From Pet to Threat:Why Integrative Medicine Directors Get Recruited as Innovators and Discarded When They Say No

From Pet to Threat: Integrative Medicine Directors - Celebrated, Abused, and Discarded

By Yoon Hang “John” Kim, MD, MPH

Board-Certified Integrative Medicine Physician

February 2026

The phone call always starts the same way. A hospital CEO, a department chair, or a health system president reaches out with unmistakable enthusiasm. They’ve been reading about integrative medicine. Their patients are asking for it. Their competitors are offering it. They want to launch a program—something innovative, something that differentiates them in the market—and they want you to build it.

You are recruited with fanfare. Introduced at medical staff meetings as a pioneer. Highlighted in the system’s marketing materials. Paraded before the board of directors as evidence that this institution is forward-thinking, patient-centered, and ahead of the curve. You are, in every sense of the word, the organization’s new pet.

Then one day, someone asks you to double your patient volume. Or to cut your 60-minute new patient visits to 20 minutes. Or to stop ordering “unnecessary” specialty labs. Or to add six more patients to your afternoon clinic. And you say no. Not out of defiance, but out of clinical integrity—because you know that what makes integrative medicine work is the very thing they’re asking you to abandon.

And just like that, the script flips. The innovator becomes the obstacle. The pioneer becomes the problem. The physician they recruited to transform their system is now the one they need to manage.

Welcome to the Pet to Threat phenomenon—and if you work in integrative medicine, you have almost certainly lived it.

Where the Term Comes From—and Why It Applies Far Beyond Its Origins

The “Pet to Threat” concept was first articulated in 2013 by Dr. Kecia Thomas and her colleagues at the University of Georgia. Their research, published in a chapter titled Women of Color at Midcareer: Going from Pet to Threat, described a pattern experienced by Black women in professional settings: initially embraced as promising, novel newcomers—celebrated as symbols of diversity and progress—only to face backlash, isolation, and hostility once they demonstrated genuine competence and began asserting their professional authority (Thomas, Johnson-Bailey, Phelps, Tran, & Johnson, 2013).

The original research focused specifically on the racialized and gendered dimensions of this dynamic, and that context remains critically important. Black women continue to experience this pattern with particular intensity, as evidenced by the staggering labor force data from 2025, when nearly 300,000 Black women exited the workforce in a single quarter—with college-educated Black women suffering the steepest declines (Economic Policy Institute, 2026).

But the underlying mechanism Dr. Thomas identified—the arc from celebrated novelty to perceived threat—is not exclusive to any single demographic. It operates wherever an individual is recruited to represent something new, different, or innovative within a system that has not actually prepared itself for the disruption that newness requires. The dynamic is triggered not by who the person is, but by what happens when the system realizes the person it invited in actually intends to change things.

For those of us in integrative medicine, this should sound painfully familiar.

The Integrative Medicine Version: How It Plays Out

Integrative medicine occupies a peculiar position in healthcare. It is simultaneously the fastest-growing area of patient demand and one of the most institutionally marginalized specialties. Health systems recruit integrative medicine directors the way museums acquire rare artifacts—to display them, to signal sophistication, to attract a certain clientele. The problem arises when the artifact starts having opinions about how the museum is run.

Phase 1: The Pet

In the pet phase, the integrative medicine physician is an organizational trophy. The recruitment process is often marked by genuine excitement from leadership. The CEO mentions you in their quarterly address. The marketing department features your program in the system’s newsletter. Your medical director title is prominently listed on the website. You are invited to sit on committees, present at grand rounds, and consult on cases that conventional approaches have failed to resolve.

The implicit message is clear: You make us look good.

During this phase, integrative medicine is treated as exotic—intriguing, aspirational, a feather in the institution’s cap. Leadership doesn’t fully understand what you do, but they like what you represent. You are the proof that their health system is innovative, patient-centered, and not just another volume-driven factory. You are their differentiator.

The pet phase can last months or years. It feels supportive. It is supportive—conditionally. The condition, which is never stated explicitly, is that your existence as an integrative medicine physician must enhance the organization’s brand without disrupting its operations. You can be different, as long as your difference stays decorative.

Phase 2: The Pivot

The pivot—the moment the pet begins its transformation into a threat—is almost always triggered by the same thing: a boundary.

