Two weeks ago, a non-medical friend alerted me to an article on a pop culture website that hailed a naturopathic nay-sayer as a Hero of 2017. Two days ago, a medical colleague tagged me in a Facebook post citing the dangers of seeking care from a naturopathic doctor. Two hours ago, I decided to officially respond.
Acknowledging the Issues
Recently, a widely-distributed publication ran a story on the nation's shortage of primary care medical doctors, and how this will likely affect the type of practitioner you'll be likely to see in the future--specifically, Advanced Practice Registered Nurses (APRNs), Physician Assistants (PAs), and yes, naturopathic doctors (NDs). The piece was pretty unflattering to docs like me, postulating that we're not as educated, not as evidence-based, and not as trustworthy as our conventional medicine counterparts.
You should know that I would never offer a blind defense of naturopathic medicine, because I actually agree with many of its criticisms. Our field is clouded by controversy, even within our ranks! Most of this stems from the fact that NDs are not regulated in all fifty states (only 20, plus Washington DC, the US Virgin Islands, and Puerto Rico by my last count), and two states have made it outright illegal to practice naturopathic medicine (Tennessee and South Carolina, if you're curious). Other than that, most of the nation is made up of unregulated jurisdictions. For lack of a better phrase, it's a bit of healthcare hot mess.
More Than a Matter of Semantics
While many practitioners call themselves naturopathic doctors, some have obtained training through online or correspondence schools, neither of which features clinical rotations supervised by licensed professionals, and we refer to them instead as "traditional naturopaths." Those of us who graduated from accredited schools--completing at least four years of post-baccalaureate training with clinical supervision, passing national board examinations, and obtaining licenses to practice naturopathic medicine in jurisdictions that regulate us--have earned the degrees of naturopathic doctors (NDs) or naturopathic medical doctors (NMDs), and in licensed jurisdictions, can call ourselves naturopathic physicians. Still, in unregulated jurisdictions, traditional naturopaths call themselves NDs, and state that they, too, have passed national board examinations. This is terribly confusing to the general public, and in my opinion, a major strike against the legitimacy of the profession.
Compound this confusion with the fact that even within regulated territories, the scope of practice varies tremendously. I'll give an example: when I graduated from school in 2011, I joined an integrative practice in Illinois (an unregulated state) with two medical doctors, a chiropractor, and a personal trainer. Because I was the only practitioner without a registration or license, my charts were reviewed by the chiropractor and/or medical doctors, and any lab work or other investigative measures I was interested in ordering had to be performed by them as well. In theory, this was not an issue, but the challenge came when actually ordering and analyzing some of these tests, as I had greater knowledge and experience with advanced testing than they. Because they were unfamiliar with the tests themselves, and even less prepared to make clinical decisions based on their results, it was always an uphill battle to deliver care in the way I felt was appropriate. *Sigh*
A year later, I relocated to Seattle, WA, and completed a residency in infectious disease and behavioral health. In Washington State, NDs are not only licensed, they are considered primary care physicians, and can perform more advanced techniques like intravenous (IV) therapy and minor surgery. While there, I performed IVs and injections, and occasionally wrote prescriptions if a situation warranted it, though these were reserved for cases showing advanced pathology. The experience was thrilling, and opened my eyes to the value of naturopathic medicine on an integrative team, especially in managing complicated cases.
Last year, I lived in Connecticut, a regulated state with a moderate scope. I sought naturopathic care for my family, and was happy to find that my insurance covered our visits, and that our ND could order blood work to investigate and help us manage illness. Still, she could not order prescriptions for us, and legally could not fill the role of our primary care physician, so with each visit, we paid a copay for a specialist--substantially more expensive--instead of a primary care doctor, despite the fact that she was most familiar with our case and coordinated our care with other doctors.
As you can see, spotty licensing laws make scope of practice completely inconsistent throughout the nation, and while all branches of medicine have differences in scope within each jurisdiction, NDs probably have the most dramatic. Again, super confusing to the general public, and yet another reason why the legitimacy of the medicine is challenged!
Doing No Harm
There is absolutely no doubt that discrepancies in scope, false claims by unqualified practitioners, and general misinformation or lack of information about natural medicine is a major Achilles' heel in the naturopathic cause. It's enough to make someone like me, who takes my oath to "do no harm" very, very seriously, want to abandon the practice forever! But then I remember the patients.
I think back to my first patient ever, a then-sixteen year old who had been hospitalized for schizophrenia three times in his short life, and whose mother was desperate for another option. I think about the hours I spent listening to their story, and how my naturopathic-trained brain saw that the hallucinations came right before migraine headaches, which occurred after eating large amounts of gluten. I remember my nervousness as I broke out textbooks to help me explain why I thought that the schizophrenia was actually a presentation of migraine aura, and that if we could prevent the migraines, we might be able to prevent the hallucinations. I remember their second visit with me, as mom hugged me and cried, so relieved that her son had a week without violent hallucinations for the first time in years.
When I reflect on the good parts of naturopathy--the time we take to truly listen to our patients, our willingness to think outside of the box in case analysis and in care options, the devotion we have to teaching our patients to care for themselves, our environmental stewardship and the reverence with which we craft our medicines--I am inspired to be its champion. Yes, there are plenty of areas where naturopathic medicine needs help. We need to perform more studies to validate (or invalidate!) some of our techniques. We need more jurisdictions to regulate NDs, so that only those with adequate training can present themselves as doctors, and in this way, streamline scope of practice throughout the nation.
Skepticism: Good for Business?
Our response to skepticism of naturopathic medicine will determine our success in making nationwide integration a real possibility. It doesn't serve us to run away from the issues that are being highlighted right now, or to become defensive and alienate our allies. Our patients deserve better than that! Let's work to remedy the confusion with education, outreach, and legislation.
Need some ideas on how to move forward?
Of course, these are only a few ways we can change the perception of naturopathic medicine. Ultimately, it comes down to not what we say, but how we make people feel. Let's acknowledge the shortcomings of our field and work like the dickens to make them better. Let's keep our pride in check and our noses to the grindstone, so that we can continue delivering excellent care to anyone who seeks it. Let's make sure that we're finding opportunity in the opposition, because that's just good business.
About the Author
Sarah Ouano is a naturopathic doctor and writer. A fierce advocate for health equity and rights of the marginalized, she frequently writes about the intersection of naturopathic medicine and public health, throwing in personal anecdotes and tasty (and practical) recipes along the way.