The American Association of Naturopathic Physicians (AANP) and the Institute for Natural Medicine (INM) would like to acknowledge the Association of Accredited Naturopathic Medical Colleges (AANMC) for its contributions to the content of this FAQ. The AANMC was established in 2001 to advance the naturopathic medical profession by actively supporting the academic efforts of accredited naturopathic medical schools.
How are naturopathic doctors educated, trained, and licensed?
What are the Differences between how MDs and DOs and naturopathic doctors (NDs) are trained?
What are prerequisites for admission into an accredited naturopathic medical school?
What are the accredited naturopathic medical schools?
What about licensure and certification?
What is Naturopathic Medicine?
Under what circumstances should I choose to see a naturopathic doctor?
What is the difference between a licensed naturopathic doctor and an unlicensed naturopath?
How should I choose a naturopathic doctor?
How does naturopathic medicine lower health care costs?
FAQ #1: HOW ARE NATUROPATHIC DOCTORS EDUCATED, TRAINED, AND LICENSED?
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Accredited naturopathic medical schools are four-year, in-residence, hands-on medical programs consisting of a minimum of 4,100 hours of class and clinical training. During naturopathic medical school, students are educated in the biomedical sciences as well as the latest advances in science in combination with natural approaches to therapy. They also study disease prevention and clinical techniques.
In addition to a standard medical curriculum, schools require their graduates to complete four years of training in disciplines such as clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, physical medicine, and counseling. For at least the final two years of their medical program, naturopathic medical students intern in clinical settings under the close supervision of licensed professionals.
Given the importance of hands-on, clinical experience for naturopathic medical students, the accrediting body for naturopathic medical colleges does not recognize degrees from online programs of study.
DIFFERENCES BETWEEN HOW MDS AND DOS AND NATUROPATHIC DOCTORS ARE TRAINED
The general educational structure for naturopathic doctors is comparable to that of conventional medical doctors (MDs) and osteopathic doctors (DOs). In all three medical programs, the first year emphasizes biomedical sciences such as anatomy and biochemistry. Second year classes focus on the diagnostic sciences, including areas such as evidence-based medicine and physiological assessment. All programs progressively increase students’ problem-based learning and integrated coursework, enabling students to learn how different concepts affect one another.
After the first two years, the curricula of the three medical programs focus on applying medical knowledge to real-life situations with simultaneous classroom studies supporting this training. Third- and fourth-year naturopathic medical students have opportunities for hands-on clinical training and practice, often at their schools’ teaching clinics and off-site clinics. This period of clinical training is essential to these students’ education—so much so that clinical training is now being introduced during the first and second years of education at several AANMC-member schools. As a result, naturopathic medical students graduate with experience in diagnosing and treating patients, even before they begin formal practice.
Third- and fourth-year naturopathic medical students have opportunities for hands-on clinical training and practice, often at their schools’ teaching clinics and off-site clinics. This period of clinical training is essential to these students’ education—so much so that clinical training is now being introduced during the first and second years of education at several AANMC-member schools. As a result, naturopathic medical students graduate with experience in diagnosing and treating patients, even before they begin formal practice.
A major difference between the training of the MDs and naturopathic doctors is medical residencies. MD residencies are mandated and regulated by conventional medical schools. As a result, many opportunities for residencies exist at a wide variety of medical facilities and are funded by the federal government.
Naturopathic medical residencies are not nearly as common because they are not yet required by most states (Utah is an exception) or funded by the federal government. In place of a residency, many new naturopathic doctors choose to practice with or shadow an experienced doctor before setting up their own practices.
Like MDs, a growing number of naturopathic doctors choose to specialize or focus their practices. Specialty associations currently exist for Endocrinology, Environmental Medicine, Gastroenterology, Parenteral Therapies, Pediatrics, Primary Care Physicians, Psychiatry, and Oncology. In addition, while practicing Family Medicine, many naturopathic doctors choose an area of focus based on a therapeutic, condition, or population subset.