The administration proposes increasing your daily patient volume from 8 to 16. You explain that integrative medicine consultations require 60 to 90 minutes for new patients because the whole-person assessment is the medicine—that you cannot practice what you were hired to practice in a 15-minute slot. They hear: He’s not a team player.

They propose replacing your specialty supplement formulary with the hospital’s generic vendor to “streamline procurement.” You explain that evidence-based integrative therapeutics require specific formulations, dosing, and quality standards that a generic supplier cannot meet. They hear: He’s being difficult.

They want to rebrand your integrative oncology program as a “wellness service” and package it as a revenue center. You push back because diluting the clinical rigor of what you offer will ultimately undermine patient outcomes and the program’s credibility. They hear: He’s not focused on the bottom line.

What has actually happened in each of these scenarios is straightforward: you exercised clinical judgment. You said no to proposals that would have compromised the quality of care you were recruited to provide. You did exactly what a competent medical director should do.

But in the organizational mind, something else has happened. The exotic, compliant, pleasantly different physician they hired has revealed himself to be a physician with standards, boundaries, and professional convictions. And that is threatening.

Phase 3: The Threat

Once the transition is complete, the organizational response follows a predictable pattern. Budget support for the integrative program begins to erode. Your staff positions are frozen or redirected to other departments. Meeting invitations that once arrived reliably now don’t come. Decisions about your program’s future are made in rooms you are no longer in.

The narrative about you shifts. Where the CEO once introduced you as “our visionary integrative medicine director,” the language now changes: “He’s a great clinician, but he doesn’t understand the business side.” “He’s passionate, but he’s not realistic about volume expectations.” “The program is wonderful, but we need to evaluate whether it’s sustainable.”

The word “sustainable”, in this context, is almost always a euphemism. It does not mean can this program endure and serve patients well over time. It means can this program generate the same RVU-per-hour metrics as our primary care clinics. The answer to the first question is almost always yes. The answer to the second is almost always no—because integrative medicine was never designed to operate that way, and the leadership who recruited you knew that when they made the hire.

Ultimately, the integrative medicine program is either defunded, absorbed into another department, or restructured in ways that strip it of the very features that made it effective. The physician who built it either leaves voluntarily or is managed out. The organization then quietly moves on, having checked the “innovation” box on their strategic plan and discarded the human being who made it possible.

Why Integrative Medicine Is Uniquely Vulnerable to This Dynamic

Several features of integrative medicine as a specialty make it especially susceptible to the pet-to-threat arc.

It Is Still Considered “Exotic”

Despite decades of evidence, fellowship programs at institutions like the University of Arizona, and growing patient demand, integrative medicine remains outside the mainstream of hospital culture. This exoticism is what makes the pet phase possible—you are recruited because you are different. But that same exoticism means leadership often lacks the framework to evaluate your work on its own terms. When they don’t understand the model, they default to the only metrics they know: volume, revenue, and throughput.

Its Value Proposition Challenges the Dominant Business Model

Integrative medicine’s core premise—longer visits, root-cause investigation, prevention-focused care, reduced reliance on pharmaceuticals and procedures—is fundamentally at odds with the fee-for-service, high-volume model that most health systems are built on. Hiring an integrative medicine director is, in essence, hiring someone whose clinical philosophy is a critique of your business model. This is manageable during the pet phase, when the program is small and symbolic. It becomes intolerable when the program gains traction, patient loyalty grows, and the integrative director’s perspective starts to influence how other providers think about care.

The “No” Is Misread as Noncompliance

In conventional specialties, a department chair who pushes back on unrealistic volume expectations is seen as advocating for quality. In integrative medicine, the same pushback is often interpreted as evidence that the physician “doesn’t understand the real world” or is “too idealistic.” The double standard is stark: cardiologists are not asked to see patients in 10-minute slots, and no one questions a surgeon’s insistence on appropriate operative time. But when an integrative medicine physician insists on the time required to do whole-person care, it is treated as a luxury the organization cannot afford.

