Integrative MDs Weil’s Arizona Center and ABIHM in major push to create a recognized specialty boardIn what they typified as a “strategic change in direction,” the Arizona Center for Integrative Medicine (ACIM) announced that it will lead the creation of
In what they typified as a “strategic change in direction,” the Arizona Center for Integrative Medicine (ACIM) announced that it will lead the creation of a formal specialty society for medical doctors in integrative medicine. ACIM, founded by Andrew Weil, MD and directed by Victoria Maizes, MD, is in dialogue with the American Board of Physician Specialties toward establishing an American Board of Integrative Medicine. They are collaborating with leaders of the American Board of Integrative Holistic Medicine (ABIHM). A brief interview with Maizes notes that ACIM felt pressure on two sides: “It is becoming very hard for the public to discern what it means to be an integrative medicine doctor when someone can take a weekend course and hang up a shingle and declare that they are an integrative doctor. Our Fellows have been asking for this for many years.” This Integrator article includes the statements from the Center and ABIHM on the decision. ACIM has graduated 800 fellows. Roughly 1500 MDs and DOs have been certified through ABIHM. The process, including grandfathering provisions, is expected to take 18-24 months.
Comment: This strategic decision by ACIM and ABIHM has many dimensions. There are clear public health implications. The ACIM-ABIHM alliance represents a significant new alignment. Grassroots access to the “integrative medical doctor” title or at least board certification may disappear. There are guild dimensions here, ground claiming, and not just for integrative medicine’s medical doctors. Many naturopathic doctors and acupuncturists and chiropractors use the term. The brand “integrative medicine” may become even more closely associated with, and effectively owned by, MDs. New clarities will emerge, new boundaries will be drawn, new possibilities empowered and old antagonisms engendered.
Item 8 on the consent calendar of the House of Delegates of the American Academy of Family Physicians at their September 2011 meeting was Resolution 511 entitled “Scope of Practice of Naturopaths.” The issue originated in the state of Alaska. Here is the resolution, in full, and the action.
RESOLVED, That the American Academy of Family Physicians (AAFP) oppose any expansion of naturopaths’ scope of practice not supported by their training, to include, but not necessarily limited to, liberal prescribing authority, “primary care physician” status, and procedures traditionally performed by physicians, such as work/school physicals and surgery.
A number of members spoke in support of this resolution. Each individual discussed the limited training, lack of clinical and hospital experience and varying medical education of naturopaths around the United States. Despite these varying qualifications, members stated that these practitioners were licensed in 15 states. Nevertheless, members clarified that they were not opposed to the use of complementary medicine by naturopaths – they were opposed to the belief that their experience was identical to that of a physician. Finally, they emphasized that the resolution was a patient safety issue and not one created simply to protect their turf.
The committee agreed wholeheartedly with the members’ comments and recommended approval of the resolution.
RECOMMENDATION: The reference committee recommends that Resolution 1 No. 511 be adopted. ADOPTED
The action follows significant activity from the American Medical Association to attack the advance of naturopathic doctors. See especially AMA SOPP Escalates Campaign Against Nurses, Chiropractors, Naturopaths, Midwives and Others and AMA Scope of Practice Partnership Targets 30 Legislative Efforts of DCs, NDs, LAcs and CPMs in 2009. It is notable that this summary of AAFP action did not include the action against naturopathic doctors among its debated priorities.
Comment: A guild declaring it is not behaving like a guild is roughly the same as your average shower singer declaring his or her voice gorgeous. Guild-behavior is in the eye of the beholder. AAFP: Where is the evidence of harm to patients from the NDs with their current, broad, primary care scope? Where is the evidence that having hospital experience actually leads to better choices in the outpatient environment? Where is the evidence that naturopathic doctors say their experience is “identical to that of a physician”? (I don’t think most would like the association with typically reductive, drug-focused approaches.) Where is the evidence that the primary care practices of naturopathic doctors have worse outcomes than your own? If it exists, share it. If not, don’t hide from your guild nature.
The timing of this resolution is particularly nasty, given the decision of integrative medical doctors (see above) to form a formal integrative medicine specialty that is limited to MDs/DOs. To many naturopathic doctors, these moves can easily look like one hand of family medicine is pushing down a competitor while another is seeking to formally establish itself above it. The set of comments I have received yet not yet posted on the move to establish the American Board of Integrative Medicine express the vehemence in the continuing mistrust between licensed CAM professionals and MDs. Meantime, the president of the Seattle, Washington-based King Country Medical Society used his September/October 2011 column in that organization’s Bulletin to lambaste naturopathic doctors. The title: “Not So Complementary.” We’ve got trouble in River City.
An October 1, 2011 New York Times feature, When the Nurse Wants to Be called Doctor, explores the most significant guild-battle percolating toward an eruption in US medicine. The vast expansion of nursing doctoral programs is leading increasing numbers of patients being greeted by nurses who say: “Hello, I am Dr. Jones …” In the article, Roland Goertz, MD, the board chairman of the American Academy of Family Physicians, is paraphrased as saying:
” … that physicians are worried that losing control over ‘doctor,’ a word that has defined their profession for centuries, will be followed by the loss of control over the profession itself. He said that patients could be confused about the roles of various health professionals who all call themselves doctors.”
