Are Naturopathic Doctors Real Doctors?

So you've done some of your homework regarding choosing the right naturopathic doctor, and have decided that you would like to work with a licensed naturopathic physician rather than a traditional naturopath. When go to tell your friends, family, or coworkers about your decision they look a bit confused and respond, "A naturo....what?! Is that even a real doctor?" How do you respond?

The first thing to be aware of is that people who engage naturopathic medicine this way are often times begging the question. Begging the question refers to a kind of circular reasoning where an ingrained assumption or belief is embedded within the question itself. In this case, what people often mean when they ask, "Is a naturopathic physician a real doctor?" is actually, "Can a naturopathic physician prescribe pharmaceutical drugs?" In this case the underlying assumption or ingrained belief is that only pharmaceutical drugs are "real" medicine, while nutrition, exercise, lifestyle interventions and natural remedies such as herbs or dietary supplements are "fake" medicine.

In actuality, real medicine is: Whatever works.

Unfortunately, when dealing with arguments based on circular reasoning, simply pointing out the circular reasoning often times doesn't change the underlying assumption. However, in the case where a person believes that only pharmaceutical drugs constitute "real" medicine, the answer is actually: Yes. Naturopathic physicians are trained in pharmacology and do prescribe drugs in cases where they feel it is necessary. What naturopathic doctors typically don't do is prescribe drugs at the first sign of trouble. Instead, most naturopathic physicians choose to work with clinical nutrition, botanical medicines, dietary supplements, and holistic modalities, before reaching for the prescription pad.

For those inquiries which aren't begging the question, what a person might be wondering is how the educational process of a naturopathic doctor compares to that of a medical doctor or osteopath. In order to address this issue, let's first take a look at a comparison of the educational process leading up to medical school. Then I will explain some of the distinctions between naturopathic and conventional medical schools. Finally, I will discuss what happens after graduation from medical school. The aim is to give you a better understanding of how naturopathic and conventional doctors are different as well as how they are alike.

High School Diploma

This may seem like an obvious point, but both naturopathic and conventional doctors must have a high school dimploma or GED in order to continue their educational process. Possessing a high school diploma means that a graduate has achieved a certain basic level of understanding of science and mathematics- which are of course essential to the practice of medicine.

Bachelor's Degree

Both naturopathic and conventional medical schools require applicants to have an undergraduate or Bachelor's degree. In many cases, the applicants will have a Bachelor's of Science degree, with pre-medical coursework that includes biology, chemistry, and physics. Many medical school applicants will also major in the natural sciences, however this is not absolutely required. It is also possible for somebody with a Bachelor of Arts degree to be accepted into medical school, provided they have taken the pre-requisite coursework, and of course passed the application process.

Entrance Exams

Most people applying to conventional medical school in the United States and Canada take an entrance exam called the Medical College Admission Test, or MCAT. However, taking the MCAT is not an absolute requirement. Currently, none of the accredited naturopathic medical colleges require the MCAT or other entrance exams.

Medical School Programs and Curricula

Both naturopathic and conventional doctors attend full-time four-year accredited medical schools. The accrediting body for MD schools is the Liaison Committee on Medical Education while osteopathic (DO) schools are accredited by the Commission on Osteopathic College Accreditation. Naturopathic medicine schools are accredited by the Council on Naturopathic Medical Education.

The curricula of all medical programs is very similar. Prospective physicians spend the first two years learning all of the basic sciences, like anatomy, physiology, biochemistry and genetics. The credit hours- as well as the textbooks used- in these basic science classes are pretty much identical among all types of medical schools.

All three kinds of medical schools teach pathology (the study of disease) and doctors learn how to diagnose disease through a combination of patient interview and observation, physical exam, lab tests like blood or urine tests, and imaging studies like x-ray, computerized tomography (CT), magnetic resonance imaging (MRI), and cardiograms. Even though the coursework is almost identical, where MD, DO, and ND programs sometimes differ is in how they choose among which test(s) to order, and how they are interpreted.

