Monday, October 18, 2010

The Cream Rises to the Top

By Carl Hangee-Bauer, ND, LAc
AANP President

Photo courtesy of psdGraphics.
In my daily practice life as well as my "political" life as AANP President, I am always on the lookout for trends and conditions in my communities, both local and national, that have effects on my practice and my profession. I came across some news recently that caught my eye and has had me thinking about its ramifications.

Along with being licensed as a naturopathic doctor here in California, I have also carried an acupuncture license since 1989 and have been a long time member of the American Association of Acupuncture and Oriental Medicine (AAAOM) as well as my state acupuncture association. Recently, the AAAOM published a study of the acupuncture profession that found, among other things, that despite the prevalent use of acupuncture in the United States, the demonstrated cost-savings and effectiveness of acupuncture treatment, and the wide reimbursement by third party payers, many licensed acupuncturists are finding it hard to make ends meet.

In John Week's Integrator Blog, he quotes Lisa Rohleder, LAc and co-founder of the Community Acupuncture Network, who concludes that "Acupuncture education, and the conventional acupuncture business model, ought to come with a warning label, the way cigarettes do: NOT SUSTAINABLE. May take years of your life and leave you with nothing, except huge student loans."

In short, licensed acupuncturists graduate and get licensed, but then struggle for years to pay off student loans and get paid appropriately for their education and skills.  Many encounter barriers in third party reimbursement.  Many fail.

Sound familiar?

As naturopathic physicians, many of us feel that one of the reasons it is hard to make a decent living is that many people out there just don't know what an ND is. But is that truly the case? It seems to me that most if not all people know something about acupuncture -- what it looks like, what it's good for (at least pain, anyway). And yet acupuncturists are dealing with some of the same frustrations and challenges that affect the naturopathic profession.

As I said before, this has given me much to think about, and I've come to some conclusions.

First, the good news: we are not alone. If LAcs are struggling with these issues, you can bet that it's affecting other "CAM" providers. We tend to think we are unique, but maybe not so much.

Next, knowing that these challenges exist, we can and must do better on all levels. Our colleges have to do a better job at preparing our graduates to enter the healthcare marketplace. The AANP has to be more active at developing programs and resources for our member physicians in order to help them excel in the business of naturopathic medicine. Our state organizations must help build awareness of our profession and, together with the AANP, "brand" naturopathic medicine as a desired choice for patients. The AANP and the states must work together better to strengthen laws and policies that allow access to naturopathic care via state and federal programs and remove the unfair barriers to naturopathic physicians in federal and state health programs. For example, did you know that while the Department of Education recognizes ND educational programs as on par with MD and DO training, we are still effectively shut out of loan repayment programs for our ND graduates? If this is not unfair, I don't know what is.

Our graduates (you) have to take the individual initiative to learn the elements of successful practice and focus on the business of our medicine as well as its practice. There are pages devoted to practice growth and success on the AANP website.  Log-in and then visit select "Practice Resource Library" after clicking on "Practice Tools."  There are several courses taught by successful NDs that will help new graduates learn the tools to be successful.  The resources are out there and we must take the responsibility to use them.

When I graduated from Bastyr in 1984, there were few choices for people entering the profession. One could go into a solo practice, perhaps join a small group practice, teach at one of the schools, or maybe work for a supplement company. Now I'm amazed at the choices graduates have, and I am particularly excited to see the increasing opportunities in integrative medical settings for us to take our place alongside our "mainstream" colleagues. I, for one, think our profession could do much more to prepare our graduates to enter these new medical settings.

I can tell you that, both individually and collectively, we are up for these challenges. "The cream rises to the top," it's said, and naturopathic medicine is the gold standard for people seeking new choices and new directions for their healthcare.

Tuesday, October 12, 2010

Welcome to the Party

By Bill Benda, MD, FACEP, FAAEM

Photo by LS Lam via Flickr, used under the Creative Commons License.
I spent this past weekend at Southwest College of Naturopathic Medicine, where I teach a 50-hour emergency medicine course to students who must sit there and wonder, “Why am I learning this stuff?” But today’s rant is not about conventional vs. alternative or botanical vs. pharmaceutical, but about a more pervasive political movement apparently sweeping the country and, yes, our own little naturopathic family.

I often break up the classroom monotony of trauma and myocardial infarctions and wound closure with philosophical diversions – public policy, healthcare reform, influence of the neutraceutical industry on medical education, and such. But this past weekend we talked a bit about the Tea Party, and how its not just for mainstream politics anymore.

