I was in the I was in the middle of an appointment with a new patient when she said the words that boil my blood…
“I went and saw my real doctor….”
This wasn’t the first time a patient had said this to me, and I’m sure it won’t be the last, but if I’m being honest, every time I hear this it takes everything I have not let me ego get the best of me and give a lengthy speech about how naturopathic doctors ARE REAL DOCTORS.
I do understand the confusion however, and my goal with this week’s blog post is to create a resource I can send people to, that educates and clarifies why and how naturopathic doctors are real doctors.
This is a very important conversation to have in this era of health information overload, where we open up our social media accounts to thousands of health influencers giving people medical advice online, some of which even call themselves “doctor”, without having real credentials. Or, even more confusing, some have earned the doctor title, but have no clinical experience (for example, PhDs) and are giving people health advice.
Education
In order to even be able to sit for licensing examinations, naturopathic doctors must complete an undergraduate degree, including specific courses such as biology, chemistry and psychology, followed by a 4-year doctoral degree. 8 years of postsecondary education in total.
Personally, I completed a kinesiology undergraduate degree, with honours from the University of Windsor, and then graduated from the Canadian College of Naturopathic Medicine (CCNM) in Toronto, Ontario thereafter.
CCNM is one of five accredited naturopathic medical schools in North America. The four others are located in the states.
This 4-year doctoral degree was grueling. The first year is quite similar to conventional medical school in that we are learning anatomy and basic sciences - biochemistry, physiology, immunology, embryology, etc. And different in that we learn different treatment modalities compared to that of conventionally educated doctors.
Naturopathic medical school teaches clinical nutrition (and A LOT of clinical nutrition), botanical medicine, Asian medicine, psychology, homeopathy, and physical medicine (hydrotherapy, massage and spinal manipulation). We also learn pharmacology and minor surgery, albeit not as in-depth as a conventionally trained doctor, as our prescription rights are not as broad, depending on the jurisdiction where the ND practices.
Naturopathic medical school is 90 credits per year. For comparison, a typical undergraduate degree is 30 credits per year.
I had 15 hours of lecture per week in my undergrad, and 40 hours of lecture per week in naturopathic medical school.
It is a ton of work, a huge time commitment and an especially huge financial commitment. Multi 6-figures to give you an idea of cost.
Licensing
After graduating from one of the five accredited naturopathic medical schools, an ND must sit for the Naturopathic Physicians Licensing Examination (NPLEX), which is a 3-day written exam. Depending on the jurisdiction a naturopathic doctor wishes to practice medicine in, he or she must also complete provincial or state board exams.
NDs, DCs (Doctors of Chiropractic), MDs, all have a license to practice medicine.
Regulation
Not every state and not every province has a regulatory college. Regulatory colleges exist to protect the public and hold doctors and other health professionals accountable for their actions, and lay out the standards of practice required to maintain a licence in that jurisdiction.
In places where naturopathic medicine is not regulated, finding a trusted naturopathic doctor can be more challenging.
In Alberta, myself and other Naturopathic Doctors are regulated by the College of Naturopathic Doctors of Alberta (CNDA). So in order to practice naturopathic medicine in Alberta, we must uphold the standards set out by the CNDA as well as the Health Professions Act. This includes completing continuing education hours, paying annual licensing fees and holding malpractice insurance.
This information becomes important when taking advice from a health coach, a nutritionist, a health influencer, etc. Although many of these individuals do amazing work and truly help many people, they do not have a governing body to hold them accountable. If they give poor health advice (which I have seen a ton of online), the people that suffer are those who took the advice and not them.
The Privilege of Diagnosis.
*Real* Doctors have a responsibility to diagnose. Doctors, naturopathic, chiropractic, medical…any clinical doctor, has the ability and the authority to diagnose their patients. We are required to take a medical history, run pertinent labs and appropriate physical exams, record what we find and report what we find.
Fake doctors cannot diagnose. Health influencers cannot diagnose.
Scope of Practice
In Alberta, Naturopathic Doctors have what I would call a “medium” scope of practice. It’s broader than some jurisdictions and much more restricted than others.
In Alberta, Naturopathic Doctors can: perform minor surgery, administer IVs, intramuscular injections, deep joint injections (for example, using prolotherapy involves the use of 4 inch needles directly into patients’ spines), and requisition blood work and other diagnostic lab tests (such as urine, saliva, and stool tests). We cannot however, prescribe pharmaceuticals in Alberta, nor perform platelet-rich plasma or use ultrasound to guide injections, all of which are in a naturopathic doctor’s scope in other jurisdictions in Canada and the United States.
Fake NDs and PhDs
In today’s social media age, we tend to define credibility by the number of followers an individual has. Having a doctor title isn’t enough to gain the public’s trust, but rather, the title PLUS hundreds of thousands of followers. And if only one of those is present, it’s often the number of followers that gets the credibility.
Here’s where it gets mucky…there are shocking a lot of individuals with large followings who call themselves doctor when they aren’t actually a doctor. OR, they are a doctor, but are not licensed and do not have the authority to give medical advice (for example, PhDs).
This happens much more frequently in the states than in Canada, but it’s definitely something the public should be aware of.
In Canada, the title ‘Naturopath’ is a protected title. Meaning, only licensed Naturopathic Doctors can call themselves a Naturopath. And so, we as naturopathic doctors, and the public, often use this title interchangeably with Naturopathic Doctor or ND.
