Holistic leader Forbes and ABIHM on grandfathering plans for the Arizona Center’s new Board Certification in Integrative Medicine; OBGyns re-publish CAM booklet written by Tracy Gaudet, MD; Battle between licensed acupuncturists and “dry-needling” escalates; Acupuncturist job listing for the Army puts salary at $73,000-$95,000; Model naturopathic standards of practice and ethics sections expected to be added to Hawai’i law
“The proposed merging process, we anticipate, will include ‘grandfathering’ of current ABIHM diplomates, making the value of becoming certified over this next year a highly valuable proposition that any interested physician (MDs and DOs) should strongly consider. Now is the time!” So writes David Forbes, MD, ABIHM, past president of the American Holistic Medical Association (AHMA) in the recent issue of AHMA’s newsletter. The italics are his. He expands: “Movement is occurring to merge interests with the Arizona Center for Integrative Medicine in an endeavor to further hone an Integrative Medicine Board Exam and increase the clout and credentials that such certification would bring.” Forbes concludes by underscoring the potential future value of the getting certified through the American Board of Integrative Holistic Medicine (ABIHM) today: “If you are not certified yet by ABIHM, I urge you to do it next year! It is a deeply valuable experience, an unparalleled exposure to the best of holistic/integrative education, and a credential that is only going to exponentially increase in value over the coming years.”
The web-page of the ABIHM makes it clear that the ABIHM is fully backing the University of Arizona-led effort to create a more formal board certification in integrative medicine through a relationship with the American Board of Physician Specialties (ABPS). Grandfathering appears to be understood: “At this time, it appears that ABIHM Diplomates whose status is current will be forgiven the fellowship requirement for sitting for the [new] exam. All ABIHM Diplomates who wish to become certified by the ABPS will be required to sit for the new exam.”
Comment: It’s a foolish medical doctor with any interest in integrative medicine who will not get moving on getting the ABIHM certification if he or she hasn’t got it already. “Forgiving the fellowship” forgives a $30,000 tuition fee, plus a significant time commitment.
The October 2011 edition of Clinical Updates Women’s Health Care from the American College of Obstetricians and Gynecologists is entitled Complementary and Alternative Medicine. The author is Tracy Gaudet, MD, former director of integrative medicine programs at the University of Arizona and at Duke University. The 98-page monograph was first published in 2004. The intent is stated in the abstract: ” … to help (OBGyns) guide patients in their treatment choices, including guiding them away from potentially dangerous alternative treatments and supporting their use of potentially beneficial treatments.” Herb-drug negative interactions are highlighted early. Figure 1 provides readers a helpful “protocol for integrating complementary and alternative medicine with conventional medicine.” Page 78 offers a 16 question exam that can be taken to gain CME credit. Chiropractors will not be pleased to see that the very first question asks about “the most significant risk” from their services.
Portland, Oregon-based Marilyn Walkey, MD, LAc is a rare medical doctor who has also completed discipline-level training in acupuncture and Oriental medicine (AOM) and gained licensing in that field. Walkey is not a fan of medical doctors or other practitioners who take short courses to practice “dry-needling” or other techniques that appear to the common person to be acupuncture. On November 25, 2011, she sent a link which she editorialized in an e-mail was “wonderful news from Medicare regarding ‘dry-needling.'” The document noted that one Mark Bucksbaum, MD from the Center for Integrative Medicine in Rutland, Vermont had paid $35,000 to settle with Medicare. The reason: Bucksbaum billed the federal agency for “trigger point injections” when these were actually “dry needling,” according to assistant US attorney Kevin Doyle. Doyle said that the only legitimate way to bill for such services was to use acupuncture codes, which are not covered by Medicare.
Meantime, across the country, in Walkey’s homestate of Oregon, the Oregon Association of Acupuncture and Oriental Medicine received a supportive finding in its suit against the state’s Board of Chiropractic Examiners and the University of Western States, which is principally a chiropractic school. The acupuncture association argues that “dry needling” as practiced by chiropractors is “substantially the same” as acupuncture, and therefore should be illegal. Walkey sent notice in mid-November that the judge has found the OAAOM had a “likelihood of winning on merits.”
