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The Integrator Blog. News, Reports and Networking for the Business, Education, Policy and Practice of Integrative Medicine, CAM and Integrated Health Care. - Reader Forum: Zaidman/FBU, Howard/AANP, Sportelli/NCMIC, Rohleder/WCA and Nixdorf/BC-DCs Respond
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Reader Forum: Zaidman/FBU, Howard/AANP, Sportelli/NCMIC, Rohleder/WCA and Nixdorf/BC-DCs Respond PDF Print E-mail
Written by John Weeks   

Reader Forum:  Zaidman/FBU, Howard/AANP, Sportelli/NCMIC, Rohleder/WCA and Nixdorf/BC Chiropractic Respond

Summary: Five Branches University president Ron Zaidman, MTCM, MBA supports a two-tiered training for the AOM field ... NCMIC president Lou Sportelli, DC on whether hospitals will lead healthcare's transformation ... AANP executive director Karen Howard on her organization's strategy for defining "integrative healthcare practitioner" in federal regulation ...Community Acupuncture Network co-founder Lisa Rohleder, LAc, clarifies fees, visits, income at her anchor clinic ...  BC chiropractic association director Nixdorf on the AMA campaign in favor of discrimination ... Anonymous acupuncturist uses discussion of fellowships to vent opposition to use of needles by MDs, others ...
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Ron Zaidman, MTCM, MBA
1.  Ron Zaidman, MTCM, MBA:
"We need two standards."

Ron Zaidman, MTCMJ, MBA is the president of Five Branches University and a board member of the Academic Consortium for Complementary and Alternative Health Care with which I am involved. Five Branches offers a Master's-level program and the Doctor of Acupuncture and Oriental Medicine (DAOM) program that is the only recognized doctoral level program in the field at this time. Zaidman writes in response to
an article entitled "AOM accrediting body chooses to go ahead with 'First Professional Doctorate,' opponents organize" in the March 2010 Integrator Round-up in which a blog posting of Lisa Rohleder, LAc, the co-founder of the Community Acupuncture Network was referenced.
"This is in reference to Lisa Rohleder's ideas.

"As you may know, many in our profession, and certainly myself, have had a constant vision of educating and training students in the U.S. in acupuncture, herbal medicine (and Western medicine) to the highest possible  standards and to graduate students as qualified as any expert from China.

"We now have a 4-year, 3200 hour comprehensive Master's degree program that covers in depth training in acupuncture, herbal medicine, Western medicine (since we are primary health care practitioners), and clinical training; plus a 2-year 1200 hour DAOM program that focuses on both a specialization AND family medicine. After 26 years of work, Five Branches University has attained this. The hours we teach, for example, in herbal medicine are higher than the hours taught in China. High level teachers from China who teach in our DAOM program are impressed with the knowledge and skills of our students.

"Lisa Rohleder brings up two important points which are the concerns of all of us.
First, unlike China and Europe, our government does not pay for our education. Second, we need differing levels of education. The US govt facilitates loans which is something, but results in ALL students, undergraduate and graduate, ending up with large debts to pay off through gainful employment. Ms. Rohleder, and all of us, would be much happier living in Denmark, France or Sweden where the cost of our education would be covered by the government - by society saying we will pay taxes so that our children have no barriers to education.

"Since our government does not support education except through loans, Lisa asks that we have a simpler, low cost education in only acupuncture to support community clinics and community medicine -- like the Barefoot Doctor idea that was used in China. This idea has value.

"However, if we have only one standard, then the whole profession must follow the lowest common denominator. We need two standards: a Barefoot Doctor standard, and Doctoral standard, an acupuncture standard, and an acupuncture, herbal medicine, primary care standard.

"I believe this is a vital issue: offering both affordable community health care, and the highest levels of health care (doctoral). I look forward to our profession clarifying the issues and finding solutions that work in offering us both.

"In parallel, I hope we will borrow from the European models and make both our health care and education more affordable and fair."

Ron Zaidman, MTCM, MBA, President
Five Branches University

Comment: I responded to Zaidman with a question: "Does this 2 tier approach have much traction? It already exists with the Masters and DAOM, but the Masters is a much higher training than I think Lisa (Rohleder) would advocate, or is necessary, for needles only." Here is Zaidman's response:
"The 2-tier approach has some traction, like you say, with Master's and DAOM, and also through our two national ACAOM standards: minimum of 1905 hours for a Master's in Acupuncture; and a minimum of 2625 hours for the Master's of Oriental Medicine. I can not consider or support less than 1905 hours for a medical professional who needs to not only know diagnosis and acupuncture, but must be able to understand what may be going on with a patient. Even for the cause of community medicine. To me (going below that level) is simply irresponsible."

