Why aren't more MD's 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 and publications and clinical efficacy (as described elsewhere in this website) 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.

EXAMPLE OF THE OBSTACLE:  For the last 6 years, we've helped Tom Brod, MD a psychiatrist in Los Angeles teach a course at the American Psychiatric annual conference. About 30 to 50 psychiatrist attend every year to learn more and to hear from other psychiatrists and therapists who work with neurofeedback.  The course gets excellent reviews.  It's a six hour course.   For the psychiatrists who attend, they are very impressed at the potential this cutting edge tools can have for their patients.  Yet six hours is not long to  understand something as complex as neurofeedback.

THE CHALLENGE:  Usually over 18,000 psychiatrists attend the annual meeting.  That means less than 1% (.2%) are learning about it at a major conference.  How long will t take to educate psychiatrists?

What are the obstacles to learn about it?   

Education.  It takes massive efforts 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 meds are already familiar.  Neurofeedback has none of those resources.   Without that, and without one or major organization funding education, the education of 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 today.    So far, they've walked away when they realized there's no way to patent any of 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, 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 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.  The rate of reimbursement can be low.  In some practices, the patient must file the insurance forms themselves, because the clinician doesn't bill insurance.  More and more practices don't accept insurance - the client must file them on their own. 

Medicaid or medicare reimbursement rates are very poor for neurofeedback (paid typically 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 have access easily to it.  But for those who have struggled, this is a major breakthrough in helping you manage - and overcome symptoms.

BEYOND Insurance, THE BIGGER ISSUES ARE: 

   1. Professionals lack education or access to education about neurofeedback
   2. A lack of peers who have adopted it (the chicken and egg is a powerful force)
   3. 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 problem which goes along with point number 2.
   4. Clinicians/MD's are frankly 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 anything about.  They didn't study it in school.  This is a major, major impediment.
   5. 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 organized a presentation for psychiatrists since 2003.  For example, in 2005, three psychiatrists and a psychologist presented on neurofeedback.  In 2006 (Toronto) four psychiatrists, 2 psychologists and a neuropsychologist will present.  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 grass roots effort by and for health professionals.

Gaining Wider Acceptance
Neurofeedback would gain wider acceptance if existing research and publications were known.  (click her for highlights of some of the best research).  They aren't.  it requires funding to support broad education efforts. There's nowhere currently that funding will come from.  So the growth - and there is growth, will continue to be a grass roots efforts by professionals and professional organizations to educate the field. There are some vendors, but they are very tiny compared to the large companies that compete to educate health professionals now.