Naturopathic medicine is a system of primary care that combines traditional and holistic methods to achieve optimal health and wellness. Naturopathic physicians (N.D.s) are trained in all of the same sciences as M.D.s, but they also study holistic approaches to health care with an emphasis on disease prevention. Naturopathic physicians use therapies that are almost exclusively natural such as homeopathy, nutrition, acupuncture, botanical medicine, and counseling. Naturopathic medicine is based on the fact that the human body has an innate power to heal itself, and naturopathic physicians use treatments to support the body's inherent self-healing abilities.
Philosophy
"We look at the body as an intelligent whole and symptoms as the way the body communicates. For example, when your nose is running, your body is communicating an infection. Finding and treating the cause of the symptom is what naturopathic medicine is all about."
-Harrison DuPont, N.D.
Naturopathic medicine dates back to the eighteenth and nineteenth centuries and is one of the oldest forms of medicine, existing long before today's technological and pharmaceutical advances. It was brought to the United States in the late 1800s by Benedict Lust, a German doctor who founded the first naturopathic medical school in New York. Naturopathy developed quickly and was booming in the 1920s, with more than twenty schools of naturopathic medicine in the country. The field began to decline in the 1940s and 1950s with the growth of allopathic medicine and the pharmaceutical industry. In recent years, renewed interest in holistic health and dissatisfaction with conventional medicine has staged a comeback for naturopathy's rebirth.
Naturopathic physicians combine natural approaches from a variety of health care traditions. The foundation of naturopathic medicine is embedded in six philosophical principles of healing. Although they use an eclectic range of healing methods, naturopathic physicians are unified by the following philosophies:
The healing power of nature: Naturopathic physicians recognize the body's inherent ability to fight disease and restore and maintain health. They work to support this process by identifying and removing obstacles to bolster the patient's own healing capacities.
Treat the whole person: Naturopathic physicians recognize the harmonious functioning of all aspects of an individual as essential to health. They consider the complex interaction of physical, mental, emotional, genetic, spiritual, environmental, and social factors in diagnosing and treating illness.
First, do no harm: Naturopathic physicians respect the body's ability to heal and use the least invasive, least toxic treatments possible. They are aware of the side effects of treatments and try to use gentle and non-disruptive methods. Naturopathic physicians avoid treatments to solely suppress symptoms as it may interfere with the healing process.
Identify and treat the cause: Naturopathic physicians seek to treat the causes of disease rather than to eliminate specific symptoms. Symptoms are seen as signs that the body is out of balance and is trying to heal itself. When only the symptom is treated, the underlying causes remain and can manifest in other more serious health problems.
Prevention is the best cure: The primary objective of a naturopathic physician is the attainment of optimal health and the prevention of disease. Naturopathic physicians work with patients to assess risk factors, heredity, and susceptibility to disease and make recommendations to prevent illness.
Doctor as teacher: The original meaning of the word doctor is "teacher." The objective of the naturopathic physician is to educate patients and help them take responsibility for their own health by making good choices.
Types of Patients and Problems
Naturopathic physicians are trained as general practitioners and primary care physicians. Thus, they treat patients with a broad range of health problems, from the common cold to acute and chronic conditions. Naturopathic physicians are often viewed as the M.D.s of holistic medicine and provide care to patients with all types of health problems.
In addition to providing comprehensive care, there are a variety of areas naturopathic physicians can specialize in. Some specialize in treating patients with chronic degenerative diseases such as diabetes, hypertension, and arthritis. Others areas include nutritionally based problems, women's health issues, Candida, neurological and structural problems, chronic fatigue syndrome, immune system disorders, allergies, gynecological problems, and muscular problems. Their greatest strength lies in preventive medicine, acute illnesses, natural childbirth, clinical nutrition, and chronic illnesses that have not responded well to other medical approaches. Research studies support the benefit of naturopathic medicine for patients with AIDS/HIV, heart disease, arthritis, and cancer. Although naturopaths are trained in bone setting and x-ray, they typically do not treat broken bones. They refer patients who need major surgery, acute trauma care, cast settings, or prescription medication to allopathic doctors. In general, naturopaths are not allowed to prescribe drugs, although in some states they have prescription rights for certain classes of drugs.
Naturopathic physicians treat patients of all ages from newborns to the elderly. Some people choose naturopathic medicine after traditional medicine has failed. Other people see naturopathic physicians as a first choice to prevent disease and maintain health or as an alternative to traditional medicine. Naturopathic physicians receive a large number of their patients through patient referrals, and it is not uncommon for a naturopathic physician to see entire families.
