By Andrea Clement, for The Atlanta Journal-Constitution

Troy Warren for CNT #Health

More large systems incorporating functional medicine as part of their care models

Functional medicine is a unique health care model that is growing in popularity among clinicians nationwide as demand increases among the patient population, particularly among people coping with chronic illness.

According to the Institute for Functional Medicine, the model “is an individualized, patient-centered, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness… (requiring) a detailed understanding of each patient’s genetic, biochemical, and lifestyle factors, and (then leveraging that data) to direct personalized treatment plans that lead to improved patient outcomes.”

One common misconception of functional medicine is that it is not evidence-based or that it involves unproven methods of care. However, according to the IFM, functional medicine entails a “biology–based approach that focuses on identifying and addressing the root cause of disease.” Additionally, more large systems across the country are starting to incorporate and adopt functional medicine as part of their care models, more private practices in functional medicine are opening, and clinical research in functional medicine continues to grow.

The care model’s focus on root cause, rather than symptoms, allows functional medicine practitioners to better understand the complexity and various conditions related to one or more underlying causes. Additionally, functional medicine recognizes that the same disease doesn’t always present the same way in different people. “Functional medicine treatment targets the specific manifestations of disease in each individual,” according to IFM’s website.

Many functional medicine practitioners are physicians or advanced practice clinicians who obtain additional training or a certification in functional medicine. One of the most common certifications is the IFM certified practioner, which is provided by the IFM after completing an extensive education and certification program. Because functional medicine is not currently a standalone practice, the IFMCP certification requires an existing license to practice health care.

Of the 209,000 practicing primary care physicians, approximately 19% (40,000) of them have invested in professional education related to functional and integrative medicine. “The rate at which physicians seek out this education has been steadily increasing for more than 10 years,” according to an IFM spokesperson.

Since 2016, the engagement of nurses in IFM training has grown by 200%. During the pandemic, IFM held much of its training online and educated nearly 3,500 practitioners. It saw a 74.3% increase in livestream registrations from 2019 to 2020.

Multiple factors driving growth

According to Lisa McDonald, founder of Integrated Connections, which provides practice growth resources and career development services, much of the growth is being driven by an increase in chronic disease, including COVID long haul syndrome.

According to the Atlanta-based Centers for Disease Control and Prevention, six in 10 people in the U.S. have a chronic disease — a condition lasting a year or more — and four in 10 have more than one chronic disease.

Integrated Connections’ online job site has experienced a 163% increase in average monthly job openings for functional medicine clinicians over the past year. “We’re seeing an uptick in the number of health systems that are adding functional medicine programs, and the number of private practices in functional medicine is growing even more rapidly,” McDonald said.

“Our nation’s healthcare system is generally not well-equipped on a broad scale to treat and reverse chronic disease, nor does it provide primary care doctors the time to educate on complex conditions or preventive care,” McDonald continued. “The pandemic has taught us the importance of health and prevention, so many patients are seeking this support in prevention and optimization via integrative and functional medicine practices.”

Local nurse practitioner Serena Kumar, ANP-BC, IFMCP, founder of Avanti Hormones and Functional Medicine in Woodstock, agrees that functional medicine fills a growing need that has been lacking in many health systems.

“We are seeing tremendous growth in the field of functional medicine. More and more patients (want) to take control of their lives and are looking for not just a temporary “band-aid”, but to really get to the root of their problems and to feel well again,” Kumar said.

Yoon Hang Kim, MD, MPH, medical director for Integrative Medicine at WellMed, agreed: “My patients are drawn to my practice often as a last resort. Some patients were drawn by the more comprehensive approach. Others find the integrative/functional approach to be in line with their belief system. Most just were not getting results in conventional medicine.”

While many practices combine the models of functional medicine with integrative medicine, and there is some overlap, the two are different. Functional medicine intently focuses on the root cause of disease more so than integrative medicine, although FM does incorporate similar philosophies. Both are comprehensive models of care that treat the patient as a whole person. Functional medicine also considers each patient’s unique physiologic, psychological and genetic factors, and is sometimes referred to as “personalized medicine,” according to McDonald.

One indication of the growth of the functional medicine field includes its adoption by larger systems and practices nationwide, especially over the past decade. In establishing its Functional Medicine Clinic in 2014, leadership at the Cleveland Clinic said functional medicine “is the future of medicine.” The clinic has since expanded its size and services, and conducts research trials on how functional medicine can help treat a variety of illnesses and conditions.

A unique systems-based approach

Kumar said she is passionate about treating her patients as a whole person, not just as a set of symptoms. For example, she said, is the difference in treating a patient with alopecia (hair loss). Conventional practices would likely spend a few minutes examining the patient’s scalp, and then prescribe a medication to help restore hair growth.

