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Can CAVM Become Board-Certified?
By Narda G. Robinson, DO, DVM, MS, FAAMA
 The American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR) recently received recognition by the American Board of Veterinary Specialties (ABVS). Given this development, some may wonder whether complementary and alternative veterinary medicine could achieve similar status.
To do so, an organizing committee would need to demonstrate to the ABVS that “improved veterinary medical services will be provided to the public … and [that CAVM would] represent a distinct and identifiable specialty of veterinary medicine, one that is supported by a base of scientific knowledge and practice.”1
It’s the last part, the scientific requirement, that usually poses the biggest hurdle for CAVM.
However, sports medicine’s specialty recognition may have conferred de facto acceptance onto at least some CAVM modalities. This is because approaches such as laser therapy, acupuncture, massage and electrotherapy frequently appear in physical medicine protocols.
Whether the ACVSMR will explicitly incorporate CAVM into residency requirements remains unspecified. If so, which techniques will qualify, and why? Will acupuncture (dry needling) and trigger-point therapy become mainstream veterinary rehabilitation methods?
A Case for Acupuncture
Acupuncture is growing in popularity in human sports medicine with mounting evidential support.2,3 Athletes turn to acupuncture for generalized pain control as well as exercise-induced muscle soreness, lateral epicondylitis, osteoarthritis of the knee, low back pain, neck pain, rotator cuff tendinitis and anterior knee pain.4
It even provides immediate benefits on muscular strength after one treatment, according to a just-released study.5 More states are authorizing physical therapists to perform dry needling for neuromuscular pain and functional movement deficits.6
On the other hand, “sports chiropractic” for humans has, at least in the past, suffered from a lack of evidential support and “unorthodox individualistic displays of egocentric treatment approaches that emphasize specific technique preference and individual prowess rather than standardized evidence-based management.”7
For veterinary sports chiropractic, few to no studies even exist documenting its safety and effectiveness. Will this lack of proven benefits impede its inclusion under the sports medicine rubric?
While certain CAVM techniques may find a home in rehabilitation, the broad applications of CAVM extend beyond physical medicine. Currently, though, no ABVS-recognized veterinary specialty organizations in CAVM exist. Instead, a wide array of certification programs in CAVM has blossomed over three decades, with more sprouting all the time.
These self-appointed certifications form an uneven patchwork and generate confusion. Few understand what these qualifications either mean or fail to mean, though the public finds comfort hearing that their veterinarian is either board-certified or certified. Many don’t know the difference between the two.
They assume the term “certified” indicates specialized training and demonstrated competence in the field. In CAVM, a long strand of post-nominal initials asserting advanced credentials in everything from Chinese food therapy to invisible energy manipulation seems to heighten the marketability of one’s services.
Defining Board-Certified
Certifications grant implied legitimacy to the modality, whether earned or not. Because no independent agency scrutinizes CAVM curricula and holds its instructors accountable to teach only scientifically based material, consumers have no guarantee that a multiply-certified practitioner knows how a treatment works or why, and whether it is safe.
Making the situation murkier, certain CAVM groups offer not just “certification” but “board certification,” completely independent of the ABVS. This process sidesteps the rigorous criteria imposed by the ABVS and muddies the meaning of “board-certified veterinary specialist.”
If CAVM practitioners could prove the legitimacy of their treatments, show that their services represent a distinct and identifiable specialty of veterinary medicine, and organize an intensive, scientifically based continuing education program in CAVM, perhaps specialty status could be in their future.
This would serve consumers and the profession well. It would assure that modalities integrated into the specialty have met muster through a preponderance of evidence based on scientific testing. Board certification in CAVM would more clearly differentiate the standard of excellence for a veterinarian CAVM practitioner from a non-veterinarian.
For example, non-veterinarian acupuncturists in Maryland who apply for animal acupuncture certification are required to submit transcripts from their school. Educational documents must verify that the acupuncturist has completed 90 of her 140 hours of training in the “diagnosis of energy dynamics and treatment of animals.” In contrast, she needs only 15 hours in anatomy and physiology, 15 hours in animal handling/restraints/emergencies, and 20 hours in animal diseases and zoonotics.8
With acupuncture as only one example, board certification in science-based CAVM would starkly contrast the educational backgrounds of veterinarians who understand acupuncture as neuromodulation versus human acupuncturists who spend the bulk of their time learning about unverified energies at the expense of animal science.
Elevating the standard of care in CAVM by dint of pursuing and achieving ABVS specialty recognition would reduce uncertainty about what constitutes reasonable medical practice.9 While veterinary medicine, like human medicine, has long valued independence and self-regulation,10 implementing a gold standard for education and practice through specialty attainment would better delineate a best-practices model for CAVM.
