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Common Themes from Top Educators on Challenges/Opportunities for Licensed CAM Professions: 2009-2012 PDF Print E-mail
Written by John Weeks   

Top Educators Note Challenges and Opportunities for the Licensed Integrative Practice Fields 2009-2012  

Summary: A recently published edited reference text on the licensed integrative practice professions includes educator-leaders' perspectives on the top challenges and opportunities for each of these fields for 2009-2012. The licensed fields represented are chiropractic medicine, acupuncture and Oriental medicine, naturopathic medicine, massage therapy and direct entry midwifery. Educator and accreditation leader Jan Schwartz, MA, analyzed the responses of the chapter author teams, each of which was selected by national educational organizations for their respective fields. Schwartz' goal: find common themes to shape a cross-disciplinary work agenda. Here is a look at the intersecting horizons of these professions, high and low, as forecast by these educator-authors. 
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Image
Schwart: Exploring areas for potential collaboration
Is there common ground on
the challenges and opportunities facing the complementary and alternative healthcare professions in the coming years?

Integrator adviser, massage educator and consortium leader Jan Schwartz, MA was charged with exploring this question as co-chair of the Education Working Group of the
Academic Consortium for Complementary and Alternative Health Care (ACCAHC). Schwartz realized she had one potential resource at her finger tips. ACCAHC recently published the Clinicians' and Educators' Desk Reference on the Licensed Complementary and Alternative Healthcare Professions. The core of the book consists of 5 chapters, written to a common outline, on chiropractic medicine, acupuncture and Oriental medicine, naturopathic medicine, massage therapy and direct entry midwifery. Some guidance was available here.

Schwartz,
a past chair of the Commission on Massage Therapy Accreditation and co-author of the chapter on massage, recalled that each author group was asked to list the challenges and opportunities for their fields in 2009-2012. Because the authors had been selected through consultation with leaders of their national educational organizations, these lists might be expected to broadly reflect the profession's views. The authors and partner organizations for the book, for which I served as co-editor in my capacity as ACCAHC executive director, are listed below.
___________________________

Chapter Authors and Partner Organizations*

 Profession   Partner Organization
  Chapter Authors
         
Acupuncture
and Oriental
medicine -AOM
  Council of Colleges of
Acupuncture and Oriental
Medicine
  David Sale, JD, LLM
Steve Givens, DAOM, LAc
Catherine Niemiec, JD, LAc
Elizabeth Goldblatt, PhD, MPA/HA

Chiropractic
medicine - DC
   Association of Chiropractic
Colleges
  Reed Phillips, DC, PhD
Michael Wiles, DC, MEd
David O’Bryon, JD

Massage
therapy

   American Massage Therapy
Association - Council of Schools

  Jan Schwartz, MA
Cherie Monterastelli, RN, MS, LMT
Direct-entry
midwifery
   Midwifery Education
Accreditation Council
  Jo Anne Myers-Ciecko, MPH
Naturopathic
medicine - ND
   Association of Accredited
Naturopathic Medical Colleges
  Paul Mittman, ND, EdD
Patricia Wolfe, ND
Michael Traub, ND, DHANP
         

For the Clinicians' and Educators' Desk Reference as developed by ACCAHC.
Parrtner organizations worked with ACCAHC to select the authors.

___________________________


Schwartz developed a grid of the responses of each author group. From these, she culled the following sets of similarities.

___________________________

 
  Table 1: Cross-Discipline Similarities in Challenges
and Opportunities for the Licensed CAM Professions^
2009-2012

 
   Key Challenge Similarities  
   1. Responding to increasing practice opportunities
 
   2. Need to enhance credibility with the public/
better educate the public
 
   
Key Opportunity Similarities
 
   1. Growing the professions to meet interest
 
   2. New collaborative opportunities
 
   3. New research opportunities
 
     

^ DC, ND, AOM, massage therapy, direct-entry midwifery

Based on compilation by Jan Schwartz, MA, for the
Education Working Group of ACCAHC.

___________________________

The blending of challenge and opportunity is evident in the #1 item listed by Schwartz under each. The opportunity for these professions is growth and the challenge is in responding effectively. They are sides of a coin.

A close examination of responses finds that areas one author or author group lists under "opportunities" may be listed by others as "challenges." The chiropractic educators, for instance, note broader inclusion in healthcare reform as a challenge while the midwives note the action of their organizations in healthcare reform lobbying as an opportunity.

Image
Text on licensed integrative disciplines
I took the opportunity presented by Schwartz' initial work to explore the commonalities and differences between the responses of these authors. Here are some repeated themes.

