A study published in 2006 indicates that the number of naturopathic physicians and doctors (NDs) in the United States and Canada has grown significantly over the past few years.1 Increased enrollment in naturopathic educational programs also shows growing interest in this field, which has been a relatively small sector of the health professional community throughout the last century. This rising number of NDs and ND candidates, as well as other recent developments in the field, points to a potentially changing healthcare landscape and raises questions regarding the future of the naturopathic profession.
Naturopathy is a medical system that incorporates elements of both historical/traditional and modern/conventional treatment modalities, including botanical medicine, acupuncture, homeopathy, diet and nutritional management, and others. According to the profession’s basic underlying principles, NDs should utilize treatments with minimal harmful effects, recognize the body’s intrinsic power to heal, identify and treat the cause of an illness rather than offer quick suppression of symptoms, treat all aspects of a patient (i.e., mind, body, and spirit), instruct patients on how to be responsible for their own health, and proactively work to prevent illness.1
According to a study published in 2006 in the journal Papers of the Applied Geography Conferences, the number of licensed and affiliated NDs within the United States and Canada seems to have nearly doubled between 2001 and 2006.1 The authors conducted a survey in early 2006 by contacting licensing boards and requesting the number of licensed NDs from those respective states or provinces. Data on affiliated NDs (from jurisdictions without licensing) were obtained from directories available through the Web sites of the American Association of Naturopathic Physicians (AANP) and the Canadian Association of Naturopathic Doctors (CAND). The survey counted 4,010 licensed and affiliated NDs in the United States and Canada. (The study did not attempt to investigate the number and distribution of “naturopaths,” who receive their education and training through workshops, seminars, correspondence courses, and other means [including self-proclamation as “traditional naturopath”], rather than accredited naturopathic educational institutions.)
The authors of the study based their methodology on a landmark report published in 2001, which counted 2,101 licensed and affiliated NDs in the United States and Canada.2 Comparing their results to this earlier report, the authors of the 2006 study note that the number of NDs nearly doubled within a 5-year period.1 Their results further indicate that there has been a larger increase in the number of NDs in the United States than in Canada, and that growth has been greatest among states and provinces offering licensing or regulation. The distribution of NDs, meanwhile, has not experienced much change, with the majority of NDs still congregated in those few states and provinces with a naturopathic medical college or university (i.e., Arizona, Connecticut, Oregon, and Washington in the United States, and British Columbia and Ontario in Canada).
The authors, however, do qualify these results. “It’s a rough count at this point,” stressed Donald Albert, PhD, associate professor in geography at Sam Houston State University and lead author of the study (oral communication, March 30, 2007). Numbers supplied by licensing boards included practicing NDs, as well as NDs operating outside the licensed state and retired NDs. Some NDs are also licensed in more than one state, so those practitioners may have been counted multiple times. Further, not all qualified non-licensed NDs join AANP or CAND, and such physicians would not have been counted as affiliated NDs. However, such issues of inflation and underestimation would also have affected the results of the 2001 study, to which the recent 2006 study was compared.1
Even though the number of NDs provided in the 2006 study represents a rough estimate, Dr. Albert emphasized that it still indicates rapid growth in the field of naturopathic medicine. “The bottom line is that it’s a growing profession right now, and if there is more licensing, more schools, and more medical coverage offered [to patients who want to be treated by NDs], it will continue to grow,” he explained.
“The rise in the number of NDs is important because the profession is so small,” said Susan Hunter, director of advancement and public relations at the National College of Natural Medicine (NCNM) in Portland, Oregon (e-mail, April 3, 2007). “There are approximately 500,000 medical doctors in the USA, 50,000 chiropractors, and 5,000 NDs. Even an increase by 100 adds significantly to the profession.”
Robin DiPasquale, ND, chair of botanical medicine at Bastyr University in Kenmore, Washington, explained that knowledge of such statistics is important for NDs, the general public, and the medical community as a whole (oral communication, June 5, 2007). “It is important for the conventional medical community to know that the number of naturopathic physicians is growing because the kind of medicine we do is different, and there’s potential for integrative and collaborative work,” she explained. “The [conventional] medical community needs to know people want a different choice and that we offer that.”
“People have some disappointment and disillusionment with the current medical models that are being offered and with their effectiveness,” she added. “As long as [naturopathic] medicine continues to help people, more people will want it and will demand it.”
Karen Howard, executive director of AANP, stated that AANP receives more than 30,000 hits on its Web site every month by people searching for NDs to provide educational information and/ or therapeutic care. “This profession could double or triple in the next 10 years in size. The demand is there,” she said (oral communication, July 13, 2007).
