Regulation or Free-for-All

 

Conventional physicians interested in providing integrated care through collaboration with CAM (Complementary and Alternative Medicine) practitioners are faced with several challenging questions:

• Who are the CAM practitioners?
• Which ones can we trust?
• What is their training?
• Does the state regulate their practice?
• How do we credential them for working in clinical and hospital settings?
• Where do we find guidelines for collaboration and communication?

 

Michael H. Cohen, JD, Director of Legal Programs at the Harvard Medical School Division for Research and Education in Complementary and Integrative Medical Therapies, has written articles and books on this subject.  One sentence from his article in Integrative Medicine: A Clinician’s Journal (Issue 2.3) sums his advice well: The essential steps include verification of: valid, current state licensure; evidence of satisfactory completion of an appropriate national certification examination; documentation of completion of required studies and continuing education; signed statements pertaining to a specified minimum amount of malpractice insurance; documentation of history of malpractice litigation; and documentation of disciplinary action.

 

Notice that he begins with state licensure.

 

Regulation of the Health Care Workforce

Over the past decade, public acceptance of CAM products, practices and practitioners has increased dramatically. This has placed considerable, and increasing, pressure on the healthcare system and state legislators for inclusion of CAM professionals. The result has been in increased CAM licensing legislation, modernization of CAM education, and progressive establishment of standards of practice. However, the past several years have seen an interesting collision of two fundamentally opposed political viewpoints: those committed to standards and accountability versus those who believe the public should have complete freedom to choose any healthcare provider, whether self-proclaimed or appropriately trained, credentialed and regulated.

                          

I believe the consumer beware, free-for-all approach not only makes collaboration and integration impossible, it also posses substantial potential for severe public harm. A few years ago, a PEW Commission comprehensively studied healthcare workforce credentialing and made 10 recommendations. Though they were developed for conventional healthcare practitioners, these recommendations are equally appropriate to the regulation of CAM practitioners and, in my opinion, should guide all legislative bodies and credentialing processes. Notice in the PEW report the strong themes of education, practice standards, scope of practice consistent with training, regulation, and competency maintained through disciplinary processes.

 

PEW Taskforce Commission Recommendations for Regulation of the Health Care Workforce

1.     States should use standardized and understandable language for health professions regulation and its functions to clearly describe them for consumers, provider organizations, businesses, and the professions.

2.     States should standardize entry-to-practice requirements and limit them to competence assessments for health professions to facilitate the physical and professional mobility of the health professions.

3.     States should base practice acts on demonstrated initial and continuing competence.  This process must allow and expect different professions to share overlapping scopes of practice.  States should explore pathways to allow all professionals to provide services to the full extent of their current knowledge, training, experience and skills.

4.     States should redesign health professional boards and their functions to reflect the interdisciplinary and public accountability demands of the changing health care delivery system.

5.     Boards should educate consumers to assist them in obtaining the information necessary to make decision about practitioners and to improve the boards’s public accountability.

6.     Boards should cooperate with other public and private organizations in collecting data on regulated health professions to support effective workforce planning.

7.     States should require each board to develop, implement and evaluate continuing competency requirements to assure the continuing competence of regulated health care professionals.

8.     States should maintain a fair, cost-effective and uniform disciplinary process to exclude incompetent practitioners to protect and promote the public’s health.

9.     States should develop evaluation tools that assess the objectives, successes and shortcomings of their regulatory systems and bodies to best protect and promote the public’s health.

10.  States should understand the links, overlaps and conflicts between their health care workforce regulatory systems and other systems which affect the education, regulation and practice of health care practitioners and work to develop partnerships to streamline regulatory structures and processes.

 

Licensure Should Correlate with Training and be Consistent Across the Nation.

CAM health care professions can only the enter mainstream healthcare through the model of "credentialability".  The standard in the U.S. health care system for the past century has been to bring into the system new types of health care practitioners through education, credentialing and regulation. The only rationale way to provide appropriate access to safe and effective complementary and alternative medicine is through the same processes, just as has occurred for all other practitioners, whether they be physical therapists or medical specialists.

 

Federal leadership may be needed to establish national standards for appropriate training and consistent state licensing. This could be facilitated by creating a national credentialing and standards roundtable.  It could include national conferences, with a blue ribbon task force representing accredited colleges of conventional healthcare and CAM professions and national associations for licensed CAM and conventional medicine.

 

This issue is critically important to the public who have every reason to expect efficacy and safety from healthcare professionals. Patients are equally entitled to expect their practitioners to work collaboratively together. Without consistent, nation-wide licensure, responsible and well-trained CAM practitioners will become permanently ghettoized and collaboration with conventional medicine impossible..