Let's just make this democratic: Are you for Specialization in TCM?

This is a tough question to answer....I would say that in a city like say Vancouver, one could, and would do well to specialize, but in a small town, like the one I live in, one could not survive specializing in one thing alone. So when it comes down to it, I see the benefits of specializing, but as it is in the western medical field, I think it is best to have both, general practitioners and specialists.

I think specialization in one area of TCM can be a blessing for
one practitioner because it would demonstate in his or her ability to treat a chronic long term condition in a patient. Of course, this is a very complex issue. Personally, there would
also be more training and education to immerse oneself in
one thing just as it would require to train and specialize
in many other areas of TCM.

This question is WAY too simplistic. As I understand it, the debate raging now is not about specialization, but rather about whether a particular group of individuals is qualified to determine who does and does not earn the credential of "specialist". Who makes the determination, on what that is based, how much it costs, how long it lasts, the requirements for re-certification, etc. are all important questions. I don't think that anyone thinks that specialization is necessarily a bad thing. It makes more sense in larger markets. If I have one acupuncturist in my town, I want that person to be a generalist. If my generalist needs are met, then I am interested in having specialists. Who will be granting this title of "specialist", on what authority, and to what gain? There is money involved in applying for this certification; where does that money go? How much should it cost? This is about much more than just specialization.

I haven't really been following the thread. If I'm repeating what others had said, my apology.

I'm just a student of TCM and in my mind specialisation in TCM is really an oxy-moron. If specialisation means child-birth or female complaints or cosmetic therapy etc. then by all means. But if it is specialisation that is disease specific such as cardiology or neurology etc. then it doesn't really make sense.

In TCM it is said that a herb can cure a 1000 symptoms and a single symptom cured by a 1000 herbs. The chinese use 1000 to mean a lot rather than the literal 1000. TCM is about individualisation and NOT specialisation. Even if one wants to specialise in cosmetic therapy the physician still need to go through the symptom profile. The liver spots, the droppy eyelids, the wrinkles etc. perhaps could be due to Lung and/or Large Intestinal problems. The manifestation on the skin is just one of the symptoms.

In short, specialisation in TCM doesn't make any sense at all......at least in my mind - who's just a student and know not enough to be really sure 8-). So I stand corrected on this.

I agree with so much being said out there, but this question was supposed to be simple, it was not about the ABORM in particular. And, as far as specialization goes, you do not have to opt in to specialize, it is quite obvious that in a small town this makes no sense.

As for the students thoughts, I agree in parts. TCM IS about specialization, just visit a TCM hospital in China and you will see this. Although, you are right that specialization in a specific disease is not normal. With that said, once you begin to practice, and if you do specialize, you will quickly see how beneficial it is to specialize,...it will show in your confidence as a practitioner, and both your patients and referring doctors confidence. This is very important in the world of clinical practice and the advancement of our profession.

