Differentiating Between ND, Integrative MD, DO and DC Providers
Choosing the right doctor can be difficult, especially when it comes to integrative health and medicine. The right doctor(s) will be able to meet your unique health needs and support you in achieving your goals. In this FAQ document you will find information that will describe the similarities as well as differences between four distinct groups of doctors, all of whom are licensed professionals and committed to whole-person, complementary, and integrative health care. These include:
- Naturopathic doctors (ND or NMD)
- Osteopathic Doctors (DO)
- Integrative MDs and DOs
- Chiropractic Doctors (DC)
This FAQ focuses primarily on licensed professionals who have graduated from a four-year, in-residence, graduate level medical school recognized by the U.S. Department of Education, have passed a standardized board examinations, and hold state issued medical licenses from their respective licensing body.
Note that all of these doctors are considered “integrative” in the sense that they may combine conventional medicine approaches with evidence-informed complementary medicine to provide patients with the most appropriate and effective treatments. They share a philosophy of health that acknowledges the role diet, lifestyle, emotions, and environment have on individuals’ health, and focus on health promotion, disease prevention, and the natural and integrative treatment of illnesses. “Integrative medical practices” often employ a combination of MDs, NDs, DOs, DCs and/or other allied care providers, either under one roof or through referral or partnership.
In this FAQ, we define integrative doctors as those who have earned a certification from the American Board of Integrative Medicine (ABOIM). While any of the listed professionals may also refer to themselves as “functional”, we define functional doctors as those who have completed study with the Institute for Functional Medicine Certified Practitioner (IFMCP) program.
Approach to Patient Care
All four types of doctors share principles of patient care. They consider the whole person, address underlying causes of illness and encourage healthy lifestyle habits while addressing the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s well-being. Patient care varies depending on provider training, education, clinical experience and personal style. Two doctors with the same titles/credentials may have unique approaches to patient care, and many doctors have training or credentials in two or more areas. All the doctors listed below may consult with and refer to a broad and diverse community of health professionals to best support their patients.
NDs follow six core principles in clinical care, leading with the healing power of nature, which recognizes that with proper support, the body often has the capacity to recover from injury and illness. NDs focus on identifying and removing obstacles to recovery in order to facilitate the body’s health-restoring and maintenance processes. NDs often spend between one and two hours with patients in an initial appointment to uncover genetic, behavioral, environmental, and lifestyle factors impacting health. NDs view symptoms as the body’s attempt to communicate and correct imbalances. When it comes to illness, naturopathic doctors work to identify and treat the underlying root cause of symptoms which inform the development of personalized treatment plans and to educate, engage and empower patients on their health care path.
NDs employ the Therapeutic Order, which prioritizes natural, minimally invasive therapies first. As state licensure defines, naturopathic doctors can order diagnostic tests such as blood tests, X-rays, MRIs, and perform minor surgery and office procedures NDs can act as primary care providers or may choose to specialize. Specialty associations currently exist for Endocrinology, Environmental Medicine, Gastroenterology, Intravenous Therapies, Pediatrics, Primary Care Medicine, and Oncology. NDs are also trained to use pharmacological drugs when necessary and may do so as state licensure permits.
DOs follow the principles that the human body is a unit, rather than a collection of systems, and that structure and function are interrelated. DOs recognize that the body’s systems are always communicating and believe that disease occurs when the systems are overloaded, and communication is hindered. They respect that the body has an innate healing ability, and osteopathic practices work to optimize structure and function to facilitate the body’s self-healing capacity.
All DOs are able to prescribe pharmaceuticals, and many practice similarly to MDs. DOs practice according to the latest science and technology in pharmaceuticals, surgery and integrative medicine. Uniquely, DOs have advanced training in osteopathic manual medicine (OMM), a hands-on technique used to help diagnose illness or injury and facilitate the body’s natural tendency for self-healing. Some DOs may go on to pursue additional training in any surgical or non-surgical specialty along with specialized fellowships.
Medical Doctors / (Board Certified in Integrative Medicine)
Integrative doctors start as conventionally trained MDs or DOs, and, after becoming board-certified in a primary specialty (i.e. neurology, orthopedics, family medicine), may choose to pursue additional study to specialize in integrative medicine. Integrative medicine doctors draw on many therapeutic approaches and disciplines to help patients identify and treat the root causes of illness as well as symptoms. There is an emphasis on less-invasive and less-harmful interventions, when possible. These providers may also employ pharmaceuticals and other conventional treatments, such as surgery.
Chiropractors practice a hands-on approach to health care and use patient examination to inform diagnosis and treatment. Chiropractors are able to recommend therapeutic and rehabilitative exercises, and many also use nutritional and lifestyle counseling.
DCs employ laboratory testing, diagnostic imaging and other diagnostic interventions as indicated. Chiropractic doctors focus on disorders of the musculoskeletal and nervous systems and the effects of disorder in these areas on general health. Chiropractic doctors commonly work with patients who complain of neuromusculoskeletal issues and back, joint and limb pain or headaches.
Doctors across the spectrum may seek to study additional medical approaches and to develop further skill and capacity for patient care. It’s important to note that all of the above licensed providers can study Integrative Medicine. Similarly, each can take coursework in Functional Medicine. Naturopathic doctors may seek advanced training in naturopathic sub-specialties as part of post-graduate education.
All four types of practitioners graduate from a four-year, full-time, in-residence medical school accredited by the U.S. Department of Education. For all doctors, the first two years of medical school focus on biomedical science, clinical science, and diagnostics.