  • Collaboration  AOM writers noted collaboration as an opportunity relative to inter-disciplinary educational opportunities. Interestingly, DC writers directly spoke to collaborative work between the CAM professions as an opportunity but to "increased opportunity for more integration and collaboration" with the broader healthcare community as a challenge. (Notably, intra-professional collaboration between the various national organizations inside a given discipline showed up as an opportunity for the AOM, ND and midwifery authors. Such internal cooperation was framed as a challenge in the chiropractic and massage therapy lists.)

  • Integration  This theme, which overlaps with collaboration, repeats and includes both the educational and clinical arenas. The ND writers spoke of the increased opportunity to practice in multidisciplinary settings as an opportunity. The chiropractic writers note as an opportunity the "integration" of chiropractic education with larger university systems. Listed as a challenge is the integration process, now under way, into the VA and other federal health systems. Massage authors referenced work with employers and in integrative health care as opportunities.

  • State licensing issues  Notably, the educator-writers for four of the disciplines highlighted state licensing-related issues. The NDs and licensed midwives, which are licensed in 15 and 26 states, respectively, frame the challenge as expanding licensing. For the AOM and the massage therapy fields, each of which is nearing the prize of all 50 states, the focus is on licensing reciprocity. The NDs and AOM fields both reference gaining clarity on scope issues. The chiropractors, meantime, the only field with licensing in all 50 states (an noted in a chart on page 9 of the text), focus their political efforts on the federal level.

  • Federal Affairs  Advancing their professions through federal policy work is listed by all but the massage writers. The AOM section speaks of the challenge of strengthening and coordinating the profession's voice in national policy and, at the same time, the opportunity represented by the growing commitment to intra-professional collaboration. The chiropractors, the only field with a historic presence as a lobbying force, has reference to policy initiatives laced through both challenges and opportunities. The midwives are docused

  • Reimbursement, Payment and Jobs The theme of payment seems to pop up for any professional group. The AOM writers list inclusion with HMOs, Medicare and third party payers as a challenge and the midwives see as an opportunity the chance to promote the profession in all public and private health payment systems. Third party reimbursement also makes the challenges list for midwives. Chiropractors are blunt. The challenge:"Increasing revenues for doctors in practice." The midwives and massage therapists frame the challenge in part as creating job opportunities. For midwives, this is connected to expanded health system reimbursement and, for the massage profession, to working with employers. The AOM writers speak to the needs to establish more "viable professional practice opportunities."

  • Public education The issue of educating the public breaks variously, based on the profession. These AOM leaders see the problem in distinguishing between their credentials and the practice of acupuncture based on less training by other professionals. NDs similarly reference the "consumer confusion" between "CAM professionals and non professionals." In massage, educational issues are framed around inconsistent nomenclature and standards. The midwives note an existing public affairs initiative. Interestingly, the chiropractic writers reference the context: an anticipation of continued growth in public demand for "alternative medicine."

  • Research/Outcomes This area also cuts two directions. The focus of some of the authors is on the challenge to develop a stronger research (AOM, DC) base while others put the accent on the perceived opening of new research opportunities (massage, midwifery). Massage and midwifery writers speak of the opportunity to create new outcomes data while the more wizened chiropractors underscore the challenge of operating in the emerging practice environment in which outcomes and cost outcomes are key. The chiropractic educators also note both the challenges of funding more researchers and the opportunity presented by increased NIH support for such programs.

Over all, the most significant differences in responses appear to be associated with the profession's level of maturation. For instance, the massage writers focus on issues relative to internal standards and clarity. Meantime, the chiropractors, the most evolved and involved as a profession of the 5 licensed integrative practice fields, note as an opportunity the continued growth and expansion of the profession worldwide.


Comment:  The responses of these authors reminds one of the Chinese character for crisis holding both danger (challenge) and opportunity. My guess is that, on a different morning for any of the educator-authors, their thinking on a key area of activity might be reframed and positioned in the opposite category.

The broader question regards why we should care, as Schwartz does, about whether or not these professions have any common ground in their views of their future.

My first thought is academic. Some 15 years ago conventional medicine rolled these very distinct fields, and more, into a ball and called it "CAM." The challenges and opportunities of emergence affirm a kind of kinship.

The more important framing is what moved Schwartz to her analysis. She sought to find common ground to help inform plans for collaborative action. Schwartz and her cohorts in ACCAHC, including me, found the similarities she culled to be confirmatory. Members of ACCAHC's working groups set their core arena as exploring the competencies, then developing or making available the tools, curricular modules, clinical models, inter-professional education strategies and best practices information that will assist integrative practice educators, students and practitioners to work in integrated environments.


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