Iva Lloyd, ND, chair of CAND, also noted a high demand for naturopathic treatment in Canada. CAND has calculated that there are approximately 1,400 properly trained and board-certified NDs practicing in Canada. “We feel that we need about 5,000 in total to meet the current demand,” said Dr. Lloyd. “There’s no place in Canada that currently has too many naturopathic doctors” (oral communication, July 25, 2007).
Meanwhile, the 6 accredited naturopathic educational institutions in the United States and Canada have experienced increased enrollment and graduating class sizes over the past few decades. Kris Ritchey, an ND candidate at NCNM, has collected data on the annual graduating class sizes of each naturopathic program
(K. Ritchey, oral communication, March 22, 2007). Such statistics show significant increases within each program, particularly around the year 2000. For the most part, those high levels have either been maintained or have further increased. Moreover, she added that most of the schools indicated that they were expecting record-breaking admissions for the fall of 2007.
Joseph Pizzorno, ND, former president and co-founder of Bastyr University, stated that more naturopathic schools should be established. However, he added that enrollment in the current ND schools will probably remain at their present levels since there are more options for students interested in alternative medicine, such as acupuncture schools and integrative medicine programs at conventional medical schools. (e-mail, July 13, 2007). Dr. Lloyd noted that, although there “won’t be schools popping up around every corner,” there are expectations that 1 or 2 new schools will be established in both the United States and Canada within the next 5 years.
Various organizations and initiatives are working to support the naturopathic field in ways that could inspire further growth. AANP has been working to educate the public about the naturopathic field by developing relationships with other organizations, creating national educational programs, developing media for use by state affiliates, and working with editorial boards in key states. CAND promotes the benefits of naturopathic medicine through its English- and French-language Web site (http://www.naturopathicassoc.ca) and by distributing bilingual educational brochures, providing sponsorship for the promotion of naturopathic medicine, and airing a national TV ad for the naturopathic profession, among other activities.
Various states have initiated efforts to obtain ND licensing. Fourteen states currently offer ND licensing in the United States, and significant efforts have recently been launched in New York and Colorado to gain ND licensing. Howard added that AANP has been active this legislative session in 9 other states with the goal of obtaining licensing for NDs. Four Canadian provinces currently provide ND regulation. According to Dr. Lloyd, a fifth province (Alberta) is expected to obtain regulation for NDs by the end of 2007.
Howard noted that licensing is important for the ND profession: “Without licensing, there’s no way to differentiate between a naturopathic physician, who has gone through an accredited medical program, and someone who calls themselves a naturopathic doctor and received their degree online through a diploma mill.” She said that this can cause serious confusion within the public and can have devastating results when patients are inadvertently treated by less qualified healthcare providers.
NDs, meanwhile, have become more visible in the media, as have alternative medicine studies. And patients have begun to receive greater coverage of naturopathic healthcare through insurance plans.
Rapid growth in the naturopathic field, however, does raise some concerns. According to Dr. DiPasquale, too much growth in the field might ultimately drive the profession away from its original intentions, particularly if NDs begin to push for prescription rights and other features of conventional medical practice. “I think the profession has a schism—people who want naturopathic medicine to become more mainstream and those who want it to maintain its roots,” she explained. “Can we do both, is the question.”
Furthermore, the increasing number of students in naturopathic educational programs has forced some schools to alter their procedures to accommodate larger student bodies. NDs, meanwhile, face their own challenges in the workforce. According to Jill Stansbury, ND, assistant professor at NCNM, a survey conducted several years ago found that the ND field “was not really a stellar income generating profession—thus more of a calling than a career” (e-mail, July 31, 2007). She added, “I know a number of people who after 4 years of expensive schooling have difficulty making a living at it and seek other employment.”
Additionally, many patients have expectations of medical treatment based on conventional medical practice. According to Dr. DiPasquale, education about how naturopathic medicine is practiced takes time and focus for both the doctors and the patients.
Dr. Albert, the recent study’s co-author, plans to continue to monitor growth in the naturopathic field, and he said he would like to do a follow-up survey in 2011. “We definitely want to keep tracking this to see if growth continues or if it levels off,” he said. He added that his research has attracted considerable interest. “I’ve received a lot of support in the naturopathic community. It’s been pretty exciting!”
- Albert DP, Martinez D. Spatial variation in the growth in number of naturopathic physicians in the United States and Canada. Papers of the Applied Geography Conferences. 2006;29:311-20.
- Hough HJ, Dower C, O’Neil EH. Profile of a Profession: Naturopathic Practice. San Francisco, CA: Center for Health Professions, University of California; 2001.