Quackwatch Home Page

National Association of Naturopathic Physicians --
Outline for Study of Services of Practitioners
Performing Health Services in Independent Practice

Part III: Practitioner

A. TOTAL MANPOWER

1. National

a. Age

The average age of today's naturopathic physician is 51.

b. Sex

Presently, about 90% of America's naturopathic physicians are male; 10% female.

c. Active and inactive

The precise number of inactive practitioners is not known. It is estimated that there are between 500-700 active and inactive naturopaths in those states with specific licensing or regulatory statutes or procedures, and an additional 3000-4000 active and inactive practitioners in states where naturopathic practice is conducted under common law.

2. States, per 100,000 population

There are approximately'2.2-2.5 naturopathic physicians per 100,000 people in the United States today.

B. ASSOCIATION MEMBERS

1. National

a. Age: The same median age of 51 years applies to members as well as non-members.

b. Sex: The same (90% female) breakdown applies to members as to non-members.

c. Active and inactive:

Active (practicing) members, approximately, 95 percent.
Inactive (non-practicing) members, 5 percent.

2. States, per 100,000 population

In the seven states where there are N.A.N.P.-affiliated chapters or associations, the ratio of member practitioners to each 100,000 of that state's population would be approximately: Oregon, 1.1; Washington, .9 ; Idaho, 3.7 ; Kansas, .7; New York, .04 ; Connecticut, .96 ; California, .1.

In states containing practitioners not associated with a local association, but nonetheless active N.A.N.P. members (32 in Nevada, Colorado, and Arizona), the median ratio of practitioner-per-100,000 population within the entire tri-state area would be .9.

C. USUAL LOCATION OF PRACTICE OR ACTIVITY

1. General or short-stay hospitals

N.A.N.P. has no knowledge of any specifically naturopathic hospital in the United States, although there are hospitals operated by religious orders, private trusts, non-profit organizations or corporations, or by other healing arts professions to which naturopathic patients (and naturopathic physicians) are admitted on par with other patients and practitioners.

Where naturopaths are admitted to such hospitals, and where naturopaths utilize minor surgery, such surgery is conducted in accordance with legal limitations upon naturopathic practitioners, and/or in accordance with the particular hospital's staff rules.

2. Specialty or long-stay hospitals

As stated above, N.A.N.P. knows of none.

3. Other inpatient institutions

A substantial number of such facilities --- primarily rest and convalescent homes --:admit patients under naturopathic care on par with all other patients.

4. Outpatient facilities

Ambulance services, clinics (school and private), patients' homes, practitioners' offices, rehabilitation centers -- are available to and utilized by naturopathic physicians.

5. Agencies and organizations

As contributing members of the national health-care fraternity, naturopathic physicians confer with the lend counsel to such entities (as an example) as Oregon's Advisory Board to its State Board of Health and the Oregon Interprofessional Health Council previously described. Naturopaths can and do minister to welfare recipients, to recipients of industrial accident insurance benefits, etc. Naturopaths are available as practitioners and clinicians to any' entity of local, state, or federal government which wishes to employ their talents.

In such facilities as the National College Of Naturopathic Medicine, outpatients are treated by practitioners and their students on a clinical basis.

D. TYPES OF PRACTITIONERS: GENERAL AND SPECIALITIES

1. Scope of practice

Naturopaths work within specific statutory limits, which usually prohibit major surgery and the administration of narcotics. Such statutes are not only acceptable to naturopathy but, in some instances, have been engendered by naturopathy, which believes -- as one case in point -- that major surgery is a highly limited, highly specialized field of medical service which, when necessary, should be performed by those allopathic practitioners who devote most of their time to that art.

Because naturopathy is by root a natural mode of healing, the restrictions against administration of narcotics are welcomed and encouraged by naturopaths.

Naturopaths have no aversion to referring. Naturopathy's educational curricula is inclusive of most elements of allopathy, but naturopathic practitioners utilize this training diagnostically in large part, referring extensively to allopaths or more specialized practitioners (podiatrists, optometrists, dentists, chiropractors, etc.) where initial diagnosis dictates or where subsequent therapy is unfruitful or where symptoms remain unabated under purely naturopathic therapy.

As an example of statutory limitations upon this profession, the salient Oregon law governing naturopathy is appended.

Roughly 90% of today's naturopathic physicians are in general practice; 10% specialize -- in pediatrics, obstetrics, gynecology, proctology, dermatology, chiropractic, etc.

2. Size of practice

The average naturopathic practitioner serves a patient population of 2000 yearly.

3. Limitations of practice

D. 1., above, touches this subject, as do the appended Oregon licensing statutes (as sample statutory language). "Limit" and "scope" of practice are in a sense synonymous.

Naturopaths in the main serve geriatric patients, by choice, not fiat. Naturopathic rights extend from pre-natal care (and subsequent obstetrics), through the detection and reporting of contagion, to signing birth and death certificates. Naturopaths are prohibited from performing major surgery, but can perform minor surgery.

Intermingling this answer with that to D.1. above, naturopaths can and do diagnose, apply naturopathic therapy to, and thereby treat, acute infectious disease and abnormalities of the digestive system, the respiratory system, the cardiovascular system, the urinary system, the hemopoetic system, the nervous system, and the endocrine system.

The only weapons they cannot bring to bear upon conditions within this systemic list are major surgery, the prescription of narcotics, and the administration of radiation therapeutically.

Additionally, because of hospital rules in most instances not law, naturopaths are limited in (or restricted from) practicing in general hospitals. Therefore, when there is need for specialized care within the confines of a hospital, the naturopath -- of procedural necessity -- most often refers to an appropriate practitioner admissable to such hospitals.

