.2% in 2019 to 7.8% in 2020. This reduction followed an already downward trend in which visits to CAM providers had decreased steadily over ten years. In this market, it is probably the providers who can reorganize into digital solutions, see new opportunities, and offer services adapted to a changing market that will succeed in the future.
References
- Stub T, Jong MC, Kristoffersen AE. The impact of COVID-19 on complementary and alternative medicine providers: a cross-sectional survey in Norway. Advances in Integrative Medicine. 2021; 8:247-55.
- Kristoffersen AE, van der Werf E, Stub T, Musial F, Wider B, Jong MC, et al. Consultations With Health Care Providers and Use of Self-management Strategies for Prevention and Treatment of COVID-19 Related Symptoms. A Population-Based Cross-sectional Study in Norway, Sweden, and the Netherlands. BMC Complement Med Ther 2021; Sep 3(1):234.
- Nasjonalt forskningssenter innen komplementær og alternativ medisin (NAFKAM). NAFKAM-undersøkelsen 2021 til 2020 (infografikk) Tromsø: NAFKAM, UiT Norges arktiske universitet; 2022 [cited 2022 27.10]. Available from https://nafkam.no/nafkam-undersokelsen-2012-til-2020-infografikk.
- Nasjonalt forskningssenter innen komplementær og alternativ medisin (NAFKAM). Antall registrerte behandlere drastisk redusert - på tide å handle? Tromsø: Nasjonalt forskningssenter innen komplementær og alternativ medisin (NAFKAM); 2022 [cited 2022 07. November]. Available from: https://nafkam.no/antall-registrerte-behandlere-drastisk-redusert-pa-tide-handle.
Text written by Trine Stub and Agnete E. Kristoffersen
