What is a Naturopathic Doctor?
Many of you may already be familiar with what a Naturopathic Doctor is but in our ever-changing world of health, it can be confusing finding the right provider to meet your healthcare needs and goals. This article is designed to provide you with details of what an ND is, how they are educated, and how they compare to other healthcare professionals. To help exemplify some of the differences and what to expect when you see a ND, I included a case study from personal experience.
What is Naturopathic Medicine
Naturopathic Medicine has been around since the dawn of the ages when we didn’t have drugs or modern medical conveniences. What did our primitive ancestors use when they felt bad? They used water, food, plants, rest, and movement to get well. In a nutshell, that is what I do! We go back to where we are failing our body in order to maintain optimal performance and wellness. Stated by the American Association of Naturopathic Physicians “Naturopathic medicine is a distinct system of health care; an art, science, and practice of preventing, diagnosing and treating conditions of the human mind and body”. NDs address the whole body, not just the symptoms each person experiences. I visualize the body as a tapestry in the making. When we look at the whole body we are looking at the whole tapestry to see the full picture. When we look at one portion of this tapestry all we see is one aspect- a bunch of threads that are really connected to the whole of your health. A gastroenterologist looks at your gut and generally nothing else. A cardiologist is all about the heart and your blood vessels and that is their goal. So who looks at the whole you? Well, you and Naturopathic Doctors. We examine the tapestry and each thread it contains. We look at all the aspects of your health tapestry from mental, physical, emotional, and spiritual to see what is helping and what is not helping your body stay beautiful.
NDs follow these naturopathic principles that allow us to see healing come in and out of our doors every day:
- First, do no harm
- Use the healing power of nature
- Identify and treat the cause
- Treat the whole person
- Doctor as teacher
Education, Regulations, and What to Expect
A Naturopathic Doctor’s Education
Before getting accepted and attending a naturopathic medical school, all students are required to have a bachelor’s degree and have met similar college-level pre-med science requirements to that of MD school requirements. An ND attends an accredited four-year naturopathic medical school. The first two years are primarily core science courses, similarly to MD school. After the first two years, ND students take a core science board exam called the NPLEX 1 in which they have to pass to continue on the same program. The last two years are focused on treatment modalities such as nutrition, physical medicine, homeopathic medicine, pharmacology, botanical medicine, and more. ND students are in the clinic for three years starting off in a training role providing hydrotherapy treatments to patients. The students then graduate into clinical rotations where they begin to use their clinical skills to perform intakes, physical exams, and formulate treatments under the supervision of an attending physician.
After four years, all students must have passed all courses, completed all clinic proficiency objectives and hours as well as over 700 hours of preceptorship with practicing physicians outside of the clinic. Upon completion of coursework and clinical rotations, NDs receive a Doctorate in Naturopathic Medicine. At this point, all students sit for their clinical board exam called the NPLEX II. After a student has completed all medical school requirements, received a diploma, passed both the NPLEX I and II, students can either continue onto a residency or start to practice as naturopathic doctors.
Each state in the United States has different regulations for NDs. Some states such as Oregon, Washington, and Arizona allow NDs to practice as primary care physicians, as they were trained, and are covered under most insurance plans. In these states, NDs have prescriptive rights meaning they can prescribe any medication on the market. Other states, such as Colorado where I practice, do not recognize the primary care education NDs receive and recognize NDs as adjunctive care doctors with minimal prescriptive rights. Each state’s rules and regulations are different for licensure or registration. Therefore, an ND practicing in Oregon has a different scope of practice than in Colorado. For example, I was trained to formulate and administer IV’s in Oregon, but in Colorado, our scope of practice is not yet open to this modality. This is why you will also see NDs in colorado also state they are RNDs (not to be confused with RDN- a registered dietician nutritionist) because this state requires that we publically state we are 'registered naturopathic doctors'. Here is a great link to what states recognize ND’s, those that are working on licensure, and those where ND’s currently do not hold licensure.
In the state of Colorado, a Naturopath and a Naturopathic Doctor are two different things. There are people all over the United States that call themselves Naturopaths. This does not mean they went to a four-year accredited naturopathic medical school. Be sure that you inquire about their background and education if you are interested in seeing them as a client/patient. If their degree did not come from one of the listed naturopathic medical schools, they are not a Naturopathic Doctor. If you live in a state where NDs are not regulated such as Texas or Arkansas, you have to be even more diligent in finding a properly trained naturopathic doctor. In order to find one that is actually a Naturopathic Doctor, ask for proof that they attended one of the accredited naturopathic medical schools.
What should I expect when I see a Naturopathic Doctor?
Before I see any individual, I provide a lengthy intake form for them to complete before coming to their appointment. This form asks about your medical history, your goals, your relationships, your sleep, your diet, and any symptoms you are experiencing that you want to address.