PREREQUISITES
Prior to admission into an accredited naturopathic medical school, the typical entering student has completed three years of pre-medical training and earned a bachelor of science degree. Students are expected to have completed courses in English and the humanities as well as math, physics, and psychology, with a strong emphasis on chemistry and biology. In addition to prerequisite course work, prospective students must demonstrate appropriate observational and communication skills, motor function, intellectual-conceptual abilities, integrative and quantitative abilities, and behavioral and social maturity.
ACCREDITED SCHOOLS
There are currently seven accredited schools with eight campus locations in the United States and Canada. A degree from an accredited medical school is required for licensure or certification by a state.
The following accrediting institutions provide accreditation services for naturopathic medical schools:
College accreditation is issued by the U.S. Department of Education (ED). All AANMC member schools have been accredited or are in candidate status for accreditation by an ED-approved regional accrediting agency.
Programmatic accreditation is issued by the Council on Naturopathic Medical Education (CNME). All AANMC member schools have also been accredited—or are candidates for accreditation—by the CNME, the recognized accrediting body for naturopathic medical programs in North America.
The exam required to qualify for naturopathic doctor licensure is administered by the North American Board of Naturopathic Examiners (NABNE). The Naturopathic Physicians Licensing Examinations (NPLEX) is a two-part examination. Only students and graduates from accredited or candidate naturopathic programs are eligible to sit for the NPLEX. Passing the NPLEX is required before a doctor of naturopathic medicine can be licensed by a state.
LICENSURE AND CERTIFICATION
Licensure and certification are the highest forms of regulation. They are designed to protect the public by ensuring that certain minimum competency requirements are met. They also set standards for the profession.
Currently 19 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands offer licensure or certification for naturopathic doctors. The American Association of Naturopathic Physicians maintains a list of states and territories that license or certify naturopathic doctors.
FAQ #2: WHAT IS NATUROPATHIC MEDICINE?
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Naturopathic medicine is a distinct practice of medicine that emphasizes prevention and the self-healing process to treat each person holistically and improve outcomes while lowering health care costs.
Naturopathic doctors are educated and trained in accredited naturopathic medical colleges. They diagnose, prevent and treat acute and chronic illness, restore and establish optimal health by supporting the person’s inherent self-healing process. Rather than just suppressing symptoms, naturopathic doctors work to identify underlying causes of illness, and develop personalized treatment plans to address them. Their Therapeutic Order™, identifies the natural order in which all therapies should be applied to provide the greatest benefit with the least potential for damage.
- Remove Obstacles to Health. Health, the “natural state” of one’s body, is disturbed by obstacles that lead to disease. The first step in returning to health is to remove the entities that disturb health such as: poor diet, digestive disturbances, inappropriate and chronic stress levels, and individual disharmony. Naturopathic doctors construct a healthy regimen based on an individual’s “obstacles to health” to change and improve the terrain in which the disease developed. This allows additional therapeutics to have the most beneficial effects possible.
- Stimulate the Self-Healing Mechanisms. NDs use therapies to stimulate and strengthen the body’s innate self-healing and curative abilities. These therapies include modalities such as clinical nutrition, botanical medicines, constitutional hydrotherapy, homeopathy, and acupuncture.
- Strengthen Weakened Systems. Systems that need repair are addressed at this level of healing. Naturopathic doctors have an arsenal of therapeutics available to enhance specific tissues, organs or systems including: lifestyle interventions, dietary modifications, botanical medicine, orthomolecular therapy (use of substances that occur naturally in the body such as vitamins, amino acids, minerals), and homeopathy.
- Correct Structural Integrity. Physical modalities such as spinal manipulation, massage therapy, and craniosacral therapy are used to improve and maintain skeletal and musculature integrity.
- Use Natural Substances to Restore and Regenerate. Naturopathic medicine’s primary objective is to restore health, not to treat pathology. However, when a specific pathology must be addressed, NDs employ safe, effective, natural substances that do not add toxicity or additionally burden the already distressed body.
- Use Pharmacologic Substances to Halt Progressive Pathology. NDs are trained in pharmacology and how to use pharmaceutical drugs when necessary. If their state license permits, they can prescribe these agents themselves or if not, refer to a conventional medical colleague.
