Your Comments: Time blast IM docs, CTCA's Model, CHP's Fees, NYT on Supps, LAc Earnings, plus
Written by John Weeks
Your Comments: Time Column, CTCA's Model, CHP's Payments, NYT on Supps and a Thoughtful Look at LAc $$, plus ...
Summary: The
coverage of the Time magazine blast against integrative medicine
doctors provoked responses from Bill Manahan, MD, Gary Sandman and an
anonymous health system leader ... Naturopathic physician Julie
Chinnock, ND questions thoroughness of the reporting in the article on
CAM network firm Complementary Healthcare Plans ... Vic Sierpina, MD
wonders if the oncologists with CTCA view the care as being as
integrated as was presented in the Integrator story ... Michael Levin
tilts the windmill of journalist integrity of the New York Times on dietary supplements, again ... Chris Foley, MD, with a pithy comment on 3rd party payment ... and Laura Ocker, LAc, presents a very thoughtful, detailed look at payment issues in acupuncture practice.
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1. Regarding Time Magazine's Blast Against Integrative Medical Doctors
When Timemagazine columnist Scott Haig
teed off at doctors for making choices to leave typical practice for
other medical practices based on what we believed were economic
reasons, he especially enjoyed blasting integrative medical doctors (In the News: NYT "Correction" on Supplements, UPI/Reiki, Time Blasts Integrative Medicine Docs). Integrator advisor Bill Manahan, MD, had a few terse words for Haig:
"Scott Haig has such a
tiny piece of reality in his article in Time Magazine that he makes George W.
Bush seem quite honest and realistic regarding his view of how the war in Iraq
is going."
I also heard from a trustee of a health system
who did not wish to be named whose commented touched some of the other
economic pursuits Haig's column referenced:
"Excellent coverage. It is
interesting to compare this kind of economic 'entrepreneuring' (in
integrative medicine) with the movement to MD-owned free-standing
surgery centers. The latter is much more rampant, with documented
risks to patients. So much of it is about financial profits!"
Gary Sandman: time to look inside
Gary Sandman, a long-time entrepreneur
himself in the integrative medicine space, had a different take
altogether on the article, wondering if we are not calling this
negativity to ourselves by failing to look within at how we are
configuring the world. Sandman has headed an integrated provider
network, mounted conferences and now is founder and CEO of Signature Supplements.
"It sounds like we as a whole – i.e. integrative practitioners and
administrators - are not following our own belief system – according to the
popular The Secret video, and using it as a representation of our belief
system, where by the universe responds in kind according to our own beliefs.
If we keep getting these negative NYT and other media responses we are, at some
level co-creating this negative response.
"Isn’t time we applied our own remedies and spent some time inside to
examine and heal our 'lack consciousness' 'arrogance' and get over our
quest to be accepted by 'Dad' or the authorities of modern medicine who
are operating with a completely different belief system and health
system than we are providing. At the sake of getting too metaphysical -
life is a feedback loop – it is time we looked inside and stopped
blaming the 'enemy' and instead acknowledging our own 'stuff' that is
showing up in the press and from medicine’s authorities as a reflection
of our own insecurities and poverty consciousness.
"Let’s us use our
tools to heal ourselves. I know personally that 20 years ago I felt the
arrogance of medical doctors as I promoted and educated doctors and the public
on alternative medicine. It wasn’t until I removed my own arrogance about my
beliefs that I have never met a arrogant doctor again in my work. Change begins
within. It is time for personal change."
Gary Sandman, CEO
Signature Supplements
2. More on the CTCA: What Do We Mean by Integation? Does CTCA Meet the Standard?
Vic Sierpina, MD: Are CTCA's oncologists bought in?
"Great edition. While I am equally appalled by the Washington ruling, my
colleagues who have actually visited CTCA found it not to be all that
integrated. Oncologists are drawn to work there by top end equipment
and facilities. Naturopathic and interdisciplinary teams seemed to be
an 'add-on' largely ignored by the oncologists though very prominent in
marketing and in public appeal.