In a functional medicine practice such as Kumar’s, that patient would be evaluated for multiple potential root causes, including levels of key vitamins and minerals. Additionally, several systems would be investigated, including endocrine (thyroid function), digestive/GI (diet, allergies, etc.), emotional/psychological stress factors, lifestyle and sleep issues, as well as exploring potential dermatological issues that could be causing the hair loss.

“This is just one of the simpler applications; each person is unique, and what may be causing migraines or anxiety or insomnia in one person, could be from a different root cause for another person,” Kumar explained.

Dr. Rob Downey, IFMCP and founder of Seaworthy Functional Medicine, a department of South Peninsula Hospital in Alaska, agreed that functional medicine offers more than conventional practices to facilitate patients’ overall well-being.

“I think (functional medicine) is the perfect adjunct toolbox to conventional training in that it opens radical new domains of how to understand the root causes of chronic problems, along with novel strategies that routinely result in outcomes beyond what is considered expected in conventional medicine,” he emphasized. “Functional medicine patients simply do better, whether they experience reversal of their conditions, or a more satisfying disease management plan.”

When asked what attracts patients to functional medicine practices, Downey broke down the benefits into several key areas:

The use of medications as a last resort, rather than a first line treatment for nonurgent clinical situations
The common-sense approach of looking for root causes that are now validated scientifically and safe to tackle with functional medicine specialty testing, lifestyle and supplements
Positive clinical outcomes
Compatibility of functional medicine with other healing traditions

Nursing careers in functional medicine

Kumar and McDonald agree that, based on their training, many nurses are already an excellent fit for the functional medicine model of care. Additionally, nurse practitioners are in high demand, and they often have an entrepreneurial mindset and drive that enables them to successfully open their own practices.

“I think that nurse practitioners will play a particularly key role in the future of the functional medicine movement nationwide,” McDonald said, citing growth in demand among her clients’ practices and their job openings seeking NPs. A certification in functional medicine is also available to RNs.

Kumar has worked in the field of functional and integrative medicine since 2013, after about two years in “traditional medicine” with a heavy emphasis on lifestyle medicine.

“When I first became an NP, I knew I wanted to be able to help patients feel better and have more control of their health, especially chronic illnesses,” Kumar said. “I had focused my NP training at Emory University in endocrinology and finished most of my clinical hours at a large endocrinology office in the greater Atlanta area,” adding that her first role as an NP was with a urology practice focusing on lifestyle medicine.

There, Kumar helped patients learn “how to lower their risk for kidney stones, how to lower their blood sugar, and work on other factors to improve their health and lower chronic illness risk. I stayed in this role for a little over a year, and then felt the need to move on and expand more in lifestyle and then into functional medicine.”

Kumar then learned about IFM and started training with their modules, eventually becoming a certified practitioner in 2016.

Career paths for other clinicians, physicians

In addition to nurses and physicians, physician assistants, chiropractors, registered dietitians, physical or occupational therapists, and naturopathic doctors can also become certified to practice functional medicine. The IFM provides a list of practitioners eligible for certification. The list also includes dentists, acupuncturists, optometrists, podiatrists and more.

More medical schools are adding courses in functional and integrative medicine, as students have shown increased interest in recent years. “The number of students and residents attending IFM programs grew by more than 45% in 2020 over 2019,” according to the IFM spokesperson.

Advice for pursuing a career in functional medicine

With any career change, research and information can go a long way in learning about a new field.

“The internet provides so many informative and free resources, I’d suggest clinicians start by simply listening to podcasts, reading articles, and even taking a few free ecourses in functional medicine, integrative medicine, and/or lifestyle medicine, to determine which educational or career path best suits you and your practice goals,” McDonald said.

You might also benefit from working with a mentor, joining professional associations, taking classes and making connections with industry experts online. For career development, education, and certifications, McDonald recommended several professional associations in the industry, including:

The Institute for Functional Medicine: IFM.org
University of Arizona’s Andrew Weil Center for Integrative Medicine
Academy of Integrative Health & Medicine: aihm.org
American Academy of Antiaging Medicine: A4M.com
Personalized Lifestyle Medicine Institute: PLMInstitute.org
American College of Lifestyle Medicine: LifestyleMedicine.org

Kim stressed the importance of balance and mindfulness in pursuing a new career in functional or integrative medicine. “First, obtain a solid medical training. Incorporate self-care and resiliency practice and explore your passion within functional medicine. Developing mindfulness and intellectual self-reliance is a key to developing in a balanced manner.”