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. 

Schwart: Exploring areas for potential collaboration

Is there common ground on

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.

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.