 |
|
 |
 |
| |
|
|
| |
| Lifestyle Medicine: Want To Practice It? - A New Specialty for Physician Assistants and Nurse Practitioners |
 |
by David Mittman, PA - August 2, 2010
|
|
 Provided by Clinician 1
Recently I saw a report which made me a bit perplexed. Take a look:
http://jama.ama-assn.org/cgi/content/extract/304/2/202?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=lifestyle+medicine&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
The AMA has come out in a JAMA article and asked physicians to consider practicing “Lifestyle Medicine”. Why would physicians see this as attractive today, while they have literally ignored this for many years? They don’t even want to practice family medicine, let alone anything seen less medical.
For many years I have had the same idea. So have many other NPs and PAs. I really like the JAMA article specialty name, although I am not sure its medicine.
For years I have advocated that both PAs and NPs add something more to their practices to the point of becoming specialists in it. Something we practice to supplement our income as well as to really change healthcare in America. It would be “health and longevity medicine”. Let me explain.......
I have always thought we should market our services as health/lifestyle coaches. Not like the people out there now, but as CLINICIANS who have the education and clinical know how to actually spend time with patients looking at their entire lives. I know we all should be doing that now, and many of us do to some degree, but I mean a dedicated specialty doing this. Not just bits and pieces which we do, but dedicated time to look at everything that effects peoples health and longevity. If depression is in the family, do a full depression screen. Look at Mom and Dad and what illnesses they had at exactly what ages. Look at seat belt use. Last Pap and Breast exam. How about PSA levels? Obesity and tobacco use. Exercise? How about cholesterol levels and Vit D levels. Physical abuse, emotional abuse? Actually have different forms made up with corresponding tests to identify many of the risk factors we all have. The initial consultation might be a series of two or three appointments with no acute illnesses being discussed or treated. Just identification of risks, genetics and counseling. Subsequent visits two or three times a year would make sure changes are being made or adhered to. To many tis would be fee for service while we lobby insurance to pay us for this valuable time spent with all who request it. I think this idea is fascinating and in actuality we can improve the quality of life for countless people more effectively practicing this “Lifestyle Medicine” as we could do later without using all the medicines in the world. We know that we can prevent so much more pathology so much more effectively if we PREVENT it. Stop it before it happens.
So I will again call for a good NP or PA program to start up an Internet/on-line postgraduate residency for BOTH professions in “Lifestyle Medicine”. It would incorporate the latest technology, screening tools, health information as well as some good coaching skills.
If we can work on its adoption with TWO great professions asking for reimbursement and recognition we should have a pretty good chance at developing this. Also I would have to believe that the government and the insurance industry want this also as we can really cut future healthcare costs practicing this specialty. And as we would not be diagnosing or treating which should really decrease our malpractice risk. And we really would get to carve out a niche that few others are doing in the same way. It would take some initial work, but anything good does.
Anyone want to sign up with me?
Dave
 Dave has been a PA, and later NP, leader for thirty years. He strongly believes that NPs and PAs must work together to insure a better future for both professions. Most recently Dave has been busy launching another dream; Clinician 1, the first internet community for PAs and NPs. In October 2008, Dave was honored by the New Jersey State society of PAs with its “Lifetime Achievement Award”.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
RECOMMEND THIS ARTICLE
You must be logged in
to recommend articles
|
 |
|
|
| A.J. (California) |
on 18 Feb 2011 at 10:36 pm |
|
| Has anybody actually made any progress on this? Samuel Merritt College in Oakland, CA has both NP and PA programs. Might be an excellent place to think about a joint Lifestyle Medicine track .... |
|
| Regina (Pierce County, WA) |
on 02 Jan 2011 at 1:51 pm |
|
| I just saw this post! I am also starting a small business in health coaching. I practice as a nurse practitioner in urgent care currently. for two years I have been trying to get University of WA school of nursing to allow me to get a DNP in the area of lifestyle medicine. Seems that the idea is just still not what nursing will grab onto. |
|
| Paula (nc) |
on 29 Aug 2010 at 1:02 am |
|
Dave, Here is a link to duke's program:
