You might be wondering what a naturopathic doctor does and I was too until I met Dr. Rebecca Green, the Clinical Director of Peninsula Integrative Medicine. I did my externship for my medical assisting certificate at the Mountain View Los Altos Adult School, (MVLA). I wanted to work in an alternative clinic and was lucky enough to find Peninsula Integrative Medicine in Palo Alto. It was a chance for me to experience naturopathic medicine first hand.
I liked Dr. Green’s warmth and sense of humor right away. Dr. Green had just given birth to her son when I started there. But she was surprisingly present and energetic, running a clinic of five doctors and two front office staff while taking care of a newborn. She took the time to help me become oriented in the clinic in the midst of all of her other duties.
The clinic is warm and friendly, with a team of knowledgeable naturopathic doctors (NDs) and a capable and helpful staff. They offer family medicine, endocrinology, nutrition, pain management, gastroenterology, and pediatrics. Dr. Green is also a licensed acupuncturist, so she often layers Chinese medicine into her treatment plans.
I Felt at Home Right Away
During my externship, I helped with filing, organizing, and taking vital signs. I also assisted with blood draws for an array of lab tests, including food sensitivity panels, hormone tests, and micronutrient evaluations. I prepared injectables for pain therapy and learned about herbs and supplements as I managed the inventory of products.
I was surprised to find that most new patients had one to two-hour appointments that covered an in-depth health history. The doctors would often order a full panel of tests, including hormone levels, nutritional status, and food sensitivities. They also included health goals, prevention, and lifestyle approaches. Returning patients had visits that varied in length depending on their needs.
After a beautiful month-long externship at the clinic working with patients of all ages, I wanted to find out more about what made Dr. Green decide to go into naturopathic medicine.
Dr. Green Was on the Conventional Medicine Track
Green knew she wanted to be a doctor from the time she was a little girl. She always felt that the symptoms her body manifested were there for a reason and used to read the Merck Manual in elementary school to understand what the signs meant.
Her mother eschewed conventional medications, but she was never exposed to any forms of alternative medicine until she came across a guide to medicinal plants. This piqued her interest, but she always thought of it as nothing more than a hobby and would try home remedies from the book whenever anyone had an ailment.
Dr. Green went to college, assuming she would become an MD with a specialty in pediatrics or primary care. She graduated with a degree in Biology and went into MCAT study-mode, working as a clinical researcher in the Gastroenterology Department at OHSU, running drug studies. Green quickly realized there had to be a better way to treat patients than just giving them medicine to treat symptoms.
Patients would come in with acid reflux, and many people would be given medication, but this did not cure the source of their reflux. She began to ask patients if they had tried anything else. Had they made any dietary changes? But most had only been offered medication and had not been given any advice on nutrition by their doctor.
Green thought it would be more interesting, useful, and rewarding, to figure out why people had the symptoms in the first place. To get to the root cause instead of merely treating the symptoms. The reason Dr. Green went into medicine was to help people. She wanted to dig deeper and have more tools than just a prescription pad.
She Wanted to Help More Fundamentally
She had initially dismissed the idea of pursuing naturopathic medicine, thinking that the quality of education would not be comparable to conventional medical school. However, she met a naturopathic medicine student that had just started at the National University of Natural Medicine (NUNM) in Portland, Oregon.
The student, Pam, had come to her house and after seeing the array of books on Ayurveda, botanical medicine, and other forms of natural healing, insisted that Dr. Green should sit-in on a class at NUNM.
Green took the invitation and knew she had found her calling after listening to the lecture on Vis Medicatrix Naturae, the healing power of nature. There were dozens of students, from all walks of life at this initial meeting.
She thought of getting her MD and then going into holistic medicine by taking the 6-year MD and then a 2-year ND route. But she spoke to doctors that had both degrees.
They encouraged her to go to naturopathic school if she wanted to practice holistically. She explained that it’s hard to switch gears and go into another program after medical school. Plus, the time and school loan commitment would have made it even more prohibitive.
