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 Special Report: Strategic Change in Direction as Weil's Arizona Center Commits to Creation of American Board of Integrative Medicie 
 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series
Summary: In a major strategic shift, the University of Arizona Center for Integrative Medicine (ACIM) has announced that it will lead the creation of a formal specialty for medical doctors in integrative medicine. ACIM, founded by Andrew Weil, MD and directed by Victoria Maizes, MD, is in dialogue with the American Board of Physician Specialties toward establishing an American Board of Integrative Medicine. They are collaborating with leaders of the American Board of Integrative and Holistic Medicine (ABIHM). Here is the ACIM announcement, a statement from two ABIHM leaders, a brief interview with Maizes and the list of 18 founding Board members. Is this the right strategic choice? What impact will this have on integrative medicine and the broader integrative healthcare movement?



Image
Strategic change to back board certification
Should "integrative medicine" be a separate MD specialty within the field of medicine? Or should integrative medicine proponents target a broader shift toward integrative medicine as a model for all conventional care, whether primary care of oncology or pediatrics?

The debate has been significant, if relatively sub rosa, over the 15 years of the emergence of integrative medicine. A town and gown divide has existed. The townies, typically practicing holistic MD/DO clinicians, formed the American Board of Holistic Medicine (ABHM) as a certifying body in 1996.
Yet those on the "gown" side of the divide, led by the Consortium of Academic Health Centers for Integrative Medicine, did not and has not promoted Board certification. The ABHM requirements were less rigid than most medical specialties.

Image
ABIHM leaders prominent on new ABIM board
Dialogue began to link town and gown. In 2008, the former ABHM
changed the name and focus of the board to the American Board of Integrative Holistic Medicine (ABIHM). As noted below, efforts were made to raise standards. Roughly 1500 MD/DO/DDS applicants have been board certified and can currently put ABIHM after their names. Yet neither CAHCIM nor any leading academic integrative medicine program stepped in to back this board process.

This month the single most important academic medical center came down on the side of not only supporting, but leading a drive to establish integrative medicine as a formal
medical specialty. On September 15, 2011, an-e-note arrived from Victoria Maizes, MD, executive director of the Arizona Center for Integrative Medicine (ACIM). ACIM is in dialogue with the American Board of Physician Specialties toward establishing an American Board of Integrative Medicine.

This step is huge for the field, and for the broader integrative healthcare movement. Arizona Center is the leading educator of academic integrative medicine leaders. Over 800 have completed their Fellowship in Integrative Medicine. ABIHM leaders are also backing this direction.

This is a momentus shift. It such times, the declaration of the founders are especially important. So here are, in full:

  • Announcement from the Arizona Center for Integrative Medicine.
  • List of the founding members of the new American Board of Integrative Medicine. 
  • Statement of support from ABIHM board members Victor Sierpina, MD and David Rakel, MD.
  • Brief interview with ACIM's Maizes.
 
I close with a few comments and invite yours. What do you anticipate will be the impacts of this development?
_________________________________

Statement from the Arizona Center for Integrative Medicine

"Strategic Change" Toward Leadership
to Establish Board Certification in Integrative Medicine


-  Andrew, Weil, MD, Founder/Director
and Victoria Maizes, MD, Executive Director

Image
Weil: ACIM founder
We are writing to let you know about an important decision that we recently made - a decision that represents a strategic change in direction for our Center.  For many years we have resisted the idea of board certification in Integrative Medicine (IM).  We have always believed that the principles and practices of IM should inform all specialties, rather than be developed into a new field.  In other words, that dermatologists, surgeons, and family physicians alike all need to learn the principles of nutrition and mind-body medicine, and to value the innate healing capacity of the body.  We still hold that belief.


   
 "We have always believed that the
principles and practices of IM should
inform all specialties, rather than
be developed into a new field."


 
Earlier this year we approached the American Board of Physician Specialties (ABPS) to discuss creating a board in IM. We did so for many reasons; chief among them was to help patients discern who truly has training and expertise in IM.  It is now popular in the marketplace to say you practice IM - yet anyone can say so, whether they studied for an hour, a weekend, or ten years.  

The American Board of Physician Specialties has been providing national board certification since 1953.  They have boards in 17 different specialties including emerging ones like urgent care, hospital medicine, and disaster medicine, as well as more conventional ones like family medicine, internal medicine, emergency medicine, and psychiatry.  

Image
Maizes: ACIM executive director
Unlike the American Board of Medical Specialties (ABMS), which would require approval by every single specialty board, ABPS is interested in creating a single pathway, recognizes fellowship training, and is an innovator. We had hoped the ABMS would consider a Certificate of Added Qualification in IM - such as exists for geriatrics -which can be applied for by different residency specialties; but ABMS is eliminating that concept.


