BC, Canada Naturopaths (ND) might get family practice type rights.

[Daemos]

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http://www.vancouversun.com/Health/...ic+doctors+prescribe+drugs/1293439/story.html

Here's a copy of the proposed changes
http://www.health.gov.bc.ca/leg/pdf...ulation_-_proposed_amendments_Dec_12-2008.pdf

What the college of physicians and surgeons in BC have to say about it:

https://www.cpsbc.ca/files/u6/MoHS_Naturopaths_090120.pdf

If the proposed amendment passes, BC Naturopaths get prescribing rights (ALL medications except controlled narcotics), ability to perform minor surgeries with anaesthetic, order lab tests and imaging, be called "physicians" without qualifier, be able to form professional corporations, be able to insert fingers and instruments into body orfices, be able to give allergy shots, etc.

I hope the amendments do not go through. Many IMGs who have passed all the needed exams to be an MD in Canada are not given the right to practice.
Why should NDs who do not receive nearly the same education be allowed to?

 

[ZincFingers]

Political correctness.

 

[facetguy]

What is their level of education and training?

 

[Daemos]

What is their level of education and training?

Similar to a chiropractor with additional training in faith healing, homeopathy, herbology, asian medicine, etc...

but they will claim to have "Medical school equivalent training"

 

[facetguy]

Similar to a chiropractor with additional training in faith healing, homeopathy, herbology, asian medicine, etc...

but they will claim to have "Medical school equivalent training"

Are you concerned that NDs are going to encroach upon your future practice, or are you saying you are concerned for the well-being of the public?

 

[Daemos]

Are you concerned that NDs are going to encroach upon your future practice, or are you saying you are concerned for the well-being of the public?

Safety of the public is paramount. If they are given free reign to prescription rights and minor surgeries when they have inadequate training, it would only cause more burden on the health care system. Being that this would effectively make BC 'two-tiered' in terms of health care and that people would pay out of pocket to see NDs, where treatment by MDs is covered by medicare.

So as far as encroaching on future practice, I don't think MDs have to worry about that in Canada.

Currently they claim to have the same level of training in pharmaceuticals as an allopathic medical school, but looking at their curriculum they do not. Knowing how easy it is to get in, and some of the people who have gotten in to the ND school in BC, BINM, I'd say the standards are even lower than those of the Caribbean Medical Schools,

I personally think if they want to prescribe they should write the same exams that a MD student would have to write to earn those rights. Safety is #1.

 

[Miami_med]

In a backward way, the system in Canada would actually favor NDs. Far from making them equivalent, they could avoid going through the Federal medical beauracracy and collect from out of pocket payers. It would actually be a little bit funny, if it weren't so sad. The "right" to medical care would actually force the people to go to NDs, as it is effectively illegal to charge out of pocket for medical care in Canada as an MD.

 

[ZincFingers]

Are you concerned that NDs are going to encroach upon your future practice, or are you saying you are concerned for the well-being of the public?

Should chiropracters be allowed to write scrips? How about acupuncturists? Or the psychic a couple blocks down who claims his crystals can cure cancer?

The primary reason why these people, or NDs, should not be allowed to practice medicine is not because of their lack of intelligence, or lack of work ethic, or lack of understanding of science and pathology, although these are certainly concerns. The primary reason is the lack of quality control. As you may be aware, physicians must go through a standardized cirriculum no matter which school they attend, and master a punishing series of standardized exams to earn their license. Also, the strict limits on the number of American/Canadian/PR med school slots per year acts as its own quality control on the people who are able to get in.

Incidentally, I have a problem with independent NPs for this reason as well. There is no standardization for NP cirricula, and no admission standards for their schools either.

 

[Daemos]

Personally I would like to "test" this claim that a Natrupaths education is as comprehensive as a Medical school education.

