What is the best functional medicine training program?

Posted on by Meg McElroy MS, PA-C

I started my path in functional and integrative medicine in the 90’s.  I’ve worked for others. I’ve co-owned my own practice. And today, I work with the amazing team at Parsley Health.  

In addition to working with patients, I also do what I can to support my colleagues through my free weekly clinical pearls emails and through a private Facebook group for my PA and NP colleagues. I receive a lot of messages asking me:

“What is the best functional medicine training program?”

My answer is always the same: There isn’t one! But I have many tips for finding the best one(s)!

Here are the 5 strategies I recommend for anyone getting started on their journey in functional medicine.

  1. Be really CLEAR about what is and what is not functional medicine
  2. Get really CURIOUS about why and what interests you the most about functional medicine.
  3. Be aware of the DOWNFALLS of functional medicine training
  4. TIPS FOR GETTING STARTED in functional medicine training.
  5. STAY ORGANIZED from the beginning.

#1: What is functional medicine, and what is not functional medicine?

If someone asked you: what is functional medicine? How would you respond?

Start with the definition provided by Institute for Functional Medicine (IFM), which is considered by many to be the “mothership” for functional medicine education.

For more of a background on how functional medicine originated, I highly recommend reading some articles by Dr. Jeffrey Bland found on PubMed (he is one of the founders of functional medicine, including IFM). One of my favorites (since I love educating my patients on the role of mucous and the gut), is this one which includes a brief story about how Dr. Bland developed the concept of functional medicine.

As you read through the above articles and definitions, what stands out for you?

Or you can start with my definition: functional medicine focuses on helping patients improve daily FUNCTION.

This care involves constantly asking “why” a symptom or condition is present, and means we have to get really good at reverse engineering the physiology and biochemistry of symptoms and conditions! 

But also be aware of the misperceptions of functional medicine:

  • Functional medicine is NOT “natural” medicine. Yes, supplements are often part of treatment, but these are not natural (most are made in a lab!).  And herbs, which are natural, may be part of these but aren’t always in the right form to provide effective treatment outcomes.
  • Functional medicine is NOT anti-pharmaceutical, or focused on replacing pharmaceuticals with supplements (aka “green allopathy”). I still prescribe pharmaceuticals in my practice, either for therapeutic or long-term use, but frequently consider ways to eventually get someone off drugs (if desired by the patient).
  • Functional medicine is NOT a specialty. For practitioners, many assume they can just transition into a functional medicine practice and learn on the job. But functional medicine is not a specialty – it’s an entirely unique model of practice. For example, with most of my patient encounters, I typically provide treatment recommendations in 8 categories (with guidance and education on each of these to help a patient understand the recommendations better): Nutrition, Supplements, Pharmaceuticals, Movement/Exercise, Sleep/Relaxation, Stress Resiliency, Environment, and Mental/Emotional/Spiritual.
  • Functional medicine does NOT include specialty IVs, compounded pharmaceuticals, and other unique treatment modalities. These treatments fall under regenerative medicine or orthomolecular medicine.

#2: Get Curious

Practitioners are increasingly becoming interested in functional medicine. Some have directly experienced a health issue that was improved via a functional medicine approach, others feel like “drug dealers” (prescribing pharmaceuticals for chronic conditions that could be reversed through lifestyle modifications), but many may just want a more fulfilling career in medicine.

Ask yourself: Why does functional medicine interest you, and what aspects of functional medicine get you the most excited?

#3: Downfalls of Functional Medicine Training

Let’s cover a few pervasive downfalls for those that have gone through conventional medical training who are wanting to practice functional medicine:

  • Most programs teach in detail about a different evaluation process.  For example, the IFM uses the Timeline and Matrix, and SAFM uses SAFM Mapping.  These are best for those with a lot of time to prepare for a patient visit.  In my current practice, where I only have 5-10 minutes to prepare for a patient visit, I use a modified “SOAP” instead.
  • Most programs don’t discuss implementing functional medicine education into insurance-based conventional practices. I haven’t found any organization that provides a list of recommended ICD-10 codes, or tips on improving insurance coverage for visits and labs. And there is very little awareness of how “comprehensive” testing (i.e. ordering a lot of blood tests) can result in a $2000-$5000 bill from the lab when insurance refuses to pay.
  • Most programs don’t provide methodical approaches to symptoms and conditions.  No program should provide one-size-fits all protocols (since functional medicine is personalized medicine), but this isn’t what I’m referencing. What I mean by “methodical” is that a functional medicine approach should start with “low-hanging fruit” (e.g. poor lifestyle habits) and basic bloodwork before considering additional testing and treatments.
  • Most programs don’t emphasize the importance of “thinking allopathically” before  “thinking functionally”.  What I mean by this is to rule out red flags like cancers, gall stones, etc.  For example, one of the worst cases I’ve heard of was a patient with refractory SIBO who actually had advanced cancer causing the SIBO (patient had been treated by 2 other functional practitioners – one was allopathic-trained, the other was not). This is also one of the reasons I recommend my colleagues (including physicians) have at least a few years experience in conventional medicine before only focusing on a functional medicine approach.
  • Many programs provide scientific literature references, but just like in conventional medicine, I rarely find that practitioners read these. Some of these are good quality options like meta analyses or RCTs. But some are not. To be really great at functional medicine you have to be curious. You have to read scientific articles and know how to interpret these.
  • Most programs don’t provide education on lab interpretation and specifics of supplements as treatment. But even more importantly, they do not provide the shortcomings of laboratory testing and the risks around treatments. This is where I see a lot of health coaches and physicians go wrong – often treating the labs and not the patient. And recommending a LOT of supplements. There are very few studies that evaluate supplement-supplement interactions!