You see, this strange wave of populism that has taken us all by surprise is lapping at the shores of our particular profession as well as flooding the red and blue bastions of conservative and liberal thinking across the land. As an MD, I have limited interest in such important clinical ND issues as CPT codes and scope of practice – these simply do not impact my personal life. But I am fascinated by the internal politics of this field and the personalities that nudge and pull on the ship of naturopathic medicine like tugboats, each chugging towards its own desired destination. And what I see in today’s political horizon is our own little populist movement announcing unhappiness with the status quo and calling rather insistently for that nebulous yet ubiquitous concept of change.

What kind of change is, as with the rest of the country, still a bit nebulous and undefined, but we will let this detail work itself out over the ensuing months. The fact is that, as an AANP Board member for the past four years, I have been able to identify and get to know a few of the players and a few of the issues. The AANP, its Board, its executive director, the state associations, their Boards, their executive directors, the schools, their presidents, past AANP presidents, future AANP presidents, journalists (including myself), the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), the Integrative Healthcare Policy Consortium (IHPC), the Naturopathic Coordinating Council (NCC), the Naturopathic Medical Student Association (NMSA) and on. And on. Tugboats pulling and pushing on the good ship Naturopathy. Stay the course. Change direction. Return to the past. Dive into the future. Toot toot.

Before any of the above mentioned begin to take this analogy a bit too personally, I wish to make one point quite clear: This is all a very, very good thing. Should we take a look at our national political system as a larger illustration, I believe we must come to the conclusion that no matter our individual views on the Tea Party movement and its leaders, we cannot but admit that our current political system has become mired in dysfunction and inertia, and it may well take an entity as disruptive as the Tea Party to shake some sense into us. In the same vein, I believe it is time for the profession of naturopathic medicine, at the national, state, academic, political, media, and individual levels to take a long, hard look at our own dysfunctions and inertia (We all have them! Yes we do!) and come to a communal course of, well, change. Naturopathy is no longer under the social and professional assault from that it was twenty years ago. Conventional medicine is no longer the ogre trying to eat our children (well, maybe the AMA might still be). We must put past thinking where it belongs – in the past.

So change is in the air, as it must be. But we must realize that change does not mean returning to past thinking, or past policies. It does, however, require transparency and openness on the part of those instigating change. Personal agendas have no place here, and will serve only to create further dysfunction and inertia. Unfortunately for me, I will no longer have a front row seat after December 31st, when my Board term expires.

But I’ll be watching from the sidelines nonetheless . . .

Monday, October 4, 2010

Fall Cleansing: Perfect Timing and Optimal Process

By Sara Thyr, ND

Have you heard that spring and fall are ideal times to do a cleanse? In the spring, new buds signal a time of growth, and people are inspired to do spring cleaning. In the fall, as the growth season winds to a close, a cleanse is an ideal way to prepare for winter, the holidays and hibernation.

A biannual detox is a welcome addition to one’s healthcare regimen.

If you are living on this planet, even under the best of circumstances, you are exposed to toxins. They are present in many situations, and we easily absorb them into our bodies. Toxins are prevalent in pollution, and in average automobile exhaust. Just driving your car or walking down the street can add to your toxic burden. Everything from our food and medications to our homes and personal care products, such as lotions and aftershave, can add toxins to our bodies.

People come to do a detox for a variety of reasons: hormonal symptoms – such as PMS or perimenopause, skin issues, fatigue, headaches, infertility, autoimmune disorders, elevated cholesterol, and a variety of inflammatory disorders. Once people are aware of the many toxins in our environment, even those who eat organic and keep their cleaning products as clean as possible often want to detoxify a couple of times per year as a good preventive strategy.

Organs in our bodies that assist us in detoxification on a daily basis include the liver, lungs, kidneys, digestive tract and skin.

Many of the over-the-counter detoxification kits include intestinal cathartics – even natural ones like senna and cascara – which can induce explosive bowel action, cramping and discomfort in many people. Having optimal digestive function is critical for proper elimination and detoxification, but this type of abrasive action is not recommended. (If someone is continually constipated, then they likely need a detox more than most people, since their detoxification action in the digestive tract is limited. They may benefit from cathartics, but should use them only in the short term. Constipation can be resolved by treating underlying causes, not just depending on laxatives.)

While all of the organs of detoxification are important for optimal health, focusing on the liver and assuring excellent elimination makes the most sense. The liver is really the powerhouse of detoxification in the body. Most medications have to pass through the liver in order to be eliminated. Our liver function affects our hormones and our ability to clear other toxins to which we are exposed.

An ideal plan for detoxification includes diet changes, such as eliminating alcohol and caffeine, sugar, refined carbohydrates and any known food allergens.

Supplements that may be helpful will provide nutrients and herbs for liver support and a fiber source to improve elimination.

Saunas, steams and massage will also aid in the body’s detoxification process.

The type of cleanse that is best for an individual will depend on one's symptoms and personal goals. A licensed naturopathic physician can tailor a plan to their specific needs.