http://www.dukeintegrativehealthcoach.org/ |
|
| Paula (NC) |
on 29 Aug 2010 at 12:38 am |
|
| Dave, this is not a new idea but I like the idea of our groups coming together to promote Life Style Modifications. Duke Integrative medicine has health coach training as do other integrative medicine sites. Andy Weil's group in AZ has a residency for non_MDs. It is pricey though, but may be worth copying. |
|
| Carrie (Vermont) |
on 19 Aug 2010 at 1:19 pm |
|
| This is a fantastic idea, but the model is not new. This is exactly what many chiropractors, naturopaths, and functionally trained medical doctors have been doing for years. While it can be challenging to get your patients to pay out of pocket, it can be done as we do it in our office every day. We educate all of our patients on the benefits of diet, exercise and lifestyle modifications that truly prevent disease. |
|
| Marie Charles NP-C (Miami, FL) |
on 11 Aug 2010 at 10:10 pm |
|
| Great idea! I am a new ARNP and during my training what I have enjoyed the most was teaching patients about lifestyle modifications. Please sign me up. |
|
| Sharon (Tampa, FL) |
on 10 Aug 2010 at 6:34 pm |
|
| love your out of the box thinking, count me in |
|
| Ann B (Pottsville, PA) |
on 09 Aug 2010 at 11:21 am |
|
| Sign me up too! Sounds interesting! |
|
| Ann Hurd, ARNP (Lansing, KS) |
on 06 Aug 2010 at 3:43 pm |
|
Sign me up! My cardiologist focuses on Health and Wellness and Lifestyle changes to stop disease. It works!!
Dr. James O'Keefe wrote the book the "Forever Young Diet"! Has an NP who counsels for Cardiac Wellness which works for all diseases! Would love to be able to counsel patients about how to prevent disease and progression of disease and get reimbursed for it!! Need to change the lifestyle our children are being introduced to with fast food and no exercise! |
|
| Summer Tangeman (Littleton, CO) |
on 05 Aug 2010 at 6:58 pm |
|
I would be very interested! I have worked in primary care and hospitalist medicine and I must say that there should be a team likely lead by PA or NP for patients who have diseases that require lifestyle modification intervention. I also agree with "vwburke" comments on how to implement this as stand alone. Patients idenitified in the hospital could be referred to the clinic for consultation.
Working on the insurance companies is another issue. Perhaps they could see it as "rehab" as they do for Cardiac and COPD? |
|
| Lorene (Minneapolis) |
on 04 Aug 2010 at 11:47 pm |
|
| I totally agree. I run an independent non profit lifestyle focused cardiac prevention program. Pooling our knowledge,outcomes and experiences as professionals to determine the most cost effective model with great clinical outcomes would be most helpful as well as networking on a peer level. Keep me in the loop Lorene ACNS BC |
|
| A. Garrett, RN,MSN, NP-C, CLNC, CPM (Troy, Alabama) |
on 04 Aug 2010 at 10:55 pm |
|
| This is what health promotion is all about. Pender was a great forerunner. As nurses we provide our best care through promoting health rather than treating disease. An ounce of prevention is more valuable than a pound of cure. |
|
| Annette, PA-C, Licensed Corporate Wellness Coach (Modesto, CA) |
on 04 Aug 2010 at 9:56 pm |
|
Hi Dave,
What an incredilbe coincidence! I have been a PA for 13 years and have been a Licensed Wellness coach for 3 years. I opened a wellness center last year and had to close it 2 weeks ago due to the economy. Most of the people that were interested in the services could not afford to pay and were asking why the insurance companies would not reimburse for the services. I closed the Wellness Center 2 weeks ago and am in the process of starting a Wellness Coaching Practice where I will be doing all of the things that you mentioned. If we could somehow get the insurance companies to pay for this it would be a win-win situation for all involved. You have my vote... especially since I am already doing it! |
|
| ann (LONG ISLAND NY) |
on 04 Aug 2010 at 8:47 pm |
|
| I agree. Very well presented Dave. As a Nurse Practitioner in Psychiatry, I would like to see more wellness, preventative medicine practice. Mind, body connection is seen in everything, ranging from pain management, hormone modulation, depression, addiction, blood pressure, obesity, etc. Instead of prescribing medication quickly and sending them on their way, month after month. There is always more to the original symptoms. Taking the time to listen to clients, patients, involving them in their own wellness, is the key to success. |
|
| Stephanie Mazal, PA-C (Columbus, OH) |
on 04 Aug 2010 at 6:48 pm |
|
Dave, I love your thoughts and have been looking to find other health professionals with the same mentality. I completely agree with taking the time to sit down with patients to discuss lifestyle and teach preventive medicine. In a utopian world, we would wean people off of their meds and reverse chronic disease instead of prescribing more meds as diseases progress.
