Janet Kahn, PhD: regarding massage therapists and the primary care workforce

One of the most significant players in national policy for integrative health and medicine is Janet Kahn, PhD. Kahn is also a well-respected researcher and a massage therapist. Kahn’s receipt of the electronic push for The Integrator Blog New & Reports #118 stimulated this response: “I just read your opening paragraph in today’s Blog and was struck by your purposeful exclusion of massage from your list of practitioners who relieve [primary care practice] burden. Given the role of massage in treatment of acute and chronic musculoskeletal pain, it seems an odd choice. Please explain your thinking.”

Kahn continued: “My own sense is that some, but not many, PCPs do recognize the value of therapeutic massage for pain relief and refer for it. But that doesn’t make a huge difference in the overall picture since there is still virtually no compensation for it for that purpose – absent a motor vehicle or worker’s compensation claim. I am not arguing at all, that MTs should think of ourselves as PCPs. We are not. We do not have that training, and our scope does not approach that. Still, we relieve the burden on PCPs when people decide to come to us with their pain rather than (or after) seeing their PCP whose approach to pain management is too often still pharmaceutical.

Kahn spoke to some patient’s perceptions that she is their primary: “I have also had clients tell me that they think of me as their PCP (meaning I am primary to them), and I am very careful to tell them that I am not. This includes one client who comes to mind who told me she was weaning herself off her anti-depressants because of our treatments. I was very clear to her that she should n

by John Weeks, Publisher/Editor of The Integrator Blog News & Reports

Janet Kahn, PhD: regarding massage therapists and the primary care workforce

One of the most significant players in national policy for integrative health and medicine is Janet Kahn, PhD. Kahn is also a well-respected researcher and a massage therapist. Kahn’s receipt of the electronic push for The Integrator Blog New & Reports #118 stimulated this response: “I just read your opening paragraph in today’s Blog and was struck by your purposeful exclusion of massage from your list of practitioners who relieve [primary care practice] burden. Given the role of massage in treatment of acute and chronic musculoskeletal pain, it seems an odd choice. Please explain your thinking.”

Kahn continued: “My own sense is that some, but not many, PCPs do recognize the value of therapeutic massage for pain relief and refer for it. But that doesn’t make a huge difference in the overall picture since there is still virtually no compensation for it for that purpose – absent a motor vehicle or worker’s compensation claim. I am not arguing at all, that MTs should think of ourselves as PCPs. We are not. We do not have that training, and our scope does not approach that. Still, we relieve the burden on PCPs when people decide to come to us with their pain rather than (or after) seeing their PCP whose approach to pain management is too often still pharmaceutical.

Kahn spoke to some patient’s perceptions that she is their primary: “I have also had clients tell me that they think of me as their PCP (meaning I am primary to them), and I am very careful to tell them that I am not. This includes one client who comes to mind who told me she was weaning herself off her anti-depressants because of our treatments. I was very clear to her that she should not embark on that alone (or with me, since I was not trained and thus not available for that) and that
she should immediately call her prescriber and arrange for a consult on how they would do that together. So, please do not leave MTs out of PCP discussions as there is much that PCPs, insurers and MTs need to collaborate on to make sure people are getting the best care they can.”

Comment: A point well-made and well-taken. Kahn invited an explanation. I wrote in that Integrator push, first: “When will US workforce planners realize that the 375,000 licensed practitioners in the integrative health and medicine movement are daily relieving the burden on the primary care system?” This number purposefully includes massage therapists – some 265,000 of the total. Then I added: “When will they start actively exploring the optimal contributions of these professionals – particularly the 110,000 doctors of chiropractic and naturopathic medicine, practitioners of acupuncture and Oriental medicine and direct-entry midwives?”

My distinction here is that each of these 4 categories of licensed providers has a tradition as primary care (though primary care for the birth process in the case of the certified professional midwives). Politically, there is enough button-pushing to get these 4 to the table in a coveted “primary care” role without asking the American Academy of Family Physicians to open themselves to considering massage therapists as part of the primary care workforce as well. Where Kahn’s points are best taken is in the concept of the idealistic “medical home” that actually features “team care” and “interprofessional practice” via an environment in which there is “non-discrimination in health care.” Yes, massage therapists are daily relieving the burden on the formal primary care workforce. This formal workforce, and the policy leaders guiding its development, would do well to explore using massage therapists – and the others – to maximum Triple Aim advantage.

Integrative pain competencies group at UC Davis sponsors Maui conference

Ian Koebner, MSc, MAOM, LAc, the acupuncturist associated with the interprofessional Division of Pain Medicine at UC Davis that recently published pain treatment competencies relevant to all health care professionals”, shares the announcement of the Integrative Health for Pain Relief Conference, that will take place April 3-6, 2014 in Maui, HI. Focus will be “on integrative approaches to pain relief.” Koebner is the director of Integrative Pain Medicine, and a clinical instructor in the Department of Anesthesiology and Pain Medicine, University of California, Davis School of Medicine.

From Google Alerts: Integrative Medicine in Health Systems and Around the World – December 2013

This monthly Integrator feature reflects a quick capture of highlights from the multitude for links that flow in daily via Google Alerts for “integrative medicine,” “complementary and alternative medicine” and “alternative medicine.” While my focus is on integrative medicine in health systems (and related media), the later search term nets developments from around the world that I began to share for November 2013. The December 2013 issue includes 8 selections for from the integrative medicine (plus related media) and 9 international. Features included interviews with former NCCAM deputy director Margaret Chesney, PhD, the incoming chair of the Consortium of Academic Health Centers for Integrative Medicine, and debate over a recent scientific paper on the value of ear acupuncture in weight loss. Internationally, an Indian governmental body urged against “commercialization” of traditional practices for fear cost will rise and the Thai government is taking steps to open new markets for Thai herbs.