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Kaminoff Makes Case Against Insurance, Formal Regulation, Dictated Standards PDF Print E-mail
Written by John Weeks   

Kaminoff Makes Case Against Insurance, Regulation, Dictated Standards

Summary:  Certification and licensing are issues in many emerging and traditional healthcare professions. Leslie Kaminoff supports high standards but believes that any third-party intervention in the teacher-patient or practitioner-patient relationship is harmful. Kaminoff, a long-time leader in Yoga, argues that not only third party (insurance) payment, but also licensing and even standardized certification by professions can create illusion and false security in consumers. His logic may have an appeal to many in the broader CAM-IM world. (Interestingly, the Yoga community's initial dialogues on certification were prompted by the staffing needs of the heart health program of Dean Ornish, MD.) This article is part of an Integrator series on the Future of Yoga Therapy sponsored through the International Association of Yoga Therapists (See related articles, below.)

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for inclusion in a future Your Comments article.


Image
Leslie Kaminoff, Yoga leader
"I compare the field of Yoga to the field of music," says Leslie Kaminoff, a Yoga practitioner and educator for the last 27 years. "Like music, Yoga is a vast, infinitely varied pursuit. There is no agreement on what constitutes good music. But people don't usually fight about it. It's not like the head of the Philharmonic is beating the crap out of P. Diddy because he's destroying the spiritual nature of music."

Kaminoff goes on:
"Yet, we see people with that attitude in the field of Yoga. They consider themselves defenders of the good name of Yoga, and they denigrate those whom they consider to be destroying their sacred tradition. Just as in music, people are attracted to the Yoga they connect with - they may keep exploring and go deeper, or they may just enjoy continually replaying their favorite golden oldies."

Kaminoff, a former vice president of Unity in Yoga, whose E-Sutra-The Worldwide Yoga List is a top Yoga blog, doesn't have much trust in Yoga teachers who are drawn to organize professional self-regulation. "There is this idea of having the power to impose your standards on your profession. Some people are attracted to it. They're the ones who tend to seize power in well-intentioned groups that seek to establish professional standards. In Yoga in particular, there needs to be an understanding of the true nature of power. There are many very advanced yet quiet Yoga teachers who will have nothing to do with these dialogues (about certification and standards) and they may, in fact, have the highest standards and the most profound influence with the people they serve."

How the Dean Ornish Program Promoted the Yoga Teacher Certification Effort

Kaminoff says he started his blog when he got tired of explaining his reasons for backing out of a national ad hoc committee
that was developing Yoga education standards. (For Kaminoff's posting on this topic, click here.) Interestingly, a key CAM integration effort into hospital care prompted the standards move.

Image
IAYT sponsored an Integrator Series which explores the future of Yoga Therapy often through the lens of the experience of other disciplines. See full series list, below.
In the mid-1990s, hospital interest in the multi-disciplinary and multi-modality program developed by Dean Ornish, MD, for reversal of coronary artery disease forced Yoga to size itself up in a very conventional mirror. Yoga played an important part of Ornish's protocol. Yoga teachers would be needed if the program was to be replicated, and expand nationally. Expansion was the goal of Ornish's Preventive Medicine Research Institute (PMRI). But how was PMRI to recommend local Yoga teachers with sufficient training that would insure the quality of the Yoga taught in each hospital?  Could Yoga teachers be credentialed? If so, to what standard?
At the time, there were no standard for the training of Yoga teachers.

Kaminoff recalls the formation of the ad hoc committee: "I was there when we set the 200-hour and 500-hour standards." He refers to the registration levels
now promulgated and managed by the Yoga Alliance(YA). (There are currently three: RYT-200, RYT-500, and an E-RYT, which stands for "Experienced.")  "The initial idea," says Kaminoff, "was to honor the Yogic principle of Ahimsa (non-injury). In other words, we saw our task as figuring out the minimal hours needed to train an instructor to teach without causing harm. That became the 200-hour entry level of certification." Other standards that required more training and mentoring were added. The Yoga Alliance would eventually register both practitioners and Yoga schools' training programs at these levels.
     

