The American Board of Integrative Holistic Medicine recently completed its 12th annual review course and certification exam, capping more than 15 years of work in creating formal educational and credentialing standards for holistically-minded MDs and DOs.
Well over 300 clinicians assembled in St. Petersburg, FL, to take the ABIHM course; 123 sat for the exam. Those who pass will join more than 1,500 physicians who became ABIHM diplomates since December 2000.
As they celebrate their progress, ABIHM leaders are preparing for a transition. The board—which evolved largely from the ‘trenches’ of clinical practice—will likely be eclipsed by a new certification board based in academia.
Earlier this fall, Drs. Andrew Weil and Victoria Maizes, directors of the University of Arizona’s Center for Integrative Medicine, announced creation of the American Board of Integrative Medicine (ABOIM), with the stated goals of “help(ing) patients discern who truly has training and expertise in integrative medicine,” and “to have all graduates of our 1000-hour fellowship become board certified.”
The new board has obtained formal specialty recognition from the American Board of Physician Specialties (ABPS), which oversees certifications in 17 different specialties including urgent care, hospital medicine, and emergency medicine.
A Typical Trajectory
“What’s happening is pretty typical of the evolution of medical specialties over the last 30 years. It starts out with people who provide certain types of services coming together to create a coherent discipline and practice standards. Then academic centers take an interest and work to create a formal area of study, leading to creation of a formal board certification,” said Scott Shannon, MD, current president of ABIHM, who is also a member of the new Board.
In an interview, Dr. Shannon said ABIHM started as the American Board of Holistic Medicine (the term “integrative” was added several years ago), “a ‘frontier’ organization trying to formalize what the American Holistic Medical Association (AHMA) had been trying to pull together since 1978.” Led by Drs. Robert Anderson and Robert Ivker, ABHM created a scientific and philosophical framework to unify holistic medicine as a coherent field, and to provide scientific validation and credentialing.”
Dr. Anderson, a pioneer in holistic family practice, compiled copious data on a host of non-allopathic therapies, diagnostic approaches, and treatment methods. This compendium became the spine for ABIHM’s review course and the basis for its exam.
In an interview in the very first edition of Holistic Primary Care, prior to the first ABHM exam in 2000, Dr. Anderson explained that: “The philosophic basis for holistic medicine, as well as the variety of procedures and approaches incorporated from other disciplines such as Ayurveda, traditional Chinese Medicine and the like are sufficiently distinct that holistic medicine should be distinguished from conventional medicine, and deserves to be recognized as a separate entity.”
Early on, ABHM hit a significant obstacle to specialty recognition because at the time, there were no holistic/integrative residency training programs. Since then, thanks to the continued educational work of the board, the leadership of U of A center, and the Consortium of Academic Health Centers in Integrative Medicine (CAHCIM) that problem has been rectified: there are now 23 residency programs across the country, Dr. Shannon said.
If the launch of the new ABOIM goes as planned, “ABIHM expects that at some point we will no longer be a certifying board,” said Dr. Shannon. This could happen within 1-2 years. ABIHM hopes to continue on as an educational organization, but without a formal certification.
Dr. Shannon acknowledged mixed emotions. “If we are to transition out of ‘business’ as a certifying organization, that’s a little bit sad. But if it’s ultimately for the good of the field, if it will result in better validation for holistic and integrative medicine, and propagation of this kind of care, then it’s a good thing. We will feel like we have completed our mission.”
He added that the relationship between the old board and the new is collegial, collaborative and mutually respectful. Two other ABIHM leaders—Drs. Mimi Guarneri and Patrick Hanaway—are also on the new ABIM.
The big question is whether certified ABIHM diplomates will be eligible to sit for the new certification without having to take the U of A fellowship or any additional training. Dr. Shannon is hopeful, but this has not yet been decided. He said both groups hope to avoid the conflict and confusion that would arise if there were two distinct certifications with very similar names and similar intentions.
Diverging Opinions, Loudly Voiced
As in the late 1990s when ABHM emerged, the ABOIM’s effort to establish an integrative specialty has its critics. The spectrum of opinion in all its color is on display in an open forum on John Weeks’ The Integrator blog.
Some contend that the very notion of “specialty” is inherently antithetical to “integration,” that this fundamental contradiction will ultimately ghettoize holistic/integrative physicians, and will reinforce rather than reform health care’s status quo.
Some non-MDs see the move as a cooptation by a medical establishment that initially vilified, then tolerated, and finally–when public demand and economic need intensified—tries to “own” natural medicine. They are irked that this new board seeking to “integrate” diverse modalities & philosophies is comprised exclusively of MDs and offers certification only to MDs and DOs.
For every critic, there are supporters who believe that the ABOIM represents a major step in establishing the legitimacy and viability of the integrative model. Still, some lament the marginalization of the term “holistic”—which is descriptive of a philosophy and a worldview–in favor of “integrative,” which is descriptive of the relationships between healing disciplines.
The new board’s leaders say the public’s growing demand for integrative medicine is precisely why a strict credential is needed. “Integrative” is now a popular marketing buzzword. Without a rigorous standard and some sort of certification, they argue, the term has little meaning.
The new board, with its basis in the U of A’s fellowship, believes it has a strong foundation for meaningful qualification. It also has strong economic incentive. Over 800 physicians have invested $30,000 and 1,000 hours for fellowship training. Formal certification would distinguish and protect the value of this training in the marketplace.
No doubt, marketplace issues are among the factors driving the establishment of a new integrative specialty. These same issues also drive the resistance to it. In that sense, the issue is not unique to the holistic/integrative world; the same dynamics play out through all of health care.
For his part, Dr. Shannon hopes that everyone can, “keep the good of the field in front of our egos and our turf battles. For ABIHM, the prime directive is and always has been to support this kind of care.” The new board, he says, shares that spirit.