Education and training of CAM practitioners
Education and training for practitioners of complementary and alternative medicine (CAM) encompass a wide range of approaches and practices, reflecting the diversity of therapies considered outside conventional medicine. These practitioners can include acupuncturists, chiropractors, homeopaths, massage therapists, and naturopaths, each with varying educational paths. Training programs can range from extensive, multi-year curricula akin to medical degrees to shorter courses that offer certification after only a few weeks. The lack of a national regulatory body leads to significant variation in training and certification requirements across states, which can create challenges for both practitioners and consumers seeking qualified care.
For instance, acupuncturists typically require four years of study and must pass a board examination, while chiropractors undergo a rigorous program that includes over 4,200 hours of training. Homeopathy and massage therapy education can vary widely, with some practitioners having no formal educational requirements. Additionally, as CAM practices gain popularity, many medical schools are starting to integrate CAM topics into their curricula, reflecting a growing recognition of these therapies in conjunction with traditional healthcare. This educational landscape illustrates the complexity and evolving nature of CAM training in the United States, emphasizing the importance of understanding qualifications and practices for informed decision-making.
Education and training of CAM practitioners
DEFINITION: Education and training for persons seeking to practice complementary and alternative forms of therapy.
Overview
The education and training of practitioners of complementary and alternative medicine (CAM) are widely varied, as these practices encompass any type of therapy that is not considered conventional or scientifically proven. Many of these therapies, however, have a long history rooted in various cultures throughout the world. CAM education and training may involve rigorous courses of study similar to those for a medical degree or for postdoctoral training. However, some CAM education consists of only minimal training, such as a six-week course that leads to a certificate. Even within the same discipline, training and certification requirements may vary widely from state to state because there is no national regulatory body to oversee the process.
The education and training of CAM practitioners are the focus here, so the discussion will cover only those areas of unconventional therapy with standard educational or training programs. Covered here are acupuncturists, chiropractors, homeopaths, massage therapists, naturopaths, and integrated medicine programs that combine conventional medicine with CAM practice.
Many other types of CAM practitioners, such as aromatherapists, crystal therapists, reflexologists, reiki practitioners, and native or indigenous healers, study for long periods with experienced experts in their field. However, no particular training programs, educational courses, recognized requirements, or state or national certifications are available in the United States for these practitioners.
Practitioners
Acupuncturist. Acupuncture is a standard accepted practice in the Chinese medicine tradition; however, it is relatively new in the United States and, as such, varies from state to state in education and certification requirements and venues. According to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), all but three states have established criteria for persons seeking to practice acupuncture. Those without regulation are Alabama, Oklahoma, and South Dakota. To become licensed as an acupuncturist, nonmedical professionals must take a four-year course of study and a board examination. Depending on the state, either the NCCAOM exam or certification is required. Some states require that persons with a medical background—such as medical doctors, dentists, nurses, and chiropractors—complete a rigorous course of study as well, including classroom study (a minimum of three hundred hours) and clinical acupuncture practice, before becoming licensed.
Courses in acupuncture focus on anatomy, physiology, and other areas that are typical for any type of medical practice. Courses also include detailed study of the nervous and vascular systems so that a practitioner has a thorough understanding of needle insertion and the body’s reaction to it. A practitioner of acupuncture may also be trained in other aspects of Chinese traditional medicine.
Two bodies certify and accredit acupuncture colleges and practitioners in the United States: the Accreditation Commission for Acupuncture and Oriental Medicine and the American Board of Medical Acupuncture. These organizations provide continuing education and examinations for practitioners and oversight of educational programs in the United States. They also provide standards for acupuncturists trained in other countries who wish to practice in the United States.
Chiropractor. This branch of CAM may be one of the most highly regulated in the United States. The Council on Chiropractic Education (CCE) is an accreditation body for chiropractic schools, and its accreditation criteria are recognized by the US Department of Education. CCE regulates all training programs for chiropractors. The American Chiropractic Association, a leading professional organization for chiropractors, provides continuing medical education and other resources to practitioners.
A chiropractic training program must include a minimum of 4,200 hours of class time, laboratory work, and clinical experience and must include courses in orthopedics, neurology, and physiotherapy (all with a focus on clinical practice of manipulation and spinal alignment). Chiropractors may also pursue studies in a specialty, such as orthopedics, sports medicine, or rehabilitation.
After completion of a Doctor of Chiropractic (D.C.) program, student practitioners must pass a four-part examination from the National Board of Chiropractic Examiners and must pass a state examination to be licensed. In some areas, the state examination takes the place of the national examination.
Homeopath. The education and training of a homeopath can take varied courses. Programs designed for medical doctors or others with medical training tend to focus on homeopathy and its application, assuming that those with a medical degree would already have a basic background in medicine and medical practice. Other courses, geared to those who do not have a medical background, focus more on medical education, such as anatomy and physiology, but also train students in homeopathy practices and principles.
