Negotiating Professional Identity at the Interface of Biomedical and Traditional Healing: Health Service Implications for Physiotherapy Practice in Cameroon Research Article

Background Healthcare delivery in sub-Saharan Africa is characterized by therapeutic pluralism, where patients and practitioners navigate between biomedical and traditional healing systems. However, little is known about how physiotherapy professionals negotiate their professional identity and clinical practice at this interface, and what implications this has for health service organization. This study examines professional identity negotiation among physiotherapists in Cameroon's pluralistic healthcare landscape and explores implications for health service delivery and workforce development. Methods This autoethnographic study was conducted over 24 months (2022–2024) in the Noun Division, West Region of Cameroon. As a licensed physiotherapist and Bamoun community member, I conducted participant observation with traditional healers (n = 12) and physiotherapists (n = 8), supplemented by semi-structured interviews with healthcare professionals utilizing dual therapeutic systems (n = 42, including 18 physicians, 12 nurses, 8 laboratory technicians, and 4 pharmacists). Data analysis employed reflexive thematic analysis with systematic member checking and peer debriefing to ensure analytical rigor despite insider positioning. Results Healthcare professionals constituted 42% of documented dual-system users, fundamentally challenging assumptions that biomedical training creates exclusive allegiance to scientific medicine. Three professional identity negotiation strategies emerged: (1) compartmentalized practice (maintaining strict separation between professional biomedical identity and personal traditional healing utilization); (2) selective integration (incorporating traditional healing insights into biomedical practice through cultural competency frameworks); and (3) hybrid practice development (creating institutional arrangements where both systems operate within shared therapeutic spaces). The documentation of "shadow pain"—a culturally-embedded neurophysiological intervention involving controlled therapeutic scarification—revealed sophisticated traditional healing knowledge that parallels biomedical pain management principles. Hybrid healthcare centers emerged as innovative organizational models, with explicit institutional recognition of both therapeutic approaches through shared signage, spatial organization, and patient referral systems. Conclusions Professional identity negotiation at the biomedical-traditional healing interface represents a significant yet under-recognized dimension of health service delivery in pluralistic contexts. The substantial participation of healthcare professionals in dual therapeutic systems suggests that therapeutic pluralism reflects sophisticated clinical reasoning rather than educational deficiency. Hybrid practice models demonstrate feasible organizational innovations for health system integration that maintain therapeutic diversity while improving cultural responsiveness and healthcare access. Health workforce development policies should recognize plural therapeutic competencies and develop integration frameworks that support rather than suppress professional identity negotiation. These findings have implications for physiotherapy education, clinical practice guidelines, and health system organization in contexts characterized by therapeutic pluralism.