CLEAR News - Summer 2004

North American Board of Naturopathic Examiners
by Christa Louise, Executive Director, NABNE

This article is a follow-up to the article on licensing of naturopaths presented in the Spring 2004 issue of CLEAR News.  Ms. Louise offers some further details on the education and examination requirements for naturopathic doctors and reasons why naturopathic medicine can play a vital role in the healthcare system.

Interest in alternative medicine has grown significantly over the last decade, creating a demand for alternative practitioners.  Three elements must be present to ensure that these healthcare professionals do not pose a threat to public health:

1. Practitioners must be educated at medical colleges that have been accredited by an agency recognized by the U.S. Department of Education;
2. Practitioners must be examined by a national examining board that sets high standards for eligibility and provides standardized test administration; board examinations must be developed in accordance with national testing standards; and
3. Practitioners must be licensed, required to take continuing education, and subject to peer review.

Four naturopathic medical colleges in the U.S. and one school in Canada are currently accredited by the Council on Naturopathic Medical Education (CNME).  The CNME is the only naturopathic accrediting body recognized by the U.S. Department of Education. 

The education of naturopathic doctors (NDs) follows a path similar to that of medical doctors (MDs).  Applicants enter naturopathic medical school after receiving a baccalaureate degree (usually pre-med) from a four-year college.  Students complete two years of post-graduate basic science coursework then have two to three years of didactic and clinical training, including time spent in supervised patient care. 

The North American Board of Naturopathic Examiners (NABNE) uses the NPLEX to examine all naturopathic physicians who want to be licensed in any of the states or provinces that license NDs.  The 16 Naturopathic Physicians Licensing Examinations (NPLEX) are criterion-referenced examinations.  Five Part I - Basic Science Examinations cover anatomy, physiology, biochemistry, microbiology, immunology, and pathology.  The Part I Examinations are taken after the second year of training.  Eleven Part II - Clinical Science Examinations cover diagnosis using physical examination and lab testing, emergency and medical procedures, as well as naturopathic treatment modalities (botanical medicine, homeopathy, clinical nutrition, physical medicine, counseling & health psychology).  The NPLEX examinations are developed according to all the guidelines set forth in the Standards for Educational and Psychological Testing.

After graduation from the accredited naturopathic medical college and passage of Part II - Clinical Science Examinations, candidates apply to one of the 21 jurisdictions that have laws that enable licensed naturopathic physicians to serve their communities as providers of primary care medicine (AK, AZ, CA, CT, HI, KS, ME, MT, NH, OR, UT, VT, WA, the District of Columbia, Puerto Rico, the Virgin Islands, and AB, BC, MB, ON, SK in Canada).  Licensed NDs are required to obtain continuing education and are subject to peer review.

Naturopathic medicine can play a vital, cost-effective role in the healthcare system:

1. Naturopathic physicians are primary care providers who treat patients for a variety of conditions, using therapies that are non-invasive, safe, and effective.  More patients are demanding these kinds of treatment options, and the cost of naturopathic care is minimal when compared to the skyrocketing costs of drugs.
2. Because naturopathic medicine places significant emphasis on prevention (not merely on screening for pre-existing conditions), it can help stem the increasing incidence of chronic disease.  For a small expenditure now, significant costs can be prevented later.
3. Naturopathic medicine provides vital adjunctive care when a patient is being treated by a medical doctor for a serious condition.  For example, naturopathic medicine can help allay the severe side effects of chemotherapy and can provide support for better healing.  A study done recently showed that this valuable care accounts for only 2% of the cost of cancer treatment.
4. NDs can meet the growing shortage of healthcare providers in rural areas.  Efforts are under way to allow naturopathic doctors to be granted the same kinds of loan repayment options to encourage participation in rural, veteran’s, and Indian health programs that are available for MDs, DOs, DCs, and other eligible providers.
5. A patient who is rushed through appointments and feels that her/his doctor does not listen is more likely to file a lawsuit in the case of a mistake than is a patient who feels a respectful partnership with her/his physician.  NDs spend a great deal of time listening to their patients, attending to their emotional, mental, and spiritual needs as well as to their physical symptoms.  Cases of malpractice are extremely rare in the naturopathic profession.

A number of “naturopaths” practicing in unlicensed states do not meet the three requirements for appropriate education, examination, and licensure.  This group has consistently opposed efforts to get new legislation passed.

The American Association of Naturopathic Physicians (AANP)
The American Association of Naturopathic Medical Colleges (AANMC)
The North American Board of Naturopathic Examiners (NABNE)
The Council on Naturopathic Medical Education (CNME)
The Canadian Association of Naturopathic Doctors (CAND)
The Federation of Naturopathic Physicians Licensing Authorities (FNPLA)
The Institute of Naturopathic Medicine (INM) Contact INM at 503-499-4343 Ext. 2005


During the first 2 ½ - 3 years of medical school, the education of naturopathic doctors (NDs) follows a path similar to that of medical doctors (MDs). Students in both allopathic and naturopathic medical colleges receive extensive training in the biomedical sciences, and in physical, clinical, and lab diagnosis.  Both receive training in emergency procedures, public health, and principles of pharmacology.   The naturopathic colleges use standard medical texts for this phase of the training.  The paths of naturopathic medical education and allopathic medical education diverge after this point.  MDs learn how to prescribe drugs and perform or refer for surgery.  NDs learn how to use herbs, clinical nutrition, physical medicine (e.g., hydrotherapy, soft tissue massage, osseous manipulation, etc.), homeopathy, and mindbody medicine.

Four keys differences distinguish the naturopathic approach from the approach used by allopathic doctors (MDs):

· Emphasis on prevention
· Search for and treatment of the cause of illness (as compared to an approach that treats the symptoms of the illness)
· Individualized treatment (e.g. two patients being treated for the same pathology may have completely different treatment protocols)
· A goal of removing obstacles to the body’s own innate healing processes (as compared to the idea that “cure” must come from external sources)