I think we need to define what this idea of specialization means. In BC we actually cannot label ourself as a specialist, meaning we cannot hide behind the label and we need to let our skills shine from our success stories and confidence. If we become competent in treating a certain problem, others will want to see us, and this is how we specialize. So how do we gain competence in a certain area and do we need to. Well I can speak for myself having been in two different worlds- one of being a generalist in a town of only 2000 people and the other as being a practitioner who only focuses on reproductive health and dermatology (My faves!). When I worked as a generalist, I was constantly bombarded with cases that I had no idea to successfully treat. I mean I was taught in a general way how to treat many disorders, but when it came down to the nitty gritty of getting meaningful results, I was often chalenged. I soon gained a lot of respect for the WM general practitioners, for the knowledge they need to carry around from day to day is immense! I also learned that many GP's do not get very deep results, mostly because of their lack of ability in knowing a certain disease really well. I actually think it is impossible to know everything about every disease. So even in my small village of 2000 people I started to focus on the areas I liked and the ones I felt confident to see results. I started to seek out teachers who were affluent in their fields. Soon a veil of ignorance started to become lifted and I gained more and more confidence in the treatment of disorders that I was afraid of previously. I could understand why Doctors of Chinese medicine for the past several hundred years, have focused on one particular area more than another- they get really good at the diagnosis of a certain disease, the treatment, and also an idea of prognosis and results.
The practice of chinese medicine that I have been taught is that we define a disease name first and then figure out the pattern differentation of that particular disease and then write a prescription. We need to know how that particular disease behaves, the mechanism behind it, and any empirical treatment methods specific to it. For example the treatment of itching for psoriasis and excema can be completly different depending on how that disease is manifesting. If we do not know the main characteristics of psoriasis and its empirical treatment and just choose to apply some standard skin formula we learned in school like Xiao Feng San, then we may not see very good results. This will frustrate the patient and also leave the practitioner questioning CM's efficacy.
I think that to be a health practitioner with integrity, one needs to know what they can treat, what they cannot treat. They need to know when to refer or where to seek out the proper guidance when they don't get the results needed. I think, if anything, specializing helps a practitioner be honest with themselves and with the public. And that honesty comes from the experience of treating a particular health concern with success, and then having gained a deep confidence that one could treat many similar cases.

TCM is about treating the individual. Also a good practitioner can treat
most any problem. It is good to discover ways to treat pain and certain
problems however to go towards specialization just furthers the western
medical agenda and waters down our practice.

If we start to specialize it is easy for people to simply study that
particular problem and creates cook book acupuncturists and plug and
play treatments. You see that all over in infertility clinics. They
treat everyone the same and charge huge amounts of money for a simple
treatment with no sophistication. It leads to lazy practitioners and
waters down the profession. You see poor practitioners with great
business skills taking people and treating them all the same.

China does this because they sold out in the communist revolution. TCM
is dead in china it will be lost altogether in 20 years due to this
specialization and integration with western quick fix medicine.

Beware of specialized practitioners they are usually not into the art
but the money.

I hope we can save traditional practice which is almost a spiritual
path and leads to masters not just a nice retirement. Don't throw out
5000 years like mao already did.

I am curious of those saying specialization goes against the foundation of TCM if any actually have a practice. If you are a student or have been practicing for less than 2 years then you are forgiven.

I am only in my 8th year of practice (very new) and at least 5 of those have been in treating gynecology (mostly infertility and pregnancy). The fact that I was once a student, like some of you on this thread, and that I also spent my first 3 years in practice being a generalist before I focused into the area of reproductive health gives me an advantage. The advantage is that I have once been in your place (a student and then a generalist) but you most likely have not been where I stand as a practice focus of Dr. TCM. (Legally we can not say we are specialist in BC so i will use the word practice focused when referring to what I do)

If one is to specialize in treating infertility their patients also come in with back pain, migraines, eczema, digestive upset etc. The doc still treats their patient wholistically. They still address all of their health concerns. To optimize a woman's reproductive health you first must regulate her cycle. So you are practicing Gynecology right from the start. You do a full in take, come up with the disease categorieS and also the pattern diagnosis. base your treatment principles on the pattern diagnosis and considering the disease diagnosis as well. That is how I was taught. Pattern diagnosis most important and disease diagnosis secondary. Secondary meaning you do not ignore the disease.

So I know I see the same variety of complicated patients as my generalist colleagues (thyroid issues, insomnia, pain, diarrhea, constipation, IBS, PMS, Painful menses, Night sweats, palpitations, eczema, acne, alopecia, and the list goes on) the only difference is my patients will not consider my treatments a success if I relieve all of her other health complaints and no baby at the end.

I know from my clinical experience that being focused in an a certain area is still TCM. Experience is priceless and specialization is sure a fast way to gain experience.