Comment: Inside the multidisciplinary Academic Consortium for Complementary and Alternative Health Care (ACCAHC) we call these guild-battles “hotspots.” They come up a lot. One field’s expansion of practice by adding a modality threatens another’s basic practice. AOM practitioners may add Western herbs or homeopathy to their score with no additional required education. These cross over into the naturopathic doctor’s core training. Or to reverse the situation AOM-DC battle over needles, the AOM practitioner may use limited training in Tuina to effectively cause spinal adjustment but without education in chiropractic manipulation. Similarly, naturopathic doctors practice spinal manipulation based on far fewer hours than chiropractors. And NDs have the right to practice acupuncture in some states, as many states chiropractors and medical doctors do, based on 200-300 or fewer hours of education. Virtually all licensed integrative practitioners can give massage, regardless of whether their training touches even a 500 hour basic massage curriculum. Meantime, integrative medical doctors piece together practices through a series of weekend or multi-weekend courses that rarely come close to matching the educational background of naturopathic doctors. At the same time, NDs and DCs claim rights as “primary care doctors” without completing post-graduate residencies.
We in ACCAHC have attempted to find “cooling places” for the “hotspots.” What are the principles that might guide educators through this mine-field of guild sniping and bombing?
Our ACCAHC discussions (we have no position statement) have suggested that all disciplines make significant distinctions between modality-level education and discipline level education. Educators in any discipline that adds therapies through “modality level” training (such as acupuncture for pain) would optimally be required to make a point of thoroughly educating students to the substantially higher standards of those who have completed discipline-level training. Example: the licensed acupuncture and Oriental medicine practitioner. Then there is the basic Pew Commission koan, as my colleague and ACCAHC co-founder Pamela Snider, ND learned through an examination of the naturopathic profession by the UCSF Center on Health Professions: Training to tested competency to scope. Something tells me that the acupuncturist versus dry needling battle will persist for some time regardless of any reasonable cooling points.
In mid-November a federal government jobs listing asked for two licensed acupuncturists for the Army Madigan Medical Center, joint Base Lewis-McChord outside Tacoma, Washington. The listing is for a salary range of $73,4200-$95,444 per year. The two professionals will be part of the Interdisciplinary Pain Management Center. The Center is described as:
” … focus(ing) on pain management strategies that are holistic, multidisciplinary, and put Soldiers quality of life first. As a licensed Acupuncturist, you will offer a full array of current and emerging evidenced-based approaches for patients with acute and chronic pain who have not responded well to conventional treatment modalities. You will work within a multidisciplinary team to provide assessment, planning, implementation, coordination, evaluation, and monitoring of patients for health options and services. You will assist in developing, analyzing, integrating, monitoring, and managing healthcare delivery systems through communication and use of resources to promote quality and cost-effective outcomes across the continuum.”
Comment: We are accustomed to seeing high-tech developments created in the military then translated for civilian use. Makes me smile to think that it is the military that is testing out the deeper integration of licensed acupuncturists for later export to regular medicine. (Thanks to Stacy Gomes, EdD, vice president for academic medicine at the Pacific College of Oriental Medicine for the tip.)
The state of Hawai’i has passed into law a new section on Standards of Practice, Care & Ethics for naturopathic physicians. The American Association of Naturopathic Physicians honored the state society for its work in passing the amendments to its practice act, calling it a “model for all states.” Some components of the Ethics section include:
- A requirement on “sufficient time” for individualized assessment and treatment (6C)
- Referral (7C)
- Requirement to not only “communicate but to educate” (8A)
- Disclosure of any financial benefit from selling natural products (9B)
The Standards of Practice portion includes a section on the NDs role in health promotion. A focus on health optimization is declared, as is the NDs responsibility to “encourage a patient toward independence and self-direction.”
Comment: For individuals not familiar with the primary care naturopathic practice, this document may be a particularly useful read.