Naturopathic Physicians Licensure

CLEAR News - Spring 2004

Naturopathic Physicians - The Path to Licensure

As the 2004 legislative sessions get underway, one issue at hand is the regulation of naturopathic physicians. Bills are being introduced or re-introduced in a number of states calling for licensure of the profession.

Currently, thirteen states - Alaska, Arizona, California, Connecticut, Hawaii, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington - the Virgin Islands, Puerto Rico, and five Canadian provinces - Alberta, British Columbia, Manitoba, Ontario, and Saskatchewan - have licensing laws for naturopathic physicians. Some of these have had laws in place since 1919/1920 (Washington, Connecticut, and Ontario). The first US school of naturopathic medicine was founded in 1902 in New York City by German emigrant Benedict Lust. During the early part of the 20th century, 22 colleges of naturopathic medicine were established in the US, and many states enacted licensure laws. Naturopathy suffered a downswing in the mid-20th century as scientific medicine, antibiotics, and high-tech treatments were introduced and the American Medical Association began to discredit what were considered alternative forms of medicine. Schools began to close, and many states stopped licensing naturopathic physicians. But by the 1970s, public interest in naturopathy was again growing as people sought alternatives to conventional medicine and its high cost.

Meaning "nature of the disease (pathos)," naturopathic medicine focuses on natural treatment methods to encourage the body's own healing powers. Naturopathic physicians treat the cause of the illness and attempt to use the least invasive treatments to treat the whole person, educating the patient on lifestyle choices that affect health and well-being.

As more and more people seek alternative healthcare, associations of naturopathic physicians are seeking the passage of licensure laws for the profession. Legislation is pending in at least nine states, and associations are preparing for such a movement in several other states and provinces. So, what factors are giving rise to this push for licensure? The over-arching reason cited by many of the naturopathic physicians associations is to increase consumer access to natural healthcare and to provide assurance to consumers that the practitioners offering care meet certain educational requirements and standards of practice.

Although details of the proposed legislation do vary by state, the bills generally require candidates for licensure as naturopathic physicians to have graduated from a four-year, graduate level, accredited naturopathic medicine college. The requirements include two years of supervised clinical internship and passing the licensure examination. The bills provide a definition of the practice of naturopathy and the scope of practice for a licensed naturopathic physician. (Some of the proposed bills refer to the licensure of "naturopathic doctors." For the sake of consistency, the term "naturopathic physician" will be used throughout this article.) The defined scope of practice in the bills would allow naturopathic physicians to perform tasks such as ordering lab tests, prescribing drugs, and performing minor surgery. Regulation of the profession would also create a system for consumers to make complaints and a board to investigate and discipline practitioners who do not meet the standards.

The American Association of Naturopathic Physicians, which advocates state licensing of naturopathic physicians, states that "licensure creates an infrastructure of accountability supported by law for the benefit of the people by affirming that the persons who possess the license are under the scrutiny of a board of examiners whose purpose is to protect the public by maintaining professional standards."

Another key issue addressed by the licensure bills is providing a distinction between naturopathic physicians and what some refer to as "traditional" naturopaths. Under current law in many states where naturopathic medicine is unregulated, practitioners who have received training at trade schools or by correspondence may practice naturopathy using the title "naturopathic physician" or "naturopathic doctor." Proponents say that licensure is necessary so that consumers can distinguish between naturopathic physicians who have undergone training as proposed in the legislation and "traditional" naturopaths who have not received such training.

On the other side of this point, many "traditional" naturopaths are against the licensure bills. One such group is the Coalition for Natural Health. The Coalition emphasizes the differences between "naturopathic medicine" and "naturopathy" and between "naturopathic physicians" and "naturopaths." They claim that licensing naturopathic physicians according to the proposed legislation would prevent naturopaths from practicing naturopathy. What is the distinction? The practice of "naturopathic medicine" combines elements of traditional naturopathy with conventional (allopathic) medical practices such as prescribing drugs and performing surgery. This is not what traditional naturopaths practice. According to the Coalition's definition, "traditional naturopaths do not diagnose or treat disease but instead focus on health and education. They teach clients how to create an internal and external environment that is conducive to good health. . ." The proposed legislation refers to the scope of practice of naturopathic medicine and requires education, training, and licensure in that type of practice in order to use the titles naturopathic physician, naturopath, doctor of naturopathy, naturopathic practitioner, or naturopathic doctor. Thus, in order to legally offer any form of naturopathic service, naturopaths - who do not prescribe drugs or perform surgery as part of their practice - would be required to have such training. The Coalition claims that, in essence, the laws would preclude naturopaths from practicing naturopathy.

Many traditional naturopaths also fear that licensing naturopathic physicians to practice naturopathic medicine would elevate the status of naturopathic physicians to primary care physicians, exposing the public to harm because these practitioners do not meet the requirements of such status. The Coalition for Natural Health claims that naturopathy as practiced by traditional naturopaths is safe and poses no threat to the public welfare, and is thus not in need of regulation. They do claim, however, that licensing naturopathic physicians to perform certain tasks currently in the scope of practice of primary care physicians would pose public harm.

Offering a similar argument against licensure of naturopathic physicians, but coming from a slightly different perspective, are various medical societies. In sunrise reviews of naturopathic regulation in several states, medical societies have offered the opinion that naturopathic physicians are not adequately educated or trained to practice within the scope of practice put forward in the legislation. Granting them such status would put the public at risk since requirements for graduation from a school of naturopathic medicine are below those required for graduation from a school of medicine. The potential risk comes from allowing naturopathic physicians to provide a broad range of primary care services within a scope of practice that overlaps and competes with already licensed healthcare professionals. Some opponents argue that giving legal recognition to the profession may mislead the public about the effectiveness of some naturopathic services which may have no clinically proven medical value. Opponents fear that dependence on some natural methods could delay the use of needed and more effective medical treatments in some cases.

Other arguments against naturopathic physician licensure include the lack of documented evidence of risk from not granting licensure, the fact that most states currently permit alternative health practices (traditional naturopathy) without regulation, and the unlikelihood that the small number of naturopathic physicians could offset the cost of administering the license.

So, the various groups continue to put forward their arguments and opinions in the hopes of pushing forward or pushing down the proposed legislation. Donald Patrick Albert, Ferry Butar Butar, and Solomon Schneider of Sam Houston State University have created a mathematical prediction of the path naturopathic physician licensure will take throughout the US and Canada. In brief, their study predicts that licensure will "diffuse via a contagious process," meaning that as more states and provinces adopt licensure laws, the states and provinces bordered by licensed neighbors will adopt the law sooner. They have categorized the states and provinces into the Existing Early Majority (which have already adopted licensure), the Remaining Early Majority, the First Half of Late Majority, and the Remaining Late Majority and Laggards. Will licensure laws be adopted following this predicted path? CLEAR will keep you updated as the issue progresses.

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