"Yoga  is about

connection - that
between the student
and teacher.

"Any third party
that inserts itself
into that relationship
will destroy it.

"It doesn't matter
if that party
is an insurer,

a government
agency or a band
of well-intentioned
Yoga teachers.
"

-Leslie Kaminoff



Standard Bearers: Certain People with Certain Personalities

Once the standard was set, Kaminoff figured the work was done. But to his consternation, it was not.

Kaminoff lays out his perspective: "The idea of a Yoga organization taking on the approval of teachers or certification programs made me nervous. In reality, the Yoga Alliance only processes information. It's based on trust. If a teacher or school lies on their application, there's very little the Alliance can do to catch it.  Since it's all based on trust and voluntary compliance anyway, once the standards were established and publicized, why did we need a group of people to administer them?  If a student or an employer has questions about a teacher's credentials, those questions should be answered in the context of a relationship with that teacher - not with a group like the Alliance."

[Note: Officially, YA does not "certify" but "register." But leaders acknowledge significant confusion on this distinction, which practically feels like certification to most.]

Does All Third-Party Intervention Between Doctor and Patient Corrupt Care?

"I am not against high standards," clarifies Kaminoff. "Yoga  is about relationship - the connection between the student and teacher. "Any third party that inserts itself into that relationship will eventually destroy it. "It doesn't matter if that third party is an insurer, a government agency or a band of well-intentioned Yoga teachers".

Kaminoff, in his inaugural posting on e-Sutra, bases his argument on what he views as the fundamental ethics of Yoga:
"Yoga ethics are very clear on this point. In fact, the teaching concerning what we should avoid (Yama) is presented before we are given the teaching concerning what we should pursue (Niyama). Furthermore, the first injunction is Ahimsa, the avoidance of doing harm. In the context of National Standards, what exactly is it that we must avoid harming? The process of teaching yoga. What is the vehicle for the process of teaching yoga? The student-teacher relationship.

"The simplest way to put it is this: 'I avoid engaging in any action that will lead to third-party interference in the student-teacher relationship.' The positive counterpart to the above is: 'I support and protect, through my actions, the sanctity, integrity and freedom of the student-teacher relationship.'"
-- From Kaminoff, e-Sutra: The Worldwide Yoga List, at this link
Kaminoff draws a breath, reflecting on the frequently poor practitioner-patient relationships in conventional medicine: "I think that the typical doctor-patient relationship has not only had the 3rd-party intervention of insurance, but also 4th-party, 5th-party and 6th-party interventions destroying that relationship. These parties are all pulling the M.D. in contradictory directions. The HMO/insurance forces want to contain costs and reduce procedures. Malpractice concerns would make the doctor want to run the extra test, take the extra MRI.  It's hard enough to be a good doctor under even the best conditions. How M.D.'s can even function under the present system is a testament to their dedication to their craft. The fact that certain forces in the Yoga community want to buy into that system is a testament to their ignorance of what it's like to work inside of it.  As my friend Tom Myers has said: 'Buying into mainstream healthcare delivery is like handcuffing yourself to the railing of the Titanic.'"

Kaminoff continues: "Government gives an illusion to consumers. Governmental standards give a false security. The patient sees the paper and thinks it is meaningful."
Kaminoff views the Yoga Alliance standards as already promoting a false security in the Yoga world: "Because a person has a certification to teach doesn't mean anything about their actual qualifications. Promoting that idea is a disservice to the consumer. Try to remember that all the doctors who malpractice are deeply credentialed and licensed. We don't need more framed paper hanging on the wall. We need more honest and open relationships between consumers and providers."

What Role then, for a Professional Organization?


