The American Medical Association is formalizing a policy that directly opposes licensure for naturopathic physicians. The new resolution is under review by the AMA's House of Delegates, and is one of several political moves clearly indicating the AMA's intention to restrict non-MD health care practitioners and re-assert its role as arbiter of health care practice.
Resolution 209 opposing ND licensure was introduced to the AMA's House of Delegates in May by the AMA's Florida delegation. It reads as follows:
- Whereas, The American Medical Association has always stood for patient safety and the science of medicine; and Whereas, The well-being of patients and the ability for them to be taken care of in the best manner is a goal of the AMA; and Whereas, There is a misconception about the extent of the education and training of naturopaths; and Whereas, The AMA has no set policy concerning the licensing of naturopaths to practice medicine without the proper educational background; and Whereas, Many states are now facing an onslaught of non-MDs/DOs wanting to practice medicine; therefore be it RESOLVED, That our American Medical Association work through its Board of Trustees to outline a policy opposing the licensure of naturopaths to practice medicine and report this policy to the House of Delegates no later than the 2006 Interim Meeting (to be held Nov. 11–14, in Las Vegas).
Though the education standards for NDs and NMDs seeking state-level licensure laws are well documented, the AMA's resolution simply uses the term "naturopath," and fails to distinguish between graduates of a 4-year naturopathic medical school accredited by the Council on Naturopathic Medical Education, and others who use the title of "naturopath."
Individuals who earn an ND or NMD from one of the four accredited US schools (National College of Natural Medicine, Bastyr University, Southwest College of Naturopathic Medicine and University of Bridgeport) receive thorough training in anatomy, physiology, biochemistry, diagnosis, and related health sciences, in a curriculum that closely overlaps conventional allopathic curricula. They also receive intensive practical training in nutrition, botanical medicine, physical medicine and pharmaceutical therapies.
However, in states without licensure laws (and currently only 14 states have ND/ NMD licensure), anyone can use the term "naturopath" regardless of level of training. If there is any "misconception" about naturopathic medical education, it is because those who drafted Resolution 209 failed to do their homework.
It is interesting that this resolution originated in Florida, where an ND licensure bill came close to passing. By opposing rather than supporting licensure, the AMA and its affiliated state medical associations actually threaten the very public well-being they claim to be protecting.
According to Jane Guiltinan, ND, President of the American Association of Naturopathic Physicians, "The AANP fully supports the AMA's stated goal of providing the highest quality of care for patients. Indeed, that is why the AANP is committed to passing licensure laws for naturopathic physicians in all 50 states. Licensing laws that clearly define scope of practice ensure patients have access to trained professionals held accountable by regulation and state oversight."
She added that, "The AMA's opposition to licensing NDs actually places patients at greater risk for misdiagnosis and improper treatment from those who call themselves naturopathic doctors, but have not attended accredited institutions or have not received the clinical training required to diagnose and treat."
Formal AMA opposition could affect ND/NMD licensure efforts in New York, Florida, Pennsylvania, Illinois, Massachusetts, North Carolina and several other states. Lise Alschuler, ND, President of the Illinois Association of Naturopathic Physicians, said Resolution 209, "is a declaration of war, and it makes their [AMA's] position on naturopathic medicine very clear. It is going to make our jobs a lot harder for the next few years, but we're doing this for one reason: licensure is necessary to provide public access to high-quality natural health care."
The AMA's position clearly does not represent the views of all MDs. Larry Palevsky, MD, President of the American Holistic Medical Association, said he has personally written letters supporting ND licensure to New York State legislators. Speaking at the AANP's annual convention, Dr. Palevsky stressed that AHMA is "committed to building relationships with the community of licensed naturopaths." However, AHMA has yet to issue a formal statement on ND licensure or the AMA resolution opposing it.
Given that there is no evidence that well-trained NDs and NMDs practicing in licensed states threaten public health in any way, one wonders about the true motives behind AMA's anti-licensure stance. Resolution 209 must be viewed in a broader context. In 2004, the AMA joined forces with six subspecialty societies and six state medical societies, to create the Scope of Practice Partnership (SOPP), with a stated mission "to oppose scope of practice expansions by allied health professionals that threaten the health and safety of the public."
The AMA also recently passed Resolution 211, identifying a "Need to Expose and Counter Nurse Doctoral Programs Misrepresentation." The target here is nursing schools offering Doctor of Nursing Practice (DNP) degrees.
According to John Weeks' The Integrator Blog (www.theintegratorblog.com), there are 19 nursing programs in 17 states now offering DNPs, and another 190 programs in the works. The AMA contends these programs misrepresent DNP training by implying that a DNP is equivalent to an MD degree. The American Association of Colleges of Nursing has stated that the DNP is not intended as substitute MD, nor do the schools represent it as such. By offering DNPs, nursing is following precedents set by pharmacists, psychologists, and other doctorate-level professions.
The AMA and SOPP are the prime drivers behind HR5688, the "Healthcare Truth and Transparency Act," a bill introduced in June by Rep. John Sullivan (R-OK) that would make it a crime for any licensed health care provider who does not have an MD, DO, DDS or DMD degree, to "make any deceptive or misleading statement, or engage in any deceptive or misleading act, that deceives or misleads the public" into thinking the he or she is an MD, DO or dentist, or possesses the same education, skills or training.
This is reasonable in principle. But the bill's intention and possible interpretations if passed are another matter. Its broad categorization of deceptive or misleading acts, and its vagueness on state level policies could conceivably turn this bill into a tool to over-ride existing state laws recognizing DCs and NDs as physicians.
I believe that beneath the rhetoric about patient safety, the true motives for the AMA's recent resolutions are arrogance, ignorance, fear and resentment. The arrogance is in the deep-seated conviction that conventionally trained physicians are somehow extraordinary, and should be the ONLY gatekeepers for ALL other healthcare professionals. The ignorance is in the substitution of fabrications for well-researched understanding. The fear and resentment relate to perceived loss of control some MDs feel in reaction to the evolution of non-MD/DO healing professions.
The AMA's policies will only isolate conventional medicine and promote discord, rather than harmonizing healthcare under the basic purpose of patient care and patients' choice. They will foster fanaticism and blind loyalty, rather than intelligent dialog. Recognizing the high level of responsibility all healing professionals must assume, we should affirm our commitment to promote appropriate standards for education, licensure and certification, to support appropriate practice and care management guidelines, and to facilitate communication and collegial relationships between all healthcare professionals.
Michael Traub, ND, practices in Kailua-Kona, HI. He is past-president of the American Association of Naturopathic Physicians (AANP). He was recently named "Physician of the Year" by the AANP. HPC congratulates him on this high honor!