21st century ushers in integrative medicine: but many questions remain about how the health care system will react - Integrative Medicine

Physician Executive, July-August, 2003 by Marc S. Micozzi

* There are fewer than 10,000 licensed acupuncturists in the U.S., with licensure available in most states and D.C. About 3,000 are MD-acupuncturists.

* There are approximately 3,000 homeopaths; most are licensed physicians.

* There are about 3,000 naturopaths, with licensure available only in a dozen states, primarily in the northwestern U.S. and New England, and five accredited graduate schools, primarily in the Northwest and Southwest. Naturopaths represent the practice of an eclectic style of medicine and "western herbalism,' drawing from the herbal traditions of other cultures worldwide.

* Perhaps some hundreds of Ayurvedic practitioners exist--many following highly individual practices, with others ascribing to a tightly controlled Maharishi Ayurveda school of practice.

* In another tradition from India, there are thousands of yoga masters who offer somewhat attenuated training in a variety of yoga, primarily designed as a meditative practice intended to influence the physical body (Hatha-Yoga).

* Energy healers now come from several organized schools of energy healing nationwide, while the practice of energy healing is widely incorporated among members of the nursing profession in the U.S. through healing touch and therapeutic touch. A number of physical therapists also include cranio-sacral therapy.

Models of integration

To provide integrated care, the health care system requires licensed health care providers--or training for existing providers--in one or more types of complementary care.

Often the health care system can make capital investments in facilities required to provide integrative care that individual practitioners can't afford to make. Sometimes the success of an integrated care clinic is based upon attracting an individual practitioner's existing client base, with the practitioner gaining new referrals from the health care system.

When complementary medical services are added to existing services, they become a cost center rather than a cost-effective source of savings. In response to consumer demand, some managed care systems offer access to a network of complementary care providers who agree to accept negotiated rates. An innovative approach is available through the WellPower (www.wellpoweronlinecom) network of licensed "holistic" health providers that offers a non-insured rider to employers, unions, and associations for access to practitioners at negotiated rates.

Many academic medical centers initially adopted an "arms-length" relationship to alternative/complementary medicine in the 1990s with isolated efforts at research, teaching or practice. But today, some like Thomas Jefferson University Center for Integrative Medicine (www.JeffersonHospital.org/cim), are developing a model for true academic research and clinical integration.

Integrated care implies that various types of medical care are provided under the supervision of a physician. To the extent that such physician-supervised centers function as full-service primary care facilities, there is a concern that if primary care "gatekeepers" refer patients for complementary care, they may never come back.