I am young doc, you do not need to take my word for it especially when you can listen on CMT radio to the opinions of the great minds of today who practice TCM. Here what they have to say about specialization. (Bob Flaws, Peter Deadman, Randine Lewis, Michael Tierra and more)

http://www.chinesemedicinetools.com/audio-podcasts/ specialty-certification-debate-the-aborm-others

PS I miss the days of being a student when every patient fit into a text book pattern.

Lorne
www.prodseminars.com
www.acubalance.ca

I'm a student of TCM but that doesn't make me naive. I'm actually quite old and had a lot of experiences in education, science and engineering.

To my mind specialisation in TCM is an oxymoron. I don't mean any disrespect but the word describes this state of affair correctly. TCM underlying philosophy is that the whole person is NOT the sum total of the individual parts. All are interconnected and the relationships , the energy flow, the fluid etc are all intimately connected and the derangement in one area could be due to disharmony in others. I remember when I was in India I had this terrible trigger finger. The doctor didn't ask me about my finger or my hand but instead asked me about symptoms of the stomach, the bloatedness, the gas discharge, shitting habit etc. He then prescribed salt pills made from vegetables and it cured my problem while western medicine was still scratching their proverbial head to understand the problem. I actually saw specialist and what good were they when the problem, according to the ayurvedic doctor, lies in my stomach. I've low agni fire , he said.

TCM is the same. Let's take a case of eye discharge, floaters in front of the person etc. An eye specialist means that the eye is looked at for causes to the problem. But in TCM that is only a symptom and is not the cause. The cause lies in the liver fire. That liver fire could be due to kidney yin deficiency or could be due to liver blood stagnation or even an overactive shen due to too much studying. This basically means looking at the whole person.

A person with skin ailment may also have asthma and dandruff. Are all these to be treated by different specialties or aren't all linked together to the derangement or disharmony in the lung meridian ? If disease differentiation is to be adopted then you have 3 different treatments and yet the underlying cause of the problems are not addressed. And this could be due to a whole range of disharmonies. In short TCM do not treat diseases but the person.

The skill to treat problem of infertility is the same as the skill needed to treat all the other problems in TCM beause all parts are linked. To argue that specialisation allows one to be competent in one area would suggest incompetence in other areas and as our body and the whole underlying philosophy of TCM is based on the notion that the whole is more important than the parts then specialisation makes us really incompetent.

I do not know why there's this need to call one a specialist unless one get to charge more for it. Competency in one specific area reason just doesn't wash with me and in fact actually argues against it.

There is a wonderful treasure and depth of information related to every facet of human spiritual/energetic/physical anatomy that is there for us to explore. Some people choose to go deep in one area because that is what appeals to them. Others want to be more broad in their focus.

I consider myself a specialist because most of my cases are in the area of gynecology. By necessity I have to be more versed in this area of medicine both from the TCM and Western sides, and I feel this is of tremendous benefit to my patients. And, in my experience, my understanding and competence in the holistic principles of Chinese Medicine has actually been fortified and strengthened by my intense focus into one aspect. It has gathered and focused my Qi and made it more capable of penetrating into layers of philosophy and thought that I was previously unable to truly grasp.

I think that we, as a community of healers, benefit greatly when each of us finds our own area of expertise and passion. But, the real beneficiaries are the patients. Countless times I have had patients come to me who said they were very happy to have connected with someone who has a focus in the area where they are suffering. They are very pleased when I can interface in a very concrete and specific way with the information their conventional doctor is giving them.

Now that I am specializing in something, I will never go back to being a generalist. That is from my experience. I'm sure yours will be different. For those who have a passion for the more general type of practice, I salute you. Yours is actually, in my opinion, a more difficult and challenging road.

And, based on the above statement, I guess what I'm implying is that even if you are a generalist, you are still a specialist. You are specializing in "General TCM". So, dive into it, and explore it to its absolute depths, and enjoy it. As long as your patients benefit, that should be all that matters.

Chris Axelrad, M.S.O.M., L. Ac., M.M.Q.
Houston, TX