Modalities most often used in naturopathic practice include clinical nutrition and dietary revision, counseling for lifestyle modification, botanical medicine, homeopathy, physical medicine, and mind-body therapies.
Scope of practice. Depending on local licensure statutes, naturopathic physicians may be fully recognized as primary healthcare providers.3 Prescriptive authority varies, as do provisions for other procedures commonly associated with general medical practice.4
Details of the scope of naturopathic practice in each licensed jurisdiction can be accessed by contacting local licensing authorities, usually via a state or provincial agency website. In the majority of jurisdictions, licensed NDs are responsible for all public health regulations including reportable diseases and immunizations. Most ND practice acts require annual continuing education credits to maintain practice privileges.
Interdisciplinary collaboration. NDs are trained to recognize serious and life-threatening situations and to identify conditions outside of the scope of their professional or legal limitations. Appropriate referral mechanisms are indoctrinated during educational and clinical training. NDs often work with conventionally trained family practice physicians, internists, and specialists in co-managing patients, participating in decisions regarding referral for evaluation and treatment by other allopathic and complementary/alternative medicine practitioners.
Safety and effectiveness of naturopathic medicine
Naturopathic practice is distinguished by treatments individualized to a patient’s physical condition and environmental circumstances, requiring combination therapies adjusted over time as guided by patient response. Documenting the safety and efficacy of naturopathic interventions presents significant challenges—eg, the limitations of the reductionistic approach of allopathic research models when applied to complex interventions and inadequacy of available funding sources. Research on the clinical and quality of life outcomes, particularly evaluation of the actual, complex whole practice as opposed to single agent or specific modalities, is relatively scant.5
Responding to this challenge, in 2002 the NIH funded more than 1200 scientists and physicians from both conventional and naturopathic academic and professional communities in a 2-year effort to design the Naturopathic Medical Research Agenda (NMRA). Guided by the NMRA process, the research departments of naturopathic academic centers are systematically developing the collaborative infrastructure required to examine the theory and practice of naturopathic medicine.6 The recently inaugurated International Journal of Naturopathic Medicine (available at www.intjnm.org) provides access to naturopathic-specific, peer-reviewed research.
Documentation of safety is as relevant as documentation of efficacy. As the potential for harm does exist within the naturopathic scope of practice,7 licensure in the US requires that adverse medical events be reported to the federally mandated National Practitioner Databank.8 The disciplinary records of naturopathic licensing boards provide scrutiny of practices regulated in those jurisdictions as well as documentation of specific offenses: over a 10-year period (1992–2002), 173 complaints were filed with state licensing boards from a total of 1805 licensees. During this period, 31 disciplinary actions were initiated, ranging from probation to fines or censure.9
Safety and efficacy are also of concern to third-party payers. More than 70 companies, trade unions, and state organizations offer health plans that cover naturopathic medical services,10-11 requiring utilization reviews incorporating documented patient outcomes. As NDs are increasingly covered as specialists and primary care providers under reimbursement plans of corporations such as Microsoft and Boeing, the credentialing processes required by their insurers (such as Blue Cross and Blue Shield, Kaiser Permanente, Connecticare, Oxford, and Healthnet) result in formal analyses of safety and efficacy of practice. Malpractice insurance industry data also verify incidents of harm that may occur related to naturopathic practice.
To access more in-depth information, including how to identify licensed NDs in a particular geographic area, contact the American Association of Naturopathic Physicians at www.naturopathic.org.
For information on naturopathic medical education, particularly the advanced standing programs available to degreed professionals, contact the American Association of Naturopathic Medical Colleges at www.aanmc.org.
An additional resource for degreed medical professionals interested in naturopathic professional practice is the website for the North American Board of Naturopathic Examiners at www.nabne.org.
The advent of integrated care has resulted in staff privileges granted to NDs at approximately 20 conventional hospitals and numerous integrated clinics. As a result, efficacy of peer review is strengthened as payers elect naturopathic medical directors to peer advisory committees charged with formulating reimbursement and case management policies.12
Nancy Dunne, ND, Bitterroot Natural Medicine, 200 East Pine St., Missoula, MT 59802. E-mail: [email protected]