The number of functional medicine (FM) practitioners in the U.S. has seen a dramatic rise, climbing from approximately 5,000 in 2010 to around 40,000 by 2020. Industry projections indicate continued growth in both employment opportunities and compensation for FM-trained professionals (2).

The origins of functional medicine can be traced back to the 1960s, emerging from the broader integrative and holistic medicine movements. This period marked a paradigm shift toward viewing patients holistically rather than as collections of isolated systems. The Institute of Functional Medicine (IFM) was established in 1991 by Dr. Jeffrey Bland and his spouse to provide educational resources and framework for practitioners interested in this healthcare approach. Their fundamental principle centered on identifying and targeting the underlying causes of illness (1).

The foundation of functional medicine rests on patient-centered care, incorporating analysis of genetic factors, lifestyle choices, and biochemical processes. This approach views food as a therapeutic tool and considers the body as an integrated system rather than separate components. It emphasizes patient accountability while focusing on identifying and addressing disease origins rather than merely managing symptoms (2).

Throughout the 2000s, functional medicine gained increasing acceptance among healthcare providers who sought alternatives to conventional medicine’s symptom-management approach (1). A significant milestone occurred in 2014 when the Cleveland Clinic established the first academic Center for Functional Medicine (7).

Functional medicine has particularly excelled in addressing chronic conditions. The practice emphasizes key lifestyle components—including dietary habits, sleep patterns, physical activity, stress management, interpersonal relationships, and genetic factors—that contribute to chronic diseases (7). FM advocates maintain that this approach offers sustainable health solutions for individuals with chronic conditions (9).

Does Insurance Cover Functional Medicine?

Most functional medicine practices operate on a cash-only basis, as insurance providers typically don’t recognize this approach (5).

Functional medicine emphasizes a collaborative provider-patient relationship, involving comprehensive gathering of health and lifestyle information. Practitioners develop customized treatment plans and continuously monitor and adjust patient progress. This approach requires significant time investment with patients and relies heavily on lifestyle interventions, nutrition guidance, education, and supplement recommendations—services that receive minimal insurance reimbursement (3). While insurance companies generally don’t cover functional medicine practices, they may reimburse certain components like laboratory tests, imaging studies, and specific procedures (5).

The current fee-for-service model prioritizes quantity over quality. As noted in T. Blue’s article “How to Package Functional Medicine for Widespread Adoption,” the existing payment structure “leads people to be dependent on the healthcare system and drives further utilization of the services for which providers are paid” (4).

After analyzing capitation options, the author advocates for bundled payments, arguing their effectiveness because:

• Payers can evaluate provider competency for agreed-upon services through bundle-associated metrics.
• Payers can effectively determine if the provided services align with the established fixed price. A bundle encompasses a specific health condition with a predetermined cost structure.
• The bundle’s focus on a defined health issue enables payers to accurately evaluate their investment returns (4).

Healthcare providers are implementing hybrid payment models:

• Accepting insurance coverage for eligible services while directly billing patients for non-covered components.
• Implementing an annual membership fee structure for all practice patients, with additional services processed through insurance channels (6).

Is Functional Medicine Legitimate?

The legitimacy of functional medicine faces some scrutiny. Several core principles await scientific validation, and comprehensive research demonstrating the effectiveness of its methodologies remains limited. The field lacks standardized educational requirements across training institutions (3). Additionally, incidents involving unauthorized practitioners falsely claiming functional medicine credentials have raised concerns.

However, emerging research demonstrates promising outcomes. A significant study conducted at the Cleveland Clinic Center for Functional Medicine between 2015 and 2017, involving 7,252 participants, revealed that the functional medicine approach yielded superior improvements in patient-reported health-related quality of life compared to traditional primary care family health centers. A comprehensive literature analysis published in the Journal of Alternative and Complementary Medicine (2017) confirmed the effectiveness of functional medicine elements in managing chronic pain and enhancing life quality. Furthermore, a 2016 review in the Journal of the American Medical Association documented functional medicine’s success in improving key health indicators, including blood pressure, cholesterol levels, and glycemic control in Type 2 diabetes patients (2).

Following the establishment of its functional medicine center, Cleveland Clinic has actively pursued “research initiatives to build a robust evidence base supporting functional medicine practices (7).”

