ND as Primary Care. Talking Points.

The are two bills before the Oregon Legislature concerning naturopaths.

House Bill 2523 that

Requires managed care organization to allow chiropractic and naturopathic physicians to serve as attending physician for injured workers for life of claim.

HB 3301 that says (bold is the new language)

“Naturopathic medicine” means the discipline that includes physiotherapy, natural healing processes, [and] minor surgery and primary care and has as its objective the maintaining of the body in, or of restoring it to, a state of normal health.

Both bills are in committee. Both bills should remain there to die.

 The ‘Naturopathy’ menu item at Ore4SBM.org has extensive links concerning naturopathy for more detailed information. See the deconstruction of the Naturopathic White Paper on why naturopaths believe they should be primary care providers. The key points about Naturopaths should be primary care providers.

1) Their education is grossly inadequate to diagnose and treat patients.

This is detailed in ND Confession, Part 1: Clinical training inside and out by Britt Hernes, a Bastyr graduate and former ND.

The summary quote from the article:

I think it is quite apparent that the 561 hours of what I calculated to be “direct patient contact” in clinical training are nothing of the sort that would instill confidence in anyone that naturopathic education can produce competent primary care physicians. There is no way that such training produces better, cheaper or more effective health care than what is currently available. Yet, this is exactly the rhetoric fed to federal and state lawmakers about naturopathic medicine, and it is wrong.

If naturopaths are going to continue to argue that their scope of practice should reflect their training, then they need to accept that their scope of practice should be severely, severely, severely dialed back or they need to conduct a massive overhaul of their training, as the DOs did in the 1970s. Furthermore, naturopaths are not required to complete residencies (except for those practicing in Utah who need one year of residency), which is where any physician will argue the real practice of medicine is learned over the course of multiple-year post-graduate training in a teaching hospital.

Realistically, if I were to practice naturopathic medicine according to my training at Bastyr University, I honestly do not even know what I would be qualified to do.

2) Their post-graduate training is usually non-existant or at best minimal.

Most medical training occurs after medical school. It is the residency and fellowship after graduation under the watchful eye of experienced physicians is when MDs/DO’s really learn their profession. No MD/DO is ready to independently care for patients right out of medical school. And the few naturopaths that have a residency do a naturopathic residency, emphasizing their inadequate education.

3) The foundations of Naturopath are pseudo-science and pseudo-medicine.

At our local naturopathic school they get 144 hours as much training in homeopathy. The have the opportunity to do electives to broaden their knowledge: 144 hours in homeopathy, 36 hours in qi gong, 26 hours in Aruyveda, 24 hours in energy work and 12 hours in colonics.

While Naturopaths may argue that they have a science/realty based practice, as the websites of the authors of the Naturopathic White paper demonstrate, it is probably impossible to naturopathic site that does not have some form of pseudo-science divorced from known reality

4) Naturopaths do a worse job at following primary care standards.

Children were significantly less likely to receive each of the four recommended vaccinations if they saw a naturopathic physician

and they do less cancer screening.

Both alternative and complementary use was associated with reduced Chlamydia screening. Cancer screening increased with complementary use but decreased with alternative use of CAM. Use of naturopathy was associated with decreased mammography…

5) Naturopaths often oppose real medicine.

For example, their opposition to tightening vaccine exemptions is further evidence of their unfitness to be primary care providers.

6) There is no standard of care.

As the White paper notes, as if it were a good thing, that naturopaths can do anything they want.

Standard of Care & Competencies

There is no naturopathic-specific standard of care. Naturopathic doctors are taught and held to the same standards of care as conventional providers.

Treatment Guidelines

Condition-specific treatment guidelines present more of a challenge with naturopathic physicians than conventional providers. Each person’s treatment is individualized taking into consideration conventional treatment guidelines, but combined with a complex array of natural and conventional modalities that may vary among providers.

An inadequate education grounded in pseudo-science and pseudo-medicine, little training, no standards and opposition to standard medical care makes naturopaths profoundly unfit to be primary care providers. Or any kind of provider.

Unfortunately it is even worse. If they get “primary care physician” designation under state law then that the non-discrimination provision of the ACA will require insurers to include them in their provider panels:

A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.

HHS had issued guidance saying that no particular type of provider need be covered by an insurance policy, but Harkin et al. jumped all over this and said no, you can’t wholly exclude a provider type (e.g., naturopaths).

So, Oregon public and private health care insurers may be required to include some naturopaths who say they are “primary care” providers in their plans.

This can only be bad for the health care of Oregonians.

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