For naturopathic doctors, much of the ND curriculum in the third and fourth years is devoted to the study of non-pharmaceutical/non-surgical approaches to managing patient conditions in addition to learning evidence-based conventional therapeutic interventions. As part of the pharmacology curriculum, naturopathic doctors learn both medical and clinical pharmacology. While pharmacology course work is similar to conventional medical schools, NDs receive additional training in botanical and supplement/drug interactions plus nutrient depletion caused by long term pharmaceutical use. NDs complete advanced training in clinical nutrition/food as medicine (155+ hours), botanical medicine/evidence-based herbal medicine (130+ hours), and behavioral medicine/counseling (150+ hours), physical medicine, homeopathy, minor surgery, and more. In order to become a licensed ND, graduates must pass the Naturopathic Physician Licensing Exam (NPLEX) administered by the North American Board of Naturopathic Examiners (NABNE).
Like MDs and DOs, a growing number of naturopathic doctors choose to specialize* or focus their practices. Specialty associations currently exist for endocrinology, environmental medicine, gastroenterology, pediatrics, primary care, psychiatry, and oncology and board certification is a component of some of those specialties.
*Use of the term specialist may vary by regulatory jurisdiction.
Osteopathic medical school curriculums are very similar to those of conventional medical doctors (MDs).DO students complete approximately 200 hours of training in osteopathic manual medicine (OMM). As the American Osteopathic Association explains, DO students “receive extra training in the musculoskeletal system, which is the body’s interconnected system of nerves, muscles and bones.” DOs use this knowledge to perform osteopathic manipulative treatment (OMT). All DOs complete a three to seven year residency towards a chosen specialty. While MD and DO students enroll in the same residency programs and take the same state board exams, DO students also take the Comprehensive Medical Licensing Examination (COMLEX) while in medical school. DOs practice in all 50 states.
Medical Doctors / (Board Certified in Integrative Medicine)
After completing a residency and becoming licensed in a primary specialty, some DOs and MDs go on to pursue training in a post-graduate sub-specialty. One- or two-year fellowships offer in-depth training in a particular area, and as of 2014, integrative medicine is one of these options. More than 18 integrative medicine fellowships exist that prepare doctors to sit for the American Board of Integrative Medicine (ABOIM) exam. Integrative medicine fellowships provide 1,000+ hours of coursework in integrative medicine. Some programs offer hands-on clinical training in botanical medicine, clinical nutrition, mind-body medicine, complementary and alternative medicine (i.e. Ayurveda, manual medicine, homeopathy), environmental health, and more. Board certification is available through the American Board of Physician Specialities (ABPS) via the American Board of Integrative Medicine (ABOIM) speciality board for MDs and DOs.
More than 60 medical schools offer an integrative medicine fellowship that prepares doctors to sit for the American Board of Integrative Medicine exam.
Integrative medicine fellowships provide 1,000+ hours of coursework and hands-on clinical training in botanical medicine, clinical nutrition, mind-body medicine, complementary and alternative medicine (i.e. Ayurveda, manual medicine, homeopathy), environmental health, and more. Board certification is available to MDs and DOs.
DCs attend four-year post graduate, full time chiropractic medical schools recognized by the U.S. Department of Education. Chiropractors study the same basic sciences as the other fields of medicine such as anatomy, and physiology as well as rehabilitation, nutrition and public health. In total, the curriculum requires at least 4,200 hours of classroom, laboratory and clinical experience. Chiropractic education is approved by the Council on Chiropractic Education recognized by the U.S. Department of Education.
After graduation, chiropractic doctors must pass national standardized board exams before being eligible for licensure and must maintain their license by acquiring continuing education (CE) credits. Certification is overseen by the National Board of Chiropractic Examiners (NBCE).
Doctors across the spectrum may seek to study additional medical approaches and to develop further skills and capacity for patient care. It’s important to note that all the above licensed providers can study Integrative Medicine or Functional Medicine.
Those practicing functional medicine can graduate from any of the four types of medical schools. After completing state licensure, doctors pursue functional medicine training in post-graduate study, through the Institute for Functional Medicine. Coursework consists of a week-long overview course and six two-to three-day modules (approximately 150 total hours) focusing on different systems of the body including: gastrointestinal, immune, hormone, and cardiometabolic. IFMCP certification is awarded after successful completion of the coursework, a written case report, and passage of a written exam. Functional medicine providers pursue a detailed understanding of each patient’s genetic, biochemical, and lifestyle factors, often through lab testing. That information is leveraged to direct personalized treatment plans. How they approach both diagnosis and treatment varies largely depending on the practitioner’s foundational medical education and training (ND, DO, DC or MD). Note that the IFMCP (the official functional medicine certification) is also available to many health care professionals who are not doctors, such as registered nurses, dieticians, occupational therapists, physical therapists, and others. There is no board certification for functional medicine.
Choosing a Doctor
Health care is highly personal. Often, there is not a single practitioner that will meet all your health and medical needs. A team or combination of doctors with a range of expertise may help you achieve more of your health goals over a lifetime. To find a practitioner and to create a team where you can address both short and long-term concerns is often more important than any single credential.
A service for consumers from the American Association of Naturopathic Physicians (AANP) and the Institute for Natural Medicine (INM). For their contributions to this piece, the AANP and the INM would like to acknowledge Tabatha Parker, ND, Romie Mushtaq, MD, ABIHM, Roger Mignosa, DO, Mary Pardee, ND, IFMCP, and Thomas Kruzel, ND.