In the states however, the title ‘Naturopath’ is not a protected title. Meaning, anyone can call themselves a naturopath! Someone can take an 8 week course, and then call themselves a naturopath. Which is incredibly frustrating as someone who has spent 8 YEARS in school and spent hundreds of thousands of dollars on their education to earn the title Naturopath.
There definitely needs to be stricter rules and regulations in the states regarding this, but as of now, this is the reality and it’s only fair that the public knows about it.
PhDs have earned the doctor title, so they can and should use this title. However, they have ZERO clinical training and are not licensed to practice medicine or give clinical advice. They are a different kind of doctor. Their job is research, and conducting research is how they have obtained their doctor title. But how is the public to know this when they see an Instagram handle that just says drmarysmith and they are posting all sorts of clinical advice?
Now, some PhDs have done extra training to be able to work with people in more of a clinical manner, however, this is the exception and not the norm. They are actually NOT supposed to be giving people medical advice because they do not hold a licence, which means there is no regulatory board keeping them accountable.
There are many other scenarios of “fakeness” when it comes to people calling themselves naturopathic doctors, which I won’t go into in this blog post, but I encourage you to listen to this podcast episode by my colleague Dr. Tyna Moore: Fake Credentials and Medical Misinformation: What You Need To Know
Pitfalls of Naturopathic Doctor Training
1. There is no residency.
Medical doctors are required to complete a challenging residency program, and this very adequately prepares them for practicing efficiently. Although there are some residency programs available for naturopathic medical school graduates, these are mostly in the oncology space.
This is something I am working on changing, or at least contributing to the change, as I do not believe naturopathic doctors are fully ready for clinical practice upon graduation, despite our last year of school being a full 12-months of internship, I believe we need more real life experience under the guidance of a supervisor before being sent off on our own to start our practices. And this is coming from someone who had completed her “numbers” 5 months prior graduating. The “numbers” being the minimum number of patients we needed to see.
A goal I am currently working on, and one of the reasons I wanted to own and operate my own clinic, is to set up a residency program for new graduates, specifically in regards to regenerative injection therapies and keeping active people active - our main mission here at Elevate Functional Health.
2. The education on musculoskeletal medicine is poor.
I am very grateful I chose kinesiology as my undergraduate degree, because I have used everything I learned in those four years at the University of Windsor a TON in my practice. I also completed a Sports Medicine focus shift during my internship, where I learned a lot about sport specific nutrition, and a bit more about MSK health. I’m also very, very grateful for having worked closely with some incredible chiropractors for the past decade, because no one knows musculoskeletal health better than them. They know their anatomy inside and out, including the neurological system.
My kinesiology degree, learning from my chiropractic colleagues, additional training in continuing education courses, as well as the many hours spent studying the musculoskeletal system has countered the poor education on musculoskeletal health and orthopedic testing I received in naturopathic medical school.
I would not trust my colleagues with MSK health, but luckily, they don’t pretend to be good at this!
As for myself, MSK health is my jam. And because I have extensive education on clinical nutrition, root cause medicine and metabolic health, I am able to truly get to the root cause of my patient’s pain or lack of healing, and THIS is my clinical superpower.
Now, before you think this article is all about touting my own horn, I want you do know that I have absolutely no problem turning away patients who I know I am not able to help, or that I would not be the best at helping.
For example, I do not take pediatric patients and I do not take oncology patients. These are not my area of expertise and these patients would get much better care from another naturopathic doctor.
I can only hope that my colleagues understand their strengths and weaknesses as practitioners as I do, and cross-refer.
3. The education could be more systematic
If I’m being honest, our education was overwhelming and when it came to seeing patients during my internship, I often had no idea where to start with making a treatment plan because there was just so many options and so many different modalities. Should I recommend acupuncture? An herbal tincture? A supplement? Perhaps do some mindset work? All of these things? How do I not overwhelm my patients?
Some of my supervisors were great at teaching us how to use the best available evidence to come up with a protocol; but others had their niche and it became confusing and difficult even after graduating to know how to streamline treatment plans.
Luckily, this is changing and naturopathic doctors are now developing standards of care across the board, so that no matter what ND a patient goes and sees, they will likely get the same advice - at least to start with.
My goal with this blog is to educate you, the public, on who is a *real* doctor and who is not. By real, I mean who are the doctors that are clinically trained and held accountable by a licensing board.
How to know if a naturopathic doctor is a *real* doctor:
In summary, if you want to check in on someone who claims to be a naturopathic doctor but you aren’t sure, here’s a checklist you can go over:
- They have completed a 4-year doctoral program from a school accredited by the Council on Naturopathic Medical Education (the CNME)
- They have passed the Naturopathic Physicians Licensing Examination (NPLEX)
- They have obtained a license from a provincial medical board, for example, the College of Naturopathic Doctors of Alberta (the CNDA)
- They practice in jurisdictions that legally recognize and regulate naturopathic medicine
It really is the wild west when it comes to individuals using the ‘doctor’ title, and even when that individual has legitimately earned that title, they may be a researcher and not a clinician.
Considering we are in a “trust recession”, my hope is that this article will help you understand the differences between the various types of doctors, and establish trust more readily with real doctors who are held to a very high standard by a regulatory body.
Thank you for reading and please share any questions or comments below!