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What is a Naturopathic Doctor?

Naturopathic doctors are the only healthcare professionals in Puerto Rico who have earned a doctorate in naturopathic medicine accredited by the Council on Naturopathic Medical Education (CNME) and recognized by the U.S. Department of Education and by Puerto Rico’s Department of Health. Naturopathic doctors (identified by the initials N.D. which means “Naturopathic Doctor”) receive training in both natural and conventional medicine, which enables them to diagnose and treat a diverse number of health conditions using natural therapies. However, they always emphasize the importance of disease prevention.

Naturopathic Doctor vs. Naturopath

A naturopathic doctor is not the same thing as a naturopath. Many people are not aware that in Puerto Rico there are 2 laws, one that authorizes the practice of naturopathic medicine by naturopathic doctors (law 208 of 1997), and another one that authorizes the practice of naturopathy by licensed naturopaths (law 211 of 1997). The educational requirements of naturopathic doctors (which include extensive supervised clinical experience and passing national level naturopathic medical boards) are much stricter than those for naturopaths.

One of the fundamental differences between both practitioners is that naturopathic doctors receive a significant amount of conventional medical training in addition to their extensive natural medicine training (see the next section for more details). This enables them to: make correct medical diagnoses; determine when it is necessary for the patient to receive conventional treatment in addition to naturopathic treatment; determine when a medical condition presents an immediate danger to the health or life of the patient (requiring a referal to an emergency room); and make sure that the naturopathic therapies given to a patient do not interfere with conventional medical treatments that he or she may be receiving.

Another fundamental difference between naturopathic doctors and licensed naturopaths is the diagnostic methods they use. While naturopaths frequently use iridology (the study of the iris of the eye) in the evaluation of their patients, naturopathic doctors do not use it. The reason for this is that multiple scientific studies have demonstrated that iridology is an unreliable diagnostic method that produces an unacceptable level of erroneous diagnoses. It is of paramount importance to make a correct diagnosis before offering any treatment to a patient. An incorrect diagnosis may have serious consequences, including the patient’s death. For this reason, naturopathic doctors are trained in and authorized to order the diagnostic methods that have been shown to be very reliable, including laboratory tests (blood, urine, feces), sonograms, x-rays, CT scans, MRI, etc. (all of which naturopaths are not allowed to order or interpret). Finally, once naturopathic doctors reach a correct diagnosis, they proceed to treat their patients in a holistic way with natural therapies.

It is important to note that a number of licensed naturopaths in Puerto Rico present themselves as naturopathic doctors, or simply as doctors when in reality they are neither. In fact, it is illegal for a naturopath to identify him or herself as a naturopathic doctor or as a doctor of naturopathic medicine, or to use the initials N.D. (the same way it would be illegal to identify themselves as a medical doctor or to use the initials M.D.). It is also illegal for a licensed naturopath to use the title of doctor or to use the prefix Dr. except when they have earned a doctoral degree from an institution accredited by Puerto Rico’s Council of Education. Only if the Puerto Rico license or certification and registration of a practitioner says “Doctor en Naturopatía” (Naturopathic Doctor) or “Doctor en Medicina Naturopática” (Doctor of Naturopathic Medicine), this person has a doctorate in naturopathy that is recognized by Puerto Rico law.

Naturopathic Doctoral Education

There are currently 6 naturopathic medical schools in the continental United States and 2 in Canada which are accredited by the “Council on Naturopathic Medical Education” (CNME), which is the agency recognized by the U.S. Department of Education to establish and maintain the educational standards for the doctoral programs in naturopathic medicine. A ninth doctoral program at Universidad del Turabo in Puerto Rico obtained the candidacy for accreditation status (the last step prior to full accreditation) in May of 2015.

Acceptance to these schools requires having a bachelor degree with credits equivalent to a pre-med program. The ND program consists of a minimum of 4 years of graduate level full time study. The first 2 years are focused in the study of basic sciences, such as anatomy, pathology, biochemistry, physiology, immunology, infectious diseases, physical and clinical diagnosis, laboratory diagnosis, and pharmacology, among others. Once this phase is completed, students need to pass a basic sciences national board exam, the “Naturopathic Physicians Licensing Examination” (NPLEX) in basic sciences (administered by the North American Board of Naturopathic Examiners, o NABNE), in order to demonstrate mastery of the material studied during the first 2 years.

The next 2 years (minimum) are focused in clinical sciences such as oncology, gastroenterology, cardiology, endocrinology, rheumatology, dermatology, urology, gynecology, geriatrics, neurology and orthopedics, among others. During all 4 years (or more), students receive extensive training in clinical nutrition, medicinal plants, physical medicine, and homeopathy, both in specific courses covering those subjects and as an integrated part of clinical courses (such as cardiology, oncology, etc.). In addition to the didactic component of their education, students receive extensive clinical experience treating patients for a minimum of 2 years under the supervision of naturopathic doctors. Once this final phase is completed, students have to pass a second national board exam, the NPLEX in clinical sciences, to demonstrate mastery of the educational and clinical material studied during the 2 clinical years. Passage of this second national board exam is required in order to obtain a license to practice as naturopathic doctor.

Currently, naturopathic doctors have licensure in Alaska, Arizona, California, Colorado, Connecticut, Hawaii, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, North Dakota, Oregon, Pennsylvania, Puerto Rico, Rhode Island, Utah, Vermont,  the Virgin Islands, Washington State, Washington D.C and 5 Canadian provinces. Other states have legislative initiatives to offer licensure in the future (see more information and a North American and Caribbean licensure map).

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Jeffrey Sepúlveda, N.D.

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For information on coverage of naturopathic medicine by some health insurance plans, please call (787) 607-9188.