"Wait, you're what kind of doctor? A nat-uro-pathic doctor? What's that?"
I get this question all the time. It's not so surprising when it comes from someone I meet in a coffee shop or on an airplane, but I still hear it from other doctors, too. In fact, it's more surprising when someone (outside of Seattle or Portland) has actually heard of what I do. To be fair, I'd never heard of an audiologist until one moved in as a housemate.
My profession is rather small, and we're yet to be licensed in every state. Naturopathic doctors (NDs) are currently licensed to practice as medical professionals in 16 states, and two U.S. territories, and five provinces in Canada.
What we do probably wouldn't make for a popular TV show like House or Grey's Anatomy. Preventing heart disease and cancer through diet or helping someone break the pattern of insomnia is not nearly as exciting as rare diagnoses or ethically questionable emergency transplant surgeries. In fact, when some "alternative" health approach is portrayed on one of these shows, you can be fairly certain it's why the patient is so ill. Ironic, considering the now-famous JAMA article reporting "medical treatment" as a leading cause of death in the United States.
When I say "naturopathic doctor," to some folks it conjures up ideas of magic wands, potions, and Kramer's holistic healer friend on Seinfeld. These sorts of clips (though hilarious!) highlight the misconceptions around what we do. Hopefully this article will help clarify what kind of training an ND gets and what they can do.
Licensed Naturopathic Doctors Have Scientific Medical Training:
Applicants to accredited naturopathic medical colleges need a bachelor's degree and a competitive GPA in scientific prerequisites, just like applicants to "conventional" medical schools.
After admission, the course work of the first two years of naturopathic and "conventional" medical school is comparable both in subjects and in hours of training. We learn all the basic medical sciences like anatomy, pathology, and biochemistry. Unlike Kramer's holistic healing friend, we learn to use the same labs, physical exams, and medical imaging (X-ray, CT, MRI) that hospitals and clinics utilize to diagnose diseases and monitor health. It's pretty rare for me to have to break out the magic wand or have someone drink a cup of tea while wearing the pyramid hat!
Our clinical training is a bit different from "conventional" medical clerkships. As ND students, we spend all our clinical time in a family practice (outpatient) setting, under the supervision of an attending (usually ND) physician. Our training includes minor surgery, like removing a mole, but we don't go into the major surgeries that happen in hospitals. Instead of rotating through a variety of medical specialties, we learn when and how to refer to specialists to diagnose or treat conditions beyond our scope, just like any other family doctor. There are few residencies available for NDs, and since all of our clinical time is spent in family medicine, we tend to go straight into private practice with other medical providers.
Depending on the state, our naturopathic medical license covers everything from dietary advice to pharmaceuticals and suturing wounds. For instance, in California my license is nearly identical to that of a nurse practitioner or physician's assistant. In Washington and Oregon, the license covers a greater scope of practices and ND care is covered by nearly every insurance provider. Unfortunately, health insurance doesn't cover ND services in every state we're licensed to practice in, but our professional organization, the AANP, is working to change that.
Naturopathic Medicine Is Not the Same Thing as Homeopathy
Homeopathy means to give a medicine in a very small dose. Scientifically, we don't know why it works, because the doses are so small. Naturopathic medicine is not how medicine is given specifically, but based on our six principles. Naturopathic medicine refers to an approach to treating people, and tends to favor natural and low-force interventions. Our treatments with patients might include dietary changes, supplementary nutrients, exercise, herbal medicine, pharmaceuticals or homeopathy. So homeopathy can be part of an ND's treatment plan, but it's not the only tool in the shed. That said, other medical providers may use homeopathy as well, and it doesn't make them naturopathic doctors.
Naturopathic Doctors Work Alongside Medical Doctors
Some folks assume that NDs are against "conventional" medicine, but this isn't true. Health care is best provided by a team, and NDs are only one part of the team. There are times when we shine, and times when specialists or other medical providers are best suited for the task at hand. We refer our patients to surgeons, cardiologists, and ERs when it's clear their conditions are beyond of our scope of training.
Naturopathic Doctors and "Naturopaths" Are Different Things
This is probably one of the most confusing things in our field. Even in a state like California, where NDs are licensed as medical providers and the term "naturopathic doctor" is protected by law, people with questionable training can call themselves "naturopaths." Someone operating as a "naturopath" can see clients as long as they don't "practice medicine." Luckily for patients, there are national and state professional associations for NDs, and departments in each state to check whether someone you'd like to see has passed their board exams and has a current license. Not every licensed ND will be a member of their professional organization (like me, since I live outside the U.S.), but they are a good place to start when looking for someone in your area.
Another thing patients need to look out for are people who advertise themselves as an ND (or NMD) without having a license. I've reported several people like this to California's Naturopathic Medicine Committee in the last year. So the moral of the story is, check to see that your health care providers have current licenses issued by the state (they should also be displayed for you to see in their office).
What Makes Naturopathic Doctors Different
Our patients often tell us the face-to-face time we spend with them is a lot longer than other doctors they've seen. We spend that time getting to know each patient as a person. We ask about everything that's going on with them physically, emotionally, and oftentimes spiritually. When making a specific recommendation or prescription, we spend time explaining treatment options and answering questions. We aim to teach our patients about their health, and how they can care for it.
Our treatments are advised using the therapeutic order, where we start by laying the basic foundations for healthy living, and use higher-force interventions (like specific nutrients, drugs and surgeries) as conditions become more severe. In this way, we also work with patients who haven't developed a disease yet, and simply seek to improve their health whether it be physically, emotionally or spiritually. We consider the term "health care" from its true meaning.
We know our patients are literally atoms, molecules, cells and organs, but we appreciate that they are so much more those physical components. We each exist uniquely in the world, with different values and priorities, and as NDs we believe our health care should reflect that.
So yeah, some of us are a little "out there," and "touchy-feely." But that's not all that guides our practice. Remember, naturopathic doctors go to real medical school. We take real board exams. Our "hippie" medicine works, and what we do is becoming less "alternative" and more "conventional" everyday.
For more by Michael Stanclift, N.D., click here.
For more on natural health, click here.