WASHINGTON, DC—Naturopathic doctors in Washington, DC, have succeeded in achieving licensure in the District, following closely on the success of their colleagues in California last fall.
Early in April, the DC City Council voted unanimously to license graduates of accredited 4-year naturopathic medical schools as primary care providers within the city limits of the nation’s capital. Bill 15-57, “Practice of Naturopathic Medicine Licensing Amendment Act of 2004,” passed its final reading and vote with the Council. A signature from the Mayor is pending, after which it will move to the US Congress for final consideration, as is the case with all legislation pertaining to the District.
To obtain licensure in DC, individuals who have completed four-year naturopathic medical school training must also pass the Naturopathic Physicians Licensing Examination (NPLEX). The bill is expected to become law some time in July, after which eligible naturopaths will be recognized as full-scope primary care physicians. NDs are now licensable in 13 states outside the District.
The new bill defines naturopathic medicine as, “a system of health care that utilizes education, natural medicines, and natural therapies to support and stimulate a patient’s intrinsic self-healing processes to prevent, diagnose, and treat human conditions and injuries.”
It also defines NDs’ scope of practice to include administration of preventive and therapeutic natural medicines “by their appropriate route of administration.” NDs in Washington, DC, will be permitted to use dietary supplements, topical medicines, counseling, hypnotherapy, dietary interventions, naturopathic physical modalities, therapeutic devices, and provide barrier contraception. They will be allowed to review and interpret all diagnostic tests commonly used by primary care physicians, including physical and orificial examinations, electrocardiograms, diagnostic imaging techniques, phlebotomy, clinical laboratory tests and examinations, and physiological function tests.
The new law prohibits NDs from prescribing, dispensing or administering controlled substances. Surgery will be limited to minor, office-based procedures. NDs will not be able to perform unsupervised childbirth unless first completing a minimum of 100 hours of training in childbirth, passing a specialty exam in obstetrics or natural childbirth, maintaining a written collaborative agreement with a licensed obstetrician; and assisting in a minimum of 50 supervised births.
The Bill does not allow NDs to practice acupuncture unless they are dually trained and qualified as licensed acupuncturists (LAc). The same holds true for chiropractic manipulation, physical therapy techniques or other practices that belong to the defined scope of practice of other health care professionals.
“The Bill is very clear in stating what naturopathic physicians are, as well as establishing that NDs are not trying to be chiropractors, physical therapists, or anything else,” said Karen Howard, executive director of the American Association of Naturopathic Physicians. Ms. Howard considers Bill 15-57 a major victory for the profession as a whole, in that it closes a major loophole through which non-qualified individuals have been able to practice as “naturopaths.”
Prior to its passage, the Washington, DC, Board of Health, officially “registered” anyone claiming to practice “naturopathy,” but without defining educational credentials or scope of practice. Ms. Howard estimated there are on the order of 800 “Un-D’s” (self-proclaimed “naturopaths” who have not completed training at one of the accredited 4-year naturopathic schools) registered with the DC Board of Health, and who use this registration as a default “license.” Most of these individuals work outside the District.
The current bill essentially creates two categories of practitioners: Naturopathic Physicians (NDs) who have completed full 4-year training programs, and “Naturopathic Practitioners,” which includes lay practitioners who have not completed such training. The latter do not qualify for licensure, and are obliged by the new regulations to post that fact in their places of practice and to inform clients of their status prior to treatment.
Bill 15-57 has a very specifically defined geographic jurisdiction, restricting licensure only to those NDs actually practicing within the city limits. It does not extend to NDs living and practicing in neighboring states.
In contrast with California, where the road to ND licensure was fraught with difficult negotiations between naturopaths, the California Medical Association, and organizations representing other health professionals, Ms. Howard said the process in Washington, DC, was quite smooth and collegial. She attributes this largely to the efforts of Andrea Sullivan, ND, who led the drive for licensure, and who has served on the DC Board of Health as its general public representative.
“Because of Andrea’s work, our Board was very well versed in what naturopathic physicians are, what they do, and what they have to offer. Opposition to licensure was very minimal, and there was not much contention with other provider groups,” she told Holistic Primary Care. Establishment of licensure in the District will likely facilitate the movement toward collaborative practice between NDs, MDs and DOs, and will also provide a foundation for the eventual establishment of naturopathic medical residency training in DC.
Ms. Howard said most of the opposition to the new bill came from groups representing un-licensable practitioners who wished to retain the right to use the term “naturopathic physician.” Under the terms of Bill 15-57, those who work within the DC city limits will be able to register as Naturopathic Practitioners, but will be prohibited from using the term “Physician” or “Doctor.”
She believes the inclusion of NDs in the Washington DC primary care community will help close a critical gap in the city’s health care landscape. “At a time when the District of Columbia is experiencing massive shortages of general medicine practitioners and closure of community health clinics … the inclusion of naturopathic physicians in the health care delivery system offers the opportunity for the residents of Washington, DC to have access to alternative care health delivery models with primary care physicians.”
Passage of licensure in DC should provide considerable hope for NDs working on similar licensure legislation in other states. Florida NDs had a near-miss this year, but according to Ms. Howard, the effort in that state is “very well organized and politically connected,” and has a strong chance of success in the next two or three years. A licensure bill is being considered in Pennsylvania, and NDs in New York are in the early stages of enlisting grass-roots support for a licensure bill they introduced to the legislature earlier this year.