Negative Outcomes
State veterinary medical boards, working to protect consumers and improve animal welfare, might achieve their aim more judiciously if the risks and benefits of CAVM were more explicitly known. Rigorous study of adverse events in CAVM is rare, though one study of 1,100 TCM practitioners in Australia identified a “cause for concern,” including 15 reports of death and other serious negative outcomes linked to Chinese herbs.11
Cultivating a dedication to research and fact-finding among CAVM practitioners would allow the veterinary profession to better define what works safely, in addition to when, why and for which species.
Another advantage of developing an ABVS-recognized specialty in CAVM is that diplomates would share a common basis of knowledge based on standardized educational goals and examinations. This would eliminate the current problem of having widely disparate curricula and assessment mechanisms.
While turning CAVM into a specialty may seem inevitable to some, it will undoubtedly sound preposterous to others, especially those who view “alternative medicine” as an “alternative to medicine.”12 Even the CAVM community may resist the idea of promoting a science-based CAVM specialty in veterinary medicine, contending it will rob CAVM of its uniqueness and exoticism.
As the Harvard Medical School-based publisher of the complementary and alternative medicine law blog CamLawBlog.com wrote, “[M]y own involvement in medical academic and policy debates has illuminated deep divides within the research, clinical and regulatory communities concerning the levels of evidence supporting (or invalidating), or required to support (or to negate) clinical (and institutional) inclusion of various therapies."13
In this author’s opinion, it is time for CAVM to step up to the plate and prove itself.
Organizing a diverse and dedicated committee, amassing clinical research and stipulating a scientific basis can bring CAVM into the fold of modern veterinary medicine. Amalgamating a board-certified specialty in CAVM built upon modalities that survive scientific scrutiny would improve standards of care and, ideally, clinical competency and patient outcomes.14 <HOME>
Narda Robinson, DVM, DO, Dipl. ABMA, FAAMA, offers an evidential and scientific perspective on the latest trends in complementary and alternative veterinary medicine. She oversees complementary veterinary education at Colorado State.
This article first appeared in the July 2010 issue of Veterinary Practice News. Click here to become a subscriber.
FOOTNOTES
1. AVMA American Board of Veterinary Specialties. April 2009. Obtained here on 05-28-10.
2. Hubscher M, Vogt L, Ziebart T, et al. Immediate effects of acupuncture on strength performance: a randomized, controlled crossover trial. Eur J Appl Physiol. 2010 May 25. [Epub ahead of print].
3. White A and Editorial Board of Acupuncture in Medicine. Western medical acupuncture: a definition. Acupunture in Medicine. 2009;27(1):33-35.
4. Hubscher M, Vogt L, Ziebart T, et al. Immediate effects of acupuncture on strength performance: a randomized, controlled crossover trial. Eur J Appl Physiol. 2010 May 25. [Epub ahead of print].
5. Hubscher M, Vogt L, Ziebart T, et al. Immediate effects of acupuncture on strength performance: a randomized, controlled crossover trial. Eur J Appl Physiol. 2010 May 25. [Epub ahead of print].
6. Colorado Physical Therapy Licensure. Rules and Regulations. 4 CCR 732-1. Effective November 30, 2007. Obtained here at on 05-28-10.
7. Pollard H, Hoskins W, McHardy A, et al. Australian chiropractic sports medicine: half way there or living on a prayer? Chiropr Osteopat. 2007;15:14.
8. Maryland State Board of Acupuncture. Board of Acupuncture Animal Acupuncture Certification Form. Obtained here at on 05-30-10.
9. Parker M. Chinese dragon or toothless tiger? Regulating the professional competence of Traditional Chinese Medicine practitioners. Journal of Law and Medicine. 2003;10(3):285-295.
10. Parker M (ed.). Four decades of complaints to a state medical board about graduates from one medical school: implications for change in self-regulation processes. Journal of Law and Medicine. 2010;17:493-501.
11. Bensoussan A, Myers SP, and Carlton A-L. Risks associated with the practice of Traditional Chinese Medicine. An Australian Study. Arch Fam Med. 2000;9:1071-1078.
12. Schneiderman LJ. Alternative medicine or alternatives to medicine? A physician’s perspective. Cambridge Quarterly of Healthcare Ethics. 2000;9:83-97.
13. Cohen MH. Harmonizing the cacophony: Commentary on ‘Status of credentialing alternative providers within a subset of US academic health centers’. J Alt Comp Med. 2006;12(3):337-339.
14. Sutherland K and Leatherman S. Does certification improve medical standards? British Medical Journal. 2006;333:439-441.
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