As medical students progress into their third and fourth years, they learn more about treatment modalities and this is where the types of medical schools differ. For example, while all medical schools teach pharmacology and minor surgery, programs may vary greatly in terms of how much clinical nutrition the medical students learn. DOs learn osteopathic bone manipulation and NDs learn naturopathic manipulative therapy. Naturopathic medical students also take coursework in botanical medicine, mind-body medicine, homeopathy, and in some cases Traditional Chinese Medicine or acupuncture. But the main difference between MD, DO, and ND medical programs is not the content of the coursework, but rather the underlying philosophy which guides the physician to choose one treatment over another.

Towards the end of a medical school program, prospective physicians spend less time in the classroom and more time in hospitals or clinics getting hands-on training seeing patients while under the supervision of a licensed physician. Supervised clinical training is a required part of all medical school programs, including naturopathic medicine programs. This is where a prospective physician practices their medical interview and physical exam techniques and learns about how to manage patient cases. Due to the fact that physician students are learning under mentors, this is in one respect the most variable part of medical school training. Even within the same program, medical students might get very different views on how to interact and build relationships with patients. Considering that the doctor-patient relationship is a keystone of care, it is no wonder that two doctors who received the exact same training in medical school can produce drastically different outcomes with their patients.

In the end, it turns out that one of the most important aspects of patient care is something that is not really capable of being quantified, measured, or regulated. This is why choosing the right doctor is as much finding somebody who you feel you can trust and relate to on an emotional level as it is evaluating credentials or determining who went to the most prestigious medical school. As the old adage goes: What do they call the person who graduated in the bottom of their class in medical school? Doctor.

For a more specific curriculum comparison between naturopathic and conventional medical school, please see: What Do Naturopaths Learn in Medical School?

Medical Board Exams and Licensing

Both naturopathic physicians and conventional doctors need to pass medical board exams if they wish to obtain a license to practice medicine. MDs pass an exam called the United States Medical Licensing Examination (USMLE). DOs may take the USMLE or an osteopathic-specific exam called the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA). Naturopathic doctors seeking medical licensure must pass the Naturopathic Physicians Licensing Examinations (NPLEX).

Once these examinations are passed, doctors can apply for medical licenses. The exact requirements to be issued a medical license vary from state to state. Currently, 17 states, the District of Columbia, and the United States territories of Puerto Rico and the United States Virgin Islands have licensing or regulation laws for naturopathic doctors. Prescription privileges for naturopathic doctors also vary among states that license them. For example, in Arizona naturopathic doctors are prohibited from prescribing psychoactive medications. In many other states, a drug must be explicitly included in a naturopathic formulary for it to be prescribed by a naturopathic doctor.

While MDs and DOs have more training in pharmacology than an ND, naturopathic doctors are more likely to be aware of how botanical medicines and dietary supplements may interact with prescription and OTC medications. Considering that two-thirds of Americans regularly take herbs and dietary supplements, that might be something worth keeping in mind when deciding whether or not to include a naturopath in your personal health care team.

In order to maintain an active medical license, most states require physicians of all types to acquire certain amount of continuing education credits annually. The exact number of hours varies from state to state.

Medical Residency

One of the biggest differences between naturopathic and conventional medical training is that most medical doctors go on to receive additional graduate medical education known as medical residency before obtaining a license to practice medicine. Medical doctor residencies range from 3 to 7 additional years of training in a particular specialty such as family practice or general surgery. Medical doctors typically apply for licenses to practice medicine during their residency. Due to a shortage of residency positions available to medical doctors, in certain circumstances medical doctors are allowed to practice without residency training.

Most naturopathic doctors do not complete a residency, in part because it is not currently required by state licensing laws and in part because there are not enough residencies available for all of the new naturopathic graduates to be guaranteed a placement. Since residencies are paid positions and naturopathic medicine is typically not covered by health insurance, it is more difficult to find funding for naturopathic residencies than for other doctors. As of 2014, just over fifty naturopathic medicine residencies are available for new graduates. These residencies are also shorter in duration than MD or DO residencies, being one or two years long rather than three to seven.

