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 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 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.

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

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,[6]

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

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.

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

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 providers. 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.[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:

Licensure will ensure that naturopathic doctors are competent by establishing educational and practice standards. Furthermore, creating a naturopathic medicine regulatory structure in Michigan will allow enforcement of the state’s rules by monitoring licensee activity and implementing disciplinary actions.

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 Michigan Senate Committee on Health Policy and Human Services, will lead to smart regulations that promote the safe practice of naturopathic medicine.