John Weeks’ Integrative Medicine, Complementary Alternative Medicine and Health Round-up #54: April 2012 on Academics
Anne Nedrow, MD to leave Oregon Health Sciences to launch primary care program at Duke Integrative Medicine
Oregon Health Sciences’ integrative medicine leader Anne Nedrow, MD, MBA is leaving the institution to become associate medical director at Duke Integrative Medicine. The position begins June 1, 2012. According to Isabell Geffner, communication’s director for the Duke program, Nedrow “will be responsible for administrative oversight of all of our clinical initiatives. She adds that “her first priority [will] be the launch of our primary care practice in July, 2012.” The new program will be called PRIMARY CARE @ Duke Integrative Medicine: New Dimensions in Health and Healing. Geffner notes that the practice will be a “retainer [concierge] model in which patients will pay a nominal annual fee ($1500).” For this they’ll receive:
- Full primary care services
- Evidence-based complementary and alternative medicine treatments as appropriate
- 24-hour/7-day-a-week access to your physician
- Same day or next day appointment
- Personalized Health Plan
- Group-Based Integrative Health Coaching
Geffner notes that the change is linked to the program’s movement to accept insurance for all physician consultations and select health psychology and nutrition services, noted above. Nedrow joins Adam Perlman, MD, MPH, the Duke IM leader. She’ll also have research and development responsibilities.
Comment: Nedrow’s move joins her with Perlman, another long-time leader of the Consortium of Academic Health Centers for Integrative Medicine. Nedrow’s cross country move also joins two of the medical doctors in that field who have most embraced the interprofessional and multidisciplinary forms of that field’s self-expression. Nedrow was the prime mover behind the Oregon Collaborative for Integrative Medicine (OCIM), which links OHSU with chiropractic, naturopathic and acupuncture schools in Portland. Nedrow also provided the cover of her license for the integrative services practice at OHSU. Nedrow’s exit will be felt. Meantime, it is fascinating that two individuals known as interdisciplinary collaborators are located at an integrative medicine program principally funded by an angel, Christy Mack, who is famous for not only MD-centrism but for routinely publicly denying – or so it seems to me – the CAM roots of “integrative medicine.” I view Nedrow’s appointment as a kind of healing.
Team care, interprofessional education and the move to give medical schools ownership of collaboration
Comment: The long-overdue movement toward team care in the academic medicine environment is called interprofessional education (IPE). As a nominally patient-centered movement, IPE would seem an exceptional arena for better collaboration between medical doctors and other allied health professionals including those not yet formally considered “allied health” such as chiropractors, naturopathic doctors and licensed acupuncturists. The March Integrator Round-up reported the unsettling movement “from dictatorship to oligarchy” in the formation of the Interprofessional Education Collaborative (IPEC) by the Big disciplines of medicine, nursing, public health, osteopathy, pharmacy, dentistry. The formation of IPEC was effectively a decision to not empower a separate US IPE organization had no discipline boundaries.
In March, the weekly bulletin from the American Association of Medical Colleges (AAMC) has announced that the Josiah Macy Foundation is funding an IPE web-portal. The decision follows the same pattern. Rather than launching it through the interdisciplinary American Interprofessional Health Collaborative that has no discipline boundaries, they placed it squarely in the lap of the profession that has most resisted collaboration in the American Association of Medical College (AAMC). The launch is presented as a collaboration with the other 5 of the Big 6. The launch also takes a positive step in noting that the American Psychological Association, Physician Assistant Education Association, and American Physical Therapy Association are to collaborate on the portal. The AAMC note states that “published resources will serve as the initial content for the interprofessional portal and resource collection, scheduled for release in March 2013 on the AAMC’s MedEdPORTAL.”
The direction of all this work is good. Perhaps I simply live with too great a legacy of mistrust of medicine’s former dictatorship to be comfortable with the dominant school as the first among equals; as, effectively, the primary steward of interprofessional collaboration. Why not let the medium be the message and place to with the AIHC or even the Canadian Interprofessional Health Collaboration which has already developed a Wiki on the subject? Then again, Macy might have been betting that the way to get the MDs to buy in was to put them in the driver’s seat. Good money suggests that IPEC will take the wind, as in cash, out of AIHC’s sails.
Comment from Integrator adviser Bill Manahan, MD: Holistic medicine leader and family medicine educator Bill Manahan, MD sent a comment on my posting on this subject in March. He sited my concluding paragraph:
“Here is the paragraph you wrote: A colleague who is a seasoned academic veteran urged time and patience. She shared her willingness to accept this as a step in the right direction for these typically silo-ed guilds. Yes, this is good. But why begin without the mind, spirit, treatment of the body and access to community services fully included– via psychology/mental health, PT/chiropractic/massage and social work — not to mention the other licensed integrative practice fields. I will learn more about this soon and report back whether my concern is valid that this was less a “patient-centered” move than a “profession-centered” power play to limit and control the emergence of democracy among professions. In place of dictatorship, oligarchy. I hope I am wrong.
