Naturopathic scope of practice expansion

Naturopathic scope of practice expansion

Naturopaths who graduate from 4-year naturopathic "medical schools" claim they are primary care physicians with education and training comparable to medical doctors and doctors of osteopathy.  This is easily refuted.  Naturopathic school graduates can go straight into practice without doing the usual three-year residencies of medical and osteopathic doctors. This is, of course, after many hours spent in clinical training during the last two years of medical school.  In fact, the sum total of clinical training in naturopathic school is roughly equivalent to about 20 working days in a primary care physician's office.  So, let's see, 20 days of naturopathic school clinical experience equals medical school clinical experience plus three years ?  Does not compute.  And then there's the fact that the naturopathic clinical training takes place largely in clinics associated with their schools, not the real-world experience of medical and osteopathic students or the hospital-based training of residents. 

Nor is the classroom education equivalent.  Naturopathic students spend large chunks of time learning about homeopathy, acupuncture and herbs.  They even have classes in humoral medicine.  Yes, that humoral medicine.  The ancient Greek system that postulated the human body is controlled by black bile, yellow bile, phelgm and blood.  It is the source of the idea that bleeding to eliminate excess blood is good for what ails you.  Ask George Washington, who may have been bled to death at the hands of his physicians. 

Unfortuantely, credulous state legislators fall for the idea that "stimulation of the body's self-healing abilities," the core concept of naturopathic treatment, actually means something. And the fact that the naturopathic schools' accrediting agency is approved by the U.S. Department of Education, even though that has nothing to do with the scientific validity of what is taught. Nor does it mean that the U.S. government thinks these graduates are ready to practice primary care medicine.  In fact, the government has most emphatically denied that they are by refusing to reimburse them for primary care (or anything else) under Medicare, despite their repeated attempts to be included. Perhaps they also confuse naturopathic board exams, which naturopathic students must pass to practice, with the stringent medical board exams, even though the former are made up entirely by naturopaths with oversight from no one. 

Yet there obviously lurks somewhere in the back of the legislators' minds some real doubts about whether naturopaths should be unleashed on the public as primary care physicians.  So, what ends up happening is that naturopaths often have to take a lesser scope of practice and keep coming back for more.  For example, they may not be able to prescribe. Or perhaps they must have a collaberative relationship with an MD or DO in order to do certain things. Or maybe the insurance companies don't have to cover their services.  The national strategy of the American Association of Naturopathic Physicians is to take what they can get and keep bugging the legislatures until they get all they want.

Several bills curently before the state legislatures exemplify this strategy.  In Utah, House and Senate Bills expand their scope of practice to include "percutaneous injection[s] into skin, tendons, ligaments, muscles and joints with local anesthetics and nonscheduled prescription medications . . . and natural substances."  This will give them authority, for example, to mix up their "vitamin cocktails," among other things, and shoot their patients up with IV injections of the stuff.  All the better to "boost the immune system." The naturopathic formulary is decided by the naturopathic board, advised by a formulary committee. This committee already has a pharmacist on board and, fortunately, the bills add one MD or DO,  again evidencing that queasy feeling on the part of legislators that naturopathic education and training isn't quite up to the task, even as they are willing to subject the public to their care. These bills passed in both houses of the legislature and are now before the governor for signature.

Colorado licensed naturopaths just last year, but the law is laced with caveats about what they can and cannot do.  One important restriction is the fact that they cannot see children under 2 as patients.  Between ages 2 and 8, the naturopath must advise the parent to have a relationship with a pediatrician and there are safegurads in place to prevent naturopaths from spreading their anti-vaccination rhetoric.  One does wonder why the legislature would allow naturopaths to practice at all if they had the kind of reservations that would engender these restrictions.  Naturally, if you will, the naturopaths are not entirely pleased with their scope of practice and have returned to the legislature this year seeking to have the law amended to lift these restrictions. 

Finally, in Alaska naturopaths are trying to expand their prescription privileges and in Arizona they want to practice telemedicine.  They should be careful what they wish for.  The latter might tempt those who wish to expose naturoapthic practices to log on and see just what they're up to via an internet consultation.  We'll be watching!

Points of Interest 3.17.2014
Deluded Emergency Room