Letter in Opposition of California's AB 765 - Regulation of the Use of the Titles: Doctor, Physician, and Surgeon

Mon, April 10, 2023 12:00 PM | Anonymous

April 10, 2023

The Federation of Naturopathic Medicine Regulatory Authorities (FNMRA) opposes AB 765 (Wood).

The FMNRA’s mission is to protect the public by connecting regulatory authorities and promoting standards of excellence in the regulation of naturopathic medicine.

AB 765 fails to protect the health and safety of Californians and should be abandoned or amended.  

The FNMRA appreciates this opportunity to illustrate how AB 765 is contrary to the purpose of protecting the public in California: 


·       AB 765 WILL LEAD TO DELAYS in Healthcare Delivery

  • ·       AB 765 WILL CAUSE CONFUSION for Patients About Qualified Healthcare Providers

·       AB 765 UNDERMINES The Established Standards of Regulation in The United States

·       AB 765 Increases Regulatory Burden and Associated Costs

AB 765 WILL LEAD TO DELAYS in Healthcare Delivery

If adopted, the California Legislature is at risk of, and potentially culpable for, harming the state’s underserved areas and populations by inhibiting the timely delivery of meaningful and effective primary care medicine or specialty referral. 

Making it a crime to call yourself a doctor when you are indeed licensed, educated, and trained to provide diagnosis and treatment to a patient will confuse the public and lead to delays in healthcare delivery.

Delays in healthcare delivery are well-known to increase medical burden and lead to a deterioration in outcomes by allowing pathology to progress unchecked - as the COVID-19 pandemic delays demonstrated.

AB 765 WILL LEAD TO DELAYS in Healthcare Delivery (cont.)

Areas with low income, high infant mortality, and older populations must have access to qualified primary care providers. This ensures that those who are most in need are provided with meaningful, effective, and timely healthcare. If naturopathic doctors (NDs) are not properly allowed to call themselves “doctors” the public will be confused and delay receiving healthcare from a qualified provider. The COVID-19 pandemic was well known to cause delays in healthcare delivery leading to poor outcomes. [1]

AB 765 will CAUSE CONFUSION for Patients about Qualified Healthcare Providers

Qualified NDs are already licensed primary care doctors in California. In all states that license naturopathic doctors, NDs use the title “doctor” or “physician” to describe their education and status to their patients. In a clinical setting, patients understand the title “doctor” is meant for providers that diagnose and treat disease.

Many patients have their healthcare delivered by a team of providers – some doctors, some physicians, and some non-physicians. This team-oriented delivery of medicine is common.

Clear advertising and informed consent rules already exist to educate the patient on the exact title and education of all health care providers on the patient’s team.

The Institute of Medicine (IOM) urges regulators to allow for innovation and inclusiveness of all healthcare practitioner types in meeting patient needs.[2],[3],[4] And the IOM encourages the use of interdisciplinary teams to optimize patient care.3,4,5

Further, the Pew Health Commission Taskforce on Health Care Workforce Regulation has called for jurisdictions to allow all qualified professionals to provide services to the full extent of their current knowledge, training, experience, and skills.3,[5]

  • ·       The title “doctor” provides consumer protection against lay naturopaths in California

Naturopathic regulatory authorities consistently report to the FNMRA that there are many more consumer complaints against lay naturopaths than licensed naturopathic doctors. It is difficult to track this number, but we have a few examples. In 2013 in California, 6 actions were taken against licensed NDs and 51 were taken against lay naturopaths. In the past ten years in Utah, there has been one disciplinary action taken against a licensed ND and an average of one action taken per year against lay naturopaths. Lay naturopaths, because of their lack of training, can recommend dangerous or ineffectual treatments, leading to physical harm or death. AB 765 will cause consumers to be unable to differentiate between licensed NDs and lay naturopaths.

The use of “naturopathic doctor” for licensed NDs protects the public, especially in California.

·       Formal Education & Training Supports the Title of “Doctor” for NDs

The use of the title “doctor” is accurate considering the education, clinical training, and regulation of NDs in California and the US.2

NDs who have graduated from a Council on Naturopathic Medical Education-accredited (CNME) doctoral training program in naturopathic medicine have been trained to be primary care doctors. The CNME provides that:

The Council’s in-depth accreditation process promotes high-quality naturopathic education and training, and safe and effective practice. Our educational standards provide the basis for licensing/regulating naturopathic doctors in the U.S. and Canada. CNME is recognized by the U.S. Department of Education to accredit doctoral programs in naturopathic medicine.