As unlikely as this is to ever happen without lots of time, money and people to agree to it, I propose a widespread experiment as follows:

• Testing fresh graduates and as well those who have just completed their licensing exam, from Medical and Naturopath schools.
• Choose a handful of Medical schools and...all the ND schools (since there are only a handful that are accredited to train "Naturopathic Medical Doctors" to begin with)
• Distribute a typical licensing exam from another country (say the Australian AMC exam detailed here: http://www.amc-exam.com/amc-exam-details.html)
• Grade them
• then we can have some solid numbers to compare to on how well Naturopaths are actually educated compared to their Medical counterparts.

If they can prove them selves qualified enough to pass the same level of testing a medical student would have to pass before practicing, then they would of backed up their claim.

 

[facetguy]

So haven't the Canadian officials in charge of all of this thought through these issues? I doubt the ND lobby has much power at all given the relatively small numbers, so it can't be a political pressure thing. So why is this proposal even being considered if concerns about safety and effectiveness haven't been laid to rest already?

 

[Daemos]

So haven't the Canadian officials in charge of all of this thought through these issues? I doubt the ND lobby has much power at all given the relatively small numbers, so it can't be a political pressure thing. So why is this proposal even being considered if concerns about safety and effectiveness haven't been laid to rest already?

Because BC is caught in the whole 'natural stuff is good for you phase' not to mention that the federal government is trying to regulate some 'naturacuticals' so that they can only be bought with prescriptions.

 

[facetguy]

Because BC is caught in the whole 'natural stuff is good for you phase' not to mention that the federal government is trying to regulate some 'naturacuticals' so that they can only be bought with prescriptions.

I still have to believe that the Naturopathic profession must have put together a heck of a presentation and rationale as to why this should go through. I don't know much about how the Canadian government works, but imagine you are a legislator who would have to approve this change. Wouldn't you want something a little more substantive than 'natural stuff is good for you' before signing off on what some consider a reckless and dangerous piece of legislation?

 

[Josh L.Ac.]

When I was in Seattle, it was being debated to to give naturopaths PCP status in Washington state. Since I was surrounded by naturopaths while I was at acupuncture school, I did occasionally (not by choice) hear the ND students give pro's and con's to it.


An interesting con is that some where afraid that if they had the scope to write a script for an antibiotic, then they would eventually be forced to if it was the conventional standard of care.


But no, when it comes down to it, a 4 year doctorate degree with 400-600 patient contacts does not make one qualified to function as a PCP.

 

[cpants]

I still have to believe that the Naturopathic profession must have put together a heck of a presentation and rationale as to why this should go through. I don't know much about how the Canadian government works, but imagine you are a legislator who would have to approve this change. Wouldn't you want something a little more substantive than 'natural stuff is good for you' before signing off on what some consider a reckless and dangerous piece of legislation?

I don't know much about the Canadian government either, but if it's anything like the US government, then it is exceedingly easy to pass reckless, dangerous legislation. See: housing meltdown caused by government mandated subprime loans, vaccine courts, patriot act....I could go on and on. Especially in healthcare, the road to hell is paved with the good intentions of congress.

 

[facetguy]

I don't know much about the Canadian government either, but if it's anything like the US government, then it is exceedingly easy to pass reckless, dangerous legislation. See: housing meltdown caused by government mandated subprime loans, vaccine courts, patriot act....I could go on and on. Especially in healthcare, the road to hell is paved with the good intentions of congress.

Does anyone have any data on how much harm to the public naturopaths are doing in Washington state, where I believe NDs already have limited prescription rights? If some are to be believed, the damage must be horrific.

I agree that Congress does have a tendency to screw things up sometimes! I don't however have a problem with the concept of a vaccine court, which gives parents of children injured for life by a mandatory vaccine a voice and some help with caring for their now-injured child. These injuries do unfortunately happen, as I'm sure you are aware, albeit infrequently. These claims aren't just about autism either. I'll admit that I don't know much about how these courts work, however.

 

[midwesterner]

Personally I would like to "test" this claim that a Natrupaths education is as comprehensive as a Medical school education.

