Senate Bipartisan Working Group

Expanded naturopathic practice  helps  bridge the shortage of primary care physician in Alaska

SB 70 greatly expands the practice of naturopathy in Alaska to establish its own board; to perform minor surgery; and to administer prescription drugs, vaccinations, hormones, and medical devices that are on the formulary approved by the department under AS 08.45.005.  While there are only 38 naturopaths licensed in Alaska, four of whom live out of state, they claim that their education and experience qualifies them to bridge the growing shortage of primary care physicians in Alaska. Naturopaths state that their basic science education is similar to that of allopathic and osteopathic physicians (MDs and ODs) and point out that they already deal with many of the same patients whom they must refer to MDs for prescriptions and minor surgery; and that nurse practitioners and physician assistants already may obtain prescription endorsements.  SB 70 would attract more naturopaths to Alaska to serve patients in need of services.

Alaska State Medical Association has opposed expanded naturopathic practice

Allopathic and osteopathic physicians and physician assistants in Alaska oppose the expansion of naturopathic practice into “non-natural” areas of medical practice reserved to licensed physicians, including surgery and prescriptive drugs. Suggestions in recent years to place naturopaths under the Alaska State Medical Board have failed.  Primary care physicians claim this is not a turf war, but rather, a matter of public safety.  They claim that naturopathic training programs do not provide the breadth and depth of education compared to medical and osteopathic medical schools; that naturopaths do not have the supervised postgraduate residency training for patient care, adverse medical effects, drug interactions, and patient safety prior to being licensed to practice independently; that recertification and continuing medical education is not the norm in naturopathy.   SB 70 attempts to address some of those concerns.  

A new Alaska Naturopathic Board

For purposes of expanding allowed practices and procedures of naturopaths and regulating the practice of naturopathic medicine in Alaska, SB 70 establishes an Alaska Naturopathic Board to the list of boards and professions under the Department of Commerce, Community, and Economic Development.  The board will consist of three naturopaths, one licensed pharmacist, and one public member who may be a licensed physician. The department at board request will issue licenses and prescription endorsements, and will have authority to investigate and to discipline as required.  

Minor surgery and prescription endorsement

SB 70 greatly expands the practice of naturopathy to include minor surgery, operative, electrical, and other methods of repair to superficial lacerations and abrasion or lesions, and removal of foreign bodies in superficial tissues; and allows the use of antiseptics and local anesthetics in connection with allowed procedures.  The law prohibits naturopaths from performing major surgery, plastic surgery, and spinal and general anesthetics.

Additionally, SB 70 allows for the first time the new naturopathic board to request that the department issue a prescription endorsement to a naturopath licensed under this chapter who has practiced for five years; who has submitted proof of 60 hours of pharmacology education from an approved program; and who has met other requirements relating to administration and prescription of drugs, vaccinations, hormones, and medical devices which the board considers necessary.  The prescription endorsement must be renewed every two years with proof of 15 hours continuing education.

Medicaid reimbursement

SB 70 adds “naturopathic services” to the list of services under AS 47.07.030(b) to allow Medicaid reimbursement under state law if the services provided are “deemed medically necessary.”   No  Medicare reimbursement was allowed as 2007. 

Naturopathic practice in other states

Thirteen states which license naturopaths and have instituted formulary laws include Arizona, Connecticut, Hawaii, Idaho, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington.  Currently there are 36 naturopaths practicing in Alaska, 802 in Washington, 715 in Oregon, 375 in Arizona, 210 in Connecticut, 117 in Vermont, 85 in Hawaii, 67 in Montana, 57 in New Hampshire, 27 in Maine, 18 in Utah, 11 in Kansas, and 8 in Idaho.    While the scope of practice of Naturopathic Doctors varies from state to state, many deal to some extent with prescribing drugs.  Of the 14 states that license naturopaths, 9 of those states allow naturopaths to prescribe independently without any MD supervision or protocol.  Arizona, which has the broadest formulary in the nation, allows naturopaths to prescribe all but IV medications, controlled substances except morphine, cancer chemotherapeutics, and antipsychotic drugs.  Naturopaths in Arizona are licensed under the state medical board with several other layers of control to protect the public.  Kansas, which instituted licensure in 2003, requires MD supervision, and Maine requires collaboration with a physician for one year prior to independent prescribing.  Massachusetts, on the other hand, refused in 2002 to license naturopaths at all after a two year intensive task force investigation and comparison to standard medical practice in 2002.

Conclusion

At a time when Alaska is experiencing a growing shortage of primary care physicians, as is true all over the country, SB 70 provides naturopaths as Complementary Alternative Medicine caregivers with professional training, experience, and interest the healing arts.  Naturopathic doctors focus on preventative care and in keeping patients healthy, and they usually rely much less than MDs on the use of drugs. Naturopaths seek prescriptive authority, among other reasons, to reduce the amount and combination of drugs patients are currently taking.  Patients often turn to naturopathic doctors when traditional medicine has failed.  Naturopaths regularly refer cases to MDs and ODs when deemed necessary, and it is expected under SB 70’s expanded practice that they would continue to use professional judgment when in doubt.  There are very few reported incidences of malpractice among naturopaths, but at the same time, there has been less opportunity for error in limited naturopathic practice.   SB 70 is designed to reasonably expand the services of naturopaths only to areas collateral to the needs of their daily practice without infringing on the duties and responsibilities of medical doctors and osteopaths licensed by the State Medical Board. 

Rev. 3/31/09