Your idea of creating online courses to teach other healthcare professionals is spectacular. I'm actually currently taking a Lifestyle Medicine Certification (telephone) course right now taught by some of the top gurus in the field.
I would love to discuss this with you further.
StephanieMazal@gmail.com |
|
| Diana (Connecticut) |
on 04 Aug 2010 at 3:50 pm |
|
| I agree with Dave and would love to pursue a degree that addresses these issues. I practice this in my clinical setting and bring years of clinical experience from an urgent care setting, college medicine, primary care, and most recently pain management. So, yes keep me updated and sign me up. |
|
| Marian Berry, FNP (Warm Springs, Ga) |
on 04 Aug 2010 at 2:42 pm |
|
| Finally the physicians are starting to get the big picture...you have treat the whole person and not just his runny nose. I'm definitely on board with this style of practice. |
|
| JOANNE (GARRISON, NEW YORK) |
on 04 Aug 2010 at 1:04 pm |
|
GREAT SUGGESTION.
I WORK IN ADDICTION MEDICINE IN BOTHE ADULT HEALTH AND PSYCHIATRY. I NEVER COULD SEPARATE THE MIND FROM THE BODY.
GOES ALONG YOUR IDEA OF WELLNESS AND INTEGRATION
MY DOCTORATE IS IN INTEGRATIVE MEDICINE.
I'M ON BOARD! |
|
| Barbara (Valdosta Ga) |
on 03 Aug 2010 at 11:46 pm |
|
| As you stated above we do it in bits and pieces already. I would enjoy a specialty such as lifestyle medicine, i firmly believe that would greatly decrease the need for many medications and people would be healthier. Less hypertension, diabetes, heart disease. Show me the way |
|
| jo Schroeder NP (Santa Fe , NM) |
on 03 Aug 2010 at 10:10 pm |
|
Bravo! Please keep me on your e-mail list. I have a medical/cardiology background and would love to see
a lifestyle focus specialty. jo |
|
| susan (beaumont, tx) |
on 03 Aug 2010 at 8:57 pm |
|
| this sounds like my cup of tea. |
|
| vwburke (memphis, tn) |
on 03 Aug 2010 at 7:42 pm |
|
The first viist would be billed as a routine physical. All of the areas for screening are addressed and physical exam are performed. Subsequent visits are an issue since insurance companies only pay for one physical a year. So there's where the patient would have to pay out of pocket but could use their flexible spending accounts so at least it would be pre-tax dollars spent.
I see on-line modules to be completed, then a certification exam, as things providers would need to to have in order to the value-added aspect of a Lifestyle Medicine practice. Just some ideas of mine. |
|
| LW (Oregon) |
on 03 Aug 2010 at 7:02 pm |
|
| I think this could have great potential. I work in oncology and I would love to see fewer people end up in my current workplace. Lifestyle medicine could accomplish that. |
|
| Sandra Rae NP (Easthampton MA) |
on 03 Aug 2010 at 5:41 pm |
|
| Sign me up! I am a strong proponent for lifestyle healing. |
|
| DAVE Mittman, PA (Livingston, NJ) |
on 03 Aug 2010 at 3:25 pm |
|
Scott: My email is MittmanPA@gmail.com
Also join Clinician 1 if you have not yet done so. There are good discussions all of the time.
Dave |
|
| Scott (Louisville) |
on 03 Aug 2010 at 2:51 pm |
|
I agree Dave, and would love to discuss some details with you in person. Please email and we can brainstorm. I currently work in Ortho Surgery, but my passion and background are in "health-care" and not "disease-care" !
Thanks. |
|
|
|
|
| |
|
|
 |
 |
|
 |
 |
 |
|
