If you recieved medical training in CAM, where did you receive it?

In what aspects of CAM have you been trained? Check all that apply.

As part of your own health regimen, how frequently do you incorporate any CAM techniques or medical approaches to promote personal health?

What health measures do you personally hope to achieve in using some form of CAM? Check all that apply.

Which CAM procedures or techniques would you recommend for family or friends? Check all that apply.

To what extent do you use CAM approaches in your own medical practice?

Do you envision yourself integrating additional CAM procedures or techniques into your medical practice?

Demographics

During June, this latest Jackson & Coker Industry Report survey was sent to several thousand physicians and healthcare professionals throughout the United States, with nearly 300 persons responding.  Sixty-one percent were males.  Seventy-six percent of respondents held M.D. degrees and almost 7% held D.O. degrees.  Slightly fewer than 6% of respondents were CRNA’s.

The breakdown of medical specialties was noteworthy.  The majority of respondents practice in these specialties:  Family Practice (15.8%), Internal Medicine (7.8%), Psychiatry (8.9%) and Surgery (8.5%). 

Almost one-third of the respondents were in the age category of 50-59.  Twenty-six percent were in the 40-49 age range.  On the other extreme, just over 17% were 30-39 years of age, and slightly more than 6% were 70 years or older.

Length of medical practice was also surveyed.  Approximately 12% had practiced fewer than five years.  Nearly 11% had practiced from 6-10 years or 11-15 years.  The largest categories were 15-20 years (15%) or 25-30 years (16%). 

Familiarity with CAM

The survey tested how familiar health practitioners were in terms of using Complementary and Alternative Medicine personally or as integrated into their medical practice.

Nearly 54% were “somewhat familiar” with CAM procedures, techniques or therapies, and 35% were “very familiar” with such.  Just over 9% indicated that they were not familiar with this approach to medicine.

Half of participants had, in fact, received either formal or informal training in CAM, whereas 48% mentioned that they had not received any such training.  Just over 13% became familiar with CAM during their medical training. Twenty-one percent were enlightened through seminars on holistic medicine, and 26% were self-taught or learned about CAM through colleagues.

With regard to training, respondents indicated their having acquired familiarity with the following CAM procedures, techniques or therapies:

Respondents’ comments indicated other facets of CAM with which they were familiar:  Osteopathy, energy medicine, Cranio-sacral techniques, Reiki, therapeutic touch, C/S therapy, guided imagery, music therapy, and the “Alexander Technique.” 

When asked whether they used any CAM techniques or medical approaches to promote their personal health, over 38% indicated that they did so occasionally, whereas just under 30% said they did so frequently.  However, over 27% indicated “not at all.” 

Personal use of Complementary and Alternative Medicine was associated with a number of specific health benefits, according to survey respondents:  These chief benefits were mentioned: 

How effective have CAM procedures or therapies been in enhancing practitioners’ personal health?  Thirty-two percent indicated “very much so” and the same percent noted “to some extent.”  Almost one-fourth of respondents indicated “not appreciably.”

The survey queried respondents as to which CAM techniques or procedures they would recommend to family or friends.  Topping the list (each with 12% or more of responses) were Herbal Medicine, Massage Therapy, and Yoga / Meditation.

Using CAM in Medical Practice 

Broadly speaking, “Complementary and Alternative Medicine” covers a wide range of modalities, techniques and therapies that are more closely associated with what is considered non-conventional medical approaches to patient care. 

Despite the general popularity of CAM, some physicians opted not to use it in their medical practice.  The main reasons included:  reluctance to use procedures not “scientifically proven” (29%), reimbursement issues (12%), and increased medical malpractice exposure (8%).

Among health practitioners who used some form of CAM in their medical practice, 42% did so occasionally, 23% frequently, or 30% not at all. Twenty-two percent of respondents were not sure about their colleagues’ use of any form of Complementary and Alternative Medicine in their practice, 

Did respondents’ colleagues employ any alternative medical approaches in their practice?  The answers were 4% frequently, 44% occasionally, and 22 percent not at all. 

When asked whether they envision themselves integrating additional CAM procedures or techniques into their medical practice, 30% of practitioners indicated “definitely,” 28% noted “perhaps,” and 31% selected “probably not.”

A follow-up question was key to the survey:  “What would motivate you to incorporate more CAM procedures or techniques into your medical practice?”  The responses were as follows:

Insurance reimbursement is a big issue for most healthcare providers using or considering the use of CAM professionally.  Among those who had sought insurance reimbursement, 2% had no significant problems with insurers, 11% had encountered some problems, and 26% had experienced major difficulty in dealing with insurers. 

Interestingly, 15% of participants anticipated more insurers reimbursing doctors for CAM procedures or therapies.  However, 62% felt that it was either “not too likely” or “probably unlikely” that insurance coverage would become more widespread in support of alternative medical approaches. 

Over 70% were unaware that professional certification for CAM practitioners is available, whereas 22% knew of its availability.  Thirty-eight percent of respondents indicated no interest in pursuing such certification, but 55% expressed possible interest (“yes” or “maybe”). 

Another key question asked:  “From your perspective, do physicians tend to draw a line between CAM procedures that are acceptable versus non-acceptable to Western-trained clinicians?”   The answers revealed strong sentiments pro and con:

• “Many of my colleagues feel if the risk of adverse event and the financial burden to patients are both minimal, then they have no objections to giving CAM a try. Of course, there are enough physician colleagues who doggedly insist that if an assessment or treatment has not been rigorously researched, then there is no reason to even discuss it.” 