- Use High Force, Invasive Modalities: Surgery, Radiation, Chemotherapy. When life, limb, or function must be preserved, NDs refer patients to MDs who are expertly trained in these arenas. At the same time, NDs use complementary or supportive therapies to decrease side effects and increase the effectiveness of these invasive procedures.
While many naturopathic doctors are trained in primary care, like conventional medical doctors (MDs), some choose to specialize or focus their practices. Specialty associations currently exist for Endocrinology, Environmental Medicine, Gastroenterology, Parental Therapies, Pediatrics, Primary Care Physicians, Psychiatry, and Oncology.
Naturopathic medical education curricula include certain areas of study not covered in conventional medical school. At the same time, aspiring naturopathic doctors receive training in the same biomedical and diagnostic sciences as MDs and osteopathic doctors (DOs). The result is a comprehensive, rigorous, and well-rounded scientific medical education that is both comparable and complementary to that of MDs and DOs.
FAQ #3: UNDER WHAT CIRCUMSTANCES SHOULD I CHOOSE TO SEE A NATUROPATHIC DOCTOR?
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- You want a doctor who will treat all of you, not just your illness.
Naturopathic doctors (NDs) are trained to treat the whole person. This requires taking the time to listen and understand the genetic, environmental, and behavioral/lifestyle factors that can affect your health. At your initial appointment, you’ll spend up to an hour or more talking with your ND. - You want personalized treatment.
NDs understand there is no one-size-fits-all treatment that works for everybody. After your visit with an ND, you’ll leave the doctor’s office with a treatment plan uniquely tailored to you, your health status, your health goals, and your lifestyle. - You want to treat the root cause of an illness, not just the symptoms.
Sometimes having trouble sleeping, aches and pains, strange or hard to treat skin rashes, and indigestion or stomach discomfort are symptoms of an underlying illness. While these symptoms can be managed, it’s more important to understand and treat the root cause—which is the focus of naturopathic medicine. - You want to actively participate in managing your own health.
An ND will help you learn what your body needs to get well and stay healthy. Patients have the opportunity to feel empowered and hopeful when they understand and are actively engaged in managing their own health. - You have chronic pain and don’t want to use pharmaceutical drugs such as ibuprofen, acetaminophen, or highly addictive opioids to manage it forever.
Pain that lasts six months or more is more complex than acute pain and requires a holistic, long-term approach to manage. NDs are trained to work with you to determine which combination of therapies will work best for you to heal or manage your pain safely so that you can resume daily activities. - You have tried all conventional medical options for diagnosing and treating a health condition.
Certain chronic health conditions that have symptoms such as fatigue, insomnia, or gastrointestinal distress can be difficult to diagnose and treat, and can benefit from a holistic approach. NDs use diagnostic tools common in conventional medicine, such as detailed health, disease, and prescription drug histories, physical exams, and targeted laboratory testing and imaging. NDs also consider detailed diet history, lifestyle habits and choices, exercise history, and social/emotional factors to assess patients’ needs. These approaches can open doors to new treatment pathways and options.
LICENSED NATUROPATHIC DOCTORS AND THEIR SCOPE OF PRACTICE
Licensed naturopathic doctors combine knowledge of the body’s natural healing properties with the rigors of modern science to focus on holistic, proactive prevention and comprehensive diagnosis and treatment. By using protocols that minimize the risk of harm, naturopathic physicians help facilitate the body’s inherent ability to restore and maintain optimal health.
Naturopathic doctors treat all medical conditions and can provide both individual and family health care. They can work as primary care providers and as part of an integrated healthcare team. Among the most common ailments they treat are allergies, chronic pain, digestive issues, hormonal imbalances, obesity, respiratory conditions, heart disease, fertility problems, menopause, adrenal fatigue, cancer, fibromyalgia, and chronic fatigue syndrome. Naturopathic doctors can perform minor surgeries, such as removing cysts or stitching up superficial wounds, however they do not practice major surgery. They also are trained to use prescription drugs, although they emphasize less toxic substances that promote natural healing first, following the Therapeutic Order to provide the greatest benefit with the least potential for damage.