Integrative Physicians Often Stand Alone

Much like the “onlyness” factor described in Dr. Thomas’s original research on Black women, integrative medicine directors are frequently the sole representative of their specialty within the institution. There is no department of 15 colleagues to validate your perspective, no national lobby with the political clout of cardiology or orthopedics, and no established RVU benchmark that administrators can point to as “normal” for your field. You are a department of one—easy to celebrate, and equally easy to eliminate.

The “Business First” Trap: When Vision Gets Overwritten by Volume

At the heart of the pet-to-threat transition in integrative medicine is a fundamental philosophical collision: the physician was hired for their vision, but the organization operates on volume. These two values can coexist—but only if leadership genuinely commits to a business model that supports the clinical model they chose to invest in.

More often, what happens is a “Business First” approach: the integrative program is expected to generate conventional revenue on an unconventional timeline. When it doesn’t—because it was never designed to—the program is deemed unsustainable, and the physician who warned against these unrealistic expectations is blamed for the shortfall.

The irony is that integrative medicine programs, when properly supported, often produce extraordinary value through patient retention, reduced downstream utilization, improved chronic disease management, and referral generation. But these outcomes are measured in quarters and years, not in weekly encounter counts. An administration that evaluates an integrative program by the same metrics as a walk-in urgent care clinic has already decided the program will fail—they just haven’t told you yet.

This is why the most sustainable path for integrative medicine may not be inside conventional health systems at all. The direct-care, membership-based model—where the physician’s accountability is to the patient rather than to the C-suite—eliminates the structural conditions that make the pet-to-threat dynamic possible. When you own your practice and your patients choose to be there, no one can redefine your mission from above.

Recognizing the Signs: Are You Becoming a Threat?

The transition from pet to threat is gradual enough that many physicians don’t recognize it until it’s well advanced. Here are the signals to watch for.

Your program’s success is reframed as a problem. Growing patient demand, long wait lists, and high satisfaction scores—metrics that would be celebrated in any other department—are reinterpreted as evidence that your model “doesn’t scale.”

Conversations about resources become interrogations about justification. Other departments request additional staff or equipment and receive approvals; your requests trigger lengthy cost-benefit analyses, committee reviews, and “pilot program” conditions that no other specialty faces.

Your clinical model is subjected to volume-based expectations. You begin hearing phrases like “We need to increase throughput,” “Can we shorten the new patient visit?” or “What if we added a mid-level to see the overflow?”—proposals that would fundamentally alter the model you were hired to deliver.

Your boundaries are labeled as rigidity. When you explain why certain compromises would undermine patient care, the response is not engagement with your reasoning but dismissal of your “flexibility” or “willingness to collaborate.”

You are excluded from strategic decisions about your own program. Changes to your budget, staffing, or scope of services are discussed and decided before you are consulted. You learn about them in implementation meetings, not planning meetings.

The language about you changes. You were once “innovative” and “visionary.” Now you are “passionate but impractical,” “a great clinician who doesn’t understand the business,” or “hard to work with.” This linguistic shift is diagnostic—it signals that the organization has begun constructing a narrative to justify your eventual marginalization.

What Twenty Years of Practice Have Taught Me

I have worked within health systems. I have built integrative medicine programs from the ground up inside hospital walls. I have sat across from administrators who recruited me with passion and then looked at me with frustration when I insisted on practicing medicine the way it needed to be practiced. I have lived the pet-to-threat arc more than once.

What I have learned from those experiences can be distilled into a few hard-won principles.

Marry results, not methods. My fellowship training under Dr. Andrew Weil at the University of Arizona instilled this principle: what matters is whether the patient improves, not whether the approach fits neatly into conventional categories. But this principle must also apply to practice models. The method of delivering integrative medicine—whether inside a hospital system, a private practice, or a direct-care membership model—matters less than whether the model allows you to produce the results your patients deserve.

Vision and sustainability must be prioritized over short-term profit. The “Business First” approach creates practices that are profitable in the short term but unsustainable in the long term—because they burn through both physicians and patients. An integrative medicine practice built on volume rather than value will eventually collapse under the weight of its own contradictions. Conversely, a practice built on vision—on what patients actually need and what the evidence actually supports—will generate loyalty, referrals, and longevity that no marketing budget can replicate.

