FNMRA News

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

Mon, 10 Apr 2023 19:00:00 GMT

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

Letter of Support for Alaska House Bill 115 - Regulation of the Practice of Naturopathic Medicine in Alaska

Wed, 22 Mar 2023 18:00:00 GMT

March 22, 2023

RE: Support of HB 115

Dear Honorable Representative Mike Prax, Chair, and Members of House Health and Social Services Committee,

The Federation of Naturopathic Medicine Regulatory Authorities (FNMRA) supports regulation of naturopathic medicine in Alaska. Regulation is integral to the safe practice of naturopathic medicine and protection of the public.

The FMNRA’s mission is to protect the public by connecting regulatory authorities and promoting standards of excellence in the regulation of naturopathic medicine. The Federation supports new and existing regulatory organizations in fulfilling their statutory obligations to regulate the profession in the interest of public protection. The FNMRA envisions a coordinated regulatory system for naturopathic medicine throughout the United States.

The FNMRA appreciates this opportunity to illustrate a verifiable need for naturopathic doctors (NDs) in Alaska. Smart regulation of the naturopathic profession permits qualified NDs to practice as trained while ensuring public safety, empowering the citizens of Alaska to pursue their choice of qualified healthcare provider, and all the associated benefits.

Verifiable Need for NDs to practice as Primary Care Providers in Alaska

· Alaska faces a statewide shortfall in primary care providers[1]

Alaska will need to add up to 237 primary care providers in the next decade, according to projected estimates.[2] By licensing NDs in Alaska to practice as trained, the state would increase its primary care provider workforce with safe, effective, and well-trained practitioners.

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

Licensed NDs Are Safe Primary Care Providers

· Licensed NDs have fewer disciplinary actions than MDs/DOs

NDs have been safely practicing as primary care providers in other jurisdictions for decades, and for approximately a century in several more. Safe practice by NDs can be objectively demonstrated by the fact that NDs have fewer disciplinary actions taken against them compared to MDs and DOs (see addendum A).

· Minimal disciplinary actions occur even when NDs have broad prescribing rights

Alaska would benefit from the regulation of NDs to include broad prescribing rights because it would effectively improve access to qualified primary care providers. An important aspect of primary care is the ability to prescribe drugs at the time of care so that the patient does not need to delay treatment by being forced to seek care with a second provider. Primary care providers need broad prescribing authority to provide timely and effective treatment, improve access to care, and ensure patient safety. FNMRA interprets “broad prescribing rights” to mean access to all major categories of prescription drugs required for primary care.

NDs have proven themselves to be safe prescribers. Through 2021, 11 out of 25 regulated jurisdictions allow NDs broad prescriptive authority. Only three of these jurisdictions have taken disciplinary action against NDs for prescribing decisions. And, the majority of these actions involved opioid management, which is a challenging area for all licensed primary care providers.

Of the six jurisdictions that allow NDs broad prescriptive authority including opioids, only two require oversight by an MD or DO: California and Vermont. Vermont requires oversight for one year or the first 100 prescriptions (or other qualified experience) after passing the NPLEX Part II – Elective Pharmacology Examination. Conversely, California currently requires ongoing prescriptive oversight, creating an unnecessary burden on MDs, DOs, and NDs. Therefore, the California regulator is currently seeking to remove this requirement because it interferes with the ability of a qualified ND to practice as trained and provide effective primary care.

Disciplinary Actions Related to Naturopathic Doctor Prescribing

All categories of disciplinary actions can be seen in Addendum B.

Formal Education, Training, and Accreditation Supports Broad Prescribing Rights for NDs

· Formal Education & Training Supports Independent Prescribing Rights for NDs

CNME does not accredit online or distance education programs.[7]

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, with all the rights and responsibilities that entails.