My initial intake is two hours long where you are sitting one on one with the doctor. Some NDs choose different visit lengths as all NDs practice differently. The first 1.5 hours is all about you and your story. We go over the intake form to determine goals, obstacles, and a treatment approach. After the intake, I perform a thorough physical exam and run any in-office tests, such as a urinalysis, if warranted. Physical exams include your basic vitals just as any doctor’s office would perform as well as examining all of your other systems such as your nervous, respiratory, and musculoskeletal. Then we talk about what your short term and long term goals are for you and your health to formulate a treatment plan together. It is also important to me to educate you on what I feel is going on with your body so you understand why we choose the treatments we do. Treatment recommendations range from lifestyle modifications and hydrotherapy treatments to dietary modifications and supplemental medicine and so much more. We may also order lab testing depending on the condition or symptoms for further investigation. Follow up visits are shorter than the initial visit and are always warranted to check up on your progress and obstacles so we can either continue the same treatments or make changes.
What is the difference between NDs and other healthcare professionals?
How NDs compare to MDs
Medical Doctors similarly attend a four-year accredited medical school. Coursework for the first two years are very similar in the core basic sciences and then they proceed into clinical coursework and clinical rotations. MDs also take two board exams called the USMLE I and II just as NDs take the NPLEX I and II. MDs are required to complete a residency in a field of study ranging from 1-9+ years depending on the discipline they choose to follow. NDs are trained in more alternative clinical modalities but still receive pharmacology courses whereas MD treatment modalities are heavier on pharmaceutical and diagnostic treatment modalities. MDs are trained in major surgery where NDs are limited to minor surgery techniques.
How NDs compare to Homeopaths
NDs are trained in homeopathy, as it is one of the many treatment modalities we use for patients. Homeopaths complete a certificate in homeopathy (CHom) which is a program either online or in person ranging from 1-3 years. Homeopaths receive a certificate in homeopathy that does not require a bachelor’s degree or educational pre-requisites whereas ND schooling requires a bachelor’s degree and college level core sciences to complete a doctorate with training in homeopathy. Some NDs continue their homeopathy education with certain institutes and get a certificate in homeopathy as the training can be more extensive in those institutes than what ND medical schools offer.
How NDs compare to Acupuncturists
Some NDs are trained in acupuncture as part of their program whereas some are not. Some Naturopathic medical programs offer Chinese medicine also as these two forms of medicine are similar in philosophy. All accredited acupuncture schools require a certain number of collegiate level courses and certain collegiate level basic sciences in order to be accepted. Acupuncturists then attend a school where they study the art of Chinese Medicine and philosophy. Depending on the level of study, an acupuncturist can hold a master’s or doctorate in Chinese or Oriental medicine. Acupuncturists use herbal medicine, cupping, needling among other treatment modalities. All ND students take introductory courses in Chinese medicine to understand the philosophy and some study further depending on their program of choice. Most NDs are not trained in the art of needling though some are so ask your ND if this is something they do if you are interested in receiving acupuncture.
How NDs compare to dieticians and nutritionists
A registered dietician, RD, holds a bachelor’s or master's degree in nutrition. RD and RDNs have also completed an internship in order to sit and pass the national exam to be considered as 'registered'. Some dieticians also go by the title of registered dietician nutritionist, RDN. A nutritionist that is not a registered dietician may or may not hold a formal degree from a university or college as the term 'nutritionist' is not regulated due to variable state regulations. For instance, Colorado does not regulate the term nutritionist therefore some people who call themselves nutritionists may not have received a formal university or college education in nutrition whereas some have a higher level of education such as a bachelor's, master's or Ph.D. This is the same situation as what NDs face with 'naturopaths' in the state of Colorado because both the term 'naturopath' and 'nutritionist' are not regulated by the state. Please note that there is a variable level of education between an RD/RDN compared to nutritionists, health coaches, and nutritional therapists. In ND medical school, nutrition is integrated into all ND course starting in their first year of medical school through the fourth year at a doctorate level of education. Therefore, some nutritionists have more hours of nutrition education than NDs whereas some do not.
How NDs compare to health coaches, wellness coaches, or nutritional therapists
Health/wellness coaches or nutritional therapists receive a certificate in a practice related to nutrition. Most of these certificate programs range from a four-month to one-year online program where a bachelor’s degree is not required for admission. A nine-month online program equates to about one term of a four-year bachelor’s degree level of education whereas NDs study these same practices and more in more detail over the course of four years at a doctorate level.
This is an example of a case close to my heart that outlines the level of care you get when you see an ND.