Dr. Green decided to go to the naturopathic medical school at NUNM. She graduated from the six-year dual degree program with a Doctorate in Naturopathic Medicine (ND) and a Master of Science degree in Oriental Medicine (MSOM).
Dr. Green is happy that she didn’t go the traditional route. But she wishes there was a type of training that combined natural medicine with an MD license.
Dr. Green met a naturopathic student right when she was applying to medical schools. That chance meeting and her idealism about helping others led her to the path she is on. The timing was everything.
Nutrition Is a Cornerstone of Naturopathic Medicine
Many of her patients pursue naturopathic care and also have a conventional doctor. For instance, people who want nutritional support will come to a naturopathic doctor because the traditional medical field does not offer a lot of support or information about nutrition. “Nutrition is a gateway into naturopathic medicine because nutrition is not too weird or off the beaten path,” Dr. Green explained.
In Palo Alto things are progressive, and people are educated about natural medicine, so she does not have to entertain much skepticism about her practice. Some of her patients come from backgrounds where natural cures have been the norm. Other patients start out being skeptical but come to the practice based on a referral and end up appreciative of the integrative approach.
Chinese Medicine Integrates Well with Naturopathic Medicine
While in college, Green started taking yoga classes and studied Ayurveda which gave her more respect for the role of natural medicine. This was another reason she went into naturopathic medicine.
She had an intuition that she would be happy with this path. She wanted to study Ayurveda as well, but there is no path for licensure in Ayurvedic practices in the US. Chinese Medicine has a similar ideology and is licensed in all 50 states, so she was inspired to study this as well.
Dr. Green looks at her patients with three lenses: Chinese medicine, naturopathic medicine, and conventional medicine, and tries to treat them with the best from all three.
It also depends on what the person is open to. Some patients don’t want to try acupuncture treatments because they are afraid of needles. Sometimes treatment in one direction is more warranted at first and then later down the line she might add other modalities as needed.
Dr. Green is from Sunny Southern California. She knew she did not want to stay in Portland forever because the rain was not going to work long term. Since she planned to relocate after finishing ND school, she knew that naturopathic medicine is not licensed in all states while acupuncture is.
Chinese Medicine gave her information that correlated somewhat with Ayurveda. And she would be able to practice acupuncture no matter what state she ended up moving to.
Why Isn’t Naturopathic Medicine Mainstream?
I asked Dr. Green if she thought naturopathic medicine would become mainstream soon. She feels that it may take a long time.
“Some of it is political and does not have to do with education. NDs are trained as primary care doctors in an outpatient setting and have a focus on preventative medicine.
But the conventional community is not always accepting of what we have to offer. There is also room for growth for validating the science behind the modalities we use.
Not everything is has been tested using double-blind, placebo-controlled studies. We use some approaches that are anecdotal but tested through time, much like Ayurveda and Chinese medicine.”
Natural Health is Hard to Validate Scientifically
“Naturopathic medicine relies on a host of natural therapies, including botanical medicine. Some of the botanical treatments are hard to study because there isn’t just one chemical constituent, but multiple parts of a plant and hundreds of chemical compounds. Isolating what works can be tricky, and studying a whole botanical formula with individualized herbs is near impossible.
While I’m sometimes unsure if my patient’s health has improved due to a placebo effect, the main goal is usually still reached: they feel better. If they don’t, we have plenty of other tools in naturopathic medicine to help them before having to use medication.”
To learn more about Peninsula Integrative Medicine and the team of specialists there, go to their site. Although they are not part of an insurance network, their treatments are often covered by individual insurance companies such as Aetna, United Health Care, and others. Just call to see if your insurance will cover part or all of your treatment there.
“Naturopath” vs. Naturopathic Doctor
Another problem that is muddying the waters is that some natural health practitioners call themselves “naturopaths,” which is very different from a licensed ND. A person calling themselves a naturopath may be an unregulated healer of some kind. They may have gone to a non-accredited naturopathic or distance learning school that requires as little as 500 hours of training.
While a Licensed ND must complete an undergraduate science-based degree to even get into ND school and then complete over 4400 hours of training. This level of training is like the requirements and hours of conventional physicians. Conventional MDs are required to take anywhere from 4300 to 5000 hours of medical school training, depending on the school.
