The Big Picture: What Is a Doctor of Integrative Medicine?

By John Weeks

A new type of doctor has emerged in the realm originally known as alternative medicine. This new entry on the scene is a “doctor of integrative medicine.”

But what exactly is he or she? No states license “doctors of integrative medicine.” In fact, any doctor can self-declare as an integrative medical doctor, so how can consumers know about whom they are choosing?

These answers are not easy, but they are becoming clearer thanks to a new board certification that will establish integrative medicine as a medical specialty. The American Board of Physician

Specialties (ABPS) just announced its eligibility standards for board certification by the American Board of Integrative Medicine (ABOIM) in March.

A look at the diverse origins of this type of doctor and at the new board certification can help consumers understand what they are, and will be, buying. Credit for coining the term “integrative medicine” is typically given to best-selling author Andrew Weil, MD.

The year was 1994 or 1995 and Weil was developing a pioneering educational program for MDs at the medical school at the University of Arizona. With his early colleagues Tracy Gaudet, MD, and Sue Fleischman—and later with Victoria Maizes, MD, Tieraona Low Dog, MD, and others—Weil built what has evolved into the now-robust Arizona Center for Integrative Medicine.

The Arizona Center is one of 52 integrative medicine programs in US medical schools. These are organized as the Consortium of Academic Health Centers for Integrative Medicine. Most focus on researching therapies to add to conventional practice, not on educating a new medical specialist.

Weil’s group is far and away the most influential in creating a new category of providers. Their centerpiece offering is a medical fellowship in integrative medicine. It costs about $40,000 and takes two years via online learning bounded and bisected by three weeks onsite. The clinical education is through a practicum the candidate establishes in his or her own community.

While there are another 20 integrative medicine fellowships, none comes close to the Center’s influence. To date, nearly 1,000 MDs and osteopaths have completed the Center’s training. Hospitals and health systems across the country now consider the Arizona fellowship the gold standard for hiring an integrative doctor.

But wait … a web search shows a different Integrative Medicine Consortium made of seven member organizations. In fact, the “integrative medical practices” of many of the members of these organizations predate the founding of the term “integrative medicine.”

Weil’s program and the relatively young academic consortium—of which the Arizona Center is a member—are not among the seven. In fact, one of the seven organizations appears to be a direct competitor. The American Board of Integrative and Holistic Medicine (ABIHM) has already board certified roughly 1,800 medical doctors and osteopaths who may designate themselves as Suzy Smith, MD (or DO), ABIHM.

And what about the naturopathic doctors? Their association is one of the seven in the Integrative Medicine Consortium. Yet their medical schools are not in the academic group of which Weil’s Center is part. In most of the 16 states naturopathic physicians are licensed, they have both pharmacy prescription rights and natural therapies in their scope. Isn’t this “integrative medicine”? Yet they can’t be ABIHM board-certified.

Eighteen months ago, Weil’s group announced an initiative that history will one day credit for providing a significant sorting out of these questions for the consumer. The Arizona Center and leaders of the ABIHM shared that they have begun working with the American Board of Physician Specialties to create a new board certification in integrative medicine.

Why a new board? Consensus among the academics in integrative medicine is that the ABIHM standards were not high enough to legitimize an integrative medicine specialty in the conventional medical system as they do not include fellowship training.

Unity among integrative MDs/DOs is being forged. The initiative will grandfather in those pioneers with the earlier certification who can prove significant experience in the field. As early as late this year, consumers will start seeing ABOIM behind some doctor’s names. It’s not a guarantee of quality, but it is at least a standard that is unifying the integrative MD/DO field.

Not everyone is pleased. The eligibility requirements ABPS published limit board certification to medical doctors and osteopaths. Integrative naturopathic doctors, chiropractic doctors, and doctors of acupuncture and Oriental medicine—a growing subset of acupuncturists—are not allowed to gain certification.

Yet the new specialty board takes a radical step, for an MD group, by acknowledging the quality of education in these three disciplines. Most physicians who are “boarded” are anticipated to complete a recognized fellowship. But there is an exception: in lieu of a fellowship, one method for the MD/DO to earn the ABOIM initials will be to have also completed the exacting standards of education or national certification in one of these three disciplines.

On the American Board of Physician Specialties website, the new specialty board posts five principles for integrative medicine that those wearing the ABOIM are expected to manifest. These are:

• a partnership between the patient and the practitioner

• consideration of all factors that influence health, wellness, and disease, including mind, body, and spirit

• use of conventional and alternative methods to facilitate the body’s innate healing response

• appropriate consideration of less-invasive and less-harmful interventions, when possible, while addressing the whole person in addition to the disease; and

• the concept that medicine is based on good science, is inquiry-driven, and is open to critical consideration of new paradigms.

Who can argue with these? For the consumer, this is good news in the present—clarity is on the near horizon.

 

John Weeks is the editor of “The Integrator Blog News and Reports” (theintegratorblog.com), a leadership-oriented news, networking, and organizing journal for the integrative medicine community, and a columnist for Integrative Medicine: A Clinician’s Journal.