Naturopathic medicine continues to grow in recognition and demand across the United States, yet many licensed naturopathic doctors (NDs) face significant limitations due to outdated or restrictive licensing laws. Advocacy efforts aimed at license and scope modernization are essential to ensuring that NDs can fully utilize their training and expertise to serve their patients effectively. Across multiple states, naturopathic associations are leading these advocacy initiatives, and licensed NDs play a crucial role in supporting these efforts, as do other integrative health professionals.
The path to becoming a legally recognized profession throughout the U.S. is one that many healthcare professions have had to travel. For example, Advanced Practice Registered Nurses (APRNs), including Nurse Practitioners (NPs), have been working toward full practice authority and nationwide licensure recognition for decades. The process has taken more than 50 years and is still evolving.
• 1970s-1980s: The NP role expanded significantly, and many states began developing specific licensure requirements.
• 1994: The National Council of State Boards of Nursing (NCSBN) created the first consensus model for APRN regulation.
• 2010: The APRN Consensus Model was introduced to standardize licensure, accreditation, certification and education (LACE) requirements.
• 2025: As of today, only 27 states and U.S. territories1 have granted Full Practice Authority (FPA) to NPs, meaning that efforts for scope expansion are still ongoing.
For over a century, naturopathic doctors have worked toward achieving licensure, with Connecticut, Hawaii, and Washington leading the way for more than 100 years. In the past 40 years, 23 states and U.S. territories have secured licensure, with 13 gaining recognition in just the last 25 years. This progress would not be possible without the unwavering dedication of volunteers. These committed individuals invest their time, energy and expertise to build coalitions, advocate for the profession, and defend the practice rights of NDs when challenges arise. Their efforts are the backbone of the AANP’s strategic goal to achieve full-scope legal recognition of the naturopathic profession throughout the United States.
Why Licensure Matters: Being Able to Practice Your Profession Is Critical
In states where NDs have not yet secured licensure, they are unable to diagnose and treat as NDs to the full extent of their primary care education and training. Many NDs hold dual education credentials, and may be able to practice under a different license, but this limits their ability to provide citizens access to naturopathic primary care or specialty medical services. Additionally, in several states where NDs are licensed, they have limited and/or restrictive scopes of practices. These barriers hinder patient access to the full scope of safe, comprehensive and integrative naturopathic medical care. Addressing these issues through advocacy helps ensure that patients can access the full extent of services and unique care that NDs can provide.
Entire regions of the U.S. have yet to adopt licensure of NDs. Licensure across Midwest states, including Illinois, Indiana, Iowa, Michigan, Missouri and Ohio could quickly address the demand for naturopathic medicine’s integrative approach and focus on preventive and natural therapies. Additionally, licensing NDs provides a qualified, educated and trained workforce to immediately address health care provider shortages in underserved regions and communities.
States throughout the Atlantic corridor, such as Virginia, New York, New Jersey, North Carolina, have large, diverse and densely populated urban centers with high demand for health care services, which leads to lengthy wait times for patients. Licensing NDs would fill the gaps by offering their citizens access to the integrative health care options they are seeking. A win-win for the health care system, the health care professionals, and most importantly—the patients.
Southeastern states, from Kentucky to Louisiana, from Texas to Florida and all the states in between, would benefit equally if not more from ND licensing. Southern states in general have high rates of chronic disease, such as heart disease, diabetes, obesity and autoimmune conditions. Peer reviewed research and scientific studies consistently show the effectiveness of naturopathic medicine in preventing and treating chronic conditions.2
Across all U.S. regions, licensing NDs to practice to the top of their education and training makes good economic sense not just for improving patient health, but also for state economies. In February of 2022, Wisconsin enacted the Wisconsin Naturopathic Medicine Act, anticipating 20 NDs would apply for a license when available. In February 2024, applications opened and within 90 days 86 applicants had applied. In Massachusetts in 2024, the number of license applications was twice that anticipated, with more than 50 applicants the first year. These are small businesses of health care practitioners moving to the state once licensure is enacted. The positive outcomes licensure brings to a state are exponential.