As unlikely as this is to ever happen without lots of time, money and people to agree to it, I propose a widespread experiment as follows:

• Testing fresh graduates and as well those who have just completed their licensing exam, from Medical and Naturopath schools.
• Choose a handful of Medical schools and...all the ND schools (since there are only a handful that are accredited to train "Naturopathic Medical Doctors" to begin with)
• Distribute a typical licensing exam from another country (say the Australian AMC exam detailed here: http://www.amc-exam.com/amc-exam-details.html)
• Grade them
• then we can have some solid numbers to compare to on how well Naturopaths are actually educated compared to their Medical counterparts.

If they can prove them selves qualified enough to pass the same level of testing a medical student would have to pass before practicing, then they would of backed up their claim.

I recently talked to an MD from Ukraine who came to the US and became a naturopath. He said his MD training in Ukraine was actually closer to naturopathic medicine than allopathic medicine, because in his home country they also use a lot of herbs and low-cost methods, and are less into pharmaceuticals and surgery. So, the results of that experiment will depend on which country we choose.

I too would like some kind of test. Not to be spiteful, just honestly to see what their qualifications are, as a new profession that is largely self-regulated. They should be open to this as well if everyone can agree on a fair test. A number of NDs I know wanted to take the USMLE to prove competence. The smartest ones I think crave credibility enough that they would be willing to take whatever test to earn it. If they can pass whatever parts of the USMLE that are within their proposed scope of practice, then that should set a fair standard.

I don't really understand why naturopaths want to be able to do minor surgery or prescribe drugs, since that seems counter to the "natural" philosophy. For me, that would be the part I would have the biggest issue with licensing. With a scope of practice that was more focused on nutrition, stress reduction, and herbs/supplements (people get those based on online information or the health food store clerk anyway), I think licensing sounds reasonable. I don't know about some of the other therapies they study, but as long as people know that these other therapies are not research-backed or proven safe, they should have the freedom to try alternative medicine if they want.

 

[midwesterner]

But no, when it comes down to it, a 4 year doctorate degree with 400-600 patient contacts does not make one qualified to function as a PCP.

Does anyone know how these numbers compare to an NPs' patient contacts?

 

[Josh L.Ac.]

I recently talked to an MD from Ukraine who came to the US and became a naturopath. He said his MD training in Ukraine was actually closer to naturopathic medicine than allopathic medicine, because in his home country they also use a lot of herbs and low-cost methods, and are less into pharmaceuticals and surgery. So, the results of that experiment will depend on which country we choose.

I too would like some kind of test. Not to be spiteful, just honestly to see what their qualifications are, as a new profession that is largely self-regulated. They should be open to this as well if everyone can agree on a fair test. A number of NDs I know wanted to take the USMLE to prove competence. The smartest ones I think crave credibility enough that they would be willing to take whatever test to earn it. If they can pass whatever parts of the USMLE that are within their proposed scope of practice, then that should set a fair standard.

I don't really understand why naturopaths want to be able to do minor surgery or prescribe drugs, since that seems counter to the "natural" philosophy. For me, that would be the part I would have the biggest issue with licensing. With a scope of practice that was more focused on nutrition, stress reduction, and herbs/supplements (people get those based on online information or the health food store clerk anyway), I think licensing sounds reasonable. I don't know about some of the other therapies they study, but as long as people know that these other therapies are not research-backed or proven safe, they should have the freedom to try alternative medicine if they want.

I think there is a vigorous debate within the naturopathic community about whether or not they want to be "green MD's" [use biomedical diagnosis then use herbs and supplements for treatment] or anti-science. I"ve heard arguments from people on both sides and IMHO, the former group tended to contain the brightest and best from naturopath pool.

It seemed like the latter group was more concerned with philosophy than reality.


Although for the green MD group, several recent studies seem to be chipping away at their supplementation rationales.

Does anyone know how these numbers compare to an NPs' patient contacts?

Patient contacts and patient hours are slightly different. Usually ND's have to complete around 500 patient contacts, each one taking about an hour. For the NP programs in my area, last time I checked they were about 500 patient hours, which probably equates to more than 1 patient an hour.