   
  "It is now popular in the marketplace
to say you practice IM - yet anyone
can say so, whether they studied for
an hour, a weekend, or ten years."
  

 
Our goal is to have all graduates of our 1000-hour fellowship become board certified. At the same time we have not relinquished our goal of bringing IM training to all physicians. The success of our Integrative Medicine in Residency makes us comfortable and confident that IM will become a part of all physicians' basic training. This 200-hour program is being used in 22 family medicine and two internal medicine residencies. In 2012 we will begin a pilot in two pediatrics residencies.

This is an exciting step for the field of Integrative Medicine (IM).  Board certification is widely recognized by physicians and the public alike as a critical step in establishing a field.  The first meeting of the American Board of Integrative Medicine will take place in Tampa, Florida, October 10-11.  Over a two-year period, we will set criteria for sitting for the board exam and develop a validated exam.

Below is the list of the founding members of the American Board of Integrative Medicine.

We so appreciate your support!

Warm regards,

Andrew T. Weil, MD                                            Victoria Maizes, MD
Director, Arizona Center                                      Executive Director, Arizona Center
for Integrative Medicine                                       for Integrative Medicine
Clinical Professor of Medicine                                Professor of Medicine,
Jones-Lovell Endowed Chair in                             Family Medicine and Public Health
Integrative Rheumatology

__________________________________
Founding Members, American Board of Integrative Medicine


Donald Abrams, MD*                                    
Brian Berman, MD*
James E. Dalen, MD, MPH#
Mimi Guarneri, MD^
Patrick Hanaway, MD^
Randy Horwitz, MD, PhD
Benjamin Kligler, MD, MPH*
Misha Kogan, MD*
Patricia Lebensohn, MD#
          
Roberta Lee, MD*
Tieraona Low Dog, MD#

Victori
a Maizes, MD*#
Hilary McClafferty, MD
Gerard Mullin, MD*
Kenneth Pelletier, MD(hc), PhD *#
Scott Shannon, MD^
Sara Warber, MD*
Andrew Weil, MD*#

The following, which may have missed some connections, were added for this Integrator article:
^ Board members of ABIHM
; * CAHCIM leaders; # ACIM leaders

_______________________________________

  Statement from ABIHM Leaders on the American Board of Integrative Medicine

-  David Rakel, MD and Victor Sierpina, MD

Note: The following statement was sent in a September 2011 newsletter of the Consortium of Academic Health Centers for Integrative Medicine. ABIHM board members Rakel and Sierpina are each members of the CAHCIM steering committee. This was presented, effectively, as an ABIHM statement.

Image
Rakel: ABIHM board member
The American Board of Integrative Holistic Medicine (ABIHM) was incorporated in 1996 to certify physicians through a psychometrically validated examination process. Since 2000, when we provided our first exam, we have certified nearly 1500 physicians. The process of educating physicians through our Annual Review Course and our extensive Core Curriculum has established a grounding and common knowledge base for those seeking board certification in integrative holistic medicine. Over the last few years, our Board of Directors has proposed more stringent criteria for board certification in Integrative Medicine (IM). The path of all medical specialties and subspecialties, as they gain more widespread acceptance and growing professional acknowledgment, is to require formal training as one of the conditions of sitting for a board certification examination.


   
"The ABPS and the U of A have invited
several current ABIHM board members
to participate in developing this
newly formed organization."

 
 
A number of educational institutions now offer fellowship programs in IM, and the leader in Integrative Medicine fellowship training has been the University of Arizona's Program in Integrative Medicine. The ABIHM had previously approached the University of Arizona (U of A) to explore the possibility of board certification. Although the U of A was not ready to move forward at that time, they have now taken a leadership role in the formation of a new board to explore this opportunity, and they recently announced that they have contracted with the American Board of Physician Specialties (ABPS) to develop a new board and certification process for those with formal IM training.

   
   "We recognize that the opportunity
for certification of physicians without
formal training in Integrative Medicine
will end soon."


The ABPS and the U of A have invited several current ABIHM board members to participate in developing this newly formed organization. This new board, with membership derived from the leadership of academic IM programs from across the US, will meet for the first time on October 10 th and 11th in Tampa, Florida. At this time the specifications for eligibility in this new certification process have not been created. An important goal of the ABIHM is to support our current active diplomats and to advocate for their eligibility in certifying with this new board. We recognize that the opportunity for certification of physicians without formal training in Integrative Medicine will end soon.

Image
Sierpina: ABIHM board member
We support this process and view it as the logical extension of our efforts over the last 15 years to bring credibility and acknowledgement to this emerging specialty within medicine. As this process unfolds, we will post updates on our website.