#4: Tips for Getting Started in Functional Medicine Education

There are many great organizations that can get you started in functional medicine.  Having trained with over 15 at this point, my personal experience is that none stand out as the “best”.  Click here to review the oldest and most well known top 3 organizations.

You can start where I did, which focused on reading scientific literature and weighing the pros and cons of various treatment approaches. I am particularly fond of popular journals like JAMA and NEJM, but also Nature, BMJ, Cochrane, and Townsend Letter. I also attended local workshops, talks, and conferences.

For formal paid learning, I generally say the program you start with depends on how you learn best, where you practice, how you practice, and your scope of practice.  Here are some questions to consider (with some possible program options that may be a good fit):

  • Do I want to learn via live content? (1, 3)
  • Do I want to obtain Category 1 CME?  (1, 2, 3)
  • Do I prefer to learn via my own-pace, with pre-recorded courses?  (2, 4, 5)
  • Do I want to have a discussion on cases studies? (2, 4)
  • Do I need transcripts for each lecture?  (2, 4) 
  • Do I want to have my own practice?  Most programs will provide guidance on the business side (even IFM, to a small extent). Ultimately, though, I highly recommend working with a company that specifically addresses the business side for you (I tried to do it all as a business owner, and got burned out quickly, despite having guidance from educational programs). There are just under a dozen companies I’m aware of that can help with this (listed in the educational guide).

(1) IFM, (2) SAFM, (3) A4M, (4) Kalish, (5) Kharrazian Institute

Beyond the above questions, some other tips I recommend (before committing to an entire program) include:

  1. Take one deep dive course from SAFM.  Experience the teachings of Tracy Harrison via a free course: Conquering Constipation (register here) or Headaches (From Rapid Relief to Root Cause Interconnectedness) (register here). Tracy is also very active on the SAFM Facebook page.
  2. Take one module from IFM, and make sure to watch pre-course materials to understand what the “Matrix” and “Timeline” are.  I recommend starting with Cardiometabolic or the Gut module (each cost close to $1500 for over 15 hours of CME).
  3. Take one course (or attend the yearly conference) from A4M (which is more focused on regenerative medicine over functional medicine).
  4. Take the core competencies course from ACLM (American College of Lifestyle Medicine). These are pre-recorded courses, CME provided. Cost is around $999 if not a member, for 32 hours of CME. This organization also has an annual conference that is covers a lot of topics (and includes CME), and is most “accepted” by mainstream medical organizations such as the American Medical Association.

What I don’t recommend?  

  • Don’t take a weekend course or a course that promises complete competency in a few weeks/months. You will be doing your patients – and the functional medicine model – a great disservice.
  • PLEASE don’t plan on owning a practice until you’ve actually practiced per the functional model for at least a year.  Many get burned out by doing this (partly because functional medicine attracts patients who have seen a lot of practitioners and still aren’t better).
  • If you’re a recent graduate, get experience in allopathic medicine first (at least 1-2 years) while receiving CME’s in functional medicine training.
  • Don’t plan on doing functional medicine “on the side” as a coach if you have an active practitioner license – lots of legal implications to this (don’t let colleagues tell you otherwise, either!).  I recommend having a good affordable attorney who knows functional/integrative medicine laws, such as Scott Rattigan or Peter Hoppenfeld.

#5: Stay Organized

Something I wish I had done in the beginning of my functional medicine journey was to keep the information I was learning in an easy-to-access format. There is 20x more information we need to recall and consider when practicing functional medicine, and to prevent mistakes and burnout, it’s important to have a system where you keep your knowledge organized and easily accessible. 

To try to decrease the chance of forgetting something important, I have over a thousand EMR templates I use in practice (I share some of these in my clinical pearls emails), and I have a single document that has an A-Z spreadsheet filled with key points on topics ranging from individual supplement ingredients to comprehensive list of things to consider in specific disease states.

I created a PDF with examples of these practices (which you can request access to via this link).

In Summary

There are over 100 options for education, and half a dozen options for comprehensive programs (I know this because I put these all in a resource!).  Start with knowing what functional medicine actually is and what it is not, be aware of limitations from all programs (specifically for those with an allopathic background, like myself), know what you want out of your education, experience a “taste” of various programs if possible before committing to an entire program, and know that there really is no “best” program!

REFERENCES:

The information above is based off my personal experiences and opinions. These should not be considered an objective reflection of any individual organization.