For Integrative Doctors, a New Turn On the Road to Specialty Recognition

The long and winding road toward creation of a widely recognized medical specialty in holistic medicine has taken a new turn, one that leaders of the effort believe can take physicians a lot farther toward that goal.

The development of the American Board of Integrative Medicine (ABOIM)—a new certifying board that recently won formal recognition by the American Board of Physician Specialties (ABPS)—is the latest step in a certification effort that began in 1996.

The new ABOIM will take up the work done by the American Board of Integrative Holistic Medicine (ABIHM) as a certifying body. ABIHM, which grew out of the original American Board of Holistic Medicine (ABHM), will continue as a membership-based educational organization, but will cease to sponsor a board certification exam after its 2013 Annual Conference and certifying exam this November.

The creators of the new ABOIM—some of whom are part of the ABIHM's brain-trust--say specialty recognition will bring greater credibility to the entire field of holistic and integrative medicine, and greater respect for the unique skill-set of integrative doctors. It paves the way for better practice opportunities, could lead to wider insurance coverage, and ultimately, to increased public access to health-centric, prevention-oriented care.

"We have recognized for over 10 years that Holistic Integrative Medicine should be a recognized specialty," says Mimi Guarneri, MD, president of the ABIHM, and one of three ABIHM officers on the leadership council of the new board. "Our hope from the beginning was that mainstream medicine would catch up in this recognition, and indeed it finally has."

Critics contend there is an inherent contradiction in creating a distinct specialty around an intrinsically inclusive concept like "integrative" medicine. The fact that ABOIM certification will be restricted solely to MDs and DOs rankles some other practitioners of natural medicine who see the new board as the latest example of a power-grab by MDs seeking a new marketing edge.

New Requirements

ABOIM certification, which will begin in May 2014, will allow physicians who successfully complete all eligibility requirements and pass the exam " to present themselves to the public as qualified medical specialists in the practice of Integrative Medicine."

To qualify, candidates must:

• Have completed residency training in a program approved by the Accreditation Council of Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC).

• Hold, or previously have held, board certification by a board recognized by the American Board of Physician Specialties (ABPS), American Board of Medical Specialties (ABMS), American Osteopathic Association (AOA), Royal College of Physicians and Surgeons of Canada (RCPSC) Board or College of Family Physicians of Canada (CFPC).

• Have completed an ABOIM-approved Fellowship in Integrative Medicine or have graduated from an accredited 4-year naturopathic college or an accredited National Certification Commission on Acupuncture and Oriental Medicine (NCCAOM) college or an accredited Council on Chiropractic Education (CCE) college.

A complete list of eligibility requirements is posted on the ABOIM's pages on the ABPS website. The deadline for applications to take the May exam is Dec. 1, 2013.

The exam is comprised of 200 questions, administered via computer, to be completed in a 4-hour period. It will be offered twice yearly, in May and November, and covers a wide range of subjects including: nutrition, supplements & botanicals, mind-body therapies, traditional healing systems (Chinese medicine, Ayurveda, etc), and integrative approaches to diverse disorders.

A Long Journey

The saga of certification has its root in the vision of Dr. Bob Anderson, a family physician in East Wenatchee, WA, and one of the founders of the original ABHM (read HPC's first-issue cover story, Holistic Medicine: A New Medical Specialty?).

Dr. Anderson and a small circle of American Holistic Medical Association members founded the board out of their dissatisfaction with the "reductionist medicine we were taught." Medicine, he added, that was "not that satisfying and not that successful."

Anderson and his colleagues set out to create a comprehensive curriculum, review course, and credentialing exam for physicians practicing holistic medicine at a time when doing so was still considered taboo within much of mainstream medicine. At that time, the various non-allopathic healing disciplines were even more fragmented and segregated than they are now.

Part of the intention was to articulate core principles of holistic practice, set education standards, and give coherence to a chaotic field---at least among MDs and DOs.

According to Dr. Anderson, the ABHM's founders saw holistic medicine as a unique and distinct approach that merited recognition as a distinct specialty. They initially hoped to create a specialty board under the American Board of Medical Specialties, the certifying board governed by the American Medical Association, and the one that has the most influence within mainstream medicine.

However, Dr. Anderson said, the ABMS doesn't often approve new medical specialty boards. ABHM's founders quickly realized that this was out of reach.

No Grandfathering

In 2008, ABHM changed its title to become the American Board of Integrative Holistic Medicine, a move that reflected the growing popularity of the term "integrative." At that time, the board created an alliance with Scripps Center for Integrative Medicine, which became the key administrator for ABIHM's annual review course and exam---a weeklong educational intensive.

Since creation of the original ABHM, roughly 1,900 physicians have sat for the exam. ABIHM expects to have certified more than 2,000 doctors by the end of 2013, according to current board executive director, Nancy Sudak, MD.

Physicians already certified under ABIHM will not be grandfathered into the ABOIM certification, said James Marzano, spokesman for the American Association of Physician Specialists. However, those who apply for the new certification before Dec. 1, 2016, will be able to get on a fast track (via experience and hours of continuing medical education) toward meeting the eligibility requirements.

On its website, ABPS indicates that it "acknowledges that many MDs and DOs have become proficient in integrative medicine through extensive training from CME, self-study, and clinical experience." The board will consider physicians with a minimum of 500 points of documented training and experience in integrative medicine subject areas.

Active ABIHM Diplomates can receive up to 200 points toward the 500 required points. For successful completion of category 1 AMA CME in Integrative Medicine, 1 point will be awarded for each documented hour of CME.

Benefit vs Cost

In its core philosophy, ABOIM is staying true to its roots. The new board defines integrative medicine as, "the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing."

That said, some observers are concerned that the sheer cost associated with the new certification puts it out of reach for many holistic physicians. Candidates must pay an application fee of $750, plus an examination fee of $1,950. That's after the cost—and time-investment—in an ABOIM-approved fellowship such as the University of Arizona's two-year Fellowship in Integrative Medicine. These fees can be as high as $35,000, after all is said and done.

Dr. Anderson expressed doubts about the effectiveness of ABOIM. "I'm not sure it will make any practical difference in how integrative holistic physicians practice their craft." He added that the new board's certification exam "will probably not be significantly different from the exam we've been offering for 14 years," and could burden already struggling integrative physicians with unnecessary costs.

"A lot of family physicians who are already in practice find it financially impossible."

The investment in certification could pay off big-time, if insurers do ultimately start reimbursing for holistic and integrative medical services. Typically, insurers limit reimbursement to practitioners who've obtained a broadly recognized credential. ABOIM's leadership believes it has developed just that—a clearly defined credential enabling payors and the public to identify qualified integrative physicians.

"With any new specialty, there is an educational process with insurance providers," said ABPS's Mr. Marzano. "As this specialty continues to grow, so will recognition of integrative medicine board certification."

ABOIM's eligibility criteria open the door to MDs or DOs who are also trained in naturopathy, chiropractic or Oriental medicine. Will there ever be room at ABOIM's table for practitioners who are not MDs and DOs?

It's possible, but not in the near future," says Dr. Guarneri.

"It is premature to discuss our plans going forward in detail. But it is safe to say we will continue as an education provider and are considering the creation of education and certification programs for non-physician providers."

END

Gabrielle Zastrocky is a multimedia journalist specializing in the fields of education and health care, and has strong interests in energy, religion and business. She is currently based in Chiangmai, Thailand.

 
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