Nonphysician Clinicians in the Health Care Workforce

To the Editor: The articles by Dr Cooper and colleagues^1- 2 regarding NPCs require clarification of 3 important points.

1. Licensing of naturopathic doctors. As stated in the article, not all naturopaths in practice receive their training from accredited colleges (Council on Naturopathic Medical Education, oral communication, September 1998).^1- 2 Graduates from unaccredited naturopathic schools, some of which have program requirements of 1 year or less, are not eligible to sit for licensing examinations or become licensed. However, license-ineligible naturopaths can practice without distinction from license-eligible naturopaths in states that do not grant licensure.

2. Training of naturopathic doctors. Currently, 2 accredited schools graduate license-eligible naturopaths: Bastyr University (Seattle, Wash) and National College of Naturopathic Medicine (Portland, Ore). Two other schools have accreditation candidacy and also are recognized by the US Department of Education: Southwest College of Naturopathic Medicine (Scottsdale, Ariz) and Canadian College of Naturopathic Medicine (Toronto, Ontario). These schools have minimum 4-year postgraduate curricula including 2 years of supervised patient management for their naturopathic medicine programs. Successful graduates who pass 4 days of basic science, conventional clinical, and naturopathic clinical board examinations are eligible for licensure as primary care physicians, specializing in natural medicine.

3. Integrated practice. It is clear that an increasing number of patients are turning to naturopathic or other alternatives to allopathic medicine, which is why we have integrated rather than separated these approaches. We have found our conventional allopathic and naturopathic collaboration not to be competitive, but mutually beneficial, providing patients a more holistic approach in meeting their health care needs.