Case: 23-year-old female suffering from frequent debilitating recurring headaches. These headaches come on about 30 minutes after waking and are constant throbbing around the head almost all day. The headaches occur about once per week and resulted in nausea and occasional vomiting.
The patient goes to her primary care MD
The patient gets to the doctor’s office and is admitted back, after waiting well over the scheduled appointment time. A nurse takes her vitals and does not report anything. The nurse then takes the patient back to a room where she then asks a series of about eight questions for ten minutes then leaves the room. The doctor comes in 15 minutes later, says hello and performs a fundoscopic exam to look in the patient’s eyes. The doctor asks a series of a few questions about symptoms, how often they occur and location of the headaches. The doctor states they want to order an MRI and lab work including a complete blood count and a comprehensive metabolic panel. The patient schedules the lab work and MRI and leaves the office.
The MRI was ordered and the patient gets the MRI done about one week later. The MRI results come in and the doctor calls to inform the patient the MRI results came back normal as well as all labs and that they want to put her on an antidepressant. The doctor states that studies show antidepressants are helpful in reducing the occurrence of headaches. The doctor asks who their pharmacy is and will fill the prescription that day and it will be ready to be picked up tomorrow. The doctor says they want to follow up in 6 months and to schedule an appointment with the front desk when the patient gets a chance.
The patient starts taking the antidepressant as prescribed. The patient cannot get to work due to the sedative effects of the medication. The patient also starts to experience even worsening constipation than before, heart palpitations, and weight gain on top of already feeling overweight. The patient now feels worse than before and is falling into depression feeling as if she cannot make it through life like this.
The patient goes to her ND
The patient arrives at the ND’s office and is seen five minutes after appointment time. Patient vitals are taken and the nurse informs the patient her blood pressure and pulse are low and will let the doctor know. The doctor comes in about five minutes later and talks to the patient for over an hour one-on-one about her health history and her concerns. A physical exam is performed: head, heart, lung, abdominal, ear, eye, muscle strength, and reflexes. The doctor informs the patient there is a lot of stool in the rectum and the patient states she has not had a bowel movement in three days indicating constipation. The doctor talks to the patient stating they believe the root cause of these headaches and constipation are possible food triggers, low hydration status, and possibly a nutrient deficiency due to the patient’s poor eating habits. The doctor orders an MRI and informs the patient why it was ordered and what conditions are being ruled out. The doctor also orders a complete blood count, complete metabolic panel, ferritin, and vitamin D to rule out any infection, nutritional deficiency, or other systemic deficiency. The doctor also discussed the patient’s options of either doing a ten-day diet diary or a food allergy test and the patient chooses to do a food allergy test.
The patient gets the MRI done one week later. The patient is called after all labs and imaging results are in and schedules a follow up in office to go over results. The doctor delivers the results in office: the MRI, complete blood count, comprehensive metabolic panel, and ferritin were all normal. Patient had mild vitamin D deficiency. The food allergy test came back positive for an allergy response to dairy, egg whites, strawberries, and coconut. The plan is now to eliminate these foods, start a vitamin D supplement, a multivitamin, and a daily water intake requirement. The patient was to follow up once weekly for massage and manual therapy manipulations to help with her tight neck muscles which were also contributing to her headaches and then have a full follow up on how the treatment is progressing in one month.
After one week of treatment, the patient experienced one mild headache but connected it to poor sleep the night before. After one month of treatment, the patient was headache free and constipation free.
This story is by no means to identify any wrongs the MD did by the patient. The MD followed the standard algorithm step by step to determine what they suspect is the diagnosis according to symptoms. They ran appropriate testing and they treated the patient with the standard of care. But is the standard of care best for everyone? Why is medical care standardized when it needs to be personalized? NDs are aware that each person is an individual and not one of many. The anti-depressant was the standard of care but fell short of caring for this patient because it was not treating the root cause of her illness. Each person has their own needs and goals and it is our job to make sure we get where we need to go to continue to live a long and healthy life together.
Our current medical model in the United States does not lend a hand to quality care either. Most MDs are unfortunately limited on time with their patients mostly due to insurance policies. Most MDs are required to meet certain goals each day as far as to the number of patients they see. If these patient number goals are not met, insurance companies will drop them as a provider, therefore, hurting their practice. Because of the time constraints placed on this doctor, this MD was not able to establish any rapport with this patient nor give them the time or opportunity for them to tell their story. This is also why you see more MDs go into private practices that do not accept certain insurance policies or are concierge based so they can give more time and energy where it matters most. NDs choose to operate on a different level of care by giving the patient the time they need to tell their story in order to get back to health. Granted, in some states, NDs are covered under insurance, they are still taking the time to care for each patient because this is what ultimately matters most. Where things matter most is our approach to finding and treating the root cause of illness so we can aid the body in the healing process.