Naturopathic doctors can order all blood reference range and diagnostic imaging tests. They can also order individualized specialty functional medicine labs, such as those for assessing digestive impairment, hormone imbalances, heavy metal and/or environmental toxin exposure, nutritional deficiencies, and adrenal dysregulation. They will evaluate your lab results in combination with your clinical presentation, your health history, and lifestyle and environment factors that might be preventing you from having optimal health.
CHOOSE YOUR NATUROPATHIC DOCTOR WISELY
When seeking medical care from a naturopathic doctor, it is important to select a doctor who has a naturopathic medical degree earned from an accredited, four-year, in-residence, naturopathic medical college and is licensed or certified.
FAQ #4: WHAT IS THE DIFFERENCE BETWEEN A LICENSED NATUROPATHIC DOCTOR AND AN UNLICENSED NATUROPATH?
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Licensed naturopathic doctors, sometimes referred to as naturopathic physicians, are regulated at the state level to practice naturopathic medicine. Naturopathic medical students attend accredited, four-year, in-residence, naturopathic medical schools where they study biomedical sciences such as anatomy, physiology, biochemistry, pathology, and pharmacology. Their medical education incorporates the latest advances in science and natural approaches to illness prevention and management. Students complete a minimum of 4,100 hours of class and clinical training, including over 1,200 hours of hands-on, supervised, clinical training.
Naturopathic doctors can order diagnostic tests such as blood tests, X-rays, MRIs, and, in some states, prescribe prescription drugs and hormones and perform minor surgery. According to the Association of Accredited Naturopathic Medical Colleges (AANMC) 2015 survey of alumni, 50 percent of naturopathic doctors practicing full-time self-report as primary care physicians, while 28 percent report working as natural health specialists. In addition, like conventional medical doctors (MDs), a growing number of naturopathic doctors choose to focus their practices in specialty areas. Specialty associations currently exist for Endocrinology, Environmental Medicine, Gastroenterology, Intravenous Therapies, Pediatrics, Primary Care Medicine, and Oncology.
A naturopathic doctor must pass rigorous professional board exams prior to being licensed or regulated in a state that regulates the practice of naturopathic medicine. State mandated regulatory bodies oversee standards of practice, complaints, and discipline for all licensed jurisdictions. Licensed naturopathic doctors also carry malpractice insurance and maintain a commitment to lifelong learning through continuing education. These requirements are safeguards to ensure patients’ rights to quality naturopathic care.
THE EXAM REQUIRED TO QUALIFY FOR NATUROPATHIC DOCTOR LICENSURE IS ADMINISTERED BY THE NORTH AMERICAN BOARD OF NATUROPATHIC EXAMINERS (NABNE)
The Naturopathic Physicians Licensing Examinations (NPLEX) is a 2-part examination. Only students and graduates from accredited or candidate naturopathic programs are eligible to sit for the NPLEX.
In some states with laws regulating naturopathic doctors, the use of the term “naturopath” or “naturopathic physician” by anyone other than a licensed naturopathic doctor is prohibited. However, not all states regulate naturopathic doctors and not all states that do protect the term “naturopath.”
Therefore, unlicensed naturopaths can have varied levels of education and experience, often from a purely online or correspondence format. Such education is not accredited by an agency recognized by the U.S. Secretary of Education and does not qualify students to take the NPLEX examination or apply for licensure in any regulated jurisdiction in North America.
BE AWARE THAT WHILE THE TERMS MAY BE USED INTERCHANGEABLY, THEY ARE NOT THE SAME
As a patient, you should also know that the terms “naturopathic doctor”, “naturopathic physician” and “naturopath” are often used interchangeably by medical practitioners in other disciplines and the public, even though unlicensed naturopaths do not have the same training or privileges. Knowing the difference between licensed naturopathic doctors and unlicensed naturopaths can help you make informed decisions about which type of provider can best help you.
FAQ #5: HOW SHOULD I CHOOSE A NATUROPATHIC DOCTOR?
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The most important criteria in selecting a naturopathic doctor are that the doctor 1) has a naturopathic medical degree earned from an accredited, four-year, in-residence, naturopathic medical college and 2) has passed rigorous board exams as part of a licensure or certification process.
