IOM Summit: Opportunities Are Huge

But CAM Practitioners Must Seize the Initiative

 By Izabella Tabarovsky

Note: This post is part of the discussion on the Summit on Integrative Medicine

The 3-day Institute of Medicine Summit on Integrative Health was truly mind-broadening for me.  I came away excited about the possibilities and bursting with ideas.

The key was that we are living at a time of huge opportunities.  But no one is going to hand anything to us on a silver platter.  We must fight for what we believe in - and we must get creative about it. 

We can continue complaining how mainstream establishment doesn't recognize or accept us, that insurance companies don't reimburse us, and how the public doesn't understand what we do.  Or we can get beyond the current paradigm and think creatively about our competitive advantages vis-a-vis mainstream medicine and go there. 

Two key ideas were voiced at the Summit in this regard:  Community-based care networks and work-site CAM interventions.  Both require initiative on our part. And to become viable, both require that we overcome our tendency to get silo'ed and act alone.  Right now we will benefit from acting together, from helping each other out, from, together, creating the new paradigm in which the benefits of CAM modalities will be apparent to everyone. 

With that, here, briefly, are some of my take-aways from the Summit:

• The new paradigm is being birthed.  It seemed that everyone, from MDs to insurance reps, agreed that the old paradigm of health care is broken. We are present at the birth of the new paradigm.  No one knows yet what it will be.  The moment to contribute to the shaping of this new paradigm is now.  Each of us participating in the CAM field must now step up to the plate and do our part in making sure that integrative health care truly becomes a reality. 

• From evidence-based practice to practice-based evidence.  Pedigreed scientists such as Ken Brigham and Lawrence Green suggested that "to reject a treatment because we don't understand the mechanism is a mistake." The idea that randomized control trials don't work with CAM modalities and that practice-based evidence is "the only way to integrate practices that have hundreds of years behind them" was voiced repeatedly.  This means that if your practice shows results, that should be considered good enough evidence.  Music to the ears of a CAM practitioner.

• Shortage of primary care physicians creates opportunities for CAM practitioners.  The PCP shortage is already affecting the health care industry.  By 2025 we could be short as many as 200,000 PCPs, and, according to Richard "Buzz" Cooper, the health care reform could increase the shortfall by another 400,000.  Doctors' functions are becoming increasingly narrow and high-tech.  The offloading of tasks by physicians will accelerate, leaving physicians with increasingly narrower responsibilities, more high-tech and less relevant to the real issues affecting the health of their patients.  Other disciplines will, by necessity, be called upon to fill the gap, and this is where CAM practitioners will have their entry.

• There is room for everyone at the table to provide an amalgam of services.  This means that there will be room for everyone, from chiropractors to acupuncturists to health coaches to energy healers in creating an amalgam of care.  Because of the above, we are moving into a place where physicians will share the platform of care with a broad range of non-physician clinicians. 

• We must educate MDs and the public about our modalities. For the above point to be true, PCPs have to become educated about what we as CAM practitioners do.  83 percent of PCP practices in this country are groups of 1 or 2.  They account for nearly 50 percent of primary care.  This means that there are great opportunities to develop community care groups that could include nutritionists, dietitians, social workers, all connected to small PCP practices. The problem is that many times MDs, along with general public, have no idea what it is that we do.  So it is up to each and every one of us to take the initiative and reach out to the PCPs and educate them.  Go introduce yourself to PCPs in your neighborhood, tell them about what you do, show your credentials, build a relationship.  Begin where you are. 

• Empathy is CAM practitioners' competitive advantage.  I was floored by a slide presented by one of the speakers that illustrated the dramatic decline of empathy in medical students as they progress through medical school. This shift particularly affects men, whose levels of empathy drop nearly to zero.  (I don't have that particular slide, but here's a link to another onethat demonstrates the same point.)  What this suggests to me that we as CAM practitioners are, first and foremost, in the business of empathy.  In fact, empathy is our competitive advantage vis-a-vis the MDs - all the more so because studies show that empathy is the top quality that patients long to see in their caregivers.  Emphasize this with your prospects, let this be your selling point.

The one thing I found myself wishing for was that the Summit had lived up to the word "integrative" in its name and included the discussion of mind and spirit, not just the body. Dealing with questions of meaning and purpose is integral to whole person health.  But hey, you can't get everything right right away.  Perhaps next time.