What Does a Naturopathic Doctor Do? Training, Licensing and Your First Visit

Short answer: A licensed naturopathic doctor (ND or NMD) is a clinician who completes a four-year graduate program at a school accredited by the Council on Naturopathic Medical Education, passes national board exams, and can diagnose and treat patients within the scope their state allows. Care usually starts with a long first visit and an individualized plan that emphasizes diet, lifestyle and other natural therapies, with referrals when needed. [S01]

The title "naturopath" is used by people with very different training, so the most useful thing to know is which kind of practitioner you are looking at, and what your state lets them do.

Three kinds of naturopathic practitioners

NCCIH, the federal research center for complementary health, describes three groups: [S01]

• Licensed naturopathic physicians complete graduate-level training at a CNME-accredited naturopathic medical school.
• Traditional naturopaths may train through non-accredited programs that vary in length and content. They are not eligible for licensing.
• Other licensed providers, such as chiropractors or physicians, may offer some of the same approaches.

This guide focuses on the first group. The profession is still small: NCCIH estimates about 5,000 licensed practitioners in the United States and more than 2,000 in Canada as of 2016, and national survey data show use of naturopathy rose from 0.2% of US adults in 2002 to 1.3% in 2022. [S01]

What a licensed naturopathic doctor does

According to NCCIH, licensed NDs can diagnose, which may include taking a medical history, doing physical exams, and ordering lab tests and diagnostic imaging, and they can treat patients. [S01] AANMC, the association of accredited schools, describes NDs as trained to work as primary care providers. [S02]

Common treatment approaches include: [S01]

• diet and lifestyle changes
• stress reduction
• herbs and other dietary supplements
• homeopathy
• manipulative therapies and exercise therapy
• counseling

AANMC describes a broad spectrum of therapies, from nutrition and lifestyle counseling to supplements, pharmaceuticals and minor surgical procedures. [S02] Which of these an ND can actually use depends on state law, because scope of practice varies by state. [S01] NDs may also refer patients to conventional providers when appropriate. [S01]

The principles behind the approach

Every ND graduate takes an oath to follow six principles of naturopathic medicine. AANMC summarizes them as treating the individual, supporting the body's ability to heal, identifying the root cause and addressing it as naturally and gently as possible, teaching patients how to create wellness, and preventing illness. [S02] A second framework, the "Therapeutic Order," developed in 1997, promotes choosing the least forceful intervention when it is safely indicated. [S02]

How naturopathic doctors are trained

The educational path has three fixed parts:

1. An accredited program. CNME is recognized by the US Department of Education to accredit naturopathic doctoral programs. Its accredited programs are primarily campus-based, typically take four years, and include two years of clinical training; CNME does not accredit programs delivered primarily or entirely online. [S04] CNME was established in 1978. [S01]
2. National board exams. The North American Board of Naturopathic Examiners administers NPLEX, the board exams used for licensure. [S05]
3. A state license and continuing education. In licensing jurisdictions, NDs must graduate from a four-year naturopathic medical college, pass the national boards, and meet any state continuing education requirement. [S01]

If you are comparing schools rather than providers, see our guides to comparing ND programs and to accredited naturopathic schools.

Licensing by state

Naturopathic licensing is set state by state, not nationally. AANP lists 26 US jurisdictions with licensing or registration laws for naturopathic doctors: 23 states plus the District of Columbia, Puerto Rico and the US Virgin Islands. [S03]

Source: AANP. [S03] AANP notes that Pennsylvania had not yet issued registrations as of 2020 and that the US Virgin Islands board was never formed. [S03] Always check the current status with the state regulator.

Scope of practice varies between these places, including whether and what NDs may prescribe. Outside them, there is no naturopathic license to check, so confirm a practitioner's training directly. For a state-by-state view, see our licensing overview and the guide to ND credentials and licensing.

Licensed ND or traditional naturopath: how they compare

Sources: NCCIH, CNME, NABNE. [S01] [S04] [S05] A third group, other health care providers such as physicians or chiropractors, may also offer naturopathic treatments as part of their practice. [S01]

Working alongside your other doctors

Many people see an ND in addition to a primary care physician or specialist, not instead of one. NCCIH encourages patients to tell all their health care providers about any complementary approaches they use, so decisions can be shared and well informed. [S01] In practice, that means:

• giving your ND your current medication list, so supplement or herb suggestions can be checked against it
• asking your ND to share visit notes or lab results with your other clinicians, with your consent
• telling your physician about any supplements, herbs or homeopathic products the ND recommends

The Oregon Association of Naturopathic Physicians notes that, when necessary, an ND will refer you to other health care practitioners. [S07] NCCIH also cautions that a license does not guarantee that a particular treatment is safe or effective, so it is fair to ask any practitioner what evidence supports a recommendation. [S01]

What a first visit looks like

First visits are longer than most conventional appointments. AANMC describes a typical first visit of 60 to 90 minutes. [S06] Expect roughly this flow:

1. Goals. The ND asks what you want to change, whether that is managing a specific condition or feeling better overall. [S06]
2. Health history. A detailed review of current and past health, medications and lifestyle. Much of the first visit is conversation. [S06]
3. Diet and daily habits. Questions about what you eat, supplements you take, and how food relates to digestion, energy, stress and sleep. You may be asked to keep a food diary before the visit. [S06]
4. Exam and tests. A physical exam and any lab tests needed for an assessment and diagnosis. [S06]
5. Plan. You and the ND agree on an individualized treatment plan and a follow-up schedule. Depending on findings, it may include therapeutic nutrition, herbal medicine, supplements, mind-body techniques, lifestyle counseling or referrals to other providers. [S06]

Follow-up visits are usually shorter. The Oregon Association of Naturopathic Physicians puts follow-ups at about 30 to 60 minutes, though this varies by practitioner. [S07]

How to prepare

• Bring a list of every medication and supplement you take, with doses.
• Bring recent lab results and records from other clinicians.
• Write down your main goals and questions in advance.
• Ask whether the ND will coordinate with your primary care doctor or specialists.

Questions to ask before you book

• Did you graduate from a CNME-accredited program, and did you pass NPLEX?
• Are you licensed in this state, and what does your license allow you to do?
• How do you work with my other doctors?
• What will the first visit and follow-ups cost, and are they covered by any insurance I have?

NCCIH also reminds patients that licenses and certificates do not by themselves guarantee safe, effective care from any provider, and encourages telling all your clinicians about any complementary approaches you use. [S01]