Pathways to healing: board certification proposed for integrative MDs.
Subject: Integrative medicine (Forecasts and trends)
Integrative medicine (Practice)
Health boards (Planning)
Author: Zablocki, Elaine
Pub Date: 02/01/2012
Publication: Name: Townsend Letter Publisher: The Townsend Letter Group Audience: General; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 The Townsend Letter Group ISSN: 1940-5464
Issue: Date: Feb-March, 2012 Source Issue: 343-344
Topic: Event Code: 010 Forecasts, trends, outlooks; 200 Management dynamics; 220 Strategy & planning Computer Subject: Market trend/market analysis; Company business planning
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 282825215
Full Text: The University of Arizona Center for integrative Medicine (ACIM) recently announced that it's working toward creation of a formal specialty in integrative medicine. ACIM is teaming with the American Board of Physician Specialties, which already offers board certification in medical specialties such as family medicine, internal medicine, emergency medicine, and urgent care.

Over the next two years, it expects to establish the American Board of Integrative Medicine (ABIM). It will develop a board exam in this topic, as well as criteria on who is eligible to take the exam. This will be a voluntary program; after physicians pass the exam, they'll be able to use ABIM as a professional credential, showing that they are board certified in integrative medicine.

Why did ACIM decide to move forward along this path? "We did so for many reasons," explained Andrew Weil, MD, ACIM director, and Victoria Maizes, MD, ACIM's executive director, in a statement. "Chief among them was to help patients discern who truly has training and expertise in integrative medicine. It is now popular in the marketplace to say you practice integrative medicine - yet anyone can say so, whether they studied for an hour, a weekend, or ten years. Our goal is to have all graduates of our 1000-hour fellowship become board certified. At the same time we have not relinquished our goal of bringing integrative medicine training to all physicians."

CAM Professions Respond with Mixed Emotions

John Weeks, publisher of the Integrator Blog, calls the new initiative a "momentous step."

His website offers a space where integrative medicine physicians and a wide variety of CAM practitioners communicate with each other in a lively, vital way. Over the past few months there's been a broad discussion, with viewpoints ranging from "timely, appropriate and wonderful" to "first they condemn, then they take over."

Daniel Redwood, DC, a professor at Cleveland Chiropractic College - Kansas City, tells the Townsend Letter that he perceives ABIM certification as a "positive effort by medical and osteopathic physicians to change their professions in an integrative direction. It is not intended to minimize or marginalize chiropractors, naturopaths, acupuncturists, massage therapists, or anyone else."

Redwood, the editor-in-chief of the online publication Health Insights Today, has been the legislative chair of a state chiropractic association. "Of course, I'm aware that these professions need to defend their rights and be ever vigilant," he notes. "However, I see these integrative MDs as our friends, as allies, as kindred spirits in many ways. It's important not to turn our friends into enemies unless there is some compelling reason to do so. At present, this seems to be a very positive development, and I wish them all the best."

Andrew Rubman, ND, who practices at Southbury Clinic for Traditional Medicines (Connecticut), also sees the new developments as generally positive. "This is welcome news because it does establish some kind of benchmark in an area that medical doctors currently enter freely, making whatever claims they chose. It is abuse of the worst sort, and the certification process would introduce some semblance of responsibility. It is far from ideal, but it is welcome first step."

The Academic Consortium for Complementary and Alternative Health Care (ACCAHC), which represents the licensed and accredited complementary health-care disciplines, discussed the new initiative, and asked Weeks, its executive director, to contact Maizes and other leaders of the process. "ACCAHC asked me to explore the extent to which they view this new discipline as one that will be firmly ensconced in interprofessional education," Weeks says. "That means, we are asking to what extent they see themselves linking closely to the people who have a deeper education in integrative disciplines and systems."

The key question here is whether integrative medicine MDs just add new therapies to their current tool kits, or whether they envision themselves as leaders in team-based health care. "Do they picture themselves working with integrative health teams that include licensed acupuncturists and chiropractors and naturopathic doctors?" Weeks asks. "Will they understand that they are receiving a limited, modality level training in fields that also have a deeper, richer aspect?"

What the New Credential Means for Patients

The new credential is designed to benefit people who rely on health-care services. It offers us additional information, but the ultimate responsibility for selecting an appropriate practitioner still rests with the patient.

"You still need find the right doctor for your needs/' says Redwood. "Patients need to explore not only the knowledge, but also the values and areas of specialized focus of any health practitioner they go to. The fact that someone has or does not have this credential cannot be seen as a guarantee of quality. On the other hand, if someone does have this credential, that should strengthen the patient's sense that this is a qualified MD who is broadly educated in integrative practice."

What Does ABIM Certification Mean for the Future?

It is possible to see the new specialty as one step in a positive trend toward prevention and team-based health care. "There is a broad process under way, expanding the reach and increasing the depth of integrative and naturally-based healthcare practices throughout all the health professions, not just CAM practitioners, but also including medical and osteopathic physicians," Redwood says.

Weeks himself expresses concerns that as the new specialty develops, integrative physicians could behave as a guild, seeking to protect and establish their own distinctiveness. "It would be something exceptional if instead they view themselves team players, continually reaching across guild barriers and working together with other providers."

If integrative medicine physicians aspire to play a deeply transformative role in health care, establishing mutually respectful working relationships with other providers will be an essential step. "For that to happen, the educational processes and certification requirements for the new specialty should include a recognition of the importance of team care, and learning competencies needed in order to work well with others," Weeks says. "The new specialists should realize that if they don't make a clear effort to establish new patterns, they could tend to behave like the guilds of old."

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Resources

The Arizona Center for Integrative Medicine: http://integratfvemedicine.arizona.edu

Three discussion on the Integrator Blog offer detailed, nuanced views of the ABIM proposal with responses from many different viewpoints:

Special Report on the ABIM proposal: http://theintegratorblog.com/index.php?option=com_content&task=view&id=780<emid=189

Integrator Forum: 20 Voices on the ABIM proposal: http://theintegratorblog.com/index.php?option=com_content&task=view&id=785<emid=189

Second Forum: Five Additional Voices: http://theintegratorblog.com/index.php?option-com_content&task=view&id=788&Itemid=169

Elaine Zablocki has been a freelance health-care journalist for more than 20 years. She was the editor of Alternative Medicine Business News and CHRF News Files. She writes regularly for many health-care publications.
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