Not every unlicensed person who calls themselves a naturopath is harmful, and inevitably some of them are very helpful. But it would be better if they called themselves something besides a Naturopath. A few quacks can ruin things for legitimate NDs.
When choosing a naturopathic doctor in the US or Canada, make sure they are a licensed ND from one of only seven schools that are accredited to license NDs.
- Bastyr University has two locations (BU): Kenmore, Washington and its sister location in CA, Bastyr University California (BUC): San Diego, CA
- Boucher Institute of Naturopathic Medicine (BINM): New Westminster, British Columbia
- Canadian College of Naturopathic Medicine (CCNM): Toronto, Ontario
- National College of Natural Medicine (NCNM): Portland, Oregon
- National University of Health Sciences (NUHS): Lombard, Illinois
- Southwest College of Naturopathic Medicine (SCNM): Tempe, Arizona
- University of Bridgeport – College of Naturopathic Medicine (UBCNM): Bridgeport, Connecticut
ND Training Requirements
Naturopathic physicians are trained in primary care and study at a four-year accredited naturopathic medical school. To get into a naturopathic school, one must complete three years of pre-med and earn a Bachelor of Science degree with a firm grasp of chemistry and biology and have at least a 3.0 GPA. ND students complete 4,500 hours of training and another 1500 hours of supervised clinical experience.
ND Licensing Process
Naturopathic physicians must also pass a postdoctoral board examination called the NPLEX to receive a license to practice. NDs must also fulfill state requirements for continuing education annually. Each state has a different scope of practice that is allowed for NDs.
There are 18 US states and the District of Columbia and some provinces in Canada, Australia, and New Zealand that recognize the ND license. At the time of this writing, the following North American states and territories allow NDs to practice:
Alaska, Arizona, British Columbia, California, Connecticut, Hawaii, Idaho, Kansas, Maine, Manitoba, Minnesota, Montana, New Hampshire, North Dakota, Ontario, Oregon, Puerto Rico, US Virgin Islands, Utah, Vermont, and Washington.
Depending on the state laws, NDs can perform minor surgery, such as stitches, but do not practice major surgery. They can prescribe drugs but usually focus on natural healing agents whenever possible. To find out more about what your state allows the American Medical Association has a state law chart for naturopath licensure.
NDs Treat the Whole Person
NDs usually spend more time with each patient, especially for the first visit. They average 45 minutes to an hour or even two hours, to make a thorough examination of all bodily systems and ask questions about health history and temperament.
Often the ND will contact other health professionals for records, including past treatments, medications, and surgeries, to get the big picture of everything that might be affecting the health of the patient.
To learn more about what to expect on your first visit, check out the FAQ page of the American Association of Naturopathic Physicians.
Collaboration Between NDs and Conventional MDs
Often naturopathic doctors work in partnership with conventionally trained doctors. A surgeon may take the lead in a cancer patient’s treatment with the primary care being radiation therapy. The naturopathic doctor will provide support for natural healing and help the patient tolerate the toxic effects of the radiation.
For a good comparison between the training of MDS, DOs and NDS check out the American Association of Naturopathic Physicians (AANP) FAQ page.
History and Origins of Naturopathic Medicine
Hippocrates, the Greek physician, first formulated the idea of the healing power of nature, and this is one of the core ideas of naturopathic medicine.
The concepts of naturopathy arose through an eclectic group of practitioners in central Europe in the 1800s, where patients went for a “water cure” and other natural-medicine treatments. These practitioners emphasized preventative care and balance through healthy lifestyle habits.
A German Doctor named Benedict Lust purchased the term naturopathy from John H. Scheel. Scheel first coined the term and began The American School of Naturopathy in 1902 in New York City.
Other people who influenced the natural health movement were John Harvey Kellogg, MD, Sylvester Graham, and Vincent Priessnitz, who created modern hydrotherapy as an alternative to conventional medicine. Read more about the origins of today’s naturopathic medicine system at The Canadian Association of Naturopathic Doctors (CAND).