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Alan Dumoff: The Move to Gain ABPS-Recognition of Board Certification in Integrative Medicine PDF Print E-mail
Written by John Weeks   

Alan Dumoff:  The Move to Gain ABPS-Recognition of Board Certification in  Integrative Medicine

Summary: "Given the stakes, watching the ABoIM/ABPS process from the outside is a bit angst-inducing." So goes the opening sentence of the article by Alan Dumoff, JD, MSW, on the status of the effort of the University of Arizona Center for Integrative Medicine to establish an American Board of Integrative Medicine (ABoIM) through the American Board of Physician Specialties (ABPS). Dumoff is an attorney-adviser to a consortium of 8 integrative physician organizations. He continues: "The eligibility criteria ... will have a dramatic effect on the future of integrative medical practice." The Arizona Center and the ABPS have been officially mum on developments since the September 2011 announcement. Here is Dumoff's perspective. I add some comments on new paradigms, old thinking, and historicide. 

Key sponsor of the ABoIM and the leading fellowship Dumoff references
If one were to gauge interest in the effort to great formal recognition of a specialty in integrative medicine by response to
September 2011 Integrator content, this move is clearly off the charts. The short story is that the University of Arizona Center in Integrative Medicine is working with others to create a board specialty with the American Board of Physician Specialties. The response was heated, from both CAM-IM interested parties and from the anti-IM bloggers who made hay with the Integrator piece.

An Integrator
attempt to follow-up in January 2012 following a second meeting of the Board led to a simple statement that the group has agreed that no one would speak about developments without ABPS authorization. No formal announcement have ensued. A placeholder webpage was created by ABPS. That's it.

I recently spoke with Alan Dumoff, JD, MSW, on the subject.
Dumoff is a leading integrative medicine attorney who, under his clinical experience as an MSW, has also been part of numerous integrative clinical initiatives over the past 20 years, most recently the Casey Health Institute. He and I have in common that we have each queried the new American Board of Integrative Medicine (ABoIM) on behalf of colleagues: I for the Academic Consortium for Complementary and Alternative Health Care (ACCAHC) and he for the Integrative Medicine Consortium (IMC) a "collaboration of physicians groups." Seven are all or mainly MDs/DOs. The 8th is IMC is the American Association of Naturopathic Physicians (AANP).  Neither organization has received any response from ABoIM. I asked Dumoff for any update he could report. This is his response.

The American Board of Integrative Medicine and the American Board of Physician Specialties

-- Alan Dumoff, JD, MSW

Alan Dumoff, JD, MSW
Given the stakes, watching the ABoIM/ABPS process from the outside is a bit angst-inducing. The eligibility criteria to sit for the examination, and inclusiveness of how core competencies are defined, will have a dramatic effect on the future of integrative medical practice. \

If eligibility is limited to graduates of academic fellowships, the more adventurous physicians who have been able to develop functional medicine to surprisingly complex levels, in part because they have been free of academic medicine, will risk losing the credential for the very field they have been central to creating. For these who would be excluded, an ABPS credential could provide well-deserved armor against the scorn of uninformed peers.

 "More adventurous (integrative) physicians
who have been able to develop functional
medicine to surprisingly complex levels, in part
because they have been free of academic
medicine, will risk losing the credential ..."

Particularly if the American Board of Integrative Holistic Medicine (ABIHM) exam fades away as springboard to eligibility, it is critical that CME credits, practice experience, and other forms of education and experience for these veterans provide a continuing basis for exam eligibility.

This is not just a grandfathering issue; alternative eligibility to academic fellowships has to be long-standing, as there will always be a need for independent professional associations to provide alternative curricula.

ABoIM intends that its exam provide a minimum level of core competency, and that physicians desiring particular approaches can always train and practice them. This is a sensible and welcome approach. When I practiced as a social worker, little of what I did in practice was what I learned in school or on the exam, but rather was learned in specialized training. Having a core competency test is standard professional development and it is very positive that ABoIM sees its examination as testing for minimal standards and not as a limit to practice.

"IMC has asked for more inclusive
eligibility criteria (including) a means
for Naturopathic Physicians to sit."

But this is a special circumstance, as physicians who reach past mind-body and holistic forms of medicine and use nonstandard therapies face legal risk that could be heightened, not reduced, because their approaches are excluded from this new source of standards for the field.

I write this solely as my opinion, but I have been privileged to work on this issue with the Integrative Medicine Consortium, a collaboration of many of the key integrative physician organizations.*

IMC has asked ABoIM for more inclusive eligibility criteria, and while recognizing this would be a significant leap for ABPS to take, has supported creating a means for Naturopathic Physicians to sit. While we await final word on the eligibility criteria, for me the real issue is that IMC has to wait on the outside. In my view, IMC should be at the table.

*American Academy of Environmental Medicine (AAEM), American Association of Naturopathic Physicians (AANP), American College for Advancement in Medicine (ACAM), American Holistic Medical Association (AHMA), International College of Integrative Medicine (ICIM), International Hyperbaric Medical Association (IHMA), International Organization of Integrative Cancer Physicians (IOIP), Pan American Allergy Society (PAAS).

Comment: The Board members of the ABoIM are in a pickle, strategically. On the one side, they want to achieve recognition from an agency, ABPS, that has been essential to the guild-building process that is a key factor in some of the worst behavior in U.S. medicine. There is no question that many of the community-based integrative medicine practices of the physicians Dumoff represents would be tough to bring to that more conservative table. Chelation. Homeopathy. In-office supplement sales. Unusual energy practices.

Yet denying these community practitioners exemplifies integrative medicine's unfortunate tendency toward historicide, air-brushing origins out of the picture. The recent Bravewell report took a similar tack in presenting "integrative medicine in America" without more than a footnote of reference to the vast majority of integrative medical doctors who are not practicing in academic or other health systems. 

On the other hand, integrative medicine's adherents claim to want to transform U.S. healthcare. Here I particularly speak from an ACCAHC perspective. In the ACCAHC letter to ABoIM, the 16-organizational member ACCAHC urged a new, interprofessional modeling of their Board. These organizations are mainly from the fields linked to 400,000 licensed practitioners in the so-called "complementary and alternative medicine" (CAM) roots of the movement for integrative medicine.
(Notably, 80,000 of these are physician-level practitioners based on U.S. Department of Education-recognized accreditation standards.) It will be tough to reflect the emerging era of team care and inter-professionalism from inside the guild box. It is easier, again, to practice historicide and not elevate the important roles of the CAM disciplines in the origin story of IM.

I am guessing that every single one of the members of the board of the American Board of Integrative Medicine has power-pointed some version of the adage that it is impossible to create new paradigms with old paradigm thinking - not to mention old paradigm practices. As a sometimes political actor, I can appreciate the ABoIM's position, and its silence on its delicate step. Yet as an interested observer of the field, I can only reiterate what Dumoff has shared:
"Given the stakes, watching the ABoIM/ABPS process from the outside is a bit angst-inducing." More than a bit.

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