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.
One of my “extracurricular activities” involves supporting the education of my peers, particularly in the correct clinical use of functional medicine. I moderate a private Facebook group for my PA and NP colleagues, and new members often ask about jobs in functional medicine, and how to get more training in this “specialty”.
A few years ago I started collecting educational resources on functional and integrative medicine. When I started my journey in functional medicine, in the 1990’s, learning was primarily from Dr. Andrew Weil’s Integrative education programs, Townsend Letter, and reading scientific literature (and applying the findings to clinical practice). The educational opportunities have significantly expanded since the 90’s, and my recent research has identified over 120 organizations for functional or integrative medicine education!
Addressing the question as to what is the “best” option requires some more information, so I’ve laid out this article into 4 parts:
- Defining the original concept of functional medicine.
- My perception on the downfalls of current functional medicine organizations.
- Questions to ask as you look for the “best” fit.
- My go-to recommendations for those just getting started.
What is functional medicine, and what is not functional medicine?
There are many definitions for functional medicine, but please don’t go off Wikipedia’s definition (which indicates it’s “alternative” and “pseudoscience”)! The Institute for Functional Medicine (IFM), considered by many to be the “mothership” for functional medicine education, definition is most accurate but also a touch obscure.
In my experience, the best functional medicine care comes from those that think through the biochemistry and physiology, and “treat” with a combination of patient education and evidence-informed treatments. This care involves constantly asking “why” a symptom or condition is present. 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.
Functional medicine sounds like the answer for patients that are suffering and aren’t feeling better via a conventional medicine model, and for practitioners that are burned out by the medical system. But practicing this model of medicine is not easy, and there are many misperceptions about functional medicine. Here are a few:
- Functional medicine is “natural” medicine. Yes, supplements are often part of treatment, but these are not natural (most are made in a lab!). We use a lot of non-pill options for treatment, such as recommending alterations in lifestyle and nutrition, but functional medicine is not intended to be all natural-treatment based or “green allopathy”.
- Functional medicine is standardized. Almost anyone can say they practice functional medicine (even without a background in medicine, or even any formal training). This lack of standardization can give functional medicine a bad reputation, and I’ve unfortunately met patients who based their entire experience (and opinion) on a bad encounter.
- Functional medicine is 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 a model of practice.
- Functional medicine uses more labs to evaluate and treat. To an extent, this is common but doesn’t need to be the norm. Labs can help, but many cannot afford these (especially specialty labs that are not covered by insurance). I always try to remind my colleagues about one of the foundational tenets in medicine: treat the patient, not the labs!
- Functional medicine is only for those who can afford it, and for practitioners who want to make a lot of money and write books. Contrary to what you see on the internet and social media, not all functional medicine practitioners are trying to get rich and famous. Some of the best practitioners I know are not on social media and don’t get caught up on the “band wagon” of marketing new products to their patients and charging thousands for a visit. There is not inherently anything wrong with this approach, it just shouldn’t be a stereotype that is placed on all who choose to practice according to the functional medicine model.
What are some downfalls of many functional medicine programs?
There are many great organizations that can get you started in functional medicine. Having trained with over a dozen at this point, my personal experience is that none stand out as the “best”! As an allopathic trained practitioner, I find the following pervasive downfalls:
- Most programs use a different evaluation process that makes it challenging for most allopathic practitioners to implement into practice. For example, the IFM uses the Timeline and Matrix, and SAFM uses SAFM Mapping. These are not easy to use quickly and efficiently, and can take weeks to months to use. I think it would be more beneficial to use a “SOAP” note template via a functional lens, rather than trying to reinvent an evaluation process that took me years to learn.
- Implementing functional medicine education into insurance-based conventional practices can be challenging. I haven’t found any organization that provides really good ways to utilize mainstream tools such as ICD-10 codes, or tips on improving insurance coverage for visits and labs. It’s not fun to deal with a patient who gets a $3000 bill for labs that insurance wouldn’t cover (especially when you are a practitioner that isn’t contract with insurance companies)!