"I was very impressed by Tim Birdsall, ND who presented at the
AHMA/AHNA (American Holistic Medical Association/American Holistic
Nurses Association) last year on CTCA. I wrote up some of their work in
the Houston Medical
Journal.
"It may, in sum, be a matter of more direct competition with the (Fred Hutchinson)
and other established cancer treatment programs in Washington and the ruling covered by
the supposed opposition to an integrative approach.
"I could be mistaken, of course. But since they seem more mainstream
than they really are, perhaps opposition has to do with their
marketing."
"Finally, I haven't actually visited their center but discussed it with a couple
very credible colleagues who did and who left with that impression. As
I said, Birdsall was very impressive in presentation but the question
remains if the naturopathic/integrative vision is truly embraced by
their oncologists. You should invite Tim's response."
Victor S. Sierpina, MD, ABFM, ABHM WD and Laura Nell Nicholson Family Professor in Integrative Medicine
Professor, Family
Medicine
University of Texas Medical Branch
3. Regarding Fees for Providers in the Complementary Healthcare Plans Article
"Was there a reason why you didn't inquire with CHP about
practitioner reimbursement fees and contracts? In addition to access to
services by patients, this area may be one of the greatest financial
challenges/decisions to a "CAM" practitioner.
"I am unaware of the
actual fees provided for reimbursement, but the buzz from most ND's I know is
that accepting CHP and even more so with American Specialty Health is not worth it in the end because of
the pitiful amount of reimbursement provided.
It may get people in the door (which is why alot of new docs are enticed
by the contract), but in the end it can actually cost you to see them.
"I do not
contract with CHP, but if this is true, companies like CHP are able to get a
free ride on the 'CAM' propaganda train without any true benefit to the
providers who make up their network. These issues of disparity in provider
(especially PCP) reimbursement need to be addressed if these professions are to
survive."
Julie Chinnock, ND
Oregon
4. Correcting a Correction: Pushing the New York Times to Come Clean on Dietary Supplements
Levin: correcting the correction
The Integrator has been following advisor Michael Levin's efforts to get the New York Times to admit to the extent of error in the article written by its own journalist Dan Hurley, based on his supplement bashing book (Disquieting Journalistic Ethics: Michael Levin Challenges New York Times and Supplement Basher Hurley). After the NYT praised
Hurley with faint damning in its "correction," Levin - who has held
executive positions in both Big Pharma and with the supplement industry
- fired off another letter asking for a correction to the correction:
"Dear Sirs: "With all due respect, your correction did not include two important facts
essential to the risk assessment associated with vitamins, minerals, herbals
(dietary supplements). While you correctly reported that the database reports
"exposures" and that all exposures do not result in an adverse
outcome, you omitted these facts which are essential in presenting an
objective, unbiased view of the data:
1) The database distinguishes between "intentional" and
"unintentional" exposures. This is an important distinction!
Intentional exposures consist of intentional suicide, intentional abuse, and
intentional for unknown reasons (pages 810-811). 12.6% of all human exposures
were "intentional acts" (p. 811). 89.6% of all adolescent deaths and
76.6% of all adult deaths were "intentional". 2) All deaths associated with vitamins/minerals/supplements (table 21) were
intentional acts, all of which included multiple agents (eg, drugs).
"Absent these important facts, it is impossible for any reader to reach an
informed conclusion regarding supplement safety within the context of
appropriate use (ie, as directed or prescribed). I would hope that you will
agree to publish yet one more clarification in order to give your readers the
opportunity to make a truly informed decision. "To underscore this point, I would hope that we never see an article published
in the NYT based on the CDC report of 3,306 unintentional drownings during
2003, suggesting that water is more dangerous than dietary supplements." (bold added)
Michael D. Levin Clackamas, Oregon
5. To Go After 3rd Party Payment or Not, That is The Question ...
"Hey
John…Just a note to remind you that 3rd
parties have no place in CAM. Insurance is for acute and severe medicine
(which can be protocoled and templated). The rest should be between 2
consenting adults or their representatives, not 3."