Lou Sportelli, DC
2.  Lou Sportelli, DC: Musings on seppuku and hospital-based reform

Lou Sportelli, DC
, the president of the NCMIC Group, has been a leader in chiropractic for nearly 50 years and integrative practice since the dialogue began in earnest 17 years ago. He served for many years on the board of his localk hospital. Sportelli responded to
Musings on Seppuku, Christo and the Likelihood of Hospitals Leading Health Care's Transformation, May 19, 2010. NCMIC Group is an Integrator sponsor.
"While I am sure the American Hospital Association means well with its leadership conference, they have one major problem and that problem is not Al Gore's inconvenient truths but rather the collective hospital mind-set of inconvenient 'relevance.' They simply have not asked themselves am I needed in the future in the same manner I have been functioning in the past.

"This group is probably still thinking that the hospitals of tomorrow will need to improve with new buildings, new technology and new procedures in order to provide better care, the build-a-better-phone-booth or buggy whip concept.  What is missing from the speakers line up are speakers like Clayton Christensen, to talk about innovative destruction of the hospital model, the eliminate-land-lines-with-a-satellite model.

"So I am not surprised that 'wellness,' 'health promotion,' 'integration,' and transforming the model of primary care is not on the agenda. We know the system is broke, there is no one who will argue with that concept. Yet the new system is being molded by those who controlled the old system, the AMA, Big Pharma, and those whose very existence depends on the old system functioning only with a 'new' and improved name and not a new innovative model. Until the motivation from the Jerry McGuire follow-the-money model is replaced by a follow-the-health model, not much will change.

"Incentives to achieve improved health must be put into the system or the system will try to remain as is. Change is never easy or comfortable, but change is inevitable or self destruction will eventually be the end result of avoidance.

"'Tomorrow's Role for Transformed Hospitals' would be a better title for the conference, especially if they then put speakers on the program who will implode the current model and provide ideas for the next phase of innovation."

Lou Sportelli, DC
Comment: Sportelli's comments underscore how far these hospital leaders are from framing their work in a patient-centered, health-oriented way. That being said, what is being asked of them is something from which most members of any guild or stakeholder interest would recoil: to willingly, and with great vision and fortitude, let go of some of their wealth and power. Now that would be leadership in transforming health care.

Karen Howard, AANP exec
3. Karen Howard: Clarity on the AANP and the definition of "integrative healthcare practitioner"

Karen Howard is the executive director of the American Association of Naturopathic Physicians and a former staffer to a member of Congress. Howard writes in response to a short article entitled "AANP makes stab at defining 'integrative practitioner' for federal policy makers" in the June 2010 Integrator Round-up.
"John's comments on the proposed definition for IHCP [integrative health care practitioner] took me immediately back to a column he wrote on October 2, 2008 entitled "Historic Alliance: Integrative Practice Groups Unite Behind Congressional Resolution Promoting Wellness."

Speaking on H.Con.Res 406, the wellness resolution introduced by Congressman [Jim] Langevin on behalf of the AANP, (John) wrote: 'Think for a moment of the profound ramifications in clinical practice, education, research, reimbursement and delivery which would flow if such 'incorporation' led to greater exploration of wellness principles.' 

"Political junkies know that using language already vetted by legislative lawyers eliminates early roadblocks. We've repackaged the words that resonated with the original supporting organizations listed in John's article and are now circulating this proposed definition on Capitol Hill and to more than 40 stakeholder organizations for comment. Government under-utilizes (and sometimes fails to use at all) both integrative practices and integrative practitioners of many types, conventional and otherwise. 

"Thanks to John for advancing the conversation. Our hope is that by starting this dialogue the regulators will not resort to current statute to simply redefine the status quo." 

Karen E. Howard, Executive Director
American Association of Naturopathic Physicians
Comment: The question of the meaning of "integrative practitioner" in federal statute is popping up as different organization start positioning around the regulation-writing phase of the new law. Good for the NDs that the AANP is active on this.

Lisa Rohleder, LAc
3.  Lisa Rohleder, LAc: "Yes, you can generate $500,000 in $15 increments ..."

Lisa Rohleder, LAc is the co-founder of Working Class Acupuncture (WCA), the cornerstone clinic of the Community Acupuncture Network and the subject of "Helgott's Tippens reports first data on socio-demographics of community acupuncture network clientele" reported in the June 2010 Integrator Round-up. She clears up some estimates I made of an average $25 per visit payments by clients. WCA clients pay on a $15-$35 sliding scale.
"Thanks for the piece about our numbers! I wanted to clarify: the 509K figure [for total revenues] includes both WCA clinics, not just Cully, and our average $ for treatment (something we do track fairly carefully) is about $18 at Cully and $20 at Hillsdale. I was mostly citing the 509K figure to make the point that you can, actually, accumulate half a million dollars in $15 increments, something lots of LAcs don't believe."
Comment:  I made the changes in the initial article following Rohleder's initial response. She shares the arithmetic: "If you divide 509K by 24,000 treatments (the total of both clinics last year), you get about $21. That's bumped up a little by conference income and book sales, but it's closer to the reality" [than the $25/visit I had initially estimated].