Though we have little further information, if you have questions or comments on this new development, please write to our Executive Director, Nancy Sudak, at nsudak@holisticboard.org.
  _________________________________

Brief Interview with ACIM Executive Director Victoria Maizes, MD 

I reached Maizes for a brief interview on September 20, 2011. She mainly reiterated key points in the announcement letter. Here are a couple of extractions from that interview.

Integrator: How long have you been mulling this?

Maizes
:
We have been thinking about this for a very long time. We first contacted the American Board of Medical Specialties in 2003 when we initiated our Integrative Family Medicine Program and received approval for a 4-year family medicine residency-integrative medicine fellowship.

Integrator: This is a significant change from your former position that your charge was to make integrative medicine the model for all medicine.

Maizes
:
It's more of a both/and strategy rather than either/or. We are very excited that our 200 hour Integrative Medicine in Residency program for family medicine and internal medicine is now in 25 residencies and we're expanding it pediatrics in 2012. Then, hopefully, to other specialties. Our belief is that everyone should learn integrative medicine. It needs to be part of the training of all physicians. Things like mind-body medicine, nutrition, when to refer to a naturopath or for acupuncture, for instance. We believe there is a body of knowledge everyone should be aware of. Integrative Medicine in Residency is a great mechanism to keep that philosophy moving. 

Integrator: The statement on the American Board of Integrative Medicine notes the issue of how anyone can call his or herself an integrative medical doctor. There is a guild aspect to this move too.

Maizes
:
It is becoming very hard for the public to discern what it means to be an integrative medicine doctor when someone can take a weekend course and hang up a shingle and declare that they are an integrative doctor. Our Fellows have been asking for this for many years.



Integrator: What does the program cost now?

Maizes
:
The fellowship tuition is $30,000. We have graduated 800 fellows and now educate about 130 each year.
 

 
Integrator: What is the time frame for the Board to be established?

Maizes
:
ABPS says its 18-24 months to complete the process of setting the criterion, grandfathering, developing validated exam questions.  We're happy to be partnering with the ABPS. They've done this successfully with 17 other specialties. 



Integrator: Funny coincidence of numbers. In the late 1980s when I was working with the re-birth of the naturopathic medical profession as they were engaging their formal recognition processes. Numbers flew around about how many naturopathic doctors there were. 1500? 2000? A board member, Harry Swope, ND, an accountant in his prior life, contacted all of the then 6 licensing boards to see exactly how many licensed naturopathic doctors there were.  The number? 763.

Maizes
:
That's a really interesting similarity.

Integrator: Good luck!

_______________________________________


Comment: The issue of credentialing is among the great ironies in the politics of "integrative medicine." Questions are frequently raised with great concern by conventional medical directors. How can we possibly credential these CAM practitioners? Yet clear educational and testing standards were and are in place for chiropractic doctors, acupuncture and Oriental medicine practitioners, naturopathic physicians, massage therapists and direct-entry midwives.

Meantime, the elephant in the room: What the heck is an integrative medical doctor? Presently, a doctor simply needs to self-declare. Forget about the weekend course. And some do, more and more as the "integrative medicine" has greater cache. Here are two experiences in the last 2 days.

  • My younger sister passed a clinic advertising a new integrative medicine MD on a jog and asked if I knew her. I Googled her. Took an herb course in England, a respected one. Involved with the American Herbalist Guild. Hmm, didn't say she was certified. No other evidence of training. Has in her office a variety of body-workers and energy healers, and one licensed acupuncturist. I wrote back: Limited education. Could be good. Who knows.
 
  • Today a local list-serve in Seattle popped out an announcement of a new integrative medicine practice opening in the north end. I checked it. She noted that she'd completed the ACIM Fellowship. I knew something more, felt some reassurance.  

Of course, one can't be sure which of these integrative medicine practitioners might help a given person to the most health. My colleague Carlo Calabrese, ND, MPH expressed a truism to the US Department of Education panel that was reviewing the standards of naturopathic education in 1990: "Any time you create standards you create pain."

This strategic decision by ACIM has many dimensions. There are clear public health implications.
The ACIM-ABIHM alliance represents a significant new alignment. Grassroots access to the "integrative medical doctor" title or at least board certification may disappear. There are guild dimensions here, ground claiming, and not just for IM doctors. My naturopathic doctors and acupuncturists and chiropractors use the term. The brand "integrative medicine" may become even more closely associated with, and effectively owned by, medical doctors. New clarities will emerge, new boundaries will be drawn, new possibilities empowered.

This is a major moment. Curious what any of you think. I look forward to a multi-voiced Integrator forum on this. Send your comments to johnweeks@theintegratorblog.com.



Send your comments to johnweeks@theintegratorblog.com
for inclusion in a future Your Comments Forum.
      
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 About The Author
Resumes are useful in employment decisions. I provide this background so that you may understand what informs the work which you may employ in your own. I have been involved as an organizer-writer in the emerging fields......moreJohn Weeks
 
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