Edit - from Bastyr's Website:

Abundant Patient Contact Hours
At Bastyr, we provide as many or more patient contact hours as comparable schools. In the naturopathic medicine program, you will receive a minimum of 1200 clinical training hours and approximately 600 patient contacts by the time you graduate, including the opportunity to provide health care to patients at 14 offsite clinical training sites.

http://www.bastyr.edu/admissions/studentlife/studentclinic.asp


It looks like their numbers of patient contacts and hours have increased.

 

[facetguy]

I think there is a vigorous debate within the naturopathic community about whether or not they want to be "green MD's" [use biomedical diagnosis then use herbs and supplements for treatment] or anti-science. I"ve heard arguments from people on both sides and IMHO, the former group tended to contain the brightest and best from naturopath pool.

...Although for the green MD group, several recent studies seem to be chipping away at their supplementation rationales.

For many, "green medicine" will provide the transitional framework toward integrative medicine. However, simply substituting St. John's Wort for Prozac misses the point. We shouldn't be focused on chasing symptoms but fixing root causes. That's why "green medicine" too will run into many of the same problems our current healthcare system has encountered.

An approach that focuses on foundational issues like inflammation, oxidative stress, hormonal function, optimal gut function and detoxification capacity, along with considering genetic 'weaknesses', goes way beyond a simplistic "green medicine" approach.

As to the recent studies mentioned above, we are again missing the point. Nutritional supplements are not drugs. Study designs that look at a very narrow endpoint for a targeted pharmaceutical agent will often lead to bias and misleading results when they are used to test, for example, a vitamin.

This type of medicine is being developed now and will gain more and more credence over time. A good starting point is the Institute for Functional Medicine (www.functionalmedicine.org), who recently published a textbook called "The Textbook of Functional Medicine".

 

[meister]

It looks like their numbers of patient contacts and hours have increased.

600 patient encounters is laughably insufficient. That's like 10 a week for a year. Yikes.

 

[midwesterner]

There's some talk to mandate at least 1 year of residency for naturopaths, largely because of the low number of contacts. However, right now residency options are somewhat limited, and I heard only about 10% of grads do a residency. These are probably the smartest ones, since it's supposed to be somewhat competitive and requires another year of commitment to education. I personally think the limited options are because the schools don't have the money (or don't want to) pay the residents, who may not be income-generating yet. This is all my speculation though...

There are a number of reasons the patient contacts are so low:
1) There's a lot of time spent with each patient. What I saw in the clinic was about 1 hr each, though I hear it could be up to two hours.
2) Still somewhat limited interest in naturopathic medicine, which means the clinics aren't booked to capacity. So, the students may want to see more patients but cannot, because there aren't enough to go around.

2 years of clinicals and 1 year of residency I think would be enough if they stick with preventive/wellness type care and see more patients during those 3 years. One or two patients a day is not what I had in mind no matter how long you spend with each one. I think that would be demoralizing for the ND student as well as not the best for learning. Maybe the schools should be more selective in admissions, so there are enough patients for everyone.

Also, the students do still take classes during those clinical years (at least the school I visited) so it's not full time in the clinic.

 

[ZincFingers]

Eh... actually I'm not too concerned about NDs. Once NPs get word that they're trying to horn in on primary care, their continued existence as practitioners would come to an abrupt and tragic conclusion.

 

[melanoleuca]

Patient contacts and patient hours are slightly different. Usually ND's have to complete around 500 patient contacts, each one taking about an hour. For the NP programs in my area, last time I checked they were about 500 patient hours, which probably equates to more than 1 patient an hour.

Man. I have almost 500 patient contacts per month and I have been hard at it for almost four years not counting third and fourth year of medical school. I probably had 4000 patient contacts in medical school and have about 15,000 for residency and yet ACEP (the American College of Emergency Physicians) will not let me sit for the licensing exam and I cannot practice independently for a few more months....yet some weed-soaking naturopath wants to practice real medicine with essentially no training in medicine at all.