Treatments
Like M.D.s, naturopathic physicians are trained, licensed, and skilled to use traditional methods for diagnosing problems through blood/urine/lab testing, x-rays, and physical exams. In addition, they use alternative methods for diagnosing patient problems. The first appointment with a naturopathic physician can take one and a half hours because an extensive individual and family health history is taken in addition to the physical exam. Patients are often asked to fill out questionnaires prior to appointments. Naturopathic physicians ask their patients about their presenting problem; symptoms; past treatments; use of vitamin supplements; allergies; medical history; diet and eating patterns; sleep patterns; use of alcohol, drugs, caffeine, and tobacco; stress levels; exercise levels; lifestyle; occupation; and social life. Naturopathic physicians attempt to assess a patient's physical, mental, emotional, and spiritual state to provide the most effective care.
Naturopathic medicine is not so much a separate form of health care, but a combination of many forms of alternative therapy. Once a diagnosis is made, naturopathic physicians choose between a wide array of treatments based on the individual needs of the patient and the specialty area of the physician. One or more treatment methods can be used. Treatment options include:
Clinical Nutrition: "Food is the best medicine" is the basis of naturopathic medicine. Naturopathic physicians use nutritional counseling and recommend dietary changes and nutritional supplements to treat, or be part of the treatment, of many medical problems.
Physical Medicine: Naturopathic physicians utilize the manipulation of muscles, bones, and spine to treat illness. They may use massage, ultra-sound, exercise, gentle electrical pulses, and hydrotherapy (the use of hot and cold water).
Homeopathic Medicine: Naturopathic physicians use homeopathic treatments to strengthen the body's immune system to promote a lasting cure for health problems. Homeopathic therapies are medicines made from highly diluted natural substances, where the substance that produces symptoms in healthy adults cures those same symptoms in ill adults. The remedies work on the body's energy level to strengthen the life force energy.
Botanical Medicine: Naturopathic physicians use plant substances and herbal remedies to treat patients. Botanical medicine can address a number of problems simultaneously, and since they are organic substances, they are compatible with the body's chemistry and can be effective with very few toxic side effects.
Naturopathic Obstetrics: Naturopathic physicians who specialize in obstetrics provide natural childbirth in nonhospital settings. They provide prenatal, delivery, and postnatal care; education; and counseling. They minimize outside interventions during childbirth and work to strengthen the woman's body to prevent pregnancy complications and deliver healthy babies.
Oriental Medicine: Many naturopathic physicians use acupressure and acupuncture to treat patients by restoring balance to the energy system. The mind/body philosophy of Oriental medicine is similar to the naturopathic physician's philosophy of healing.
Psychological Medicine: Naturopathic physicians attend to the psychological aspects of their patients because they believe mental attitude and emotional state can influence or even cause physical illness. Naturopathic physicians provide counseling, nutritional balancing, stress management, hypnotherapy, biofeedback, and other therapies to help patients heal on the psychological level.
Minor Surgery: As general practitioners, naturopathic physicians do in-office minor surgery. They use local anesthesia, repair superficial wounds, and remove foreign bodies, cysts, and other superficial masses.
Environmental Medicine: Some naturopaths specialize in detoxification of the body to help patients eliminate poisonous, toxic, or chemical substances that result from environmental exposure.
Because of the training in traditional and holistic medicine, naturopathic physicians interact with a diverse number of health care professionals, including traditional medical doctors. They are not opposed to drugs, major surgery, or traditional medicine when these methods are necessary. They make and receive referrals to other practitioners in the best interest of the patient.
Employment Settings and Working Conditions
"When you choose to be a naturopathic doctor, you need to be aware that you are also going to run a business and you need business savvy. I entered this profession very naive about that. I was going to heal the world, which is the most gratifying part-but running the business can be almost as much work as the rest of it."
-Carey Cromar, N.D.
Most naturopathic physicians are in private practice. Some teach and conduct research at schools of naturopathic medicine. A small number are involved in doing research and advise the National Institute of Health at one of the two Alternative Medicine Centers in the United States. Others work for natural-product companies as consultants or sales representatives. As naturopathic medicine gains ground in the political arena and as acceptance by traditional medicine and society increases, naturopathic physicians may be found in hospitals, clinics, and other traditional health care arenas.
Naturopathic physicians primarily work individually or in group practices. Group practices may also include other health care practitioners such as nutritionists, massage therapists, herbalists, or acupuncturists. Naturopathic physicians working in private practice or in small practices have the responsibility for running the business as well as treating patients. They are responsible for advertising and marketing, billing patients and insurance companies, keeping records, and supervising staff. Naturopathic physicians usually have office employees working for them and are responsible for all aspects of employee management.
