Why not naturopaths? [mid-level thread #39150]

[Josh L.Ac.]

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After sorting through thread after thread about the "mid-level threat", especially the CRNA's, I started to wonder why they are getting all of the attention and other groups, like naturopaths, only receive scorn but no threats of "elimination".


CRNA's and NP's/PA's have been threatened on this board with all manner of interventions - eliminate the CRNA schools at the hospital level, attempting to get docs to no longer higher NP's in favor of PA's, and the threat of legislative modification to the scope of practice of mid-levels. But when it comes down to it, all of these mid-levels have training that far exceeds that of naturopaths.

Yes, naturopaths get a four-year degree that allows them to be called doctors in a number of states...they take pharmacology, anatomy, and other basic sciences...which exceeds the didactic training of NP's. On the clinical side, however, naturopaths get only 400-500 patient contacts [not patient hours], which includes large numbers of fellow students to fill the time when actually patients are scarce, and very few complete a residency. But in 12 or so states, they are considered PCP's.


If handfuls of physicians on this site are utterly opposed to the amount of autonomy that mid-levels have, why do naturopaths get a pass? If a number of physicians argue that patient safety is compromised by mid-levels, and the amount [and quality] of training that a mid-level receives exceeds that of the naturopaths, then why is there not an effort at the local, state, and federal level to reign them in? Is it because they are not seen as a monetary threat?



Disclaimer: Yes, in the past, some might say I have argued on behalf of the naturopaths [I think it is a logical fallacy to dismiss everything they do without analyzing the data first], although I have always brought up the issue of lack of clinical training.

 

[ForbiddenComma]

Physicians and med students respect PAs/NPs enough to see them as a serious threat.

Not so much naturopaths.

 

[sdn1977]

I'd also suggest that there are just a few folks who would seek out a naturopath - like those who would go to an herbalist.

Some might seek that path as a first resort to be more "natural" or as a last resort - with the thought that, after all - traditional medicine didn't work (some terminal CA pts).

But, beyond treating with diet, thyroid hormone, herbs (which can be tremendously dangerous!!) - they really don't have much to offer independently beyond what grandma might have suggested.

I think some large group practices might have some - in addition to psychologists, accupuncture, physical therapy, massage, internal med, ob-gyn, geriatrics, pain specialistis, etc....all sorts of alternative & traditional therapies intermingled. In these settings, naturopaths function under a practice agreement with a supervising physician - at least in CA...so there is overview.

Who is to say actually what works? The danger is in mis-diagnosing a real illness or delaying treatment for actual illness which might cause morbidity or mortality. But, for some circumstances - if a combination of herbal tea & yoga will help someone with "aches & pains" which no one can figure a cause for - I'd rather that than an endless rx for vicodin & ibuprofen.

 

[Josh L.Ac.]

Physicians and med students respect PAs/NPs enough to see them as a serious threat.

Not so much naturopaths.

But if all the arguments against mid-levels are accurate, then they are doubly so against the ND's. Physicians might bring up stories of how a NP missed an obvious zebra, but with ND's, they might call it a fish [lame analogy I know, but it is early and I am supposed to be studying for a management test].

There are several studies that conclude that the outcomes between NP's are equivalent to that of physicians, and they are routinely critiqued for being biased, having a poor design, or not taking into account confounding variables. But ND's do not have any studies comparing outcomes that could be critiqued.

Physicians point to the lack of clinical training as a serious flaw in mid-level training, but even those in master's entry NP programs get 2-3X the amount of clinical training of a ND.


Where is the outrage? The ND's might not have the numbers of mid-levels, but when assessing them according to the same arguments used against mid-levels, they are much more of a threat to patient safety.

I'd also suggest that there are just a few folks who would seek out a naturopath - like those who would go to an herbalist.

Some might seek that path as a first resort to be more "natural" or as a last resort - with the thought that, after all - traditional medicine didn't work (some terminal CA pts).

But, beyond treating with diet, thyroid hormone, herbs (which can be tremendously dangerous!!) - they really don't have much to offer independently beyond what grandma might have suggested.

I think some large group practices might have some - in addition to psychologists, accupuncture, physical therapy, massage, internal med, ob-gyn, geriatrics, pain specialistis, etc....all sorts of alternative & traditional therapies intermingled. In these settings, naturopaths function under a practice agreement with a supervising physician - at least in CA...so there is overview.

Who is to say actually what works? The danger is in mis-diagnosing a real illness or delaying treatment for actual illness which might cause morbidity or mortality. But, for some circumstances - if a combination of herbal tea & yoga will help someone with "aches & pains" which no one can figure a cause for - I'd rather that than an endless rx for vicodin & ibuprofen.

One of the reasons I like acupuncture is that it is usually performed in the context of the patient having a PCP [except in the Republic of California]. Very few patients come to us and expect us to act in that role. But in the states where naturopaths can practice as PCP's, patients can be at substantial risk. This is different than a naturopath working in an integrated practice with proper supervision.

We might able to discuss the different conditions that naturopaths could effectively treat [please Panda, resist your urges], but that would be irrelevant to the topic as a whole. It does not matter if ND's are great at eliminating food allergies through diet modification and supplementation if they are also seeing patients in the role as a PCP.