The Cleveland Clinic Center for Functional Medicine currently conducts several research studies:

• Investigating Functional Medicine’s Impact on Wound Healing Post-Delayed Autologous Breast Reconstruction
• Comparing Diabetes Management, Care Costs, and Quality of Life: Functional Medicine Plus Standard Care versus Standard Care Alone
• Maintaining a Center for Functional Medicine Patient Registry
• Assessing Functional Medicine Shared Medical Appointment Effects on Patient-Reported Outcomes
• Analyzing Diabetes Control, Care Costs, and Life Quality Through Functional Medicine
• Testing Functioning for Life Shared Medical Appointments in Community Settings (10)

Functional Medicine Practitioners

Medical Doctors (MD), Doctors of Osteopathic Medicine (DO), and Certified Nurse Practitioners can obtain functional medicine certification and implement its principles in their practice.

The field also welcomes contributions from physician assistants, nurses, registered dieticians, and health coaches.

Functional Medicine Training Courses.

The curriculum for Functional Medicine programs varies based on pre-program licensure and desired certification, encompassing diverse subjects. These include comprehensive studies of immune system dysfunction, persistent infections, autoimmune conditions, and atopic disorders (including allergies, asthma, and eczema). The programs also cover hormonal equilibrium restoration, environmental toxicity impacts, therapeutic dietary approaches, cellular energy transfer mechanisms (ATP), and adjustable lifestyle components (7).

FM practitioners emphasize optimal laboratory ranges rather than standard normal ranges to gain deeper insights into disease processes. Their approach includes more specific laboratory testing. A prominent laboratory has identified the most frequently requested tests by FM practitioners. These include a comprehensive gastrointestinal function assessment series that evaluates microbial conditions, digestive efficiency, and inflammatory markers. A specialized female health panel provides insights into hormonal interactions and reproductive health. These assessments can detect nutritional inadequacies and toxic accumulation. Specific tests are available for identifying small intestinal bacterial overgrowth (SIBO), which has been recognized as the underlying cause in numerous patients with long-standing, conventionally untreatable GI symptoms. Additionally, specialized panels are utilized to identify food sensitivities (11).

Training institutions emphasize their commitment to evidence-based research in their programs. Notable training options include:

• Wisdom Institute Functional Medicine Training
• The Institute for Functional Medicine
• The American Academy of Functional Health
• The Kresser Institute
• The School of Applied Functional Medicine (8).

Conclusion

Healthcare providers increasingly express frustration with the U.S. healthcare system, where compensation prioritizes patient volume over quality care and sustainable health outcomes. Insurance companies and the pharmaceutical industry have evolved into multi-billion-dollar enterprises, while the healthcare system primarily manages illness rather than promoting wellness. The pharmaceutical sector’s expansion reflects a tendency to treat symptoms with medications instead of investigating root causes. Patients themselves advocate for a healthcare approach that addresses fundamental causes after experiencing unsuccessful conventional treatments. Functional medicine principles address many of these concerns. As ongoing research validates FM’s effectiveness and educational standards become more uniform, insurance providers will need to adapt their coverage policies accordingly.

Sources:

1. 1. https://voganfm.com/history-of-functional-medicine/
   2. https://calciumhealth.com/understanding-the-history-and-foundations-of-functional-medicine/#:~:text=In%20the%20United%20States%2C%20the,million%20patient%20visits%20per%20year.
   3. https://www.webmd.com/a-to-z-guides/what-is-a-functional-medicine-doctor
   4. https://pmc.ncbi.nlm.nih.gov/articles/PMC6601442/
   5. https://www.restartmed.com/downsides-to-functional-medicine/#:~:text=As%20a%20physician,%20this%20one%20is%20particularly
   6. https://www.kalishinstitute.com/blog/pros-cons-functional-medicine#:~:text=Con%27s%20of%20Functional%20Medicine&text=There%27s%20the%20whole%20lazy%20factor,ruptured%20appendix%20and%20so%20on
   7. https://consultqd.clevelandclinic.org/study-compares-two-models-of-care-for-chronic-disease
   8. https://www.mindisthemaster.com/best-functional-medicine-training/#elementor-toc__heading-anchor-6
   9. https://schoolafm.com/
   10. https://my.clevelandclinic.org/departments/functional-medicine/research-innovations
   11. https://www.rupahealth.com/post/the-5-most-commonly-ordered-functional-medicine-lab-tests#:~:text=Functional%20medicine%20practitioners%20recognize
   12. https://www.rupahealth.com/post/best-practices-for-functional-medicine-clinic-staff-training-a-complete-guide
   13. https://vytalhealth.com/using-insurance-with-functional-medicine/

Patty Blevins loved living in Saudi Arabia as a youngster. Now she enjoys the picturesque farmland of the midwest. She strives to make a connection with readers and is passionate about health and wellness.

Disclaimer: 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.