Several US states offer training in homeopathy. Admission requirements for courses of study vary widely. Some require a medical doctor (M.D.) or similar degree, and others enroll students with little or no medical background. Because homeopathy itself is not regulated in the US, anyone can use the word “homeopath” to describe themselves or their type of work. However, a person cannot identify themselves as a homeopathic doctor or imply to the public that they are practicing medicine if they do not hold a medical license.
Several programs offer homeopathic education, but no single certification is recognized throughout the US. Each state has its own standards for licensing this type of care. Some homeopaths are licensed in a conventional type of medicine and may hold a degree as an M.D. or as a nurse practitioner. In Arizona, Connecticut, and Nevada, M.D.s and M.D.s (Doctors of Osteopathy) can be licensed as homeopathic physicians. Homeopathic assistants, who practice under the supervision of a homeopath, are licensed in Arizona and Nevada.
Organizations such as the Council for Homeopathic Certification and the American Board of Homeotherapeutics offer certifications to homeopaths who have completed certain requirements: for example, M.D.s or D.O.s who pass oral and written exams in homeopathy. Upon completing these exams, the successful candidate is awarded a diplomate of homeotherapeutics (D.Ht.). Even though the Department of Education does not recognize any one organization as a certifying body, homeopathic practitioners use the standards upheld by these organizations to maintain competency and to encourage self-regulation.
Massage therapist. Most US states regulate the practice of massage therapy in some way, with a type of governing board providing certification or licensure. Usually, a massage therapist must complete some course of training and pass a board examination to be licensed. However, the requirements vary widely from state to state. Education provided in massage therapy schools typically requires about five hundred hours of study and involves courses in anatomy, physiology, motion and body mechanics, and clinical massage practice. Licensure also may involve passing a nationally recognized test, such as the National Certification Examination for Therapeutic Massage and Bodywork or the Massage and Bodywork Licensing Examination.
Naturopath. There are two basic types of naturopaths: traditional and naturopathic physicians. Education and training for traditional naturopaths vary from nondegree certificate programs to undergraduate degree programs. After completion of a degree program, a traditional naturopath can certify with the American Naturopathic Medical Certificate Board and become a naturopathic consultant. Traditionally, these types of naturopaths do not practice medicine and thus do not require a license.
A naturopathic physician must have a doctor of naturopathic medicine (N.D., or N.M.D. in Arizona) degree from an accredited school of naturopathic medicine. Only six schools in the US (in California, Washington, Oregon, Arizona, Connecticut, and IIllinois) are accredited for this type of education. The N.D. involves four years of graduate-level study in a standard medical curriculum, with added courses in natural therapeutics. Practitioners must then pass a state board licensing examination. (In the state of Utah, naturopathic doctors must complete a residency before starting a practice.)
Practitioners often work as primary care clinicians, but some states do not recognize the D.M. degree, so practitioners in these areas cannot legally practice medicine. Generally, they may still practice traditional naturopathic medicine. Twenty-five jurisdictions in the US allow the practice of naturopathy in any form.
The Council of Naturopathic Medical Education is a governing body that provides accreditation for education in naturopathy. The American Naturopathic Certification Board provides testing and continuing education for this profession.
CAM Education and Training in Mainstream Institutions
As the practice of CAM became more widespread and integrated into society, many medical colleges in the US began offering courses in CAM. One area of complementary medicine that is often taught in integrative medicine courses is pain management. CAM courses often teach conventional physicians how CAM methods can be incorporated into, and can truly complement, conventional medicine.
The University of Arizona College of Medicine teaches a program of integrative medicine that critically examines branches of alternative medicine and trains clinicians in practices that it finds helpful and that cause no harm. Other such programs include the Mayo Clinic Complementary and Integrative Medicine, the Integrative Medicine Program at MD Anderson Cancer Center, and the University of Michigan Integrative Medicine.
Other schools are incorporating CAM courses into their studies. An overview of over one hundred US medical schools found that 50 percent offered at least one CAM course or clerkship. The most common topics covered were traditional medicine, acupuncture, spirituality, and herbs.
Bibliography
American Academy of Medical Acupuncture. medicalacupuncture.org. Accessed 25 Sept. 2024.
American Association of Naturopathic Physicians. naturopathic.org. Accessed 25 Sept. 2024.
American Chiropractic Association. www.acatoday.org. Accessed 25 Sept. 2024.
American Massage Therapy Association. www.amtamassage.org. Accessed 25 Sept. 2024.
Institute of Medicine (US) Committee on the Use of Complementary and Alternative Medicine by the American Public. “Educational Programs in CAM - Complementary and Alternative Medicine in the United States.” NCBI, National Academics Press, www.ncbi.nlm.nih.gov/books/NBK83809/. Accessed 25 Sept. 2024.
The International Academy of Classical Homeopathy (IACH). www.vithoulkas.com. Accessed 25 Sept. 2024.
National Center for Complementary and Alternative Medicine. “Be an Informed Consumer.” nccam.nih.gov/health/decisions/practitioner.htm. Accessed 25 Sept. 2024.
Tierney, Gillian. Opportunities in Holistic Health Care Careers. Rev. ed., McGraw-Hill, 2007.