Chris Foley, MD Minnesota Natural Medicine
6. More Discussion of Acupuncture Fees Provoked by the Working Class Acupuncture Model
"Wow! I am so glad that you all have started this
conversation about pay rates of licensed acupuncturists working in the public
health arena (or any arena). I look forward to continued discussion and
debate.
"I love my work as a licensed acupuncturist with
Virginia Garcia Memorial Health Centerin Hillsboro, Oregon. It is amazing to me
to see the results that we can get with Chinese medicine. I love taking a
moment to pause and look around at the relaxed faces of the clients in my group
treatment room. I wish I could describe them to you, paint an image for you of
the intensely beautiful mosaic of culture, ethnicity, and life experiences of
the families and individuals who find relief in our acupuncture clinic. I have
also valued my work as an on-call L.Ac. at Portland Alternative Health Center,
Hooper Detox, and Washington County Community Corrections Center. Working in the
field of public health, providing care with acupuncture and Oriental medicine,
is an extraordinarily gratifying way to make a living.
"I
am a 37 year-old mother of two children and a licensed acupuncturist,
residing in the Portland Metropolitan area. I have a few observations
based on personal experience:
"On student loans:
"If you ignore your student loans for several years,
they do not go away ...
" ... buying lottery tickets is usually not a practical solution."
If you ignore your student loans for several years,
they do not go away. In fact, they increase quite a bit. By purchasing several
lottery tickets every week, you can nicely maintain the fantasy of being able to
take care of your student loans with one sizable payment. However, it is usually
not a practical solution.
"On living expenses:
If you work part time as a licensed acupuncturist at a
public health clinic and you are not eligible for benefits, and if you do not
have health insurance coverage through your spouse or partner, and if you make
just enough money as a family to not qualify for public assistance, you might
find yourself pregnant and uninsured.
"On pay rates of health care professionals:
In some cases (I wonder how many), RNs with a 4-year
degree earn more money than licensed acupuncturists. Acupuncturists are required
to have a Master’s level education in order to practice. I’m not saying that
L.Ac.s are more valuable than RNs. That’s just stupid. Everyone knows that RNs
are phenomenal and the backbone of most health institutions. But L.Ac.s do pay
quite a bit more for their education, and somewhere along the line, this has to
get paid off. Consider the level of education and responsibility required to
work as a nurse practitioner or physician assistant. Where should the pay rate
of a licensed acupuncturist fall?
A. Less than an RN?
B. Somewhere between that of an RN and an Nurse
Practitioner or Physician Assistant?
C. Equal to or greater than a Nurse Practitioner or
Physician Assistant?
"On the number of L.Ac.s practicing in the Portland
Metropolitan area:
"Pay the acupuncturist a minimal amount, don't offer benefits, and charge the clients a minimal amount. That's what
makes the equation work in too many cases.
"Unfortunately, the result is
devaluing our profession."
Tonight I discovered more than 50 Licensed
Acupuncturists are in private practice within 5 miles of my home in S.E.
Portland (according to membership data from the Oregon Acupuncture Association
website). So, honestly, we Portland acupuncturists are relieved to be earning
anything for our services. But can we really build the viability of our
profession by devaluing our services? And can we adequately support ourselves
and our families?
"On public health and TCM:
I believe that working in public health is an honorable
thing to do, not to mention immensely rewarding. I would like to see a much
greater spectrum of our population have access to quality health care, including
regular acupuncture treatments. It is easy to argue that keeping the pay rate
low for acupuncturists in the public health arena makes it possible to serve
more people. Pay the acupuncturists a minimal amount (somewhere between $16 and
$23), don't offer benefits, and charge the clients a minimal amount. That's what
makes the equation work in too many cases. Unfortunately, the result is
devaluing our profession. There’s got to be a better answer. What is it?"
Laura Ocker, LAc
Portland, Oregon
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