 

[sdn1977]

But if all the arguments against mid-levels are accurate, then they are doubly so against the ND's. Physicians might bring up stories of how a NP missed an obvious zebra, but with ND's, they might call it a fish [lame analogy I know, but it is early and I am supposed to be studying for a management test].

There are several studies that conclude that the outcomes between NP's are equivalent to that of physicians, and they are routinely critiqued for being biased, having a poor design, or not taking into account confounding variables. But ND's do not have any studies comparing outcomes that could be critiqued.

Physicians point to the lack of clinical training as a serious flaw in mid-level training, but even those in master's entry NP programs get 2-3X the amount of clinical training of a ND.


Where is the outrage? The ND's might not have the numbers of mid-levels, but when assessing them according to the same arguments used against mid-levels, they are much more of a threat to patient safety.



One of the reasons I like acupuncture is that it is usually performed in the context of the patient having a PCP [except in the Republic of California]. Very few patients come to us and expect us to act in that role. But in the states where naturopaths can practice as PCP's, patients can be at substantial risk. This is different than a naturopath working in an integrated practice with proper supervision.

We might able to discuss the different conditions that naturopaths could effectively treat [please Panda, resist your urges], but that would be irrelevant to the topic as a whole. It does not matter if ND's are great at eliminating food allergies through diet modification and supplementation if they are also seeing patients in the role as a PCP.

Well....as crazy as CA is - & I admit it is, but then we do have some crazy things which do indeed catch on in the mainstream (ie - not smoking in public places...oh - which still hasn't caught on in some parts of the..ehhh - Republic. But as you said...another thread!)

As I was saying, with NDs being able to "practice", even here where they've had that opportunity, I've yet to know of ANY which do anything other than dabble in herbs, vitamins & diet.

So...then the theory holds that, yes - they might influence someone to delay seeking medical advice. That is true. However, I don't feel that even the public holds their opinion on medical advice in any higher degree than those who are part of their bridge club. Why? Because they function "outside" of traditional medicine & the sense of those I know who go to them is they don't want traditional medicine. Denial perhaps...or perhaps they never needed traditional medicine or perhaps traditional medicine has not "helped" their problem - fibromyalgia for instance.

Now...NP/PA's have "some" experience in traditional medicine & at times the public gets those roles confused. That is where the adage a little knowledge is a dangerous thing comes in.

In my field, I've got that same "some" experience. I know physiology & disease, but to the extent I've needed to know it to adequately be a pharmacist - certainly not enough to diagnose an illness. So, if someone comes to me wanting to know if a sunburn should be seen by a physician, I can tell how serious the burn is & make that recommendation. But, if someone comes to me saying they've got an ache in their back & they just took their blood pressure on the store machine & its 210/97....I know enough to not speculate on the back ache. I tell them to call their dr & if they can't be seen today, go see an urgent care or ER.

Thats probably the same thing most NP/PA's would do in an independent setting, but the concern is....they might prescribe a drug first rather than doing a full workup. I not only can't prescribe those drugs, I can't do a full workup or even partial workup. Hopefully, the ND is doing the same. I have NEVER received an rx from an ND & in my state they can prescribe thryoid products & natural hormones only, unless supervised & under a protocol. Likewise, the folks I know who see NDs also have physicians for their "other" medical stuff - PAP smears, etc

I'm in the middle of ND-land & I just don't see them acting as PCPs - altho back in the Santa Cruz mtns they might be....???🙄

 

[611]

www.nuhs.edu

 

[deleted50478]

There are several studies that conclude that the outcomes between NP's are equivalent to that of physicians, and they are routinely critiqued for being biased, having a poor design, or not taking into account confounding variables. But ND's do not have any studies comparing outcomes that could be critiqued.

You've answered your own question. Nurses are pretending to be equivalents of doctors while naturopaths are not. Nurses are trying to position themselves as a cheaper alternative provider of the 'same' thing. Naturopaths are not. Naturopaths have a niche to fill with the granola crowd and they fill it without stepping on too many toes since most people either have no interest in their practices or see them in addition to doctors.

 

[fab4fan]

You've answered your own question. Nurses are pretending to be equivalents of doctors while naturopaths are not. Nurses are trying to position themselves as a cheaper alternative provider of the 'same' thing. Naturopaths are not. Naturopaths have a niche to fill with the granola crowd and they fill it without stepping on too many toes since most people either have no interest in their practices or see them in addition to doctors.

No, they're not claiming to be the same as doctors. That's your misinterpretation. BTW, you're a...what? Your profile doesn't say.

Love the "stepping on toes" comment. That says it all.

 

[Taurus]

If it makes you feel any better, I lump ND's with DNP's - doctor wannabes.

 

[Josh L.Ac.]

You've answered your own question. Nurses are pretending to be equivalents of doctors while naturopaths are not. Nurses are trying to position themselves as a cheaper alternative provider of the 'same' thing. Naturopaths are not. Naturopaths have a niche to fill with the granola crowd and they fill it without stepping on too many toes since most people either have no interest in their practices or see them in addition to doctors.

So regardless of how the scope of practice is written for naturopaths, their lack of clinical training is not a concern because they haven't tried to publish any research comparing their outcomes to that of physicians?


If you believe that naturopaths do have a niche to fill but they should operate in the context of the patient having a conventional physician, then why not restrict their scope of practice so that they have no choice to practice otherwise?