Your “no” is not the problem—the system’s inability to hear it is. Every time an integrative medicine director says no to a proposal that would compromise clinical quality, that “no” is an act of professional integrity. It is the same “no” that a surgeon would give if asked to operate without adequate anesthesia, or that a pharmacist would give if asked to fill a dangerous prescription. The fact that it is treated as insubordination rather than stewardship reveals the organization’s values—not yours.

Know when the system cannot be reformed from the inside. Some health systems are genuinely open to integrative medicine as a clinical discipline, not just a marketing concept. These are the ones worth fighting for. But when leadership treats your program as a revenue line item rather than a clinical mission—when “innovation” means “novelty we can monetize on our terms”—it may be time to build something outside those walls that actually serves patients the way you were trained to serve them.

Luck favors the prepared bold. The integrative medicine physicians who thrive long-term are not the ones who capitulate to volume demands or abandon their clinical standards to keep administrators happy. They are the ones who prepare themselves—financially, professionally, and psychologically—to practice on their own terms when the system proves incapable of supporting them. This is not idealism. It is survival strategy.

A Note to Health System Leaders: You Recruited Us for a Reason

If you are a CEO, medical director, or department chair who has hired—or is considering hiring—an integrative medicine physician, I want to speak to you directly.

You recruited this person because you saw value in what they offer. You were right. The evidence for integrative approaches in chronic disease management, cancer supportive care, pain management, mental health, and preventive medicine is substantial and growing. Patient demand is real. The differentiator you sought is genuine.

But the value you recognized in the interview cannot survive the operational conditions you may be imposing in practice. If you compress integrative visits into conventional time slots, you eliminate the mechanism of action. If you evaluate integrative programs exclusively by RVU output, you are measuring the wrong thing. If you withdraw support the moment your physician draws a clinical boundary, you are not managing a program—you are dismantling one.

The question is not whether integrative medicine is sustainable. It is. The question is whether your institution is willing to sustain it on the terms that make it work, rather than the terms that make it indistinguishable from every other service line in your building.

Do not let the physician you recruited as a pet become a threat simply because they had the integrity to practice what you hired them to practice.

Conclusion: The Way Forward

The pet-to-threat phenomenon, as Dr. Thomas described it, is fundamentally about what happens when institutions embrace the idea of someone’s difference without accepting the reality of what that difference demands. For Black women, that difference is identity and the power that comes with professional excellence. For integrative medicine physicians, that difference is a clinical philosophy that challenges the dominant model of care delivery.

In both cases, the solution is the same: institutions must learn to welcome not just the presence of the people they recruit, but the full implications of what those people bring. Innovation is not a decoration. Diversity is not a performance. Clinical excellence is not a negotiable commodity.

And for those of us who have been through the pet-to-threat arc and emerged on the other side: our value was never contingent on the institution’s willingness to see it. The work continues—whether inside their walls or outside them. The patients we serve know the difference. And so do we.

References

Economic Policy Institute. (2026). Black women suffered large employment losses in 2025—particularly among college graduates and public-sector workers. https://www.epi.org/blog/black-women-suffered-large-employment-losses-in-2025/

Roy, K. (2025, August 15). Future CEOs, erased: The economic cost of losing Black women in the workforce. Fortune. https://fortune.com/2025/08/15/black-female-leadership-future-ceos-erased-dei/

Sacramento Observer. (2025, August 28). Pet to threat: Naming the workplace pattern that pushes out Black women. Sacramento Observer. https://sacobserver.com/2025/08/black-women-workplace-discrimination/

Thomas, K. M., Johnson-Bailey, J., Phelps, R. E., Tran, N. M., & Johnson, L. (2013). Women of color at midcareer: Going from pet to threat. In L. Comas-Díaz & B. Greene (Eds.), The psychological health of women of color: Intersections, challenges, and opportunities (pp. 275–286). Guilford Press.

About the Author

Yoon Hang “John” Kim, MD, MPH is a board-certified integrative medicine physician with over 20 years of clinical experience. He completed his integrative medicine fellowship at the University of Arizona under Dr. Andrew Weil and holds certifications in preventive medicine, medical acupuncture, and integrative/holistic medicine. He is the founder of Direct Integrative Care, a membership-based telemedicine practice, and the author of three books on Low-Dose Naltrexone therapy. He leads an LDN Support Group with over 7,000 members and can be found at directintegrativecare.com.