There are currently seven accredited naturopathic medical programs in North America. They are: Bastyr University, National University of Natural Medicine, National University of Health Sciences, Southwest College of Naturopathic Medicine, University of Bridgeport—College of Naturopathic Medicine, Canadian College of Naturopathic Medicine, and Boucher Institute of Naturopathic Medicine.
Twenty-three states and U.S. territories permit access to safe, effective, and affordable licensed or certified naturopathic doctors. These include Alaska, Arizona, California, Colorado, Connecticut, District of Columbia, Hawaii, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, North Dakota, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Washington, and the U.S. territories of Puerto Rico and Virgin Islands. For a map of regulated states and states seeking licensure, click here.
WHAT TO EXPECT WITH YOUR FIRST VISIT
During your first visit, your licensed naturopathic doctor will take your health history, ask questions about your diet, stress levels, lifestyle habits and exercise, use of tobacco and alcohol, prescription drugs and supplements you are taking, and discuss the reasons you sought out a naturopathic doctor. He or she might also perform a physical examination and order diagnostic tests. Based on findings, the doctor will work with you to set up a customized treatment plan and health management strategy. If necessary, the doctor will refer you to other health care practitioners.
Naturopathic doctors understand conventional medicine and use many of its diagnostic tools and treatments in their practices. They also bring an array of treatments and insights into treatment plans and health management strategies that typically are not taught in conventional medical schools and might not be available from a conventional medical doctor. One example is the use of plant-based medicines (botanicals). Used correctly, these medicines along with lifestyle changes can improve many aspects of a patient’s health.
Be prepared for your naturopathic doctor to focus on understanding the root causes of health symptoms you might be experiencing as well as your overall health and wellness goals. This takes time. As a result, your first visit might last an hour or more and follow-up visits could last 30 minutes or more, although this varies depending on the individual.
HOW TO FIND A NATUROPATHIC DOCTOR
Licensed naturopathic doctors work in a variety of clinical settings, including private practices, hospitals, clinics, and community health centers. As a service to consumers, the AANP provides a naturopathic doctor directory of its members and finder tool on its website, available here.
FAQ #6: HOW DOES NATUROPATHIC MEDICINE LOWER HEALTH CARE COSTS?
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As concerns grow over high health care costs and poor health outcomes in the United States, a growing number of policymakers, health care practitioners, and other stakeholders are calling for an expansion of the focus of our health care system to keeping people healthy in addition to providing medical treatment after a person gets sick. To accomplish this change, health care professionals from a broad range of disciplines must come together in primary care teams. Trained as primary care doctors and to emphasize prevention, licensed naturopathic doctors have a central role to play in these efforts.
Naturopathic medicine is a distinct practice of medicine that emphasizes wellness and the self-healing process to treat each person holistically. Licensed naturopathic doctors are known for following a unique Therapeutic Order, an approach that identifies the natural order in which naturopathic therapies should be applied to provide the greatest benefit with the least potential for harm. This approach leads to improved outcomes and lower health care costs.
HERE ARE 8 WAYS NATUROPATHIC MEDICINE LOWERS HEALTH CARE COSTS:
1. ADDRESS THE ROOT CAUSES OF ILLNESS
By addressing and treating the root causes of disease rather than its symptoms, the need for repeated, expensive, and sometimes ineffective treatment is eliminated. For example, the underlying causes of conditions such as high cholesterol and diabetes is often poor diet and lifestyle factors such as lack of exercise. Changing these lifestyle factors can eliminate the need for one or more prescription medications that would typically be recommended for the rest of that patient’s life.
2. OFFER LESS EXPENSIVE DIAGNOSIS AND TREATMENT
Naturopathic medical diagnostics and treatments are often less expensive than those in conventional medicine. Many treatments incur no cost whatsoever. One example is taking the time to engage patients in ongoing discussions of lifestyle choices, making the connection between these choices and their health condition and guiding patients to healthier options.
