Virtually every corner of the medical industry houses an entangling drama between mission and money. There is the service, the need to make a living, and then the way making a living can transform into a production orientation dominated by the impulse to make more money. For integrative health and medicine, the drama is intense, whether in integrative centers owned by large institutions or solo practices in the community. The mission-money challenges get “curiouser and curiouser” for the licensed integrative practice fields that are not fully swept up into the thundering $3.3 trillion river of cash that annually rips through the dominant medical industry. An edginess sets in when, as the sick joke has it, you have just enough recognition to get into debt, but not enough to get out of it yet. So it is always interesting to explore new data on income and practice methods such as were recently published by the Association of Accredited Naturopathic Medical Colleges in it’s 2020 Graduate Success and Compensation Study.
When Oregon announced in 2016 that it would shift its back and neck care for Medicaid clients from opioids toward acupuncture, spinal manipulation, massage, yoga therapy and mind-body methods, it was heralded as a breakthrough for pain treatment nationally. Inside that policy was a mandate many now consider even bigger news. Doctors were required to totally taper patients off opioids. A backlash propelled by a letter signed by over 100 conventional pain academics nationwide – plus with one notable signer from the integrative pain community – stopped Oregon’s planned expansion of the model in its tracks. While there are good reasons for caution on mandatory tapering, the one-sided reactivity missed a chance for practitioners and patients alike to gain more experience with non pharmacologic tools to rein in the known abuses associated with opioids.
On the surface of things, the values of “accountable care” and “patient-centered medical homes (PCMH)” and those of integrative medicine suggest a convergence. A survey found alignment in integrative medicine leaders. Maryland integrative doctors David Fogel, MD, and his spouse Ilana Bar-Levav, MD, presented with a substantial philanthropic gift, jumped into the apparently convergent rivers with both feet, creating the interprofessionally rich environment that is now CHI Health Care. The goal was and remains to prove the value proposition of integrative medicine in the medical industry’s move from volume to value. The center gained recognition as a PCMH and became part of a Medicare Shared Savings accountable care organization (ACO). Now Fogel makes clear that the convergence of the two paradigms have produced rumblings of boulders at the river bottom. While he remains positive about the model, the systemic obstacles are daunting.
The co-founder of the Evolution of Medicine/Functional Forum, James Maskell, is a non-stop communicator and marketeer. He operates at the visionary edges of the integrative and functional medicine worlds. Business success. Health coaching. Blue Zones and zip-codes. Root-causes. The employer stakeholder. The “micropractice.”