- 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. For example, I rarely order a SIBO breath test if I suspect this (I’ll treat empirically, and tell patients why a test may be needed). Many practitioners (new and experienced) unfortunately order a lot of expensive functional tests at the first visit and practice green allopathy (giving a supplement to treat every lab abnormality and symptom).
- 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. Most of these are good quality options (e.g. 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. Like Dr. Ruscio says, you have to be “evidence-informed” and know which study types are the best for clinical application (i.e. an in vivo study is NOT a good option!).
- 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 (not unlike conventional medicine approaches, actually…). And recommending a LOT of supplements. Although we have studies to support single ingredients found in supplements, we don’t have a lot that show what happens when we combine ingredients! And every patient is unique. I’ve had patients react negatively to benign treatments like basic vitamins and minerals (often related to the source/coating on the supplements, but genetic SNPs play a role as well).
Questions to consider as you look for the “best” program.
The program you choose depends on your learning style and what you want to treat. It always comes down to 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 need CME? (1, 2, 3)
- Do I prefer to learn via my own-pace, with pre-recorded courses? (2, 4, 6)
- Do I want a mentorship option? (6)
- Do I need a way to “search” for clinical tools or case studies? (1, 2, 5, 6)
- Do I need transcripts for each lecture? (2, 4)
- Do I need the option to download mp3 versions of lectures? (1, 4)
- Do I want a program that uses a lot of scientific literature? (1, 2, 3)
- Do I want to be employed by a practice? (IFM certification is still the gold-standard for this).
- Do I want to have my own practice? Most programs will provide guidance on the business side (even IFM, to a small extent). Kresser Institute is particularly well-known for this (he provides templates and handouts for use in the clinical settings, and a significant amount of training is provided on the business side). 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).
No matter what your learning style, no education program will truly make you feel confident to implement functional medicine in a clinical setting. You have to practice it! And you still have to ask “why” and question everything (even what you are taught in educational programs!). Click here for a brief overview of some of the top programs.
My go-to recommendation for those new to functional medicine.
Before committing to an entire program, I recommend the following:
- Take one deep dive course from SAFM. There are over 17 options (don’t start with a complicated one like “Detox” or “Fibromyalgia” though!). No CME for these (there is CME for each semester), but cost is around $300. **Update as of May 2021, these are no longer available for individual purchase without joining the semester program, BUT you can get one on constipation for free (register here), or see a free 4-part webinar series on the root cause of dis-ease (register here).
- Take one module from IFM, and make sure to watch pre-course materials to understand what the “Matrix” and “Timeline” are. Just like with SAFM, don’t take an advance topic like Immune or Biotransformation. I recommend starting with Cardiometabolic or the Gut module (each cost close to $1500 for over 15 hours of CME).
- After taking a course from one of the above, try out a monthly membership for a few months (most don’t require a full year commitment). I like Ruscio Institute ($29/mo), Consult Dr. Paul Anderson ($49/mo), and Kara Fitzgerald’s program ($99/mo after a registration fee). I like Kresser’s Academy as well, but that appears to be shut down at this point.
- Consider taking 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 CME. This organization also has an annual conference that is covers a lot of topics (and includes CME).
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 is great disservice. And the functional medicine model a great disservice.
- Don’t go just off of recommendations from others. Ask about the potential downfalls that are specific to your needs (see questions to ask above)!
- 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) which 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.
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!
- Bland J. Defining Function in the Functional Medicine Model. Integr Med (Encinitas). 2017;16(1):22-25.
- Bland J. The Gut Mucosal Firewall and Functional Medicine. Integr Med (Encinitas). 2016;15(4):19-22.
The information above is based off my personal experiences and opinions. These should not be considered reflective of any organization from where I’ve received training or with whom I may be affiliated.