3. REDUCE THE NEED FOR EXPENSIVE SURGICAL PROCEDURES, WHEN APPROPRIATE
According to the American College of Surgeons and the American Medical Association, among the most common surgeries performed in the United States are coronary artery bypass surgery, carotid endarterectomy, and low back pain surgery.1 Because naturopathic doctors often suggest less expensive, non-surgical options to patients, some of these expensive surgeries can be avoided. One major study investigating the effects of lifestyle improvement in patients with coronary atherosclerosis found that after only one year of following lifestyle recommendations, about 80 percent of participants were able to bring about plaque regression and avoid surgery without the use of lipid lowering agents.2 The study estimated that this would save almost $30,000 per patient in the first year alone.3
4. DECREASE COSTS ASSOCIATED WITH ADVERSE REACTIONS TO PRESCRIPTION DRUGS
According to a 2014 report from the Harvard University Center for Ethics, there are 2.7 million serious adverse reactions to prescription drugs that have been legally prescribed each year, resulting in 128,000 deaths. This makes prescription drugs a major health risk, ranking fourth with stroke as a leading cause of death. Whenever possible, naturopathic doctors prescribe natural therapies first, turning to prescription pharmacology when they are necessary.
5. REDUCE THE INCIDENCE OF ILLNESSES AND FATALITIES CAUSED BY HOSPITAL ERRORS
Research shows that preventable hospital errors are the third leading cause of death in the United States.4 Naturopathic medicine focuses on preventative care and patient education, which can reduce the length of hospital stays and hospital re-admissions. The power of patient education has been well documented. A case study at Sentara Virginia Beach Hospital found that when heart failure patients were provided with education on their condition, their readmission rates dropped by 74 percent and hospital stays were 13 percent shorter.5
6. LOWER MALPRACTICE RATES, RESULTING IN REDUCED PATIENT COSTS
Malpractice insurance rates are much lower for naturopathic doctors than they are for conventional medical doctors. According to NCMIC, the largest malpractice insurer for naturopathic doctors, the yearly rate for naturopathic doctors in Arizona, Oregon, Minnesota, and New Hampshire is approximately $3,803. Rates for MDs in the same states are $18,646.6
7. OFFER DISEASE PREVENTION
Naturopathic doctors emphasize health-building practices such as weight bearing exercise and adequate vitamin D intake to prevent osteoporosis and the importance of eating a nutrient dense diet with healthy fats to help prevent heart disease. These practices can reduce the high future cost of preventable degenerative and chronic health conditions.
8. REDUCE INSURANCE COSTS
Naturopathic medicine billing is far lower per patient than conventional medical billing. One study compared health care expenditures between complementary and alternative medicine (CAM) users and non-users, with CAM providers being defined as naturopathic doctors, chiropractors, acupuncturists, and licensed massage therapists. While CAM users had higher outpatient expenditures, they had lower inpatient and imaging expenditures. Overall, CAM users had a lower average expenditure than non-users during the one-year study, at $3,797 versus $4,153.7
Sources
1 Stanford Health Care. General Surgery-Common Surgical Procedures. Online access: https://stanfordhealthcare.org/medical-treatments/g/general-surgery/procedures.html
2 Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990;336:129–133.
3 Guarneri E, Horringan, BJ, Pechura, CM. 2010. The Efficacy and Cost-Effectiveness of Integrative Medicine: A Review of the Medical and Corporate Literature. Bravewell Collaborative Report. June, 2010.
4 Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016 05 3;353:i2139. doi: http://dx.doi.org/10.1136/bmj.i2139 PMID: 27143499. Online access: https://www.ncbi.nlm.nih.gov/pubmed/27143499
5 GetWellNetwork. Improving Heart Failure Outcomes through Interactive Patient Care: The Sentara Virginia Beach General Hospital Experience. 2009. Online access: http://amandanenaber.weebly.com/uploads/6/1/7/6/6176087/hf-_get_well_network.pdf
6 Whitmer, Mike. Letter to Ron Mensching at National University of Health Sciences. Jan 2017.
Online access: http://www.naturopathic.org/files/NCMIC%20Letter%20re%20Malpractice%20Risk%201-26-17(2).pdf
7 Lind BK, Lafferty WE, Tyree PT, Diehr PK. Comparison of Health Care Expenditures Among Insured Users and Nonusers of Complementary and Alternative Medicine in Washington State: A Cost Minimization Analysis. J Altern Complement Med. 2010;16(4):411–7. doi: 10.1089/acm.2009.0261. Online access here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110809/