Naturopaths are eligible for licensure in California

But they can't do even minor surgeries or call themselves physicians.

By Myrle Croasdale, amednews staff. Oct. 20, 2003.

Gov. Gray Davis signed the Naturopathic Doctors Act into law last month, making California the 13th state to license naturopathic doctors.

The legislation retains some physician oversight of NDs when they write prescriptions for pharmaceuticals. But it allows them to practice independently in other areas. Naturopaths consider the legislation a critical victory, key to their goal of being able to act as front-line health care practitioners.

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California's physicians say that without insurance reimbursement, NDs will not make significant inroads into primary care.

"I don't think there will be a significant change," said Rebecca Patchin, MD, chair of the California Medical Assn. legislative committee. "People who pursue naturopathy are paying on a cash basis as it is, and it's unlikely the licensing of naturopaths will increase these numbers alone. Only if those with health insurance are able to get reimbursement for this care will this be likely to change."

George DeVries, CEO of American Specialty Health Plans, a company that offers insurance products to cover alternative medicine to full-service health plans, said he intends to try to add naturopathic services to that company's product line.

The company already has 4 million members in the state with insurance for chiropractic treatment and a small number with acupuncture coverage.

About 3,000 naturopaths in the U.S. meet California's licensing requirements.

The American Assn. of Naturopathic Physicians said state employees in Oregon, Washington and Connecticut have naturopathy coverage, but otherwise it's unusual to find it offered as a benefit.

In California, the Naturopathic Doctors Act goes into effect Jan. 1, 2004. Some 200 NDs are expected to apply the first year. Applicants must have graduated from one of five accredited four-year programs in the United States and Canada and have passed a licensing exam.

An estimated 2,500 to 3,500 naturopaths in the United States meet California's licensing requirements. In response to the new licensing law, Bastyr University, an accredited naturopathic college in Seattle, announced that it would open a branch campus in the state.

Can't call themselves physicians

Unable to block the bill's passage, the CMA did succeed in preventing naturopathic doctors from calling themselves physicians. As a result, the California Assn. for Naturopathic Physicians will be changing its name.

The CMA was able to win physician supervision of ND prescriptions of pharmaceuticals that is similar to the oversight physicians now provide nurse practitioners. NDs also must meet the same criteria as certified nurse midwives to deliver babies.

Naturopaths will be able to prescribe epinephrine for anaphylaxis, natural and synthetic hormones and devices such as barrier contraceptives. They may also diagnose and treat disease, perform physical exams, draw blood, order lab tests, and dispense and administer herbs, vitamins and minerals.

California's NDs likely will be looking for physicians open to working with them.

Bruce Wapen, MD, an emergency physician in San Francisco who has an interest in naturopathy, said that once physicians understand what naturopaths do, they'll see them as a way to fill a need.

"Their patients are asking for this," Dr. Wapen said. "They come into the office with a list of nutritional supplements they are taking and [the doctors] don't know anything about it."

Doctors wanting to offer such patients resources could turn to naturopaths, he said.

"People pay out of pocket because they believe in it," Dr. Wapen said. "They'll go to their chiropractors, who are willing to work with alternatives. We'd rather have MDs keep these patients."

In 2004, legislation on naturopathic licensing is expected to be introduced in seven states.