Fellowship Programs

After completing residency, some doctors decide to pursue a subspecialty through additional training known as a fellowship program. This training period can last another one to three years after residency. Medical doctors and osteopaths who want to practice integrative medicine may choose to attend an integrative medicine fellowship approved by the American Board of Physican Specialties. There are over 20 different fellowship programs for integrative medicine which are offered by various universities.

Board Certification

In addition to the various training programs, physicians may elect to become board-certified in a particular area of practice. This typically entails a special certification exam and extra continuing education requirements. Medical doctors and osteopathic physicians practicing integrative, holistic, or functional medicine most often get certified through the American Board of Integrative Holistic Medicine (ABIHM) or the Institute for Functional Medicine (IFM-CP).

Naturopathic physicians who work with cancer patients may pursue board-certification through the Oncology Association of Naturopathic Physicians to become a Fellow of the American Board of Naturopathic Oncology (FABNO).

Summary

Comparison of ND, MD, and DO Education and Training
(as of November 2014)
Stage of EducationNaturopathic Doctor (ND)Medical Doctor (MD) or
Osteopathic Doctor (DO)
High School Diploma or GEDYesYes
Bachelor's DegreeYes
Typically a Bachelor's of Science with
pre-medical focus (not required)
Yes
Typically a Bachelor's of Science with
pre-medical focus (not required)
Entrance ExamNoYes - MCAT
With a Few Exceptions
Medical SchoolFull-time four-year accredited program
Basic Medical Sciences
Pathology and Diagnosis
Pharmacology (less)
Clinical Nutrition (more)
Naturopathic Manipulative Therapy
Dietary Supplements
Botanical Medicine
Holistic Remedies
Supervised Clinical Training
Full-time four-year accredited program
Basic Medical Sciences
Pathology and Diagnosis
Pharmacology (more)
Clinical Nutrition (less)
Osteopathic Manipulation (DOs only)
------------
------------
------------
Supervised Clinical Training
Board ExamsYes - NPLEXYes - USMLE or COMLEX-USA
Medical License17 states, Washington D.C.,
and 2 U.S. Territories
50 states, Washington D.C.,
and 3 U.S. Territories
Continuing Medical EducationMost StatesMost States
Residency1-2 Years
Not required
3-7 Years Depending on Specialty
Required, With a Few Exceptions
FellowshipNot
Available
1-3 Years
Not Required
Board CertificationOncology Only
Not Required
24 Medical Specialty Boards
Not Required

A thorough comparison of the educational process between naturopathic doctors and conventional doctors reveals many similarities as well as differences. The most similarities are actually found all the way through graduation from medical school, at which point the title of "doctor" is awarded by a diploma.

Post-doctoral training like residencies, fellowships, and board-certifications add a considerable amount of complexity to the process that can make it quite bewildering for patients to sort out. Some physicians practicing in sub-specialties could receive 6 or 7 more years of medical training than a family doctor.

The point is- which kind of doctor is the "best" doctor really depends on what you are looking for. Especially if you are in the two-thirds of Americans who regularly take herbs and dietary supplements, the best doctor to consult about those may very well be a naturopathic physician. One thing you certainly don't want to do is fall prey to the naturalistic fallacy and think that, just because something is "natural" that means it is safe. Especially if you are also taking prescription medicines. At the end of the day, the best strategy is likely to take a team approach to health care and not rely on any single practitioner too heavily.

There are certainly many circumstances where a naturopathic physician may not be the ideal person to consult with. For example, when considering very specialized or experimental medications or surgical procedures, you will naturally want to consult with the physician that is most knowledgeable about them.

As for the question, "Are naturopathic doctors real doctors?" the answer may ultimately depend on who is doing the asking and why, but at least according to the diplomas hanging on the wall of naturopathic doctors' offices throughout the country, the answer is: Yes.