It is common knowledge now that the American health care system faces a looming crisis. A confluence of factors, including physician burnout, a growing population, and an aging workforce, has led to a critical shortage of primary care providers. This shortage not only strains the system but also limits patient access to quality care. While building a larger health care workforce is a multi-faceted, complex and long-term need, there are some low-hanging solutions that can easily and quickly rectify the barriers that prevent our existing health care workforce from providing care to the full extent of their education and training.
One solution lies in recognizing the valuable role that licensed naturopathic doctors (NDs) can play in expanding access to primary care.
Overcoming Systemic Barriers
A key barrier preventing NDs from fully contributing to the health care workforce is the outdated definition of “physician” in the Social Security Act (SSA). This definition excludes licensed NDs, despite their extensive training as whole-person primary care providers. This exclusion leads to a cascade of issues for patients:
• Patients who “graduate” to Medicare coverage from other coverage become ineligible to continue seeing their preferred ND providers, thereby disrupting continuity of care.
• Patients cannot see NDs in rural clinics and Federally Qualified Health Centers (FQHCs) that rely on Medicare funding to hire providers.
• Patients in underserved areas are restricted from seeing NDs since NDs are currently ineligible for loan repayment programs like the National Health Service Corps.
• Patients cannot see NDs in most residency programs since these are largely funded by Medicare.
Addressing these systemic barriers by updating the SSA definition of “physician” to include licensed naturopathic doctors would unlock their potential to help alleviate the health care workforce shortage.
Another key systemic barrier that needs to be addressed is the lack of licensing for naturopathic doctors in the U.S. Naturopathic doctors are regulated in 23 states, the District of Columbia, Puerto Rico and the U.S., Virgin Islands and many state legislatures are stepping up to the challenge, with six states having licensed NDs in the last seven years, and an additional six states are currently considering licensing. In states that have recently licensed NDs, all show an influx of providers immediately after the first licenses are issued, increasing access to health care for patients. Expanding licensing for naturopathic doctors to the full extent of their training and education in more states would help address the health care workforce shortage.
Leveraging the Expertise of Naturopathic Doctors
Naturopathic doctors are trained as whole-person primary care providers, with a focus on disease prevention and health promotion. They bring valuable expertise in non-pharmacologic treatments, lifestyle counseling and integrative approaches that can complement the care provided by other health care professionals. Integrating NDs into the health care system, particularly in underserved and rural areas, could enhance access to personalized, proactive and patient-centered care. This is especially relevant for the Veterans Health Administration (VA), which is facing severe provider shortages. While the VA has already implemented a Whole-Health Initiative that directly aligns with the philosophy and whole-person approach of naturopathic medicine, they have yet to create an employment code for NDs allowing them to be hired at sites where they are needed and wanted.
Addressing Physician Burnout
In addition to the health care workforce shortage, the United States is also grappling with high rates of physician burnout. Studies have shown that:
• Approximately 63 percent of U.S. physicians report burnout at least once a week.
• Physician burnout is associated with higher rates of alcohol abuse, suicidal ideation, medical errors and worse patient outcomes.
• Burnout is particularly prevalent among physicians in emergency medicine, intensive care and those in the early stages of their careers.
Incorporating NDs into the health care system could help alleviate the burden on overworked physicians, allowing them to focus on their areas of expertise while NDs provide the preventive and whole-person care needed to reduce the overload on hospitals. This could help reduce physician burnout and improve the overall quality of patient care.
Overcoming Entrenched Biases
Unfortunately, the American Medical Association has chosen this time of health care crisis to amplify its opposition strategies to misinform policymakers about the value of other professions with its #StopScopeCreep campaign, whose sole focus is to protect MDs and DOs from market competition and deny patients the ability to choose and access other health care practitioners. While policymakers are generally very receptive to finding solutions to meet patient needs, the AMA and their affiliated state and specialty societies continue to block patient access to NDs, nurse practitioners, physicians assistants, chiropractors, pharmacists and many other health care professionals.
A Path Forward
If current trends continue, it is estimated that 57 percent of the state and local public health workforce could be lost by 2025. With a rapidly declining workforce of physicians and other medical providers, rising health care expenses and an aging population, the U.S. health care system needs policy solutions to help address these challenges. By updating the outdated definition of “physician” in the Social Security Act, expanding licensing for naturopathic doctors in more states, and formally incorporating NDs into the VA, Congress and state legislatures can unlock the potential of licensed NDs to contribute to the health care workforce. These policy solutions, coupled with efforts to address student loans and residency opportunities for NDs, could yield both short-term and long-term benefits in addressing the provider shortage and burnout crisis.
The American Association of Naturopathic Physicians (AANP) is the national professional association representing Naturopathic Doctors (NDs) who are licensed or regulated in 26 states and territories. The AANP’s physician members are graduates of naturopathic medical schools accredited by the Council on Naturopathic Medical Education. CNME is recognized by the U.S. Department of Education as the national accrediting agency for programs leading to the Doctorate of Naturopathic Medicine (ND or NMD) or Doctor of Naturopathy (ND) degree. Laura Culberson Farr is executive director of the AANP, the professional membership association advancing recognition of licensed naturopathic physicians to transform access to whole health naturopathic medicine in the U.S. Farr brings nearly 30 years of service advocating for naturopathic medicine, its profession and health care reform generally. She has been executive director with the AANP since 2017. Through enhancing collaboration with AANP’s 48 affiliates, licensure has recently been achieved in Wisconsin, New Mexico and Idaho, with a dozen more states in active development of licensure initiatives to significantly expand patient access to naturopathic care. Prior to AANP, she served as the executive director with the Oregon Association of Naturopathic Medicine (OANP), where she successfully expanded prescribing authority and improved access to naturopathic doctors for Medicaid patients. Under her guidance, naturopathic doctors were recognized as Patient-Centered Primary Care Homes, further enhancing the quality of patient care. For her unwavering commitment to the profession, she was awarded the AANP’s Champion of Naturopathic Medicine Award in 2014. Farr is recognized for deep knowledge of the complexities of health care reform, expertise on how naturopathic doctors, conventional clinics, and insurers can collaborate to improve patient care and reduce health care costs and a commitment to integrating naturopathic medicine into primary care systems across the country. Her dedication to advocating for naturopathic medicine mirrors the core values of the AANP.
