Responses to patients’ demand for access to complementary and alternative medicine (CAM) health care services provide a unique opportunity to understand how health care systems evolve and change over time to accommodate new health care professions. Much of the research on the professional development of CAM practitioner groups focuses on the professional process, including what these groups are doing to attain professional status, especially regulation by the state (Adams, 2006; Boon et al., 2004; Broom and Tovey, 2007; Cant and Sharma, 1996; Cant et al., 2011; Kelner et al., 2002; Saks, 1995; Shuval, 2006; Welsh et al., 2004). The dominant theoretical perspective guiding this work is that of social closure (Collins, 1990; Hollengerg, 2006; Saks, 2001; Welsh et al., 2004). Without denying the importance of social closure for understanding the professional development of CAM practitioner groups, we want to focus on a different aspect of this process. Using Abbott’s system of professions model (1988), we use the case of traditional Chinese medicine/acupuncture (TCM/A) practitioners in Ontario to show how vacancies are created in the system of professions. It is through these vacancies that professional groups then gain entry into the system of professions and where social closure issues come into play. This focus allows us to discuss the role of the state in creating vacancies and how this has the potential to change the existing system of health care professions in Ontario. We also build on the work of Adams, who emphasizes the usefulness of examining professional processes and interprofessional conflict simultaneously (Adams, 2004). TCM/A practitioners are involved in a process whereby the state has opened up jurisdictions to the group, yet other groups are battling with TCM/A practitioners over these jurisdictions and TCM/A practitioners are 247battling within their own ranks to decide how best to capitalize on the newly opened jurisdiction.