Transcript The Naturopathic Industry

Georgette de Groot
Devon Poznanski
Garth Vatkin
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First began with Hippocrates
over 2400 years ago with his
concept of “The healing power
of nature”
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Began in North America by Dr.
Benedict Lust who designed a
clinical practice that integrated
natural methods such as
botanical medicine,
homeopathy, nutritional
therapy, acupuncture and
lifestyle counseling
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In 1902 the American School of Naturopathy
(founded by Dr. Lust) graduated its first class
Graduates from this school formed the
Naturopathic Society of America and began
institutions throughout North America
By 1920, naturopathic medicine was widely
used in Canada
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Medical advances (examples:
new surgical techniques,
introduction of antibiotics)
during and after WWII placed
the naturopathic industry on
the backburner
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However over the past two
decades, as people are
becoming more proactive in
their health, naturopathy has
had a resurgence in popularity
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In British Columbia, from 1921-1936,
naturopathic doctors were regulated by the
College of Physicians and Surgeons
In 1936, the Naturopathic Physicians Act was
established separating naturopathy from
homeopathy, osteopathy, and most
importantly the College of Physicians and
Surgeons
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The act ultimately empowered NDs to selfregulate and they did this by creating the
Association of Naturopathic Physicians of BC
(ANPBC)
Initially the ANPBC was the provincial
association and the regulatory body
Numerous amendments were made to the
act between 1938-1993
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In 1993 the ANPBC split into the regulatory
board (BC Naturopathic Association) and the
provincial association (ANPBC)
In 2000 the ANPBC -> College of
Naturopathic Physicians of BC (CNPBC)
2009, NDs finally recognized as primary
health providers by BC Ministry of Health
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Elsewhere, Ontario, Saskatchewan,
Manitoba, and Nova Scotia developed similar
regulatory bodies
No other province or territory has regulation
standards; however, Alberta is in the process
of developing a regulatory body
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Professional Associations and Regulatory Boards:
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In 1978 the first naturopathic institution was
created in Toronto called the Ontario College
of Naturopathic Medicine (OCNM)
In 1983 the first ND program was established
In 1992, it became the Canadian College of
Naturopathic Medicine (CCNM)
In 2000, a second school called the Boucher
Institute opened in New Westminster, BC
One way that the industry is regulated is through its
accredited schools (2 in Canada, 4 in the US and 1 in
the process of accreditation)
 The Council on Naturopathic Medical Education
(CNME) is responsible for setting the criteria used in
the accreditation process
 CNME was established in 1978 and was designated by
national naturopathic associations in the US and
Canada in conjunction with the North American Board
of Naturopathic Examiners (NABNE)
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Complete undergraduate degree
Attend accredited naturopathic institution
and complete 4 years of ND training
Sit for NPLEX (2 written tests and 1 oral exam
with further elective testing in acupuncture
and minor surgery)
Apply for registration with regulatory body in
regulated province or state
Maintain continuing education competencies
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OR????
Take an online program and work in an
unregulated state or province under the self
proclaimed title of “Doctor or Physician”
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What the government “should“ do
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Economic efficiency
Other social objectives
Fairness
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Imperfect competition
 Traditional medical
domination in primary care
 In effect, a monopoly
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Informational market failure
 Public payment suggests
government preference
 Self-regulation signals
“quality” and legitimacy
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Distribution of net benefits among interested
parties
Primary care not equitable or sustainable
across province
Access to providers = better health
Increased primary care providers = increased
access =better population health
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Public funded primary care versus private
Naturopaths report spending up to 90 min on
assessment: mostly private pay.
 money= more time spent with provider
 Paying privately and through taxation may lead to
double cost for certain patients
 Naturopaths set their rate independently
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BCMA negotiates the contract
 Negotiation may not pass the “veil of ignorance”
test
Less advantaged may consume more healthcare
resources because of the “free” service while
affluent may use less and pay more
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What are the reasons the regulation takes the
form that it does?
