For over a century, the American Medical Association (AMA) has held itself out as the premier physician association with the core purpose “to promote the science and art of medicine and the betterment of public health.” However, the AMA’s two national campaigns, Fight Against Scope Creep and Truth in Advertising, seem to contradict the organization’s stated purpose. How does pouring millions of dollars into fighting against recognition and limiting practice of entire fields of medically trained health care professionals promote the science and art of medicine ot the betterment of public health? This essay explores the hypocrisy of the AMA’s actions—which to me, speak much louder than their words.
Over the past several years, the American Association of Naturopathic Physicians (AANP), the national professional association representing more than 8,000 licensed naturopathic physicians (NDs) throughout 26 U.S. jurisdictions, has experienced first-hand the hypocrisy of the AMA’s efforts to “protect patients’’ by ensuring that physicians are the only recognized arbiters of health at the state level. They seem proud of their efforts claiming to have killed 100s of scope and licensure bills since 2023. But at what cost and for the benefit of whom?
The AMA believes it is the responsibility of policymakers to ensure that naturopaths’ claims that they can treat a broad range of conditions are backed by facts—facts that include the specific education and training necessary to ensure patient safety. What the AMA fails to grasp, whether intentional or not, is the established distinction between a licensable naturopathic doctor and a traditional lay naturopath. The two are not interchangeable. The standards of education and training (more on that below), and commitment to a Code of Ethics, are foundational differences. Many lay naturopaths may have post-doctoral degrees; however, a significant percentage of lay naturopaths secure their education and certificates of achievement through fee-based, online diploma mills.
The AANP and its members respect all practitioners in the natural health community, but advocate solely to secure licensure in all U.S. States, territories and jurisdictions to ensure regulatory oversight and recognition so that when a patient chooses to see an ND, they are able to make informed decisions regarding their health care provider. It is also why we are adamant in securing title protection for NDs and NMDs, to ensure the terms naturopath, naturopathic physician, naturopathic doctor and naturopathic medical doctor are only afforded to licensed or license-eligible NDs. We encourage the AMA to visit the American Association of Naturopathic Medical Colleges webpage, “What is the Difference Between a Licensed Naturopathic Doctor and a Traditional Naturopath?” (https://aanmc.org/featured-articles/difference-between-traditional-naturopath-and-licensed-naturopathic-doctor/). This way when you’re trying to make a point, your argument is at least grounded in fact.
Back to ND education and training. Yes, ND education and training are different—but not inferior. The AMA asserts ND education is only a fraction of the training that doctors of Medicine (MD) or doctors of osteopathy (DO). The facts are as follows. To earn an ND or NMD degree, students complete an intensive four-year medical education program at a naturopathic medical school accredited by the Council on Naturopathic Medical Education (CNME), that meet rigorous academic standards in basic and clinical sciences, diagnostics and various modalities such as herbal medicine, nutrition and physical medicine. ND students must complete at least 1,200 hours in naturopathic therapeutics and biomedical and clinical sciences.
The AMA has actively promoted to state legislators, regulators and the general public that ND education and coursework lack exposure to key clinical scenarios for patients of any particular age, particular health care setting or particular condition. This is not accurate. In fact, the CNME curriculum assures naturopathic doctors are educated and trained at providing care at all stages of life, identifying and treating the root causes of illness and disease combining traditional and evidence-based practices such as nutrition, herbal medicine, physical therapies and lifestyle counseling with conventional approaches like pharmaceutical therapies, when indicated. The ND practice aims to avoid complicated, expensive and high-force interventions resulting in unnecessary treatment(s) and undue financial strain. Naturopathic doctors are also uniquely trained to identify and anticipate possible interactions between natural therapies and conventional treatments. Further, NDs receive more than 140 hours of standard training in clinical nutrition and lifestyle counseling, which is absent in MD/DO education standards, even though it is an essential cornerstone of wellness vs. disease care.
Another logical fallacy the AMA continues to promote is that allowing NDs to practice to their full education and training will introduce safety risk to patients. This is also not factual. In Oregon, a state where NDs have been licensed since 1927 and NDs are able to prescribe and treat their patients using the full toolbox of naturopathic remedies and when necessary, any pharmaceutical needed in a primary care setting, including controlled substances under DEA Schedules II-V. According to the Federation of Naturopathic Regulatory Authorities (FNMRA), which tracks ND disciplinary actions from January 2010 to present, there were a total of 61 disciplinary actions across 26 regulated jurisdictions, of which only 13 were in Oregon. The Oregon Medical Board on the other hand reports 29 letters to MD/DOs in 2023 alone. If the AMA is benchmarking safety against MD/DO education and training, they may want to incorporate some of the philosophies and practices of an ND in preventive medicine.
The AMA’s stated strategic priority on advancing equity in health care, which aims to create a system where all communities have the opportunity to achieve optimal health, raises even more questions. How does continually opposing legislation to license naturopathic doctors and/or modernize their scope of practice, to include them in addressing the health care provider shortage, bring about equity and optimal health? The challenge to better the U.S. health care system requires new thinking and new approaches, rather than trying to hold on to an antiquated model that really just looks like it protects their practice model—and bottom line.
Actions may speak louder than words, but the words of Linda Girigis, MD, FAAFP, who wrote, “The AMA is not the voice of doctors and it is time that people stop recognizing them as something other than a political organization shaping reforms and selling products off the backs of doctors for their own agendas and profits,”1 are words worth listening to. The AANP and our fellow health care professionals are not looking to create turf wars among our members. Rather, we are at the point where we are no longer willing to allow the AMA to drive false and inaccurate narratives—it’s time to call out the hypocrisy and set the record straight.
The AANP welcomes the AMA to engage in a healthy, factual discussion regarding opportunities to expand access to qualified health care practitioners in the U.S. Redirecting the millions of dollars spent fighting against the AANP and other qualified, educated and trained health care professions, our collective talents and resources could conceivably solve the health care provider shortage, physician burnout and address the high costs of health care for U.S. citizens and patients.
Reference:
1 Is the AMA Really the Voice of Physicians in the US?, Physician’s Weekly, June 2015, accessed May 30, 2024 at www.physiciansweekly.com/is-the-ama-really-the-voice-of-physicians-in-the-us/#:~:text=The%20American%20Medical%20Association%20is,their%20memberships%20in%20large%20numbers.
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. 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.