4. Practice conducted on authorization or under supervision of another health care practitioner

Naturopaths do not practice as "technicians" for allopaths or any other practitioners. In general, they practice independently of supervision -- neither their diagnoses nor their therapy nor prescribed medications are subject to review (by law or protocol) by any other practitioners. Naturopaths refer extensively. This has been dealt with in prior answers, and to the extent that the specialist and the naturopath who referred a patient to him may confer on continuing diagnoses or treatment, there is consultation and cooperation, but not implied or actual supervision by one doctor over another.

5. What percent of service is given in independent practice

100% of most naturopathic practice is devoted to individual patients, on a nonclinical basis. If the question refers to modes of payment for individuals! treatment, it is estimated that 80% of all naturopathic patients are personally responsible for their physicians' billings; 20% are "Medicaid", welfare, Industrial accident, or private-public insurance carrier benefit recipients.

E. RELATIONSHIPS TO OTHER HEALTH CARE PRACTITIONERS

1. All patients

a. To allopaths, chiropractors, other naturopaths, optometrists, podiatrists, osteopaths, dentists, pharmacists, nurses

(1) Who refers. -- The naturopathic physician.

(2) Why -- When the naturopathic physician feels that specialized attention is in the best interest of the patient.

The appended N.A.N.P. Code of Ethics touches upon referral in several ways. Articles 1, Section 7 states that the "naturopathic physician may decline to attend a patient when he deems the treatment required is beyond the scope of his license"; Article 1, Section 8 states that "The naturopathic physician shall act upon the desire of the patient for consultation or if he deems his art, skill, or experience inadequate, he shall advise consultation"; Article III, Section 2 states that "The attending physician shall give the case, history and laboratory. and clinical findings to the consulting physician".

b. From other naturopathic physicians ' chiropractors, optometrists, podiatrists, osteopaths, allopaths, nurses, dentists, and pharmacists

(1) To whom referred. -- The naturopathic physician.

(2) Why. -- Re-referral of an originally-naturopathic patient, when the specialist's course of treatment (or major surgery) is concluded, or when the natural healing techniques of naturopathy are indicated as most potentially beneficial, or, lacking a specific, when the best interest of the patient would be so served (or when the patient himself requests such consultation or referral).

2. Consultation

a. Given by any of the practitioners named in 1.a. and b. above.

(1) Who requests. -- The patient, his attending naturopath, or a member of another healing arts profession who is either a family retainer or who has been called upon by the patient or the attending naturopath.

(2) Why. -- As recited in 1. a. and b. above, primarily, because of the best interest of the patient.

b. Requested by the patient, the attending naturopathic physician, or a member of another health care profession

(1) Who provides. -- Any of the practitioners named in 1. a. and b. above.

(2) Why. -- More extensive diagnosis is indicated or a specialist's particular attention is desired.

F. MAJOR PROBLEMS PRESENTED BY PATIENTS TO PRACTITIONER

1. All patients

Patients under 40 years of age account for the highest percentage of acute, illnesses and infections, trauma, and musculo-skeletal problems. Problems affecting patients over 40 but under 65 are more or less chronic in character.

2. Patients 65 and over

More geriatric/gerontological in nature, the problems of the elderly are progressively chronic as age advances, and are primarily cardio-vascular or respiratory and are generally degenerative.

G. ACTIVITIES OTHER THAN DIRECT PATIENT CARE

Teaching is of necessity confined to those practitioners headquartered near the National College of Naturopathic Medicine -- in the Pacific Northwest: 30 licensed naturopaths currently serve as full- or part-time faculty members at the College, with the ranks of Assistant or Associate Professor, X-Ray Technician, and Clinical Laboratory Technologist.

Six naturopaths hold full Professorships at the College; college administration is handled by. a staff including five naturopaths, and eight naturopaths, comprise the College's rank of officers and trustees.

Naturopaths serve on state boards of examiners and other licensing or regulatory bodies administering their own or allied professions.

Naturopaths report contagious, and infectious diseases to their respective departments of health; issue birth and death certificates; serve on formal or informal interprofessional health councils; support food chemistry. and nutritional research.

H. RELATIONSHIP WITH THIRD-PARTY PAYERS

1. Federal programs

Naturopathy's involvement is not consistent state-to-state, depending upon the number of practitioners and status of the profession in a given state, and depending upon the state's degree of implementation of federal programs requiring matching state participation. In Oregon, for instance, naturopaths are included in the coverage provisions of Title XIX-"Medicaid" (Chapter 502, Oregon laws, 1967; ORS 414.025, Section 3. In Bremerton, Washington, another case in point, naturopaths' services to U.S. Navy personnel are paid for federally.

2. Blue Cross

Payments to naturopaths from Blue Cross-affiliated societies or corporations have been limited to emergency diagnostic procedures and laboratory work.

3. Blue Shield

The above answer to H.2. applies here.

4. Commercial insurance companies

Many private carriers honor naturopathic billings, in whole or in specified (within varying policy limits) part, among them Standard Insurance Co., Mutual of Omaha, Continental Casualty Co., Bankers Life & Casualty, Monarch Life, and New York Life -- all of which pay for naturopathic services in full.

5. Consumer-sponsored organizations

Some trade union-sponsored health care plans honor naturopathic billings. The profession, to our knowledge, does not deal through any other consumer-sponsored third-party payers at this time.

Index ||| Part I, II, IV, V
Quackwatch Home Page