Scope of Practice

What's the difference between physicians and naturopaths?

Timothy M. Smith , Contributing News Writer

AMA News Wire

What's the difference between physicians and naturopaths?

Feb 26, 2024

Education matters, especially when it comes to health care. Patients know it too—more than 90% say a physician’s years of education and training are vital to optimal patient care.

Yet there are nonphysician providers known as naturopaths whose state licensing is so wildly inconsistent that some, known as traditional naturopaths, have little or no formal training in the practice.

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Naturopaths are educated on the basic sciences and complementary and alternative treatment modalities, focusing on “body, mind and spirit,” according to the Association of Accredited Naturopathic Medical Colleges. Naturopaths also focus on “the body’s natural ability to heal itself,” the association’s website says. While traditional naturopathy avoided drugs and surgery, contemporary naturopathy attempts to incorporate elements of conventional medicine.

Even the most highly educated naturopaths get only a fraction of the training that physicians get. Lawmakers should therefore exercise extreme caution when considering legislation that would expand the scope of practice for naturopaths.

Fighting scope creep is a critical component of the AMA Recovery Plan for America’s Physicians.

Patients deserve care led by physicians—the most highly educated, trained and skilled health professionals. The AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety.

There are three types of health professionals who offer naturopathic treatment:

  • Naturopathic doctors. These nonphysicians graduate from a four-year, professional-level program at an accredited naturopathic medical school, earning either the doctor of naturopathy (ND) degree or the doctor of naturopathic medicine (NMD) degree.
  • Traditional naturopaths, who have obtained education through some combination of a mentorship program with another professional or at an alternative clinic, distance-learning program or classroom schooling on natural health, or other holistic studies.
  • Other health professionals such as chiropractors, massage therapists, dentists, nurses, nutritionists, or physicians who practice under a professional license but include some naturopathic methods in their practice and who may have studied on their own or taken courses on naturopathic methods.

At least 24 states and the District of Columbia regulate the practice of naturopathy. In order to be licensed, naturopaths in these states must earn an ND or NMD from an accredited naturopathic program and pass the Naturopathic Physicians Licensing Exam. Three states—Florida, South Carolina and Tennessee—prohibit the practice of naturopathy. In states that neither license nor prohibit the practice of naturopathy, traditional naturopaths and NDs alike may practice without being subject to state regulation.

Postgraduate training is neither common nor required of graduates of naturopathic schools, except in Utah, which requires one year. Some naturopathic students may choose to shadow or practice with an experienced naturopath before setting up their own practice, while others may choose residencies. Medical literature indicates that less than 10% of naturopaths participate in an approved residency, and such residencies last only a year and lack a high degree of standardization.

Unlike the standards for family medicine residencies, the Council on Naturopathic Medical Education standards for naturopathic residencies do not require that naturopathic residents treat patients across the lifespan, with any particular health condition, or in different health care settings—including hospitalized patients.

Compare this with physicians—either doctors of medicine (MDs) or doctors of osteopathy (DOs)—who complete four years of medical school followed by a minimum of three and as many as seven years of residency.

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In addition, whereas naturopaths are required to get at least 1,200 hours of direct patient contact, physicians get 12,000–16,000 hours of clinical training—at least 10 times more than that minimum.

There are only five accredited ND or NMD programs in the U.S., and they are all private.

ND programs emphasize naturopathic principes—for example, the healing power of nature—and naturopathic therapeutics such as botanical medicine, homeopoathy and hydrotherapy. Coursework in naturopathic therapeutics is combined with, and taught alongside, coursework in sciences. But there are no specifications around the number of hours required in each area.

ND programs often purport to teach the same content as MD or DO programs in addition to naturopathic philosophy and therapeutics in the same time frame as medical school. The big problem is that naturopathic students may lack exposure to key clinical scenarios in the course of their training. As noted above, the accreditation standards establish no requirement that naturopathic students see patients of any particular age, in any particular health care setting, or with any particular condition as part of their clinical training.

On top of that, naturopathic students’ clinical experience is typically gained through outpatient health care clinics, as naturopathic medical schools typically do not have significant hospital affiliation. This means there is no guarantee that a naturopathic student completing a clinical rotation will see patients who are actually sick or hospitalized, and they may not be exposed to infants, children, adolescents or the elderly. It has been said that naturopaths tend to treat the “worried well.”

Find out in detail why education matters to medical scope of practice, with information on:

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Learn more with the AMA about great resources that set the record straight for policymakers on scope of practice. The AMA is one of the only national organizations that has created hundreds of advocacy tools for medicine to use when fighting scope creep.

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Through their state chapters, some licensed naturopaths seek to expanded their scope of practice to include the authority to prescribe controlled substances. Some also seek “primary care physician” status and inclusion in Medicare and the Veterans Health Administration, as well as mandated insurance coverage for naturopathic services.

Naturopaths claim they are trained as primary care providers and, as such, are educated and trained to diagnose, manage and treat many conditions, including bloodstream infections, heart disease and autoimmune disorders. Yet their education and training falls several years and thousands of hours short of what physicians get.

For example, in comparison with naturopaths’ four years of education and training, hematologists have eight to 10, and medical oncologists, endocrinologists and rheumatologists—all of whom are experts in bloodstream infections—have nine.

The numbers are similar for physicians who specialize in treating heart disease. Cardiologists get 10-plus years of medical education and training, and three of those are spent studying vascular disease.

And they are similar for physicians who specialize in autoimmune disorders. Family physicians have seven years of comprehensive medical training; neurologists have eight; and rheumatologists and radiation oncologists have nine.

The AMA believes it is the responsibility of policymakers to ensure that naturopaths’ claims that they can treat a broad range of conditions are backed by facts—facts that include the specific education and training necessary to ensure patient safety.

Visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.