Why aren’t more doctors recommending or offering neurofeedback?
The answer is straightforward. It’s a lack of education and familiarity, particularly among medical and mental health professionals. There’s enough good research, publications, and clinical efficacy to warrant much wider acceptance.
Most of the medical and mental health community are not aware of the clinical efficacy and research that exists. Even those who have heard of neurofeedback rarely understand it’s full clinical impact to help patients. Like most fields, research is often published in specialized journals professionals in other fields don’t tend to read. Most are busy within their own profession and do not often study outside the scope of their established practice.
The challenge: Usually over 18,000 psychiatrists attend the annual meeting. That means approximately 0.2% are learning about it at a major conference. How long will it take to educate psychiatrists?
What are the obstacles to learning about it?
Education. It takes massive effort and resources to educate physicians about the research, clinical applications, and the underlying neuroscience. For any one new drug, pharmaceutical companies may spend $20 million, or far more. And medications are already familiar. Neurofeedback has none of those resources. Without that, and without a major organization funding education, educating the medical community will be slow.
Neurofeedback can’t be patented. That means large capital investments can’t be “protected.” Neurofeedback is based on non-proprietary software and hardware. Major capital has looked at the field of neurofeedback and, so far, they’ve walked away when they realized there’s no way to patent the technology or process.
Without large amounts of funding, it’s impossible to pay for the education required – paying fees for speakers, for educational materials, for copies of obscure journal articles, or for appearances by experts at major medical conferences. Those efforts require funding that neurofeedback, because of it’s non-proprietary nature, doesn’t have. As a result, no experts from the field tend to present at major medical conferences, which is expensive and time-consuming.
What about insurance coverage? Insurance reimbursement is a big obstacle for many people. Many insurance companies try to deny coverage for neurofeedback, and the rate of reimbursement can be low. More and more practices don’t accept insurance, and the client must file the forms on their own.
Medicaid or Medicare reimbursement rates are very poor for neurofeedback and typically paid as biofeedback. As a result, many clinicians now shy away from trying to service that community. Because of low reimbursement , many clinicians don’t like dealing with insurance companies and many are opting out of it.
Many clients pay for neurofeedback out of their own pocket. Some clinicians bill insurance, and many don’t accept insurance.
When medications aren’t working well, many people will pay for neurofeedback even if insurance doesn’t pay. But lack of insurance reimbursement does limit how many can easily have access to it. For those who have struggled, this is a major breakthrough in helping them manage, and overcome, symptoms. For the many people who don’t have insurance, neurofeedback is less expensive than doctor’s visits, medications, or missed time from work.
Beyond insurance, the bigger issues are:
- Professionals lack education or access to education about neurofeedback
- A lack of peers who have adopted it and concern about being “the first”.
- INIMJ. It’s not in my journals. The fact that studies appear in smaller specialty journals rather than “”my journal” is often cited as a challenge.
- Clinicians/MD’s are too busy to learn something entirely new. There’s a high comfort level with dealing with pharmaceuticals or psychotherapy. It’s familiar, even when it doesn’t work that well. Neurofeedback is not something highly-educated MD’s and psychologists know much about. They didn’t study it in school and are not exposed to its efficacy. This is a major impediment.
- The healthcare system has a disincentive for innovation. Does anyone get REWARDED for better outcomes? No. You only get rewarded for reducing costs. It’s a difficult problem for everyone in the system.
Editorial
At the American Psychiatric Association, Dr. Tom Brod, a psychiatrist and adjunct professor at UCLA and Mike Cohen have organized a presentation for psychiatrists since 2003. For example, in 2005, three psychiatrists and a psychologist presented on neurofeedback. In 2006, four psychiatrists, 2 psychologists and a neuropsychologist presented, and this presentation continues. All use neurofeedback in their practice. All paid their own expenses because of their belief in the importance of this new modality for patients. None have commercial interests. They are part of a growing grassroots effort by and for health professionals.
Gaining Wider Acceptance
Neurofeedback would gain wider acceptance if existing research and publications were known. They aren’t. Funding is necessary to support broad education efforts. So the growth, and there is growth, will continue to be a grassroots effort by professionals and professional organizations to educate others about the field. There are some vendors that help with education, but they are very tiny compared to the large companies that compete to educate health professionals now.
