Remember the good old days when the AMA used to talk about the “worship of chiropractic” or the really old days when doctors forbade doctors from accepting patients?
If so, there is once again an air of déju vu in Sacramento, where California lawmakers are considering a bill that would allow naturopathic doctors more prescription and other privileges.
The California Naturopathic Physicians Association (CNDA) website states that naturopathic physicians (also known as naturopathic physicians, or NDs) are “trained in an accredited four-year postgraduate residential naturopathic medical program.” It is stated that. “This training provides a comprehensive study of conventional medicine, including anatomy, physiology, pathology, microbiology, immunology, clinical and physical diagnosis, laboratory diagnosis, cardiology, gastroenterology, gynecology, etc. and consists of in-depth study of various areas of natural medicine.
Although resident training is not required for the ND license, some NDs may attend a residency.
Arena
Currently, 16 states, in addition to the District of Columbia and Puerto Rico, license NDs to practice medicine. “In these states, NDs operate as independent primary care general practitioners with the ability to diagnose and treat medical conditions, perform physical examinations, and order laboratory tests,” the website states. There is.
When naturopathic doctors were first licensed in California in 2003, they received a limited license that required them to be under the supervision of a physician or physician when writing prescriptions. The restrictions were “introduced as an interim measure while the regulatory subcommittee determines what a naturopathic physician’s independent prescriptions should be,” the association said in an email. today’s med page.
But in the real world, the ND Association argues, this restriction severely limits the ability of NDs to practice, as most physicians and physicians are not interested in supervising NDs so they can prescribe to patients. There is. “This restriction imposes significant limitations on NDs who receive extensive didactic, practical, and continuing education training in traditional pharmacology,” the association said.
Progress in Congress
The bill passed the state Senate Business, Professions and Economic Development Committee on a 5-2 vote on May 26, and was later passed by the state Senate with relative ease on a 21-9 vote. The bill is currently being debated in the state legislature.
So what does it do?
- Expanding the types of imaging tests naturopaths can order
- Authorizes naturopathic physicians to perform surgical procedures for superficial tears, certain superficial injuries, and superficial abrasions.
- Authorizes naturopathic physicians to prescribe, administer, or order Schedule IV, V, and unclassified prescription drugs without physician supervision.
MD reaction
Many MD groups in California have concerns about the bill, but few have publicly discussed their concerns. One exception is the Medical Board of California in Sacramento, which shared a letter it sent to State Sen. Marty Bullock (D-39th District) on May 14. [San Diego]), bill sponsor.
“While NDs may be well-qualified to practice naturopathic medicine, which utilizes natural medicine and natural approaches to treatment, NDs are well-qualified to safely perform minor procedures and prescribe without medical supervision.” They have not received any education or training in a naturopathic education program,” Kimberly Kirchmeier wrote. the executive director of the California Medical Board said in his letter. “Physician oversight helps ensure that the patient care provided by NDs includes physician involvement and oversight.”
“Expanding the scope of practice for NDs and removing the need for physician oversight could undermine patient care and consumer protections,” Kirchmeyer continued. “For these reasons, the Board opposes this bill.”
Other groups were reluctant to discuss their concerns.The California Academy of Family Physicians declined to be interviewed. today’s med page. Kaiser Permanente, an HMO and medical organization with a large presence in California, confirmed that it opposes the bill, but declined to discuss the issue further.
The California Medical Association (CMA) did not respond to several requests for comment, but the CNDA said the medical association’s objections “are likely due to confusion between certified naturopathic physicians who have completed a four-year graduate program accredited by the U.S. Department of Education.” It’s related.” A naturopathic doctor who has graduated from medical school, passed the National Board of Education Examination, and is licensed and regulated by the state is a lay person who has no formal training and is not regulated by the state. ”
Not all GPs are opposed to the bill.
Dr. Daniel Brousseau, a family physician in Pasadena, Calif., who practices with four ND physicians, said at a committee hearing in April that he was “constantly impressed by the rigor of their clinical training… I never had such an opportunity until now,” he testified. No need to worry as they were not well trained in any field including pharmaceuticals. ”
Several NDs who testified at the hearing said they can’t prescribe without supervision, they must be able to legally prescribe the drug to change the dosage, and they can’t independently administer the medication when a patient’s condition is improving. He also pointed out that the amount cannot be reduced.
Caused by shortage of doctors
block said Today’s Medpage Ironically, it was the CMA that got him to write the bill. “For my first two years in office, the CMA brought in a delegation and told me to vote against single-payer. [healthcare] “In California, there weren’t enough primary care physicians to take care of everyone if everyone had insurance,” he said in a phone interview.
“Frankly, they were right, and now that the federal government has passed this bill, [Affordable Care Act] “And even though we have insurance coverage for almost everyone, California has almost no shortage of primary care physicians,” Block continued. ”
He supports putting more money into AAMC-accredited medical schools and using loan forgiveness to encourage more primary care physicians to practice in underserved areas, but says, It doesn’t make up for the lack of medical care.” [physician] “There’s a shortage and we need to expand the reach of providers such as naturopaths and allow them to do more than they can do today,” Block said.
He said tens of thousands of Californians currently have NDs as their primary care physicians, but if someone does, [nagging] If someone has a cough or diarrhea and needs a prescription, “doctors’ hands are tied. Instead, they have to send patients to the doctor with a referral, which can take weeks or weeks to get an appointment.” It often takes months, and many patients are unable to get an appointment.”Don’t go at all. ”
Block also said he recognizes that NDs do not have the same training as physicians, so “we are not asking for parity in coverage. This bill would require NDs to be classified as Level IV. “We are allowing them to prescribe V drugs, but we are not allowing them to prescribe potentially more harmful drugs.” Removal of warts and skin tags from parts of the body other than the face is permitted, but major surgery is not permitted. ”
If the bill passes the state Legislature and is signed by the governor, it would go into effect early next year, Block said.
This article has been updated to reflect that some naturopathic doctors are undergoing residency training.
