1. Georgette de Groot Devon Poznanski Garth Vatkin

2.  First began with Hippocrates over 2400 years ago with his concept of “The healing power of nature”  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

3.  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

4.  Medical advances (examples: new surgical techniques, introduction of antibiotics) during and after WWII placed the naturopathic industry on the backburner  However over the past two decades, as people are becoming more proactive in their health, naturopathy has had a resurgence in popularity

5.  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

6.  The act ultimately empowered NDs to self- regulate 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

7.  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

8.  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

10.  Professional Associations and Regulatory Boards:

11.  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

12.  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)

13.  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

14.  OR????  Take an online program and work in an unregulated state or province under the self proclaimed title of “Doctor or Physician”

15.  What the government “should“ do Economic efficiency Other social objectives Fairness

16.  Imperfect competition  Traditional medical domination in primary care  In effect, a monopoly  Informational market failure  Public payment suggests government preference  Self-regulation signals “quality” and legitimacy

17.  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

18.  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

19.  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

20.  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 ▪ Government ▪ Public ▪ Naturopaths ▪ BCMA

22.  Government ▪ Increased primary care providers ▪ Maximize votes ▪ Transfer public funds – spend money to regulate today and gain the money back from physician visits  Public  Improved access to new types of primary care providers  Choice

23.  Naturopathic Doctors  Improved professional standards  Public protection  Proof their standards are high  Creates a commodity  BCMA  Medical dominance  Concern for public safety  Issues regarding use of “Physician” and “Doctor”  Loss of market dominance

24.  Government, public and naturopathic physicians collaborative  BCMA adversarial

25. Three current reforms:  1) Regulation for all provinces and territories  2) Prescription and lab rights  3) Internal reform

26.  A) Education institutions  B) Foreign trained NDs  C) Pharmaceutical manipulation

27.  NDs  Public  Medical Doctors  Government

28.  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

29.  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

30.  Drawbacks  Arguments among naturopaths: types of research, older practitioners  Cost: time and money

31.  Increased standards of care and education  Better health outcomes through increased exposure?  Patient empowerment

32.  BCMA voiced concern over ND’s increased scope of practice  Proper training/education  Patients at risk  Motivated by concern for patients or concern for themselves?  Benefit: potential for lighter patient load  Drawback: economic loss?

33.  Better health outcomes = reduced strain on health care system  Legislation of regulations took time and money  Increased demand = increased expenditures

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