Many things about primary care have changed over the last decade. A lot of those changes haven’t exactly been beneficial to either doctors or patients. Others are well worth celebrating. In particular, the incorporation of nutrition-based interventions and other holistic approaches into mainstream practice is one of the brightest developments of the last 10 years.
Primary care physicians today, even many who identify as “conventional” in practice style, are vastly more open to nutrition-based therapies than they were 10 or 20 years ago. At least that’s what the data from Holistic Primary Care’s 2010 Physician Survey are telling us.
It seems that the “integration” we’ve been hearing so much about is actually happening, and not just in academic medical centers with CAM departments, but in the real-world, rough-and-tumble of daily clinical practice. And we say, “Here’s to that!”
The survey, sponsored by Holistic Primary Care, and conducted by Signet Research, an independent 3rd party survey firm, involved 2,000 primary care doctors across the US, randomly chosen from this publication’s mailing list. The study consisted of a 52-item questionnaire, and generated a 9% response rate-- strong for any market research, and remarkable for a survey of busy clinicians. That response rate, in and of itself, signals the growth of interest in holistic medicine.
The numbers tell us that nearly 80% of all primary care practitioners are incorporating some modalities from holistic or “alternative” medicine into their practices, with nutrition counseling and stress management being most common. Many are getting into functional medicine, botanical medicine, and acupuncture. One-fifth of you are using some form of hands-on manual technique with your patients.
Imagine how low those numbers would have been 10 years ago!
Who Are You?
Seventy eight percent of respondents are MDs, 12% are osteopaths, and the remainder naturopaths, chiropractors, nurses and others. Sixty-two percent are men, and the average age is 50. Nearly half practice in the suburbs, with another 37% in city settings, and the rest in rural areas.
One third run solo practices, and another third are in small group practices of under 10 practitioners. Half are fully insurance-based, while 8% (and growing) have opted out of insurance entirely. The rest have a mix of insured and self-pay patients.
Two-thirds of you self-identify as “primarily conventional” in practice style; a robust 29% identify as “integrative/mixed,” and 7% identified as fully “holistic.” On average, you’re seeing 18 patients per day, and a quarter of you are seeing between 20 and 30 patients.
Nutrition Moves to Center Stage
There’s no question that nutrition, dietary supplements and other natural products have become part of day-to-day clinical reality. Nearly all respondents—the “Conventionals” and the “Integrative/Holistic” types alike—are having discussions with patients about supplements and natural products. About half are having such discussions several times per day.
More than three-quarters of you are routinely recommending or “prescribing” some type of dietary supplements to patients. Mutivitamins, omega-3s and probiotics top the list. Most are taking some sort of dietary supplements, and the supplement categories you are most comfortable recommending to patients closely mirror the ones you are taking for your own health maintenance.
All that said, many respondents still felt cautious about supplements and natural products. Quality assurance and safety are major determinants in your willingness to “prescribe” or in some cases, sell particular products.
Roughly one-third said they’ve seen a serious adverse reaction associated with supplement use. However, few who say they’ve seen such events reported what they saw to either the FDA or the product manufacturer(s), as is mandated by the new Adverse Events Reporting regulations. MDs and non-MDs in the survey were pretty much equivalent in their lack of reporting.
Collectively, the medical community definitely needs to step up the reporting effort; it’s the only way we’ll ever get an accurate picture of dietary supplement safety.
Organic & Eco-Friendly: Walkin’ the Talk
We are particularly heartened by respondents’ eagerness to learn about holistic medicine, and to fill the gaps in medical education. Seventy five percent said they want more education in dietary and lifestyle-based interventions; 60% specifically indicated a desire for more education about the role of dietary supplements in clinical practice. Half want more information on stress management.
Clearly, you’re endeavoring to “walk the talk” toward healthier, more eco-conscious lives. Over 90% regularly participate in one or more physical activities, with running, working out, and hiking being especially popular. Swimming, yoga, and meditation were also frequently cited recreation favorites. A large number are buying organic food, and eco-friendly “green” cleaning products.
Pondering Practice Change
The data show that many of you are less-than-happy with your current practice situation, and are considering a substantial change in practice model, such as a move to direct-pay fee for service or a concierge/membership practice model.
Many are considering ways to bring new revenue into your practices such as dispensing supplements, aesthetic procedures and“spa” treatments, and advanced diagnostic testing. One of the more troubling--though not surprising--findings is that 10% of you are considering leaving medicine altogether.
We were pleased to learn that our publication is helping you navigate the ever-changing and somewhat unknown terrain of holistic or “alternative” medicine. More than three-quarters of respondents said the information in Holistic Primary Care is useful in their practices, particularly in understanding the role of nutrition, dietary supplements and natural products in clinical practice. More than half are sharing information from HPC with patients and medical colleagues. We were especially pleased that almost one-third of you are leaving HPC in your waiting rooms for patients to read!
Whether you’ve been practicing the principles of holistic medicine for decades or you’ve only recently begun to explore options outside the framework of allopathic, drug-based medicine, we hope these survey findings encourage you, and help you to realize that many other physicians share your vision for a gentler, more humanistic way of practice in synch with the core principles of physiology and the laws of nature.
If you are among the 2,000 clinicians who participated in the survey, we thank you heartily for sharing information about your life and your practice. The knowledge we’ve gleaned from the survey will help us make HPC a stronger publication, and enable us to better serve you and your primary care colleagues.
Holistic Primary Care’s “Primary Care Physicians & Holistic Medicine:
Transition, Transformation, Opportunity--An Executive Report from Holistic Primary Care’s 2010 Physicians’ Survey,” is a comprehensive analysis of physician attitudes, practice patterns, and personal experience with holistic nutrition-based medicine, nutraceuticals and natural products. It is the first survey of its kind to assess a large and representative sampling of conventionally trained MDs across the United States. The complete report, complete with charts, graphs and a detailed analysis, is available for purchase here.