If a professional organization is not to be caught up in the business of requiring certain educational standards and in promoting licensing, insurance inclusion and expanded scope of practice - typical health professional association activities - what then are its functions? Kaminoff, with his laissez faire (he calls it"objectivist") perspective - ticks off the agenda:

  • "Because the Yoga therapist's fundamental role is that of an educator, the main role of a professional organization should also be that of education (not certification, approval or enforcement).
  • "A useful role would be to help schools, training programs, practitioners, and the public understand what is meant by terms like scope of practice, competency, certification, licensing, etc.
  • "Rather than taking a stand to endorse a specific set of standards, IAYT could function as a clearing-house for accurate information about what standards are, as well as the range of standards that are being embraced by the different training programs. This would help to put vital information into the hands of the right people, in order to empower them to make their own educational and healthcare decisions.
  • "Advocate for the free, open, transparent sharing of accurate information about competency and training standards for Yoga Therapists.
  • "Advocate against any third party (read government/insurance) interference in the free market of health care choices."

Kaminoff believes that this "free market approach would actually lead the various schools and training programs into a natural and healthy competition to create maximum standards." He feels that the ad hoc committee went "terribly wrong by setting a menu for minimum standards." One of the unfortunate results, in his mind, was "cookbook, minimum-level training programs, and hour-grubbing students treating their precious education as if they were filling up books of Green Stamps."

Comment:
Kaminoff was introduced to me by John Kepner, IAYT executive director, as a useful interview for capturing the strong current of antagonism among some in Yoga toward profession-wide standards, licensing, and insurance participation. I credit the openness of John and Veronica Zador, RYT-500, IAYT president. Zador, an internationally known Yoga teacher and therapist, is not only president of IAYT but is vice president of the Yoga Alliance and head of the Alliance's Standards Committee.

 
Part of the value
in listening to
uncompromising
spirits, such as
Kaminoff, is
that our own
agreements and
adjustments, well,
compromises
are cast in
bold relief.

 
Part of the value in listening to uncompromising spirits, such as Kaminoff, is that our own agreements and adjustments, well, compromises, are cast in bold relief. This can be a good therapeutic process for anyone wishing to engage a refrom or transformative process.

These issues are dynamic for all professions. The patriarchy, paternalism and vertical, top-down orientations of conventional medicine (and more than a few CAM-IM practitioners) are all caulked and hammered together with certifications, accreditations, qualifications,
regulations, credentialing and licensing which are all, of course, without fail, are developed solely to foster the public interest and to protect  consumers. Sarcasm is merited here, is it not?

One would assume that the consumer was steady on the altar for all this regulatory and self-regulatory action.
Yet two earlier articles in this "Future of Yoga Therapy" series on the role of 3rd-party payment in the development of the chiropractic and naturopathic medical professions shows how much the consumer-patient can be lost.

The irony - and here Kaminoff's perspectives strike a resonant chord - is that here we are, a half-century into this wild explosion of organized and bureaucratized medicine and what are we doing? We are struggling to put our minds and actions around how to provide care in a way that is "patient-centered."

Let's hear from you on this!

Send your comments to
for inclusion in a future Your Comments article.

_____________________

Links to additional articles in the IAYT Future of Yoga Therapy series:

Naturopathic Insurance Leaders on 3rd Party Payment, the CPT, Villani's Views, and CAM-IM Maturation (10/08/06)

(Another Kind of) Integration in Georgia: Yoga, Mindfulness, TCM and Functional Medicine at Athens Regional Medical Center (09/07/06)


Harvard Researcher Sat Bir Khalsa on "Hygiene for the Body-Mind" and Yoga's Emergence (8/4/06)

Insurance Coverage and Development of the CAM Professions: Perspective of Triad's Agostino Villani, DC (7/9/06)

IAYT Sponsors IBN&R Series on the Future of Yoga Therapy: Part 1 - Context and Current Initiatives (5/19/06)


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