The writer notes state legislative efforts under way to restrict the use of the title “Doctor” then adds: “The deeper battle is over who gets to treat patients first.”
Comment: The MD versus the nurse doctor is the guild battle of battles, engaged fully since last fall when the Institute of Medicine report on Future of Nursing: Leader Changes, Advancing Health fully promoted nurses into leadership. If health care was in better shape, the smart money would be on the MDs. But the facts seems to be that, all in all, health care got pretty messy in the US under the watch and control of MDs this past century. This has been especially true the last 60 years. The MDs are fighting a rear-guard action. Let it go, dudes. Start playing with others. (Thanks to reader Christy Lee-Engel, ND, LAc for tipping me about this article.)
At their September 2011 meeting, the House of Delegates of the American Chiropractic Association passed significant resolutions. Some of those highlighted by the ACA, reported here in their words, are:
- “Chiropractic Physicians Training as Primary Care Physicians.” The ACA policy informs the health-care consuming public, policy makers, and payers of the fact that chiropractic physicians are well-trained, portal of entry physicians currently providing primary care services.
- “ACA Support for Antidiscrimination Language in the Patient Protection and Affordable Care Act (PPACA).” Expanding on the anti-discrimination provision (Section 2706) included in the health care reform law, the ACA policy lists four specific examples of discriminatory practices that could be harmful to public health by restricting access to chiropractic care.
- “Position on AMA’s Discriminatory Resolutions and Practices.” The policy opposes attempts by the American Medical Association to limit the use of the titles Doctor, Resident and Residency to physicians licensed to practice medicine, podiatrists, and dentists.
- “Scope of Practice.” The policy states: “It is the ACA’s position that the scope of practice of chiropractic physicians and post-doctoral chiropractic specialties should be determined by the education and training provided within [Council on Chiropractic Education] accredited institutions and/or the education and training provided through post-graduate/post-doctoral courses and specialties. The ACA encourages individual states and U.S. Territories to establish uniform scopes of practice commensurate with contemporary education and training.”
Comment: Notably, the position on the AMA’s Discriminatory Resolutions and Practices also opposes such acts when aimed against other licensed practitioners. The sentence reads: “Resolved, that the American Chiropractic Association remains strongly opposed to attempts by the American Medical Association to limit patient access to care by chiropractic physicians and all other duly licensed non-M.D./DO provider groups.” This is good modeling of collaborative policy. I am curious when or if the naturopathic medical, acupuncture and Oriental medical, integrative medicine, nursing, or other integrative practice groups have cast such a broadly protective web in a formal resolution. All the resolutions are available online here. Perhaps more collaborative policy might help in this time.
On September 13-14, 2011, representatives of the 7 primary organizations that comprise the massage therapy profession gathered in St. Louis for a Leadership Summit. According to a post-meeting notice, the purpose of the meeting was twofold. First: identify the most significant challenges and limitations that currently exist in this field. Second: Begin the process of developing and implementing solutions that will enable it to move forward in its evolution. According to the report, the “current challenge, at its most fundamental level, goes to the inconsistent quality of massage therapy services provided to clients.” Uneven education standard were a focus. Barely half of the 1,382 massage therapy programs in the United States have received institutional accreditation and only 100 have received specialized programmatic accreditation.
The massage field is also challenged by the great unevenness in licensing standards from state to state: “On the issue of portability, the group affirmed the role of the Federation of State Massage Therapy Boards in its recently-launched project to develop a Model Practice Act.” The dialogue will continue, including another face-to-face meeting on May 1-2, 2012. Organizations represented were: Alliance for Massage Therapy Education, American Massage Therapy Association, Associated Bodywork & Massage Professionals, Commission on Massage Therapy Accreditation, Federation of State Massage Therapy Boards, Massage Therapy Foundation and the National Certification Board for Therapeutic Massage & Bodywork.
Comment: Notably, the group’s post-meeting release referred to the field as a “profession” and not a trade. This is one important point of agreement. Consensus on the 2 points noted above – educational standards and licensing standards – would be a huge advance. There remains the wild west of 1,382 mostly for-profit educational programs. Those represent a horde of cats to herd.
A late September 2011 message from the American Association for Acupuncture and Oriental Medicine (AAAOM) informed members that the association has decided to devote the next 18 months to planning for a national membership conference to be held in spring, 2013. Instead of a 2012 conference, the AAAOM host a meeting of the state and national leadership which will address the current and future strategic plans of the AAAOM and other AOM organizations. The message notes that this “scaled-down format for 2012 will give AAAOM the time and resources it needs to focus primarily on membership services, revenue generation programs, organizational sustainability, and a successful 2013 membership conference. The AAAOM mission is to “defend, enhance, and advance the profession.”
Comment: Is there a homeopath out there who can suggest a remedy to treat the licensed AOM profession’s apparent constitutional inability to create a functioning national organization? The potential is huge. Good luck, this round.