CAMLAW: Complementary and Alternative Medicine Law Blog

Credentialing Physicians as Holistic and Integrative Medicine Doctors

How do you know whether a physician is properly certified as a holistic and integrative medicine doctor? The answer isn't easy, because the field is new, and lots of providers would like to claim the title.

Degrees of Experience and Training in Holistic/Integrative Medicine
Physicians have varying experience when it comes to complementary, alternative, holistic, and integrative medicine. Some have graduated from extensive, full-time, in-residence programs (such as the Program on Integrative Medicine run by Andrew Weil, M.D. at the University of Arizona School of Medicine), whereas others have learned a smattering of information about herbal or other therapies from a Continuing Medical Education course, or even educated themselves on the Web. Many would like to use the label "holistic medicine" or "integrative medicine doctor" for marketing purposes. That makes claims and credentials confusing to the average health care consumer.

But a relatively new credentialing organization helps distinguish those who have advanced training from doctors who are merely using "holistic" or "integrative" as a marketing device. The American Board of Holistic Medicine (ABHM) has as its mission: to "establish standards of care in the application of the body of knowledge encompassed by Holistic Medicine, so that these concepts can be fully integrated into medical practice, education, health planning and research."

Board Certification in Holistic Medicine
The ABHM offers Board Certification in Holistic Medicine, which it defines as: "the art and science that addresses the whole person, body, mind and spirit. The practice of holistic medicine integrates conventional and complementary therapies to prevent and treat disease, but most importantly to promote optimal health." The ABHM grants certification as a diplomate of the ABHM through a certifying process that includes:
1. Submission of evidence of licensure requirements as an M.D. or D.O., copies of diplomas of the graduate degree and residency training, evidence of board certification, and other postgraduate certified training.
2. Completion of all informational material, including an autobiographical paper and holistic health questionnaire.
3. Submission of one letter of reference from a professional colleague.
4.Completion of a screening interview.
5. ayment of all applicable fees
6. Achieving an acceptable score in the qualifying examination.
The American Board of Holistic medicine also offers a review course entitled, "The Art, Science and Practice of Holistic Medicine."

Professional certification is different than licensure, which authorizes a health care provider to practice within a state; it also differs from credentialing, the process of vetting a provider (conventional or complementary and alternative) within a health care organization. Rather, professional certification offers a stamp of excellence on a particular specialty or sub-specialty within the profession. Or, as the ABHM puts it: "The certification enables physicians to obtain a credential, which attests to their knowledge in the field and affords them the recognition of having met an identified peer-developed standard of achievement."

What the Credential Might Accomplish
To understand the meaning of this credential, I spoke with Lee Lipsenthal, MD, who runs a program for physicians seeking to "find balance" in their lives, and is involved in the ABHM. He told me that the ABHM not only offers a way for physicians to receive professional recognition as having expertise in holistic medicine, but also creates community among those who have studied holistic and integrative medicine. At present, the ABHM has over 900 diplomates and is putting together a research network for data collection and information-sharing, similar to that used by the specialty of family medicine.

I asked Lee whether he conceptualized a difference between a doctor practicing "holistic" medicine and one practicing "integrative" medicine. He replied that while some saw the terms as synonymous, the ABHM used the term "holistic" because this term typically designated "how you approach the patient overall," while "integrative" tended to refer to the "tools you use."

I next asked: before (or without) the ABHM certification, how would one know whether a doctor really was a holistic or integrative medicine physician. Lee replied that there were a number of ways: first might be participation in a recognized fellowship program, such as the one run by Andrew Weil, MD; another might be participation in one of the six residency programs now being conducted in medical schools around the countryas 1-1/2 year extensions of family medicine programs.

As a lawyer interested in credentialing complementary and alternative medical providers, I asked Lee what he thought might be the future of credentialing physicians in this field. He thought that like cardiology, holistic and integrative medicine ultimately would be considered a specialty within medicine; and that ABHM might become the national certifying agency for holistic/integrative medicine doctors.

The Route to Specialization
This notion reminded me of my study, while an undergrad at Columbia, of U.S.-Soviet relations. Throughout the Cold War, the two nations alternated between active hostility and what many analysts began to call periods of "peaceful coexistence." The movement from adversarial relationship to peaceful coexistence, and ultimately integration seemed to be the road Lee was indicating for the meshing of conventional and complementary/alternative health care.

I asked Lee that if medicine, conventional and alternative, were to move to peaceful coexistence and beyond, what might be the logical route for that adapation? How would holistic and integrative medicine come to be recognized as a bona fide specialty of medicine? He commented that holistic/integrative medicine would likely first become a recognized subspecialty within medicine--one that would be officially granted subspecialty status by the American Board of Medical Specialties. This process would take a few years. Till then, one could still get the subspecialty approved as a certificate program; this has been done with subspecialties of Internal Medicine (such as pain management or geriatric medicine).

"Twenty years from now," Lee concluded, "you'll need the certificate to call yourself a holistic, integrative doctor. In the intermediate phase, I see (from least to most rigorous) certificate-level, residency-level, and fellowship-level certification in integrative medicine. The certificate-level folks may not be able to offer multiple modalities to their patients, but at least they will have awareness of those modalities." Lee commented that by way of comparison, in cardiology, a physician must complete a fellowship.

Legal and Ethical Issues
The ABHM's website offers the following reasons why a doctor might want to seek diplomate certification:
"· They have met the only comprehensive peer-reviewed test standard for M.D.s and D.O.s regarding knowledge in Complementary, Integrative and Holistic Medicine
· Their patients will benefit from the enhancement of their holistic medical skills
· Their status as board-certified holistic physicians will appear on the ABHM national listings
· They have become leaders in the field of holistic medicine
· In licensure, medical disciplinary and medicolegal issues, they will be recognized as members of a group with peer-reviewed, acknowledged standards with an identified database and scientific basis."

If the ABHM succeeds in setting national standards for credentialing the holistic or integrative medicine physician, and thereby creating a community of doctors who share training, skills and standards, there could be not only research and clinical gains, but also implications for malpractice liability and risk management. Consider, for example, that the defense in a medical malpractice case involving CAM typically brings an expert to testify that the physician's conduct did not fall below the standard of care; but courts (at least in important cases so far) have tended to follow the conventional physician's testimony and perspective that the deviation from conventional care was sub-standard and hence negligent.

The very existence of the ABHM and a large number of diplomates might suggest that there are evolving standards of care in medical cases involving CAM therapies. In other words, use of CAM therapies is not malpractice per se. Further, one ABHM diplomate might successfully testify in defense of another--and have their testimony trump that of their strictly conventional counterpart on the plaintiff's side.

And finally, the more community, the greater the chance that the respectable minority defense (discussed in the Johns Hopkins book and in Legal Issues in Alternative Medicine) will succeed.

The legal rule for medical malpractice has been critiqued as allowing the medical profession to set its own standards of what constitutes negligence; on the other hand, in the case of the ABHM and allegations of physician malpractice involving complementary therapies, the notion of setting emerging standards of care that incorporate holistic/CAM therapies could actually help free physicians from the spectre of unwarranted liability.

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COMPLEMENTARY & ALTERNATIVE MEDICINE LAW BLOG

Michael H. Cohen, Esq.; 468 North Camden Dr. | Beverly Hills, California 90210 | 310-844-3173