Why Scope Modernization Matters
In states where NDs are already regulated, their scope of practice may differ from state to state. For example, Colorado’s ND scope of practice is much more limited than neighboring states Arizona and Utah where NDs have a very broad scope commensurate with other primary care providers. In today’s mobile environment, these differences create barriers to patients who choose NDs as their provider.
Many think that, because of the emphasis on more natural modalities, that prescriptive authority is not necessary in naturopathic practice. While it is true that naturopathic doctors will prioritize less expensive and less invasive natural substances and modalities first, sometimes the safest, most effective drug is a pharmaceutical. For example, a patient presenting with dangerously high blood pressure should be put on a pharmaceutical to quickly and safely bring their blood pressure into a safe zone, while slower acting natural substances and lifestyle changes treat the underlying cause of the symptom.
Because some states allow broad prescribing privileges for NDs, all naturopathic medical schools thoroughly teach pharmaceutical prescribing, as well as how to safely deprescribe if warranted. Further, regulatory boards report that NDs have an extremely safe track record managing pharmaceutical prescriptions, with fewer disciplinary actions than other prescribing professions.
Patients of NDs in states with limited scope of practice are subjected to increased health risk and health care costs. Having to see multiple providers increases their health care risk and overall expense by delayed access to treatment, time costs in scheduling multiple appointments, and travel to and from. Patients can only benefit from having access to a naturopathic doctor that is allowed to practice to the full extent of their training and education.
Scope modernization is equally important to achieving the AANP’s strategic goals. Advocating for and defending a consistent scope of practice commensurate with primary care education of NDs advances their ability to fully participate in our health care systems through inclusion in private, state and federally funded health care programs and insurance programs. With our health care system facing such dire shortages of primary care providers and dangerously long wait times, it makes no sense at all to not utilize every healthcare profession to the full extent of their training and education.
How You Can Get Involved
Licensed NDs, other health care professionals, and patients can support these efforts by engaging in grassroots advocacy, educating legislators and participating in public awareness campaigns. Below are some of the key organizations working toward these goals:
1. NDs Can Join Your State Association: Membership strengthens the association’s ability to advocate effectively.
2. Educate Legislators: Other health care professions, in particular conventional physicians, advanced practice nurses and pharmacists interested in supporting the advancement of integrative medicine can meet with policymakers to explain the benefits of naturopathic medicine.
3. Engage Patients: Encourage patients to share their experiences with legislators and decision-makers through public hearings, emails and calls.
4. Donate to Advocacy Efforts: Financial contributions help support lobbying, legal fees and public awareness campaigns.
5. Attend Advocacy Events: Participate in lobby days, public hearings and professional conferences.
Conclusion
Advocacy for naturopathic medicine is a collective effort that requires participation from licensed NDs, allied health professionals, and patients across the country. By actively supporting license and scope correction efforts, advocates of integrative medicine can help shape a future where naturopathic medicine is fully recognized and integrated into health care systems nationwide. Get involved today and make a difference, for the patients who depend on naturopathic care.
References:
1 In What States Can Nurse Practitioners Practice Independently? Barton Associates, www.bartonassociates.com/blog/best-states-for-nurse-practitioner-nps/#:~:text=Nurse%20practitioners%20can%20open%20their,%2C%20North%20Dakota%2C%20Oregon%2C%20Rhode Accessed 02.04.2025.
2 Lloyd, I., Steele, A., and Wardle, J., Naturopathy, practice, effectiveness economics & safety. World Naturopathic Federation. Section 3, Chapter 8. 2022, accessed October 2, 2024 at https://worldnaturopathicfederation.org/wp-content/uploads/2021/12/Section-3.pdf.
Linn Wheeling, CAE, MBA, Director of Community Engagement at the AANP brings a wealth of experience in strategy development and organizational performance across technology, health care and professional services.