 

[Zosyn79]

Should chiropracters be allowed to write scrips? How about acupuncturists? Or the psychic a couple blocks down who claims his crystals can cure cancer?

The primary reason why these people, or NDs, should not be allowed to practice medicine is not because of their lack of intelligence, or lack of work ethic, or lack of understanding of science and pathology, although these are certainly concerns. The primary reason is the lack of quality control. As you may be aware, physicians must go through a standardized cirriculum no matter which school they attend, and master a punishing series of standardized exams to earn their license. Also, the strict limits on the number of American/Canadian/PR med school slots per year acts as its own quality control on the people who are able to get in.

Incidentally, I have a problem with independent NPs for this reason as well. There is no standardization for NP cirricula, and no admission standards for their schools either.

HAHA! Pot meet kettle! You do realize the AMA and current modern medicine was in the same state of affairs as naturopathy is in now? Disorganized, unstandardized, etc. etc. You also realize that your founding father Mr. Rockefeller had an allopathic doctor AND a homeopathic doctor caring for him up until his death?????? I agree whole heartedly but let's be honest if naturopaths had the same background as medical doctors and the same training/education etc. and STILL practiced naturopathy you'd still be bitching and complaining. Again your frustration with naturopathy has nothing to do with standardization etc. You simply don't believe in it and would chaulk it up to quackery. And let's define minor surgery........removing an ingrown toenail? Draining an abscess? LMAO! That doesn't take 8 years of medical school and 4 years of residency to master.

 

[Zosyn79]

Man. I have almost 500 patient contacts per month and I have been hard at it for almost four years not counting third and fourth year of medical school. I probably had 4000 patient contacts in medical school and have about 15,000 for residency and yet ACEP (the American College of Emergency Physicians) will not let me sit for the licensing exam and I cannot practice independently for a few more months....yet some weed-soaking naturopath wants to practice real medicine with essentially no training in medicine at all.

Funny thing is that weed smoking naturopath probably is much more successful at treating HTN, diabetes, and pain managment and much cheaper than you are. Now if I were in an ER suffering a TBI no I wouldn't want a naturopath opening up my skull and putting in a ventriculostomy. But I'd put more faith in a naturopath treating my diabetes naturally through diet and exercise and other means than sending me home on sliding scale insulin, telling me nothing about diet and then complaining months later I'm "noncompliant".

 

[J-Rad]

Funny thing is that weed smoking naturopath probably is much more successful at treating HTN, diabetes, and pain managment and much cheaper than you are. Now if I were in an ER suffering a TBI no I wouldn't want a naturopath opening up my skull and putting in a ventriculostomy. But I'd put more faith in a naturopath treating my diabetes naturally through diet and exercise and other means than sending me home on sliding scale insulin, telling me nothing about diet and then complaining months later I'm "noncompliant".

No, the naturopath is more likely to get the patient in her clinic who desires lifestyle modification as first line treatment and is more likely to abide by the advice for the lifestyle changes. The medical PCP dreams of these patients, but rarely gets them. You assume that medical physicians don't do lifestyle counseling (and are incorrect) and judging by your reference of sliding scale insulin (umm, who goes home on that only for DMII?) I take it your experience as a physician would be limited to non-existent. Please understand what you attack. (Please forgive the vastly overused idiom to follow) Knocking down straw men isn't that hard or convincing.

 

[melanoleuca]

Funny thing is that weed smoking naturopath probably is much more successful at treating HTN, diabetes, and pain managment and much cheaper than you are. Now if I were in an ER suffering a TBI no I wouldn't want a naturopath opening up my skull and putting in a ventriculostomy. But I'd put more faith in a naturopath treating my diabetes naturally through diet and exercise and other means than sending me home on sliding scale insulin, telling me nothing about diet and then complaining months later I'm "noncompliant".

