Dennis Godby’s office looks a lot like that of a typical doctor – stacks of books, chairs for patient conferences and a bench for taking vitals. But the diplomas and certificates on the wall behind him reveal a small variation – an N.D. after his name rather than an M.D.
The uncommon initials stand for naturopathic doctor, a health care provider trained in healing therapies, herbal medicine, clinical nutrition, homeopathy and lifestyle counseling, in addition to many of the same basic sciences as a conventional physician.
Godby, like most naturopathic doctors, prefers not to rely on pharmaceuticals, which he says can be toxic to the body. Instead, he offers herbal remedies for allergies, fungal problems, fatigue and other ailments.
“The demand definitely has grown,” said Godby, who sees 40 or more patients each week at his midtown Sacramento office. “There are more and more people realizing that there are alternatives. They keep going back to the (medical) doctor over and over again … getting the same results and realizing there has to be another way.”
Once considered on the fringe, this branch of health care professionals is growing in number. Naturopathic doctors are licensed to practice in 17 states, including California, and are lobbying for recognition in nine more. Licensed here since 2003, they are pushing to expand their scope of practice with Senate Bill 538, which would allow them to prescribe certain drugs and perform minor procedures.
“Given the tragic primary care shortage experienced by many in California, it’s especially important that we not unreasonably limit scope,” said the bill’s author, state Sen. Marty Block, D-San Diego, during discussion on the Senate floor. The bill passed the Senate on June 1 on a 21-9 vote and is now in the Assembly.
“The changes will ensure that patients receiving primary care from a naturopathic doctor can receive the appropriate care without the time, cost and health risk of finding another doctor for these routine procedures,” Block added.
Advocates argue that N.D.s can help expand health care access, particularly as more patients seek primary care providers under the Affordable Care Act. Their efforts come amid similar efforts by nurse practitioners, pharmacists and optometrists to be able to provide some of the same services as medical doctors.
Prospective N.D.s attend a four-year graduate naturopathic medical school (there are just six in the United States, including one in San Diego) and must pass a national licensing exam, as well as complete 60 hours of continuing education every two years. About 10 percent of the state’s 550 licensed N.D.s practice in the Sacramento area, according to the California Naturopathic Doctors Association.
N.D.s in California can order lab tests and imaging, dispense nonprescription drugs such as herbal remedies, hormones and dietary supplements, perform hot or cold hydrotherapy, provide health education and administer approved substances intravenously. The new law, if successful, would allow them to prescribe certain drugs, such as antibiotics, and perform minor in-office procedures such as suturing or skin tag removal. It would also give N.D.s the authority to take patients off pharmaceuticals prescribed by a primary care provider.
But many physicians oppose the bill, arguing that N.D. training is far less vigorous than that offered in conventional medical schools. Most notably, N.D.s are not required to undergo a residency program and therefore lack clinical experience, according to a letter from the California Medical Association urging senators to vote “no” on the bill.
Jay W. Lee, president of the California Academy of Family Physicians, said he is particularly concerned with a piece of the bill that would allow naturopathic doctors to take patients off of prescribed medications, a situation he feels could be “quite dangerous” for patients.
“I do believe there is a place for naturopathic doctors in the health care system,” he said. “Their expertise is in complementary medicine. It doesn’t replace primary care and it doesn’t replace sound, evidence-based treatment.”
For Godby, a naturopathic doctor who has been practicing in Sacramento for the past decade, the approach is about managing overall health rather than just confronting disease. He looks for the root cause of symptoms, which can be as simple as vitamin deficiency or sleep habits, he said.
Godby, who previously worked at the Sutter Center for Integrative Holistic Health, believes the ideal situation would have N.D.s and M.D.s working together to care for patients, with one handling preventive care and the other intervening in more critical situations or when surgery is necessary.
Currently, naturopathic doctors will refer patients to M.D.s when a health care situation is beyond their scope, such as to prescribe antibiotics. The current bill would alleviate that inconvenient situation, Godby said, particularly in rural areas with few practicing doctors.
550 Number of licensed naturopathic doctors in California
55 Number of naturopathic doctors in Sacramento
Jill Bernard, a Sacramento resident who runs a local holistic directory called WellBEing Resource, said she goes to both naturopathic doctors and medical doctors, depending on her health needs. She said she sometimes prefers holistic practitioners because they look at lifestyle factors, such as nutrition, she said.
“People just want to feel better,” she said. “A lot of people now are seeking alternative forms of healing, whether that be from the spiritual, energetic or physical realm.”
What they can/can’t do
- Order lab tests, including blood tests
- Order X-rays, ultrasounds and mammograms
- Dispense vitamins, amino acids, enzymes, supplements and other nonprescription drugs
- Repair superficial lacerations and abrasions, not including suturing*
- Attend to childbirth, with additional certifications
- Prescribe any controlled substance*
- Administer general or spinal anesthesia
- Perform any surgical procedure
- Perform acupuncture or traditional Chinese medicine
*Would change with passage of SB538f
Source: California Physician’s Legal Handbook