CNME does not accredit online or distance education programs.[6]

NDs are required to pass competency-based national naturopathic licensing examinations to demonstrate that they are competent to safely and effectively use naturopathic medicine to diagnose and treat disease while optimizing overall health. The formal education and clinical training prepare NDs to be independent prescribers and clinical primary care doctors, with all the rights and responsibilities that entails.

·       NDs Have Specialty Titles Earned Through Board Certification

The naturopathic medical profession has several specialty organizations that provide board certification. For example, the American Board of Naturopathic Oncology, which certifies called Fellow to the American Board of Naturopathic Oncologist (FABNO) and the American Board of Naturopathic Pediatrics, which certifies Fellow to the American Board of Naturopathic Pediatrics (FABNP). These specialty designations are already regulated by California regulators, but AB 765 would prevent those who have specialty designations from their rightful use of titles.

AB 765 UNDERMINES the Established Standards of Regulation in The United States

·       AB 765 undermines established licensing and regulatory standards

All primary care providers (NDs, MDs, DOs, PAs, RNs, DCs, etc.) in the US must go through, at minimum, a three-step process to acquire a license: 

1)    Graduation from a US Department of Education (ED) accredited academic institution 

2)    Passage of multiple licensing examinations 

3)    Verification of the first two steps by a state licensing authority, which then grants the licensee the right to practice and oversees that practice 

It is only through the completion of all three steps that proof to practice safely on the public is demonstrated. 

The Federation of State Medical Boards (FSMB) advises that while the 10th Amendment of the United States Constitution authorizes its jurisdictions to establish laws and regulations protecting the health, safety, and general welfare of their citizens, each jurisdiction must bear in mind the implications of potential practice act changes in the greater national landscape.[7] Thus, it is the responsibility of the individual jurisdictions to regulate the practice of naturopathic medicine within the established national framework. 

AB 765 interferes with the proper use of “doctor” for NDs in California, when that title is commonly used in statutes nationwide.

AB 765 Increases Regulatory Burden and Associated Costs 

·       Cost-effective regulatory mechanisms already exist 

California has an established regulatory structure that allows for consumer protection and accountability of safe and effective licensed NDs. The current regulation also protects consumers against lay practitioners. By protecting California’s duly licensed NDs through enforcing the current regulation the public is educated on the difference between qualified naturopathic doctors and lay naturopaths. 

In Conclusion: 

·       AB 765 WILL LEAD TO DELAYS in Healthcare Delivery

  • ·       AB 765 WILL CAUSE CONFUSION for Patients About Qualified Healthcare Providers

·       AB 765 UNDERMINES The Established Standards of Regulation in The United States for safe and smart healthcare regulation. 

·       AB 765 Increases Regulatory Burden and Associated Costs 

We know that as a member of the California legislature, you are a champion of public safety. Your support of smart naturopathic medical regulation will effectively increase the number of safe primary care providers in California by improving access to and efficient delivery of healthcare. 

We thank you for the opportunity to share our comments and hope this information, and any future dialogue between the Federation of Naturopathic Medicine Regulatory Authorities and the Members of the California Legislature, will lead to the refinement of regulations that promote the safe practice of naturopathic medicine. 

[1] https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a4.htm

[2] https://www.fsmb.org/siteassets/advocacy/policies/assessing-scope-of-practice-in-health-care-delivery.pdf

[3] Crossing the Quality Chasm: A New Health System for the 21 st Century, The Institute of Medicine, National Academy Press, 2001.

[4] Health Professions Education: A Bridge to Quality, The Institute of Medicine, Committee on Health Professions Education Summit, National Academies Press, 2003.

[5] Reforming Health Care Workforce Regulation: Policy Considerations for the 21 st Century, Report of the Pew Health Professions Commission’s Taskforce on Health Care Workforce Regulation, December 1995, ix.

[6] https://cnme.org/

[7] https://www.fsmb.org/siteassets/education/pdf/best-module-text-intro-to-medical-regulation.pdf

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