The work setting is professional, clean, and comfortable. Naturopathic physicians work a schedule similar to other primary care physicians, seeing patients on a typical workday schedule. Because of the demand for naturopathic medical services, and the low number of naturopathic physicians available, naturopathic physicians have a tight schedule, with new patients often waiting months for an appointment.
Naturopathic physicians tend to locate in areas where holistic medicine is recognized and accepted and in states where they can be licensed. There are areas of the country where there are no naturopathic physicians. Naturopathic physicians should research geographic areas carefully in deciding where to practice, as the level of acceptance varies.
The Profession
There are approximately 1,300 licensable naturopathic physicians in the United States. The American Association of Naturopathic Physicians (AANP) represents approximately 500 licensed naturopathic physicians. With three professional schools of naturopathic medicine in the United States, the field is graduating several hundred more every year. Naturopathic physicians are licensed in eleven states, although they practice in many other states under different regulations. The profession is well organized and the American Association of Naturopathic Physicians is the leading organization to support and further the field of naturopathic medicine.
Training and Qualifications
"One of the biggest challenges in choosing to be a naturopathic doctor is financial. Education is very costly and you graduate with a lot of debt. Then you need a loan to start a practice, and it takes a while to break even."
-Carey Cromar, N.D.
Currently there are three schools of naturopathic medicine in the United States and one in Canada. Admission is competitive and typically a bachelor's degree is required. Students must have prerequisite courses in pre-medical chemistry and physics, organic chemistry, biology, psychology, social science, humanities, English, and writing. Schools look for mature candidates with strong moral character and a commitment to naturopathic medicine. The degree awarded is the N.D.-Doctor of Naturopath. Training takes four to five years. In the first two years, students take courses in anatomy and physiology, psychology, philosophy of naturopathic medicine, clinical diagnosis, homeopathy, pharmacology, nutrition, orthopedics, and immunology. In the third and fourth year, students study obstetrics, Chinese medicine, medical genetics, cardiology, minor surgery, botanical medicine, pediatrics, therapeutic exercises, emergency medicine, ear/nose/throat, gastroenterology, geriatrics, neurology, urology, oncology, dermatology, medical ethics, and take business practice seminars. The training also includes a series of clinical internships. In addition to the four years of training, some naturopathic medical students elect to take a fifth year in a specialty area such as obstetrics or homeopathy.
Prospective students should be aware of some confusion regarding naturopathic education. The American Association of Naturopathic Physicians accredits and recognizes three schools of naturopathic education in the United States. These are the only training programs that lead to licensure.
There are a variety of other programs that award an N.D. degree that do not meet accreditation guidelines. These programs are often correspondence schools with no clinical training or uniform curriculum standards. Students considering programs other than the three recognized by the American Association of Naturopathic Physicians should conduct thorough research to be sure the program meets their needs and goals. These alternative N.D. programs can provide useful training in health and wellness education, but do not train individuals to be physicians. Only physicians with degrees from the three recognized naturopathic medical schools are eligible for licensure. Naturopathic physicians practice under various legal provisions in almost every state with varying guidelines. The following eleven states formally license and regulate naturopathic physicians:
- Alaska
- New Hampshire
- Arizona
- Oregon
- Connecticut
- Utah
- Florida
- Washington
- Hawaii
- Washington D.C.
- Montana
Naturopathic physicians must pass a standard exam called NPLEX (Naturopathic Physicians Licensing Examination), which is required by all licensing states. The test includes five basic science exams covering anatomy, physiology, pathology, biochemistry, microbiology, and immunology, which are taken after the first two years of study. Clinical exams are taken after the fourth year. They include clinical and physical diagnosis, lab diagnosis and diagnostic imaging, nutrition, physical medicine, pharmacology, botanical medicine, homeopathy, psychology, lifestyle counseling, minor surgery, and emergency medicine. Depending on the state, additional exams may be given in jurisprudence and acupuncture.
Because this is a small field, naturopathic physicians are very involved in the professional growth of their career area. Naturopathic physicians work with states and their professional organizations to secure licensing for naturopathic physicians.
Job Outlook and Salary
"This profession is going to just boom! The demand is already there, and there are way too few of us to serve the demand."
-Carey Cromar, N.D.
Naturopathic medicine is a growing field with excellent prospects for new professionals. There is an increasing demand from the public for naturopathic medical services and a small number of physicians to meet the demand. During the first four years of practice, naturopathic physicians earn approximately $40,000 to $50,000, and after six to ten years $60,000 to $80,000. Naturopathic physicians collect their salaries directly from patients and insurance companies. Patients primarily pay for service, but more and more insurance companies are covering naturopathic medicine. Some states have passed laws requiring insurance companies to cover naturopathic medical services. This is expected to continue as insurance companies realize it is cost effective to use natural treatment methods and prevent disease.