Proposed Regulatory Mechanism to Support Independent Prescribing Rights for NDs

· Naturopathic Physicians Licensing Examination (NPLEX) Part II - Elective Pharmacology Examination can be adopted to establish prescribing competency

The NPLEX has developed four Part II – Clinical Elective Examinations (Acupuncture, Minor Surgery, Pharmacology, Parenteral Medicine).[8]The Elective Pharmacology Examination is composed of 75 stand-alone items. This exam has been adopted by several jurisdictions to establish prescribing competency, allowing qualified NDs to practice as trained with broad and independent prescribing rights.

Accountability & Liability Issues Related to Regulation

· Regulation provides consumer protection and accountability

For the purpose of public protection, Naturopathic doctors have been regulated for decades in many states and for approximately a century in several more. This protection is provided in part by the use of proper title (Naturopathic Doctor (ND), or Naturopathic Medical Doctor (NMD), by excluding unqualified persons from practicing naturopathic medicine, and by creating a structure through which the public can report complaints where both licensees and lay practitioners can be investigated.

Naturopathic regulatory authorities consistently report to the FNMRA that there are many more consumer complaints against lay naturopaths than licensed naturopathic doctors. It is difficultto 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. More recently, California has reported that approximately 75% of investigations are related to 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 and prevent consumers from accessing appropriate care, leading to physical harm or death.

In Conclusion:

Allowing NDs to practice as trained will ensure that Alaska increases it number of primary care providers. NDs have been safely practicing as primary care providers with broad prescribing rights in other states for decades, and for approximately a century in several more.

As a member of this committee, we know you are a champion of public safety. Your support of naturopathic medical regulation will effectively increase the number of safe primary care prescribers by improving access 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 Alaska House Health and Social Services Committee, will lead to smart regulations that promote the safe practice of naturopathic medicine.

[1] https://data.hrsa.gov/topics/health-workforce/shortage-areas

[2] Petterson, Stephen M; Cai, Angela; Moore, Miranda; Bazemore, Andrew. State-level projections of primary care workforce, 2010-2030. September 2013, Robert Graham Center, Washington, D.C. https://www.graham-center.org/content/dam/rgc/documents/maps-data-tools/state-collections/workforce-projections/Alaska.pdf

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

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

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

[6] 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.

[7] https://cnme.org/

[8] https://www.nabne.org/exam-overview/

Letter of Support for Senate Bill 990 Regulation of the Practice of Naturopathic Medicine in Michigan

Thu, 26 May 2022 19:00:00 GMT

RE: Support for Licensure of Naturopathic Doctors in Michigan SB 990

Dear Honorable Senator Vander Wall, Chair, and Members of the Committee on Health Policy and Human Services,

The Federation of Naturopathic Medicine Regulatory Authorities (FNMRA) supports regulation of naturopathic medicine in Michigan. Regulation is integral to the safe practice of naturopathic medicine and protection of the public.

The FNMRA appreciates this opportunity to illustrate a verifiable need for naturopathic doctors (NDs) in Michigan. Smart regulation of the naturopathic profession permits qualified NDs to practice as trained while ensuring public safety, empowering the citizens of Michigan to pursue their choice of qualified healthcare provider, and all the associated benefits.

Verifiable Need for Regulation of NDs in Michigan

· Michigan faces a statewide shortfall in primary care providers[1]

Michigan will need an additional 832 primary care providers in the next decade, according to projected estimates.[2] By licensing NDs in Michigan to practice as trained, the state would increase its primary care provider workforce with safe, effective, and well-trained practitioners.

Licensed NDs Are Safe Primary Care Providers

· Licensed NDs have fewer disciplinary actions than MDs/DOs

· Minimal disciplinary actions occur even when NDs have broad prescribing rights

Michigan would benefit from the regulation of NDs to include broad prescribing rights because it would effectively improve access to qualified primary care providers. An important aspect of primary care is the ability to prescribe drugs at the time of care so that the patient does not need to delay treatment by being forced to seek care with a second provider. Primary care providers need broad prescribing authority to provide timely and effective treatment, improve access to care, and ensure patient safety. FNMRA interprets “broad prescribing rights” to mean access to all major categories of prescription drugs required for primary care.