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.

President's Message: Advocating for Naturopathic Medicine

By Carl Hangee-Bauer, ND, LAc
AANP President

American Medical Association headquarters in Chicago, IL. Photo by Steve Silverman via Flickr, used
under the Creative Commons License.

It’s been quite a busy time over the past few weeks, with trips to Washington, D.C., and Chicago to educate and advocate for the naturopathic profession.

2011 DC FLI

In late April, I flew to Washington to spend three days at DC FLI followed by our Spring Board meeting. This was my fourth DC FLI and I have to say it is one of the most fun and interesting events put on by the AANP. Most of us come together at our August conventions, but this gathering has its own flavor.

150+ people were in attendance this year, and at least 100 were students from the naturopathic colleges. There were a number of our more experienced doctors present, many of whom are active in either state licensing or federal legislative issues, as well as AANP Board members and some NDs local to the East Coast and D.C. area.

We started Saturday morning with a meeting of the State Alliance, where general trends and issues were discussed affecting state licensing efforts. There were some great conversations and sharing as we learned from each other’s gains and obstacles. For me, the most interesting part was when a representative from each state where licensing or scope expansion is being sought updated the group on their progress so far this year. It is very encouraging to hear the gains that have been made recently, and I am certain that, by following the lead of North Dakota, we could see as many as three to five states successfully gain licensure in the next year or so. The momentum is palpable and all of the due diligence that has been carried forward in different states by dedicated naturopathic doctors and their patients appears to be on the cusp of paying off.

Saturday afternoon began in earnest with presentations by representatives from the chiropractic profession, sharing with us their lessons learned in the legislative arena and overviews of the current political landscape in D.C. On Sunday, we spent the day reviewing our key messages and goals for this year’s federal political agenda, largely around two topics: offering a definition of “integrative health care practitioner” (described but not defined in numerous sections of the PPACA passed last year), and seeking sponsors or co-sponsors for a bill amending the Public Health Services Act to ensure equity for naturopathic physicians in federal loan programs, scholarships, and primary care residencies funded by the federal government. Of course, while these are our stated goals, our ongoing agenda is to inform and educate legislators and their staff members about naturopathic medicine and the role we play in our health-care system. It’s about building relationships.

On Monday, we fanned out across Capitol Hill, carrying our messages to congressional offices as well as other agencies including the Veteran’s Administration (the largest managed care system in the world) and the National Institutes of Health. From the feedback I’ve heard so far, we were well received and our messages were heard. And, as always, our reception In the Rayburn Foyer was a huge success with many staffers and a few U.S. Representatives present. One experience I can briefly relate was watching Rep. Dennis Kucinich arrive and make a beeline to Dr. Joseph Pizzorno’s table. I was told that Rep. Kucinich is a great admirer of Dr. Pizzorno’s books, keeping them in his living room at home.

The success of DC FLI is in large part due to the tremendous enthusiasm of our naturopathic medical students who take time away from their studies, fundraise, and make the long journey to D.C. to be a part of the change in the health-care system this profession promises. In many ways they are our strongest voices, and there is no doubt that the future leaders of our profession are cutting their teeth at DC FLI.

AMA Meeting

After a few days back in San Francisco seeing patients and getting a bit of rest, it was off to Chicago for our meeting with the American Medical Association (AMA). Karen Howard and I represented the AANP as part of the Coalition for Patient Rights (CPR), a group of 35+ health professions who came together in response to the AMA’s Scope of Practice Partnership (SOPP) campaign. This campaign is part of the AMA’s goal to educate their state constituencies and state legislators about scope of practice bills, largely opposing other health-care professions who seek either expanded scope or independent practices. One of the data series produced by the SOPP concerned naturopathic medicine and was filled with many inaccuracies about our training and practice.

Karen and I were joined by representatives from other groups including the American Nurses Association, American Association of Nurse Anesthetists, American Psychological Association, and American Physical Therapy Association. Our group met with some of the top brass at the AMA including the Chair of the Board of Trustees and CEO.

I’m happy to say it was a cordial and respectful meeting on all sides, and I believe it is a start to a productive dialogue with our medical colleagues. There was general consensus in the room that we all need to work better together in integrative and collaborative settings, and this starts with thoughtful communication and a willingness to engage in productive dialogue. Our coalition gave specific feedback that I believe was heard.

I left the meeting encouraged but realistic. These issues won’t change overnight and it will take a lot of further conversation and willingness on both sides to effect the change we are all working toward. This meeting felt to me a bit like a first date; getting to know one another and seeing where things can go. But the conversation was elevated from the usual and I’m optimistic that we can build on this start.