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Academia and the Profession |

Credentialing Complementary and Alternative Medical Providers

David M. Eisenberg, MD; Michael H. Cohen, JD; Andrea Hrbek; Jonathan Grayzel, MD; Maria I. Van Rompay, BA; and Richard A. Cooper, MD
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From Harvard Medical School, Boston, Massachusetts; University of Massachusetts Medical Center, Worcester, Massachusetts; and the Medical College of Wisconsin, Milwaukee, Wisconsin.

Information on the various health professions changes rapidly. The figures in this article represent a snapshot of the profession [as reported by the professions or their representatives] at various dates before acceptance of this article for publication.

Acknowledgments: The authors thank Edward H. Chapman, MD; James Dillard, MD, DC; Janet Kahn, PhD, NCTMB; Barbara Mitchell; Joseph E. Pizzorno Jr., ND; Lou Sportelli, DC; and David Studdert, JD, for their assistance with the preparation of this paper. They also thank John C. Wilson for his research and administrative assistance.

Grant Support: By grants from the National Institutes of Health (U24 AR43441 and AT00144); American Specialty Health, San Diego, California; and Medtronic Foundation, Minneapolis, Minnesota. The funding institutions had no editorial input into the paper, and the views expressed in this article do not necessarily represent those of the funding institutions.

Requests for Single Reprints: David M. Eisenberg, MD, Division for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical School, Suite 22A, 401 Park Drive, Boston, MA 02215; e-mail, Osher_Institute@hms.harvard.edu.

Current Author Addresses: Dr. Eisenberg, Mr. Cohen, Ms. Hrbek, and Ms. Van Rompay: Division for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical School, Suite 22A, 401 Park Drive, Boston, MA 02215.

Dr. Grayzel: Department of Emergency Medicine, University of Massachusetts Medical Center, 72 Pointe Rok Drive, Worcester, MA 01604.

Dr. Cooper: Health Policy Institute, Medical College of Wisconsin, PO Box 26509, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509.

Ann Intern Med. 2002;137(12):965-973. doi:10.7326/0003-4819-137-12-200212170-00010
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Since the late 19th century, state legislatures and professional medical organizations have developed mechanisms to license physicians and other conventional nonphysician providers, establish standards of practice, and protect health care consumers by establishing standardized credentials as markers of competence. The popularity of complementary and alternative medical (CAM) therapies presents new challenges. This article describes the current status of, and central issues in, efforts to create models for health care credentialing of chiropractors, acupuncturists, naturopaths, massage therapists, and other CAM practitioners. It also suggests a strategy of CAM provider credentialing for use by physicians, health care administrators, insurance companies, and national professional organizations.The credentialing debate reflects fundamental questions about who determines which providers and therapies will be accepted as safe, effective, appropriate, and reimbursable. More nationally uniform credentialing mechanisms are necessary to ensure high standards of care and more generalizable clinical research. However, the result of more uniform licensure and credentialing may be excessive standardization and a decrease in individualization of services. Thus, increased standardization of credentialing for CAM practitioners may alter CAM practice substantially. Furthermore, even credentialed providers can deliver ineffective therapy. The suggested framework balances the desire to protect the public from dangerous practices against the wish to grant patients access to reasonably safe and effective therapies.


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Figure 1.
Complementary and alternative medical and conventional practitioners.
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Figure 2.
Complementary and alternative medical and conventional schools

. BSN = Bachelor of Science in Nursing.

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