• “Yes.  Medicine is intrinsically conservative, for good reasons.  After all, ‘If it ain’t broke, don’t fix it’ tends to work fairly well.  Why stop doing something if it has worked in the past?  Many CAM procedures and modalities are untested, or are still at a stage where we don’t know how to measure or observe what they do. Asking someone to give something they know works for something that can’t be tested is bound to be problematic.” 

• “No.  It seems to me to be driven almost entirely by personal preferences / exposure.”

• “I draw the line on anything that isn’t proven scientifically.  Unacceptable are those treatments that only target the practice’s bottom line.” 

• “Yes, only those that have stood up to the test of controlled studies are accepted.”

• “[Most doctors] believe in the old school and get incentives from companies; so a lot of them really do not accept the new therapies as a way for people to heal.”

• “It is acceptable because more and more Western trained people are now practicing yoga as a health habit, which itself says they believe that CAM can be beneficial to them.” 

• “Yes—there is line between practices that are harmless and those that potentially could cause harm.” 

• “Probably not.  From my experience, physicians who discount CAM tend to lump all CAM modalities together regardless of their actual credibility (or lack thereof) and toss out proven methods such as acupuncture regardless of the results.” 

• “Yes—many physicians are familiar or willing to use or recommend CAM therapies only if they read articles in the major journals.”

• “Doctors are not properly trained in the use of alternative medicines and therefore are very reluctant to use them in their practice.” 

• “MD awareness to such alternative procedures is limited and hindered by the insurance / financial patient issues.”

• “I believe that most physicians are fixed in their mind set about “scientific medicine” and “alternative medicine,” and it is difficult to change their mind set. 

Interview with a Doctor Favoring CAM

To put our survey topic into clearer perspective, we recently interviewed a Board Certified Internist whose practice incorporates certain complementary approaches to conventional medical treatment of patients requiring Primary Care treatment.

Dr. Frenesa Hall is Founder, CEO and Chief Medical Officer of Mobile-Medicine.net.  The practice provides mobile medical services to busy patients in metro Atlanta, GA, by treating them in their offices.  Here are the interview questions and responses:

When and how did you become interested in complementary and alternative medicine (CAM)?

I became interested in complementary and alternative medicine around twelve years ago when I attended a week-long conference at Harvard on CAM topics.

To what extent do you use certain CAM procedures, techniques or therapies to enhance your own health and physical well-being?

For myself, I extensively use supplements, homeopathy, chiropractic treatment, massage, and other means to boost my energy.  I use all of these and others for interested clients.

What CAM procedures, techniques or therapies do you typically incorporate into your medical practice?

I typically use nutritional testing, supplements, functional medical approaches and referrals to CAM practitioners.

Is it a fair assumption that patients treated in their offices are more receptive to CAM procedures due to being treated in a more “relaxed” atmosphere?

No.  They are open to it because of their own experiences, or their friends’ or families’ experiences, or become receptive because I take the time to explain the benefits of an alternative approach to improving their health.

Heretofore, why has the health profession in the U.S. been reluctant to recognize Complementary and Alternative Medicine as “legitimate” medical treatment?

Probably because many health professionals are not educated in these areas.   Also, there is the fear of malpractice exposure since CAM therapies are not generally considered “standard of care” recognized by the medical profession.

Do you see any trends in terms of more healthcare providers being receptive to using some aspects of CAM in their medical practice?  If so, what do you suppose accounts for such trends?

Yes, I see some trends in this regard—due to more publicity and more public demand.  Another factor is being able to incorporate and add cash (unrelated to insurance) revenue into the practice.  Also, patients actually get better.

What advice would you share with colleagues concerning the advisability of at least considering incorporating some aspects of CAM into their patient treatment?

Start with something that is easy.  Example:  SpectraCell nutritional test and a quality line of supplements like AmeriSciences that has a marketing system specifically for physician practices.  Many patients are already familiar with their supplements.

Do you have any other comments concerning Complementary and Alternative Medicine that you would like to share?

Since utilizing CAM techniques—after attending many conferences, independent reading and working with CAM practitioners—I have seen incredible results in difficult cases that conventional medicine was unable to help.

For example, a 50 year old woman with GERD, fibromyalgia and asthma on 8-10 meds having symptoms daily came off all meds by eliminating wheat, tomato products and red wine from her diet.  I have followed her for three years and she had no symptoms unless she ate these foods.

Another illustration:  a 47 year old man with severe Parkinson’s despite trying every drug was able to drive for the first time in eight months after several weeks of IV glutathione treatment.

I can go on and on with examples.  These interventions are safe, effective and generally inexpensive.  We (the conventional medical community) should embrace the chance to help more people and “do no harm.”

Information on Dr. Hall’s professional background and clinical focus can be found on her website:  www.mobile-medicine.net.

Summary

Complementary and Alternative Medicine has gained increased usage among medical providers who gravitate toward it due to personal belief and usage, patient demand, and / or general awareness within the medical community that alternative approaches to patient care cannot be discounted as invalid.  To what degree CAM techniques, procedures and therapies become much more acceptable to the medical community—in contrast to what is already deemed “standard of care” according to conventional, Western medicine—remains to be seen.

An apparent trend is that more physicians and health professionals are at least open-minded about considering the use of some facet of CAM in their medical practice or at least referring patients to CAM practitioners.  Certainly the question of what insurers consider reimbursable medical procedures plays a big part of increased acceptance of CAM by healthcare practitioners.  The fact that professional certification is an option for medical providers expands the possibility of Complementary and Alternative Medicine becoming more “mainstream” to the healthcare profession at large.