Fighting for Licensure

In order to obtain a license to practice naturopathic medicine, someone must attend a four year accredited naturopathic medical institution and pass the NPLEX boards. These schools teach core medical curriculum in addition to naturopathic modalities such as, but not limited to, botanical medicine, nutritional counseling, homeopathy, and physical medicine. Thousands of hours are spent in classroom and clinical settings.

After graduating from an accredited institution and passing boards, then someone may apply for a state-specific license. In the state of Oregon, after doing all of that I would then need to sit for formulary and jurisprudence exams, overseen by Oregon's Board of Naturopathic Medicine. (Follow the link to see all of Oregon's requirements.) It's an incredibly rigorous process. 

Unfortunately, not every state has licensure laws. This means two things. I could not practice medicine in those states, despite my education and ANYONE could call himself or herself a naturopath and offer "naturopathic" services. 

But how could someone else practice as a naturopath, if I couldn't practice in those states? What has happened in the past and is still prevalent is that these people offer consulting services, much like health/wellness/fitness coaches are doing all over the place. Some of these "naturopaths" go far enough to actually practice medicine. But they don't know what they're doing, because they never went to medical school.  In the case of one such unlicensed practitioner in Colorado in 2006, the patient died. From what I've heard around school, this death was part of the reason Colorado legislature finally passed laws licensing and regulating naturopathic doctors in 2013.

It is incredibly dangerous for people to masquerade as healthcare providers of any kind. Natural medicine is not safe. Just because something is natural does not mean it's safe. I've been told many times by a professor, who is a DO, that the point of medical school-MD, DO, or ND-is to learn how not to kill someone. My education is giving me the tools to make good decisions that should not harm my future patients. Quite frankly, MDs and DOs do not have the knowledge base to prescribing naturopathic therapies, especially botanical medicine. It's important that properly educated and licensed naturopathic doctors are out in the world. 

However, there are online schools that want people to think they can earn a doctorate of naturopathic medicine entirely online without any clinical or hands-on experience. People who pay for those programs cannot sit for boards or apply for licensure. They didn't actually go to medical school. But people do pay for these programs and go out and practice naturopathy. And patients get hurt.

When patients get hurt, those stories go to the media. The people calling themselves naturopaths without the proper credentials make the real naturopaths look bad. A Google search of naturopathic doctors reveals some pretty interesting results. There are lots of sites dedicated to calling NDs quacks and taking apart naturopathy (Very badly too. I mean, at least make a logical effort, right?) Results for the American Association of Naturopathic Physicians (AANP) and some of the ND schools might come up too, but most of the results are about how naturopaths are a bunch of mystical witch doctors who should not get licensure. 

Anyone who really thinks that can come to school with me for a week. 

Currently, 20 states, Washington D.C., Puerto Rico, the Virgin Islands and five Canadian provinces license naturopathic doctors. Scopes of practice differ location to location. For instance, in Oregon, NDs can basically do anything an MD does. But in Montana, NDs cannot prescribe certain pharmaceuticals, like anti-hypertensives. (But they can prescribe morphine, because it's more "natural!" Hopefully the formulary is re-evaluated soon.) Despite different scopes of practice, all NDs have the same education and take the same boards, so the variety of scopes is not something I understand. In my lifetime, I would like every state get licensure and to see the scope of every state be similar if not equal to Oregon's. 

I believe that NDs are not licensed in all 50 states for a few reasons. In some states, like Alabama, there are fewer than five naturopaths. Based on my directory search of the AANP's website, I think there might only be two! As far as I can tell, only one ND has a physical office in the state. It's hard to get a busy state legislature to take the time to pass laws when there are so few NDs within a state. Additionally, it would be difficult to create awareness and demand in the first place in a state with so few naturopathic doctors. 

In my opinion, other licensed providers, like MDs and DOs, probably do not want competition. Not that there are many NDs to compete with in the first place.  In the same vein, pharmaceutical companies do not stand to benefit from naturopathic physicians, so I could see those corporations trying to squash licensure efforts. In its infancy, naturopathy was part of the "drugless" doctor movement, and naturopaths in general try to get patients off their medications through diet and lifestyle modifications, if possible, as opposed to prescribing more. 

Licensure protects patients. People who complete the online only programs should be totally barred from any patient contact.  If a patient wants to seek care from a naturopathic doctor, she should be able to do safely, with the assurance the physician completed the appropriate training, just like any other provider. 

Licensure would encourage new NDs to go to states where there are few practicing naturopathic doctors. Patients really do benefit from naturopathic care, but most naturopaths prefer to be in states where they can utilize their education (understandably so). Some graduates choose to return to unlicensed states, often their home states, while maintaining a license in one of the licensed states. I applaud those who choose that path. I would be too frustrated in that kind of a situation. 

Several states will have pushes for licensure legislation in the new year: Idaho, Nevada, New Mexico, Texas, Wisconsin, Illinois, Indiana, Michigan, Ohio, Mississippi, Virginia, New Jersey and Georgia. If any of these states pulls at your heart, look up that state's naturopathic organization and see how you can contribute. I've signed many emails and petitions for states that I do not call home, and I do so because every little bit helps. 

Want to know if your state is a licensed state? Go here.

Further questions? Put them in the comments below or send me an email.