Q&A: Overcoming the Hurdles of Incorporating Integrative Healthcare into Medical Training

Ideally, future medical training will not include a separate unit on functional and integrative medicine, according to Melinda Ring, MD, FACP, ABOIM, Director of the Osher Center for Integrative Health at the Feinberg School of Medicine at Northwestern University in Chicago. Instead, Ring said the ultimate goal is for integrative modalities to be fully incorporated into the existing curriculum.

Earlier this month, Ring described the hurdles of including integrative medicine in the curriculum of conventional medical schools and ways to address them in a presentation at the Institute for Functional Medicine Annual International Conference in Orlando, Florida.

After her session, we spoke with Ring about her vision for future medical school curriculums and the integrative medicine movements that are already beginning to show up within conventional medicine.  

Integrative Practitioner: What challenges did you face when you started as director at the Osher Center for Integrative Health? How do you think you were percieved by the rest of the institution?

Melinda Ring: I think there's still a lot of work to do. I'll just start by saying that while I think the center is generally perceived well and as a valued part of [the Feinberg School], there are still plenty of people at Northwestern, physicians, et cetera, who have no idea we exist. It's such a small part of the school. Academic institutions tend to promote things like orthopedic surgery, cardiovascular surgery, you know, the big revenue generators. We support all those [areas of study] but we aren’t as well known.

When I first came in and was working to grow the program, there were certainly people who thought of integrative medicine as “woo-woo” medicine, not valid and not evidence-based. There were certainly instances where a hospital leader would say, “Hey, it's fine if you do meditation or talk about nutrition, but don't do any of that herbal and homeopathy stuff. There’s no evidence for that.”

I’ve realized that there are always going to be skeptics. There will be people whose minds I'm never going to change. And now, I don't even try, frankly. There are physicians and providers at Northwestern who are already advocates [of integrative medicine modalities] and active users or referrers for patients. And then there’s also the middle set who are curious and open to being on board. Those groups are the ones I focus on trying to educate and share the benefits [of integrative medicine] with.

Integrative Practitioner: Do you think the younger generation of students is more open to integrative strategies?

Melinda Ring: At the beginning of their training, they tend to be more open because they're coming from college. They're more interested in wellbeing because it's part of the social media culture, and there's talk about it. But what I see is that through the course of medical training, unfortunately, [students] can lose a lot of that openness to an integrative and functional medicine approach.

It's well documented that there's such strain on these medical students that they lose a lot of their empathy by their third year of medical school. They're so overwhelmed with how much they have to learn, which is very much focused on subjects like drugs and anatomy. That, and medical school is often taught as, “this is the way it is” without an appreciation for “and this is very different from how it was even ten years ago.” Fourth-year students tend to be more open, but it's always best to catch them early on because I think that’s when they’re most willing to learn about different modalities.

When I was in medical school, I already went in with that mindset of, 'This isn't all that medicine has to offer,' and that was just reinforced throughout my training. But what I've seen is that more often, it's physicians who have actually been in practice for a while after medical school, and they realize that there are a lot of people they’re not able to help or can only help to a certain extent. That's when they seek further training, like attending IFM training or seeking an integrative medicine fellowship. It's when they see the limitations of what we can do through conventional biomedicine.

Integrative Practitioner: What is the goal of including these integrative programs in medical institutions?

The goal is that, eventually, integrative medicine and functional medicine will go away because it's just good medicine. When there is enough of an evidence base, then it becomes part of training. We already see things that have been done in functional and integrative medicine for a long time, for example, some of the more advanced cardiovascular risk markers or the stool test for calprotectin for inflammation, showing up in conventional medicine pathways as recommended options. So, it does happen. It's just a slow process.

There are so many demands on the medical schools for how much they have to cover that it's a challenge, but ideally integrative medicine isn't just an add-on. There shouldn’t be a gastroenterology unit, a cardiology unit, and then a separate integrative functional medicine unit. Ideally, training includes, say, a gastroenterology unit that talks about probiotics and the role of gut permeability. And then, of course, an even bigger goal is to stop thinking in systems and instead talk about how those units intersect. There is a long way to go before we get there. But to me, that's the ultimate goal.

At the minimum, medical doctors and other health professionals need to be trained in lifestyle approaches like nutrition, the role of stress, how to help our patients sleep better and move better, and the importance of connection. That needs to be emphasized as much, if not more, than treatments involving pharmaceuticals. So, that must be the first point before you even start talking about acupuncture and dietary supplements.

Integrative Practitioner: What are some of the movements within integrative medicine that you’re most excited about and see potential in?

Melinda Ring: I think that the best ways forward, or the things that are going to happen the quickest, are along the lines of nutrition education and also a greater focus on lifestyle and self-care for the provider themselves, which will translate into their patient care.

We're reaching a crisis point. People are leaving medicine. Statistics show that there will not be enough doctors in the future. We need to address burnout, and I think lifestyle feeds into that too. We need more self-care for the providers, and the more they can appreciate that, starting in their medical training, the more they'll see how their patients can benefit from it as well.

Editor’s note: This interview was edited and condensed.