In April, Maryland Governor Martin O'Malley signed a bill authorizing Maryland NDs to be licensed to practice naturopathic medicine. Passage of the bill, which received strong bipartisan support, represented years of coordinated efforts by naturopathic doctors in the state.
That's only one part of the story. In recent years there's been significant progress in quite a few states. Puerto Rico attained licensure in 2004, California and Kansas in 2003, Washington, DC, in 2005, Minnesota in 2008, North Dakota in 2011, and Colorado in 2013. Connecticut passed a law modernizing the scope of practice in 2014.
"The fact that so many states have become licensed in past decade, and especially in the last couple of years, means that their success is an inspiration to NDs elsewhere," says Mike Jawer, director of government and public affairs at the American Association of Naturopathic Physicians (AANP). "Our members all across the country are looking enthusiastically at what these colleagues have been able to do and saying, why not us? When there is a critical mass of practitioners in a given state, and folks decide they're willing to make the investment of time and money and energy to become licensed, they go for it."
Licensure requires a considerable commitment. It took Maryland four years for NDs to become licensed. "In Colorado, they were biting at that apple for over 20 years," Jawer says. "Colorado is one of the states where there are many traditional naturopaths, who were concerned that they might be put out of business. However, that's not the intent of these licensure efforts."
Currently there are 4500 licensed naturopathic physicians in the US. They have each graduated from an accredited four-year residential naturopathic medical school and passed an extensive postdoctoral board examination (the Naturopathic Physicians Licensing Examination) to receive a license.
Traditional naturopaths rely on varied forms of training, perhaps through online courses or community schools. In states that do not have licensure for NDs, anyone who wishes can use the name naturopath or naturopathic physician, or put ND after his/her name, because there is no regulation. "One significant reason to pursue licensure is that the public needs to understand the difference," says Jawer. "In a state that has licensure, when someone goes to a naturopathic physician who has ND after their name, it means this person has graduated from a recognized school with a rigorous training program."
At present, six additional states are working toward ND licensure. "There is a significant ongoing effort now in Massachusetts," Jawer says. "In Pennsylvania, the bill passed their House earlier this year and it's now being considered in the Senate."
Maryland NDs Achieve Licensure
The first step in passing legislation is to identify supporters in the state legislature. "We were not even sure if we were going to introduce the bill, but at a fund-raiser just before the legislative session we had an opportunity to meet a key legislator," said Emily Telfair, ND, president of the Maryland Naturopathic Doctors Association (MDDA). "He said, 'Just go ahead and introduce the bill and I'll make sure it gets a fair hearing.' It was an informal conversation that basically put the ball in motion."
MNDA started out with sample legislation from the AANP, and the next step was to find sponsors in the legislature. "On my first day in Annapolis I arranged meetings with my state senator and state delegates just to introduce myself," Telfair recalls. "I really struck gold when I walked into my state senator's office, because it turned out she was very supportive of natural medicine, and she is extremely well respected in the legislature."
Another crucial aspect of the process was support from naturopaths in the state.
Last year Telfair was part of a team of six who were involved throughout the process. Someone from the ND community was present at the legislature every day throughout its 90-day session: "By working together as a team, we were able to use each other's abilities for making a PowerPoint presentation or meeting with a legislator. We dressed the part, we were professional, and we made important relationships with legislators on a human level."
MNDA held many meetings and conversations with legislators and organizations, and assembled extensive materials to educate legislators and other providers about the profession. After opposing licensure for four years, the medical society representing Maryland physicians dropped its opposition, largely because of a growing number of MDs who strongly supported the bill. (The educational materials are now available on the AANP website as model resources for NDs in other states.)
The association also mobilized a significant grassroots effort, with patients writing individual letters about their healing stories. These letters were compiled and presented as part of MDNA testimony. When the bill came up for a vote in the General Assembly, practitioners encouraged patients to contact their legislators.
A turning point in the licensure effort came when Maryland's health secretary, Joshua Sharfstein, MD, and leaders from the General Assembly visited the Casey Health Institute in Gaithersburg. It is one of the very few integrative patient-centered medical homes. "The staff includes medical doctors, nurse practitioners, and a naturopathic doctor," Telfair says. "They hired her even though it was before licensure, because they saw the future that was coming and wanted to be right there to meet it. When we brought legislators to this facility, they met with medical doctors who had experience working with a naturopath. They were very impressed by the patient-centered, integrative approaches being used there to treat patients."
Telfair is available to consult with other NDs who are involved in similar efforts in their own states. "You know, when I was working on this, every time I reached out to someone, medical doctors or naturopaths in other states, they contacted me right away," she says. "What a gift that was! So many people have blazed a trail before me. Now, if I get to get to blaze a trail that will help someone else and their future students, that's what this whole process has been about."
Currently, 17 states, the District of Columbia, and two US territories have licensing or regulation laws for naturopathic doctors. They are:
• District of Columbia
• New Hampshire
• North Dakota
• US Territories: Puerto Rico and Virgin Islands
Source: American Association of Naturopathic Physicians
American Association of Naturopathic Physicians
Mike Jawer, director of government and public affairs
For information on state licensure campaigns, including model legislation and educational materials: http://www.naturopathic.org/advocacy
Maryland Naturopathic Doctors Association
Emily Telfair, ND, president
For more information about the Maryland licensure law for NDs:
Elaine Zablocki has been a freelance health-care journalist for more than 20 years. She was the editor of Alternative Medicine Business News and CHRF News Files. She writes regularly for many health-care publications.