How is a Naturopathic Doctor different from a Medical Doctor?
If I had a dollar for every time I was asked, “How is a Naturopathic Doctor different from a Medical Doctor”, my medical school loans would be paid off by now! This is the question I get asked most often as a Naturopathic Physician, which isn’t surprising considering there are many more Medical Doctors (MDs) compared to Naturopathic Doctors (NDs) in the U.S.
Before I address the differences between MDs and NDs, let me highlight the similarities. Both MDs and NDs are required to graduate from an accredited 4-year medical program with extensive didactic and clinical training hours. The training for MDs and NDs includes anatomy, biochemistry, physiology, pathology, infectious diseases, pharmacology, and standards of care in primary care including diagnosis, laboratory testing, imaging, and treatments. To practice, both must pass licensing board exams and then apply for a medical license to practice medicine in accordance with the laws of the given state of practice.
Now, let’s dive into what makes NDs unique from MDs. NDs are currently only licensed to practice in 26 jurisdictions, compared to MDs who are licensed across all 50 states. As of now, the scope of practice for naturopathic medicine differs depending on the state. It can range from only being able to counsel on diet and lifestyle interventions to being able to provide primary care services, prescribe pharmaceuticals, and even perform minor office procedures. In Washington, where I earned by doctorate degree, NDs have a large scope of practice. The education at each accredited naturopathic medical school trains students for the broadest scope, despite some states having a limited scope.
The main reason I chose to pursue naturopathic medicine training over a conventional medical profession was to gain a foundation of medicine rooted in a philosophy I deeply resonated with. The philosophy and approach to treatment is one of the biggest differences in these trainings. The “Therapeutic Order” is the framework for which NDs are taught to think about symptoms, diseases, and how to apply treatment strategies to promote healing. Additionally, NDs have extensive training in nutrition, homeopathy, hydrotherapy, counseling, and physical medicine because these modalities align with the philosophy and hierarchy of healing.
So, what is the Therapeutic Order?
The Therapeutic Order is the framework for thinking about how disease and symptoms can manifest and how to approach healing and creating optimal health. It was developed by Drs. Jared Zeff and Pamela Snider. A bottom up approach, starting with the foundations of health and moving towards higher force interventions is often how NDs desire to approach care. However, given the individual and their conditions, treatments may be from all or any level of the pyramid. So, let’s break down the Therapeutic Order:
1. Establish the foundations of health and remove obstacles to cure:
To promote healing, it is essential to remove obstacles and provide the basic foundational needs for optimal health and healing. This includes addressing diet, exercise, sleep, time in nature, a sense of purpose, stress, rest, environmental exposures, socioeconomic stressors, and trauma. Identifying obstacles and establishing health promoting foundations is key to addressing the root cause of disease.
2. Stimulate self-healing mechanisms:
NDs believe the body has an innate healing ability. We refer to this as the “Vis Medicatrix Naturae“. We use treatments to support and encourage the body’s innate healing process to allow the body to heal itself. Natural therapies including nutrition, botanical medicine, homeopathy, hydrotherapy, physical medicine, and acupuncture can be used to stimulate the body’s natural healing processes.
3. Support and restore weakened systems:
Overtime, specific tissues, organs, body systems, or the psycho-emotional body can be affected to a point beyond the body’s innate healing ability. These systems may become over-active or under-active and require interventions to enhance and restore function. Natural therapies targeted to enhance the function of weakened systems are applied.
4. Address physical alignment:
Structural integrity and biomechanics is essential for our bodies. NDs can use physical modalities such as spinal manipulation, massage therapy, electrotherapy, craniosacral therapy, and therapeutic exercise to promote musculature, fascial, and skeletal integrity.
5. Suppressive therapies and higher force intervention:
At times, it may be necessary to stop or suppress symptoms that may be negatively impacting an individuals quality of life. NDs recognize symptoms are often clues to the root cause of disease and suppression of these symptoms often does not treat the underlying pathology. However, natural therapies, pharmaceutical therapies, and higher force, invasive interventions may be necessary to minimize suffering and prevent further dysfunction.
This philosophy was constantly woven into our medical training. Year 1 of medical school we took naturopathic philosophy classes discussing different approaches to medicine. In our case studies classes years 2 and 3, we discussed how to address each level of the Therapeutic Order in regards to different clinical case presentations. During clinical rotations years 3 and 4, we had to reflect on which level of the Therapeutic Order our treatment plans addressed.
In short, NDs are different because they think differently! For more information, check out these resources:
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