Don Nixdorf, DC, BC chiro exec
5.  Don Nixdorf, DC: Lobbying for "wealth care" against 2706

Don Nixdorf, DC, the director of the British Columbia Chiropractic Association responds here to the Integrator article on the proposal before the American Medical Association to pull out all stops to continue discrimination against non-MD practitioners and ovreturn Section 2706 of the healthcare overhaul law. (See Battle Engaged: MD Specialists Promote Repeal of Non-Discrimination Vs Integrative Practitioners, Others, May 28, 2010.)
He titled his email "2706 Milestone."
"Thank you for reporting on 2706 and it's positive impact for the American public.  Hopefully the public's voice will be heard and prevail in something that is clearly in the public's interest.

"It is unfortunate to read, again, the lobbying for the wealth care of and by the opponents to this milestone legislation for better care."

Dr. Don Nixdorf
Executive Director
Comment: The AMA House of Delegates has passed the Resolution but I haven't yet seen all the amended language. The recommendation is listed as "Res. 220: Averting a Collision Course Between New Federal Law and Existing State Scope of Practice Laws." Well titled, obscuring the war within. One might think that this move to maintain discrimination is little more than what legislators would call a "housekeeping amendment."

6.  New York-based Licensed acupuncturist writes on inpatient residencies and MD-acupuncturists

A licensed acupuncturist in the greater New York
City area weighed in on the discussion of fellowships for licensed acupuncturists at Beth Israel Hospital and for an integrative medical doctor at Stamford Hospital. The LAc requested that her name be withheld.
"In response to your blog on May 27, 2010 regarding Beth Israel's Acupuncture Fellowship program. You had written praise for Stamford Hospital's integrative program in which ‘Interested candidates must be primary care physicians and are expected to already be board certified in a primary care specialty or to achieve board certification during their first year of fellowship'.

"Yet again, it is a slap in the face to acupuncture that these programs exist along with the included ‘300 hour acupuncture program for physicians'

"The Beth Israel (as well as the earlier St.Vincent's program) should be applauded for the fact that all the acupuncturists in their fellowship are required to be fully trained and licensed acupuncturists, not MD's with abbreviated training.

"The reason why they are not being paid (as yet) is the simple fact that hospitals and most insurance companies will not pay for acupuncture that is being done by licensed acupuncturist professionals who are not physicians.

"In almost every state in this nation, acupuncture is a fully licensed profession, just like any health profession, requiring 3-4 years, and up to 3000+ hours of training (didactic & clinical), not including pre-requisite requirements in anatomy physiology, biology etc. Beyond the training, it is a lifelong craft and its own complete system of healing.

"There are absolutely no similarities whatsoever that exist between acupuncture and Western medicine, from theory to diagnosis to practice, the difference is akin to the knowing the English language and being able to speak Chinese. There is no correlation that can be made between the two and hence no logical reason why having a medical degree would lead one to be able to practice acupuncture without having to conform to the requirements of the profession as they exist.

"The medical profession has diverted this issue by creating their own educational programs and certifications and even calling acupuncture a medical  ‘modality' which it is not.

"This practice could be considered on the same level as a bunch of acupuncturists putting up a school with 300 hours of training and being certified as surgeons. It would never happen, because the laws state that anyone wanting to practice a licensed profession must conform to the standards and requirements of that profession, or call it something else, hence, I cannot use a scalpel to prick a point and call it Surgery.

"Unfortunately for some reason this does not apply to the licensed profession of acupuncture. It is unfortunate, especially here in the state of CT (where any health professional, except acupuncturists, are allowed, and do, by law, practice acupuncture without any training whatsoever) for the millions of people who are being misled that all acupuncturists are trained to a certain level of standard of practice and could truly benefit from the full depth and breadth of acupuncture as the complete health system that it is, from licensed, fully trained professionals, will never have that opportunity, as long as state legislatures, physicians, hospitals and insurance companies continue on this path of total disregard for acupuncture, as the fully integrated health profession that it is, with established legal standards of training, licensing and practice."
Comment: My perspective on this issue is that this horse, as the saying goes, is already out of the barn. It's long past time to accept and advance co-habitation among the diverse practitioners who use needles, as many in the AOM field have been advocating since the mid-1990s "Seattle Statement."

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