 Objective of the regulation
▪ Standardize and promote self-regulation of naturopaths
 Interactions between stakeholder groups
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Government
Public
Naturopaths
BCMA
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Government
▪ Increased primary care providers
▪ Maximize votes
▪ Transfer public funds – spend money to regulate today
and gain the money back from physician visits
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Public
 Improved access to new types of primary care
providers
 Choice
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Naturopathic Doctors
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Improved professional standards
Public protection
Proof their standards are high
Creates a commodity
BCMA
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Medical dominance
Concern for public safety
Issues regarding use of “Physician” and “Doctor”
Loss of market dominance
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Government, public and naturopathic
physicians collaborative
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BCMA adversarial
Three current reforms:
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1) Regulation for all provinces and territories
2) Prescription and lab rights
3) Internal reform
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A) Education institutions
B) Foreign trained NDs
C) Pharmaceutical manipulation
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NDs
Public
Medical Doctors
Government
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Self-regulation offers credibility to their
therapeutic modalities
Increased legitimacy in the eyes of outsiders
Obtain research funding and government
funds for services
 This will all lead to a greater market share of the
health care sector
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New prescribing privileges in BC
 Over time, certain naturopathic remedies have
become scheduled
 Scope of practice was shrinking
 Can now fully attend to patients’ needs and keep
track of patients medications
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Drawbacks
 Arguments among naturopaths: types of
research, older practitioners
 Cost: time and money
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Increased standards of care and education
Better health outcomes through increased
exposure?
Patient empowerment
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BCMA voiced concern over ND’s increased
scope of practice
 Proper training/education
 Patients at risk
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Motivated by concern for patients or concern
for themselves?
Benefit: potential for lighter patient load
Drawback: economic loss?
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Better health outcomes = reduced strain on
health care system
Legislation of regulations took time and
money
Increased demand = increased expenditures
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The Canadian Association of Naturopathic Doctors [Online]. No date [cited 2009 Oct 1]; Available from: http://www.cand.ca
The College of Naturopathic Physicians of British Columbia [Online]. No date [cited 2009 Oct 1]; Available from: http://www.cnpbc.bc.ca
British Columbia Naturopathic Association [Online]. No date [cited 2009 Oct 1]; Available from: http://www.bcna.ca/
Council on Naturopathic Education Council [Online]. No date [cited 2009 Oct 2]; Available from: http://www.cnme.org/
North American Board of Naturopathic Examiners [Online]. No date [cited 2009 Oct 2]; Available from: http://www.nabne.org/
Association of Accredited Naturopathic Accredited Colleges [Online]. No date [cited 2009 Oct 1]; Available from: http://www.aanmc.org/
BC Naturopathic Association Applauds Provincial Government’s Realization of Commitment to Improve Patient Care in BC [Online]. 2009 [cited 2009
Oct 2]; Available from: http://www.bcna.ca/documents/BCNAapprovalreleaseFINAL.pdf
Roles Expand for midwives, naturopaths, and nurses [Online]. 2009 [cited 2009 Oct 2]; Available from:
http://www.binm.org/docs/binmprescription.pdf
Alberta Association of Naturopathic Practitioners [Online]. No date [cited 2009 Oct 1]; Available from: http://www.naturopathic-alberta.com/
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CBC News: B.C. gives naturopaths right to prescribe drugs [Online]. 2009 Apr 10 [cited 2009 Oct 6]; Available from:
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Primary Health Care Charter: A Collaborative Approach [Online]. 2007 [cited 2009 Oct 3]; Available from:
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The Quebec Association of Naturopathic Medicine [Online]. No date [cited 2009 Oct 3]; Available from:
http://www.qanm.org/safety_regulation.html
NLM Gateway. Abstract: The Scope of Primary Care Practices in British Columbia, Canada [Online]. 2000 [cited 2009 Oct 4]; Available from:
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102272797.html
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British Columbia Medical Association [Online]. No date [cited 2009 Oct 4]; Available from:
https://www.bcma.org/files/BCMA_Submission_NP_Regulation.pdf
CBC News: Canadian doctors overworked, unable to meet patients’ needs: survey [Online]. 2008 Jan 9 [cited 2009 15 Oct]; Available from:
http://www.cbc.ca/health/story/2008/01/09/doctors-survey.html
Boon H. Regulation of complimentary/alternative medicine: a Canadian perspective. Complimentary Therapies in Medicine. 2002; 10: 14-19