By Arielle Dreher
The Spokesman-Review

Washington was one of the first states to regulate naturopaths, and even today, the law requires providers to attend an accredited four-year graduate program before being eligible for a license.

It is an unusually strict approach for a medical industry that is loosely regulated in many states.

Naturopathic medicine is not licensed or regulated in every state, and nationally, there is no standardized credentialing system.

It is considered complementary or alternative by the National Institutes of Health, depending on how a person uses it.

That leaves it up to states to determine how to issue credentials and licenses. In Washington, naturopathic physicians can practice medicine along similar lines as primary care physicians. They can perform routine medical exams, order bloodwork, suture minor wounds and prescribe noncontrolled medications, including antibiotics, antivirals, insulin, birth control and antidepressants. 

In Washington, naturopathic physicians can prescribe testosterone and codeine, but not controlled substances. 

Angela Ross, a naturopathic physician and executive director of the Washington Association of Naturopathic Physicians, said that when appropriate, naturopathic physicians explore other options for health, such as changing diet, exercise or supplements and herbal formulations, before recommending pharmaceuticals as the only or first option for patients.

The focus of naturopathic medicine and what sets it apart from traditional medicine is the integration of botanical medicines, from herbs to supplements, used to treat common ailments, alongside more traditional treatments.

One main difference between a medical doctor and a naturopathic physician’s training is the residency requirement, which happens after medical school.

All medical doctors in the United States must attend a four-year medical school, pass specific exams and be matched into a residency, which can last from three to seven years, where they train under physicians and sometimes learn specialties. Only after that residency can they be licensed to practice medicine in a state or become board-certified in their specialty.

Naturopathic physicians cannot participate in residency programs for the most part, however.

“Residencies in the conventional realm are funded by Medicare, which is a federal program, and because naturopathic medicine is not regulated at the federal level, only the state level, we’re not eligible to work in the federal Medicare program,” Ross said.

Medical doctors and doctors of osteopathic medicine have much larger scopes of practice under Washington state law that allows them to prescribe more medications than naturopaths.

Prevention medicine and whole health are at the heart of naturopathy.

“The No. 1 foundational tenet is to remove obstacles for care and establish conditions for optimal health, and that’s prevention,” Ross said.

Not all states have regulations and licensing in place for naturopathy, and in states without regulations, Ross says public safety is at risk if anyone can call themselves a naturopath and practice on patients. There are 22 states with regulations and licensing requirements for naturopathic physicians. Idaho enacted state licensing procedures for naturopaths in 2020.

In the four years of graduate training required in Washington to become a naturopathic physician, Ross said students learn how herbs and plant-based medicines interact with pharmaceuticals, an important skill for many naturopathic physicians who practice in a primary care setting.

In Washington, some private health insurance companies cover naturopathy, and in 2013, licensed naturopathic physicians could enroll to take Medicaid patients as well.

Technically, naturopathic physicians are required under state law to be vaccinated against COVID-19, although vaccination across providers in this field is far from a unanimous discussion point.

The state association was established in 1935 and has never taken an official position on vaccinations.

“It is a very heated issue within our community, right, wrong or indifferent,” Ross said.

Even though it is complicated, the association did sign on to a Department of Health initiative encouraging providers to ask their patients’ vaccination status and to offer resources should they want more information.

Arielle Dreher’s reporting for The Spokesman-Review is primarily funded by the Smith-Barbieri Progressive Fund, with additional support from Report for America and members of the Spokane community. Dreher, who grew up in the Tri-Cities, is a former freelancer for the Tri-Cities Area Journal of Business.