Complement or threat? Naturopathic doctors aim to fill holistic healing niche
This is the first in a series of articles on the expanding scope of practice of clinicians who are not fully licensed physicians. Last July, members of the AOA House of Delegates debated the issue of who has the right to be identified as a “doctor” or a “physician.” And as they consider how to expand health care coverage while controlling costs, members of the U.S. Congress are weighing who can deliver primary care and which health professionals must be reimbursed by insurance companies.
Embracing a holistic philosophy of healing that resembles osteopathic medicine’s, naturopaths tout themselves as primary care doctors who can help remedy the country’s burgeoning physician shortage. Tapping the public’s growing interest in complementary and alternative medicine, they have been increasing their scope of practice state by state, much as the osteopathic medical profession did in the 20th century.
Licensed in 15 states and the District of Columbia, naturopathic doctors have limited but expanding prescriptive drug authority and other practice rights, with Oregon and Arizona NDs having the broadest prescribing privileges. In Arizona, Hawaii, Oregon, Vermont and Washington, naturopathic doctors can call themselves naturopathic physicians. Last year, two states—Oregon and Hawaii—passed legislation expanding ND scope of practice.
Most recently, the health reform bill that the U.S. Senate approved on Dec. 24, 2009, contains a “nondiscrimination” provision that could require health insurers to cover naturopathic and other alternative treatments provided by licensed health care professionals who are not fully licensed physicians, points out Virginia M. Johnson, DO, who practices neuromusculoskeletal and osteopathic manipulative medicine in Santa Monica, Calif.
“Those trained in a limited paradigm of healing who seek additional practice rights—without commensurate education or responsibility—pose a threat to patients,” Dr. Johnson contends. “What’s more, as a fully trained and licensed physician, I feel this is a lot like identity theft.”
The superficial similarities between naturopathy and osteopathic medicine belie deep differences in training, according to Dr. Johnson and many other osteopathic physicians, who note that the apparent similarities have caused considerable confusion among patients and health policymakers. In a possible example of such confusion, as well as political maneuvering, California Gov. Arnold Schwarzenegger in late July 2009 approved budget legislation requiring California’s Bureau of Naturopathic Medicine to merge with the Osteopathic Medical Board of California.
Some osteopathic physicians, however, fault the osteopathic medical profession for failing to reinforce osteopathic medicine’s distinctiveness. These DOs contend that the profession’s movement toward the mainstream and away from osteopathic manipulative medicine has provided an opening for naturopathic doctors to promote themselves as the true holistic healers.
But not all osteopathic physicians are worried about naturopathic doctors’ practice rights. A number of DOs work cooperatively with naturopathic doctors, referring patients to NDs in some circumstances and receiving referrals from them as well. These osteopathic physicians point out that naturopathy as a profession has improved its training and credentialing standards, just as the osteopathic medical profession did decades ago. While anyone can claim to be a naturopath, a licensed naturopathic doctor must have a doctor of naturopathy degree from an accredited four-year naturopathic medical college and pass the Naturopathic Physician Licensing Examination (known as NPLEX), administered by the North American Board of Naturopathic Examiners.
According to the American Association of Naturopathic Physicians, the United States has four naturopathic medical colleges accredited by the Council on Naturopathic Medical Education (CNME):
- the Bastyr University School of Naturopathic Medicine in Kenmore, Wash.
- the National College of Natural Medicine in Portland, Ore.
- the Southwest College of Naturopathic Medicine in Tempe, Ariz.
- the University of Bridgeport (Conn.) College of Naturopathic Medicine.
In addition, the naturopathic doctoral program at National University of Health Sciences in Lombard, Ill., is a candidate for CNME accreditation.
Part of the team?
In 1919, Washington became the first state to establish licensure for naturopathic doctors. Today, with more than 800 NDs, Washington has more licensed naturopathic doctors than any other state.
Since 2005, Washington has allowed naturopathic doctors to prescribe vitamins, minerals, botanical medicines, homeopathic medicines, hormones and “legend drugs and controlled substances consistent with naturopathic medical practice.” As of November 2007, Washington NDs have been permitted to prescribe codeine and testosterone products.
Seattle family physician Lindy Griffin, DO, accepts NDs as part of Washington’s medical community. She believes that most licensed NDs in the state adhere to their practice limitations and are well-trained in their sphere of health care, which emphasizes dietary and wellness counseling, botanical medicine, and non-Western healing arts such as acupuncture.
“I have worked well my entire practice life with naturopathic physicians,” Dr. Griffin says. “Good naturopathic physicians know what they can do and what they can’t do and get help when they need it.”
Dr. Griffin maintains practice agreements with NDs, who refer patients to her for procedures they can’t perform and medications they can’t prescribe. In turn, she has referred patients to NDs for acupuncture and dietary counseling.
“Some patients need extensive dietary therapy. A naturopathic physician can spend 45 minutes with a patient to provide nutritional counseling,” Dr. Griffin says. “I don’t have the time to do that.”
In Washington, naturopathic doctors often provide primary care, points out Dr. Griffin. “To deny this would be to deny reality,” she contends. “The people in this state want naturopathic physicians. Not being cooperative would be foolish for DOs.”
In contrast, family physician Kelli M. Ward, DO, MPH, of Lake Havasu City, Ariz., does not seek collaborative relationships with naturopathic doctors. However, she treats patients who also see NDs, who in Arizona can prescribe drugs other than antipsychotics after completing pharmacology coursework and passing an examination.
“Sometimes patients come to me with lab orders or prescriptions written by naturopaths that the patients’ health insurance plans won’t cover,” says Dr. Ward, the president-elect of the Arizona Osteopathic Medical Association (AOMA). “These patients want me to write the prescriptions or order the tests instead. I will do so only if I feel that a medication or lab order is medically necessary.”