The number of Americans using complementary and alternative medicine (CAM) rose from 34% to 42% from 1990 to 1997, with annual spending for CAM therapies in excess of $21 billion . The majority of the research on the use of CAM services has focused on patients or consumers of CAM. Several patient characteristics have been found to be associated with increased CAM use including female gender, child-bearing age, above average income, above average education and diagnosis with a chronic or life-threatening condition [1–4]. Reasons why consumers seek care from CAM practitioners have also been identified. These include: the failure of conventional treatment to alleviate symptoms; psychological congruence between the individual's belief system and the CAM therapy; individuals' expectations that use of CAM will empower them by offering a greater sense of control over personal health care decisions; adverse effects of conventional therapies; and dissatisfaction with the care of conventional practitioners [1–3, 5–8].
Although we now have some understanding of who seeks CAM care and why, relatively little is known about the actual practices of CAM practitioners including the type of patients they treat, the kinds of therapies they use, and the numbers of patients they see each day. In addition, it is unclear if the practice patterns of CAM practitioners vary by state. The objective of this paper is to describe and compare the practice of naturopathic physicians in two US states: Washington and Connecticut.
Naturopathic medicine is a system of health care, based on the teachings of Benedict Lust , with a primary goal of enhancing the individual's innate self-healing ability by employing a variety of natural and largely non-invasive healing modalities. In some states, naturopathic physicians are authorized to employ more invasive interventions (i.e., prescription drugs, and minor surgery). Naturopathic medicine is defined by the American Association of Naturopathic Physicians (AANP) as:
... a distinct system of primary health care – an art, science, philosophy and practice of diagnosis, treatment and prevention of illness. Naturopathic medicine is distinguished by the principles upon which its practice is based. These principles are continually reexamined in the light of scientific advances. The techniques of naturopathic medicine include modern and traditional, scientific and empirical methods .
Naturopathic physicians are trained as generalists with expertise in a variety of core treatment methods including nutrition, hydrotherapy, colonic irrigation, physiotherapy, naturopathic manipulation, botanical medicine, homeopathy, pharmacology and minor office surgical procedures. Some licensed naturopathic physicians are also trained in traditional Chinese medicine, acupuncture and Ayurvedic medicine as well as clinical specialties such as natural childbirth [9, 11–14]. There are currently six North American schools of naturopathic medicine whose graduates are eligible to sit state licensing examinations: Bastyr University (Seattle, WA), the Canadian College of Naturopathic Medicine (Toronto, ON, Canada), National College of Naturopathic Medicine (Portland, OR), Southwest College of Naturopathic Medicine (Tempe, AZ), the University of Bridgeport College of Naturopathic Medicine (Bridgeport, CT) (has applied for accreditation candidacy with the Council on Naturopathic Medical Education (CNME)), and the West Coast Naturopathic Medical College (Vancouver, BC) (not accredited by the CNME) .
Accurate estimates of the number of naturopathic physicians practicing in North America are difficult to obtain. A recent estimate (based on data from licensing bodies) indicated that in 2000 approximately 1300 licensed naturopathic physicians were practicing in the United States and another 500 were practicing in Canada. Naturopathic medicine is a licensed health care profession in twelve US states (Alaska, Arizona, Connecticut, Hawaii, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, Washington, California), Puerto Rico and four Canadian provinces (British Columbia, Manitoba, Ontario and Saskatchewan) [9, 15]. In most states and provinces where naturopathic medicine is not regulated, individuals may practice similar therapeutic approaches and/or call themselves naturopaths (whether or not they have been trained at a school for naturopathic medicine) because the term naturopathic medicine is not a restricted term. The number of individuals practicing in unregulated jurisdictions is unknown. In South Carolina and Tennessee, it is illegal to practice naturopathy .
Legal regulation of naturopathic medicine varies by state and province. Connecticut and Washington have relatively similar (and representative of the other ten states) requirements for licensure including: Graduation from an accredited four-year naturopathic medical school, successful completion of licensing examination (normally NPLEX), the submission of completed application forms and paying the required fee. In addition, Washington State requires that individuals be of good moral character with no history of unprofessional conduct .
The legal scopes of naturopathic practice in Connecticut and Washington are similar and relatively broad compared to the other states that license naturopathic physicians. Naturopathic physicians in these two states can diagnose and treat disease, utilizing a wide range of modalities and specialties including: minor surgery such as suturing (limited in Washington); physical therapies including hydrotherapy, naturopathic manipulation, and physiotherapy; colonic irrigation; electrotherapy (for example TENs); diagnostic x-ray; venipuncture; obstetrics (in Washington a midwifery license is required); gynecology; botanical medicine; nutrition; and homeopathy. Naturopathic physicians in Washington may prescribe a limited range of drugs; however, this is not part of the scope of practice in Connecticut. The practice of acupuncture requires separate licensure in both states .