1. Define "natural" and "naturally" and also be so good as to explain, without using any religious terms, why "natural" is better. In fact, "natural" is a marketing term and not a rigorous description.

2. You don't have diabetes. Neither do most of the patients who see naturopaths, the majority of whose patients are the so-called "worried well." The typical consumer of complementary and alternative medicine is not really sick at all (except spiritually) and therefore needs no treatment...and with apologies to Cool Hand Luke, sometimes the best treatment is no treatment at all. The trick is to keep people from seeking medical care when they don't need it, not to cater to their hypochondriac fantasies.

3. Diet and exercise are fine but it is those "other means," expensive and poorly understood herbal remedies, dangerous botanicals produced with shoddy quality control, and the whole parcel of obviously ridiculous therapies like Homeopathy, Reiki, and Acupuncture which are the naturopaths adjunctive therapy that are the problem.

4. Naturopaths are not more successful in treating anything. I'll tell you what, I'll trade my patients for a naturopath's patients and let's see how well she'll do with a panel of people with real diseases. For my part, I will probably spend the day in idle banter talking to essentially healthy people with nothing better to do but obsess about their qi.

 

[melanoleuca]

HAHA! Pot meet kettle! You do realize the AMA and current modern medicine was in the same state of affairs as naturopathy is in now? Disorganized, unstandardized, etc. etc. You also realize that your founding father Mr. Rockefeller had an allopathic doctor AND a homeopathic doctor caring for him up until his death?????? I agree whole heartedly but let's be honest if naturopaths had the same background as medical doctors and the same training/education etc. and STILL practiced naturopathy you'd still be bitching and complaining. Again your frustration with naturopathy has nothing to do with standardization etc. You simply don't believe in it and would chaulk it up to quackery. And let's define minor surgery........removing an ingrown toenail? Draining an abscess? LMAO! That doesn't take 8 years of medical school and 4 years of residency to master.

Whoa. Naturopaths do not have the same training and education as medical doctors, not in quality and not in quantity, not by a long shot, and therefore they are not qualified to serve as primary care physicians, a job that requires more than some haphazard study of herb lore. If they had the same training including the now de facto required residency training they would be medical doctors...but they don't so they're not.

The funny thing is that I would never try to pass myself off as a surgeon, an obstetrician, an internist, or a neurologists because I lack the training and knowledge to honestly represent myself to the public as something I am not...and yet naturopaths, chiropractors, and the whole pack of Snake Oil Salesmen with a fraction of the training required for the job lack the humility, the self-awareness that comes with an appreciation of their own limitations, to consider that maybe, just maybe, they don't know enough to be primary care physicians.

And that, my friend, is the Big Problem with CAM practitioners...namely not knowing enough to know what they don't know.

Removing an ingrown toenail and draining an abscess are mechanical skills...and yet would you let a untrained chiropractor drain an abscess on the back of your hand? On your neck? Would he know how deep to go? How far to probe? What structures to avoid? The early subtle signs of systemic infection? What to do for follow-up? What antibiotics to give, if any? Oral? IV? Follow-up? I have seen some horrific abscesses that looked simple but turned out to require surgical debridment in the OR, are you ready for those? How about a little rash on the scrotum? Gonna' ignore it or put some bacitracin on it and see how it goes?

Sure, many things are simple but your plan, to have a cadre of poorly trained medical workers to handle really simple things but who nevertheless want full practice rights and equivalent prestige and respect as physicians is impractical and contradictory.

 

[Josh L.Ac.]

No, the naturopath is more likely to get the patient in her clinic who desires lifestyle modification as first line treatment and is more likely to abide by the advice for the lifestyle changes. The medical PCP dreams of these patients, but rarely gets them. You assume that medical physicians don't do lifestyle counseling (and are incorrect) and judging by your reference of sliding scale insulin (umm, who goes home on that only for DMII?) I take it your experience as a physician would be limited to non-existent. Please understand what you attack. (Please forgive the vastly overused idiom to follow) Knocking down straw men isn't that hard or convincing.

Thread. Over.