State medical groups resist naturopaths' licensure push

Organized medicine says licensing advances can jeopardize public safety.

By Myrle Croasdale — Posted March 27, 2006

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Billing themselves as primary care practitioners who use natural therapies to prevent and treat disease, naturopaths are steadily extending their geographical reach and practice scope.

So far, 14 states and the District of Columbia have licensed naturopaths. Idaho most recently established a naturopath license, passing a bill in April 2005. The American Assn. of Naturopathic Physicians hopes New York will be the next to license the practitioners, with a Senate committee recently passing a bill the state medical society opposes.

New York is one of eight states considering legislation that would license naturopaths or expand their scope of practice, according to Netscan's Health Policy Tracking Service. Virginia will consider a bill in 2007.

Ultimately, the AANP would like to see naturopaths licensed in all 50 states to the full extent of their scope of practice, which the AANP says includes prescribing medication, attending childbirth and performing minor office-based surgery. These are activities organized medicine says fall under physicians' purview. In general, organized medicine doesn't agree licensing naturopaths is the best way to protect patients.

The American Medical Association doesn't have specific policy regarding naturopaths, but it opposes the practice of medicine by those without the appropriate training.

In some instances when bills have arisen, state medical societies, for example those in California and Idaho, have taken a neutral stand on naturopaths' legislative initiatives but only after amendments to bills limited naturopaths' scope of practice through requirements such as physician supervision or collaboration. Before the amendments, the groups opposed the bills in their states.

Jim King, MD, an American Academy of Family Physicians board member, said family physicians want to make sure those who perform these services are adequately trained, particularly those who call themselves primary care doctors. The AAFP, like the AMA, does not have specific policy on naturopaths.

"How much training do they have? Are we comparing apples to apples?" he said. "Much of this legislation is looking to bypass going to medical school. That's the concern most physicians have."

Jane Guiltinan, ND, president of the AANP and director of the Bastyr Center for Women's Wellness in Seattle, said patient safety was a priority for naturopaths and one reason they were seeking licensure.

"Our main focus is to make the case that regulation and oversight of naturopathic medicine is important to protect the public," she said. "Without it, people who have not had legitimate training in naturopathic medicine can put up a shingle."

But naturopaths and physicians don't agree on what scope of practice licensure should cover.

The Medical Society of the State of New York, for instance, said language in a bill it's battling is overly broad. For example, the measure defines naturopathic medicine as all that's covered within the naturopathic curriculum. If the bill passes, MSSNY officials say, naturopaths could perform general surgery if it were taught.

General surgery is not taught, but minor surgical procedures are. MSSNY officials say it would be better to limit naturopaths to approved natural therapies if licensure is permitted and let physicians do the diagnosing.

Push from patients

Consumer demand for alternative health care is on the rise.

According to government reports, annual patient visits to alternative medicine practitioners exceed those to primary care physicians. The studies show patients spend more than $27 billion a year on alternative treatments. This has not gone unnoticed by the medical profession.

Dr. King said he and his five partners in Selmer, Tenn., considered bringing in alternative practitioners in the past, but haven't done so yet.

"When patients and consumers move to other avenues to get their care, we should pay attention to that and determine why it's occurring," Dr. King said. "There are so many things we can learn from alternative medicine."

California, considered a trendsetting state, made it legal for naturopaths to practice a little more than two years ago. Since then, 165 naturopaths have been licensed and can prescribe epinephrine for anaphylaxis, natural and synthetic hormones and devices such as barrier contraceptives. They also may diagnose and treat diseases, perform physical exams, draw blood, order lab tests, and dispense and administer herbs, vitamins and minerals.

As the bill that made it legal for naturopaths to practice wound through the state Legislature, the California Medical Assn. was able to amend it so a physician must supervise ND pharmaceutical prescriptions and naturopaths must meet the same criteria as certified nurse midwives to deliver babies.

Gloria St. John, executive director of the California Naturopathic Doctors Assn., said that since the California Naturopathic Doctors Act passed, her organization has received so many physician inquiries, her group is considering holding a conference to educate physicians on who naturopaths are and how they can fit into a physician's practice.

A spokesman said CMA had not received any inquiries from physicians about working with naturopaths.

Robert T. Mathis, MD, a family physician board certified in holistic medicine, prefers to work with naturopaths. Six months ago he joined the practice of chiropractor and newly licensed naturopath Luc Maes, ND, DC, in Santa Barbara, Calif.

"We're on the same page," he said.

Dr. Maes consults with Dr. Mathis before prescribing pharmaceuticals, and Dr. Mathis is interested in learning from Dr. Maes, who does nutritional work with autistic children.

"We share knowledge back and forth," Dr. Mathis said.

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Naturopaths on the move

Between 4,000 and 5,000 naturopaths have graduated from four-year accredited programs, according to the American Assn. of Naturopathic Physicians. The practitioners have won licensure in 14 states and the District of Columbia and are looking to establish licenses in other states. When the requests come up in state legislatures, the physician community traditionally has opposed naturopaths' requests to prescribe medication, attend home childbirths and perform minor surgeries such as repairing superficial wounds and removing foreign bodies, warts and cysts with local anesthesia.

Where naturopaths are licensed: Alaska, Arizona, California, Connecticut, District of Columbia, Idaho, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont

Where naturopaths are licensed and seeking scope expansion: Hawaii, Washington

Where naturopaths are seeking licensure: Arkansas, Florida, Illinois, Missouri, New York, Tennessee, Virginia

Sources: American Assn. of Naturopathic Physicians and NetScan's Health Policy Tracking Service

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