Naturopathic doctors focus of latest scope-of-practice debate

Out of all of the strategies proposed to help ease the United States primary care shortage, expanding the scope of practice may be the most contentious. The latest chapter in the debate surrounds proposed legislation to allow naturopathic doctors (ND) to prescribe some medications and perform minor procedures in California, MedPage Today reported.

Currently 16 states plus the District of Columbia and Puerto Rico license NDs for medical practice. "In these states, NDs practice as independent primary care general practitioners, with the ability to diagnose and treat medical conditions, perform physical exams and order laboratory testing," according to the California Naturopathic Doctors Association (CNDA) website.

Since California began licensing NDs in 2003, it has required that the practitioners be under the supervision of a physician when writing prescriptions. That restriction "was put in place as a temporary measure to allow a regulatory subcommittee to determine what the independent formulary for naturopathic doctors should be," the CNDA told MedPage Today.

A proposed update headed to the state assembly for consideration would expand the types of imaging an ND can order; allow NDs to perform procedures, such as removal of warts and skin tags from parts of the body other than the face; and prescribe/change dosage of level IV and V medications without supervision.

While the bill passed the state's senates and has garnered support from some practicing physicians, the Medical Board of California has expressed opposition and gave MedPage Today a copy of a letter Executive Director Kimberly Kirchmeyer wrote to Democratic state Sen. Marty Block, the bill's sponsor. "Although NDs may be well qualified to practice naturopathic medicine that utilizes natural medicine and treatments in a natural approach, NDs do not receive the education and training in naturopathic education programs to safely perform minor procedures and prescribe without physician supervision," she wrote.

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