April 8, 2013
April 2, 2013 -- Have 106,000 licensed health care practitioners been left out of workforce planning on how to meet the nation’s primary care needs? This question is explored in a white paper generated by the Primary Care Project of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC - www.accahc.org) in collaboration with UCLA Center for Health Policy Research senior research scientist Michael Goldstein, PhD. The project is entitled: Meeting the Nation’s Primary Care Needs: Current and Prospective Roles of Doctors of Chiropractic and Naturopathic Medicine, Practitioners of Acupuncture and Oriental Medicine, and DirectEntry Midwives. These four distinct integrative medicine and health professions are sometimes referred to as “complementary and alternative medicine” (CAM) disciplines. Goldstein describes the reasons for undertaking the project: “Even though significant numbers of people actively use these four licensed disciplines as their first choice for primary care, workforce analyses have not included the potential contributions of these disciplines.” ACCAHC – Meeting the Nation’s Primary Care Needs, page 2 Goldstein notes that Section 5101 of the Affordable Care Act explicitly includes these licensed disciplines in a section on workforce planning. “Our goal with this paper is to assist policy makers, regulators, third-party payers, delivery system executives, administrators, practitioners, and other concerned parties -- as well as the disciplines themselves -- to discover the optimal use of these professions as part of the nation’s primary care matrix.” The core of the white paper consists of four 6000-word chapters written by carefully-selected academic leaders of each discipline. These chapters probe the status of each profession relative to accepted and internal definitions of primary care. Topics include: state regulatory status, government agency recognition, educational standards, US Department of Education-recognized accreditation requirements, practice scope, research basis, and formal position statements. Chapters Endorsed by Key National Academic Organizations The ACCAHC Primary Care Project was engaged through partnership with national academic organizations associated with the four disciplines. These groups selected the authors for the disciplinespecific chapter and subsequently endorsed that chapter. The partner organizations are the Association of Accredited Naturopathic Medical Colleges (www.aanmc.org), Association of Chiropractic Colleges(www.chirocolleges.org), Council of Colleges of Acupuncture and Oriental Medicine (www.ccaom.org) and the Midwifery Education Accreditation Council (www.meacschools.org). In an Executive Summary and introductory chapter, Goldstein and John Weeks, co-director of the project and ACCAHC’s executive director, offer analysis and recommendations. Goldstein notes: “In numerous jurisdictions, some of these disciplines are already legally recognized as primary care providers. More notably, some are currently already included in state medical home planning and programs to stimulate provision of primary care services to the underserved.” Recommendations: Engage and Research this Hidden Dimension of Primary Care The authors’ recommendations were endorsed by the Board of Directors of ACCAHC, the core membership of which is 17 national organizations. The Goldstein-Weeks team charge the disciplines to clarify identified gaps in training and to prioritize research on the profession’s role in primary care. They recommend that policy makers and workforce planners to “prioritize learning about this hidden dimension of primary care delivery.” One recommended means is through “funding and engaging high quality health services and epidemiological research on those individuals and families whose ‘first choice’ for treatment is a licensed practitioner from one of these four disciplines.” The recommendations also urge “examining the contributions of these practitioners to patient satisfaction, quality of life, and cost.” Goldstein concludes: “It’s clear that while generally unrecognized by the conventional medical community and workforce planners, these disciplines presently relieve some of the burden on the primary care system. These practitioner groups represent a hidden dimension of primary care in the United States. Especially in a patient-centered era with the emergence of patient-centered medical homes (PCMHs) and accountable care organizations (ACOs), these disciplines merit more focused and objective examination.” ________________________