Then Manahan added his comment:
“In my opinion, your concern is valid. I do not believe that those six professions do not exclude other groups such as PT, DC, ND, MSW, psychology, etc on purpose. It is that they do not know enough about them to even understand that they are excluding them. Ignorance is bliss – but sometimes not all that healthy. The silo those professions exist in is so tight and exclusionary that it does not even enter their world view to include those other disciplines in their new group. In their thinking, it would be similar to the college sports team including the high school sports team on their roster. Anyway, my experience has been that the majority of our MD/DO/RN/Etc. colleagues are good people who don’t have a clue!”
Comment on Manahan’s comment: The good news in the roll-out of the website is that there is a good sign of a “clue” having been found. The psychologists, physical therapists and physicians assistants have at least been invited to dinner, if at the kiddies table.
National College of Natural Medicine reports the institution’s $56-million contribution to Portland, Oregon economy
A study of the impact of National College of Natural Medicine (NCNM) on the Portland, Oregon economy by ECONorthwest found a $56-million contribution. The institution, with 550 students studying naturopathic medicine and Classical Chinese Medicine, contributed in these ways: $25,815,000 in direct spending on payroll and other operating costs, capital spending, and student spending on food, rent, entertainment and other expenses within the city; $10,883,700 in indirect or supply-chain spending related to the college’s purchases of goods and services from local businesses; and $19,160,700 in other spending resulting from the enhanced purchasing power of households directly or indirectly affected by NCNM’s economic activity.” Altogether these impacts were estimated to have generated 613 jobs and contributed $55,859,400 to the local economy.
Comment: Bastyr University carried out a similar study last year. My guess is that these millions will make some of Portland’s leaders who were formerly skeptical about non-conventional care begin to think that there just might be something to it. This is bound to have a nice placebo effect on the Portland Chamber of Commerce. Notably, the college was subsequently featured in the local business media laying out an ambitious master plan.
Frank Vitale’s frank explanation of Tai Sophia’s transition from the “academic wellness institute” toward university
Maryland’s Tai Sophia Institute is poised to become a university. Institute president Frank Vitale made an unusual decision to publicize and post a transcription of his meeting with his leadership team on the transition of what founding president Bob Duggan used to call an “academic wellness institution.” Vitale positioned the action this way: “The field of integrative medicine is growing and Tai Sophia needs to remain in the forefront in its evolution.” Tai Sophia’s move toward university status began in 1998 and is expected to be completed in 2-3 years. The university status is expected to confer prestige on diplomas. Vitale also shares that the school is still carrying too much debt for an institute of its size. Vitale and his team have been exploring an array of strategic partnerships.
Comment: The positioning of this institution as “integrative medicine” may come as a surprise to the authors of the recent Bravewell mapping report. That noted, overall, the piece feels a bit like voyeurism even as I respect Vitale’s forthright presentation of the issues. How well the radicalism of the Institute’s original message be maintained as it gains the trappings of a university? The tendency in the transformationof the school to university will be a regression to a typically conservative academic mean. An “academic wellness institution” seems easier to maintain on mission than an “academic wellness university.” Here is hoping that Tai Sophia holds on to the advocacy of a wellness model as it builds into this conventional framework. A wellness university is exactly the kind of innovation in health professional education that we need.
School seeks Director, Nutrition & Integrative Health Program:
Horse needling: LSU veterinarian school goes integrative
The March 2012 Integrator Round-up included a brief note entitled Insurance coverage of alternative therapies on the rise … for pets!. Now comes news that the LSU Veterinary Teaching Hospital has “broadened its services to include acupuncture, massage therapy and herbal treatments for animals — the large ones for now and dogs and cats soon.” Associate professor of veterinary medicine Rebecca McConnico notes that horses seems to be particularly amenable to acupuncture. She notes that she has “worked with about two dozen animals since her recent certification, including horses, goats and cattle.” The reception of the new program has been good: “It seems to be well-received. Some clients just ask for it and sometimes it’s offered to them. Most are willing to try it.” The initial consult to see if the animal is right for the care costs $40. An acupuncture treatment is $100.
New York Chiropractic Colleges announces the Veteran’s Administration’s first chiropractic clinical Residency
The Seneca Falls-based New York Chiropractic College announced in late March the establishment of “an integrated care chiropractic residency program.” According to the release, this is “the first such program to be located at a Veteran’s Health Administration (VHA) facility.” NYCC has been running several academic and research programs at the Canandaigua, NY, VHA site. The residency is anticipated to prepare the College’s chiropractic clinical residents for optimal management of patients with a diversity of musculoskeletal disorders. Executive vice president and provost Michael Mestan, DC stated:”The new groundbreaking VA residency program significantly complements the College’s existing offerings there.” Residents’ duties will include working alongside the VA system’s established providers while providing rotations with specialists in neurology, orthopedics, physiatry, pain management, primary care and physical therapy.