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Pew Commission's Competency Strategy Suggested for CAM-IM Turf Battles PDF Print E-mail
Written by John Weeks   

Pew Commission's Strategy Suggested for CAM-IM Turf Battles

Summary: A scope/standards issue between the AOM and chiropractic professions (see related IBN&R article) has led to a suggestion that the mid-1990s recommendations of the Pew Commission be used as guidance to break the wasteful energies of old, inter-disciplinary behaviors. This article looks at a few of those recommendations, and some commentary from a CAM-IM leader who was involved in that work.

Boys-with-swords may be the best image to capture most behavior of healthcare disciplines around turf. Like all good wars, various gods are typically invoked to justify this lower-Chakra behavior. Often all sides chant to these same gods as they prepare their lances.

For the good of our patients. To protect the public health. To prevent wastefulness.

Such gods have recently been invoked in two battle zones involving the CAM-IM world. (See IBN&R articles regarding the Scope of Practice Partnership of the American Medical Association, the Coalition for Patients Rights organized by the American Nursing Association and others to fight the AMA, and the issues raised by the Association of Acupuncture and Oriental Medicine (AAOM) regarding Chiropractic's 300 Hour Acupuncture Certification.) I have not yet been in touch with the American Chiropractic Association (ACA), but I anticipate that service to the patient figures prominently in the rationale behind their efforts to expand scope.

Pew Commission: Might Their Recommendations Guide Us?

ImageAs noted in the article on the AAOM-ACA issue, colleague Pamela Snider, ND, executive director of the Academic Consortium for Complementary and Alternative Health Care, reminded me of work of the Pew Health Professions Commission, in the mid-1990s. The work was engaged through the Center for Health Professions at the University of California at San Francisco. The Commission attempted to provide guidance so that the turf battles between the professions would no longer be a significant obstacle to healthcare reform. Snider sent along 10 recommendations, mainly targeting regulators. I include three which are particularly useful.

From the Pew Commission Recommendations
for Regulation of the Health Care Workforce
(3 of 10)

      States should standardize entry-to-practice requirements and limit them to competence assessments for health professions to facilitate the physical and professional mobility of the health professions

3.      States should base practice acts on demonstrated initial and continuing competence. This process must allow and expect different professions to share overlapping scopes of practice. States should explore pathways to allow all professionals to provide services to the full extent of their current knowledge, training, experience and skills.

4.      States should redesign health professional boards and their functions to reflect the interdisciplinary and public accountability demands of the changing health care delivery system.
(bolding added)


Snider participated in a UCSF Center for Health Professions project related to profiling emerging professions and naturopathic medicine. The work analyzed differences between ND graduates of four-year, federally-recognized, residential programs and individuals who also call themselves naturopaths but typically receive their degrees from mail-order businesses. The UCSF study was a key tool in clarifying legislative issues and opening the way to a 2001 California law which provides a license to practice to the graduates of the 4-year programs. 

Pamela Snider, ND, promoting the use of the Pew recommendations
Snider challenges the leaders of the disciplines: "The basic Pew approach is that we 'train to competency to scope.' These recommendations - all 10 of them - provide a powerful roadmap for real reform. They are a manifesto on how we can do things differently. Can we collectively take up the call? Can we in the CAM-IM fields potentially use these recommendations to model more mature relationships?" She adds: "These are deep

"These recommendations
provide a powerful
roadmap for reform.

"Can we collectively

take up the call?"

Pamela Snider, ND

discussions as our disciplines go about renewing themselves to to hopefully create a healthier world."

A forum now is in place for potentially convening and problem solving some of the practical issues between the CAM professions.  Reed Phillips, PhD, DC, chair of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC) is urging that ACCAHC take up the inter-disciplinary CAM issues - including the AOM-chiropractic issues on overlapping practices or services. This young agency has representatives from all but one of the councils of colleges and accrediting bodies of the CAM professions with federally-recognized accrediting agencies. Will Morris, DAOM, MSEd, LAc, president of the Association of Acupuncture and Oriental Medicine (AAOM), has indicated his personal interest in exploring this venue.

Resource: Snider notes that the report from the White House Commission on CAM Policy (2002) includes a good discussion and analysis of related issues, in Chapter 6 on Access and Delivery (page 65, Appendix B).

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