Well, it's been 8 years since the government of Ontario passed the Naturopathy Act. It has taken 8 years for the government, the naturopathic profession, and the public to decide what it currently means to be a Naturopathic Doctor in this province. But we finally did it. On July 1, 2015 the Naturopathy Act, 2007 will come into effect, and NDs will move under the same legislation (Regulated Healthcare Practitioners a Act or RHPA for short) as most other health professions in Ontario.
So what does this mean to you? I'll try to highlight the most important parts, in my opinion. It is long, so if you are short on time, you can read the purple text for a summary.
Naturopathic Medicine has been a self-regulated profession in Ontario since 1925, under the Drugless Practitioners Act (DPA). Self-regulated professionals are those who have shown they can put the interests of the public ahead of their own professional interests. NDs have been doing this for 90+ years, and will continue to do so under the RHPA.
Bottom Line: NDs are professional.
Your Benefit: You can trust your ND.
NDs will undergo structured self-assessments, and practice assessments on a regular basis - something that is not currently part of the DPA. While most NDs are regularly performing their own self and practice assessments, this new structure will ensure that all NDs are practicing safely and effectively, and are following best practices. The new guidelines for professional development are quite similar to what was required under the DPA.
Bottom Line: NDs will continue to update their skills on a regular basis.
Your Benefit: Your ND is practicing safely, and their skills are up to date.
Defined scope of practice
As you can imagine, the guidelines in the DPA, 1925 are quite dated and are also quite vague. Under the DPA, the scope of practice for NDs is loosely defined as whatever was taught at the Canadian College of Naturopathic Medicine. Under the RHPA, NDs will have a clearly defined role, with clearly defined rules. While naturopathic medicine is inherently quite safe, this ensures that NDs have the knowledge, skills, and judgment to perform the roles set out in the new Act.
Bottom Line: Clear rules for practice.
Your Benefit: Improved safety.
Access to Ontario Labs
NDs have been running labs with the help of MDs for years. Under the RHPA, NDs will be able to order most labs directly through Ontario labs, without having to go through a middleman. These test still won't be covered by OHIP, although there is a subset of public health tests that NDs will be able to order free of charge to you, the patient. To comply with the Laboratory Act, NDs will no longer be able to collect blood samples in office, with the exception of certain point-of-care tests like blood glucose and blood typing. With the way the Act is currently written, NDs will no longer be able to send samples to and labs outside of Ontario. While this limits some care, it is really quite important, as the Ontario government is not able to ensure the quality of any labs outside of their jurisdiction. The profession is actively working with the Ministry of Health and Long Term Care to find a solution that will enable access to certain labs, while ensuring the integrity of the facility.
Bottom Line: NDs can order lab tests directly.
Your Benefit: Faster access to lab tests.
NDs have always had access to several controlled acts, including communicating a diagnosis, gynecological and rectal exams, spinal manipulations, acupuncture, and administering substances through injection or inhalation. Under the RHPA, not only will NDs have access to all of those acts, but they will also be allowed to delegate some of them to staff or associates. This helps to improve your access to naturopathic care. NDs will also be gaining certain prescribing rights (see below).
Bottom Line: NDs have the knowledge, skills and ability to perform several controlled acts.
Your Benefit: You have health care options.
NDs have not had prescribing rights in the past. Under the RHPA, NDs will have access to certain prescription substances after taking an extra course and passing the associated exam. The exam is on par with the rest of our licensing exams. NDs will have access to intramuscular injections, higher doses of vitamins like vitamin D (>1000 IU), vitamin A (>10,000 IU) and folic acid (>1mg), as well as thyroid hormone, bio-identical hormones, and some restricted herbs. In the short term, you may experience a disruption in care with services like B12 injections as the new regulations require NDs to pass the exam before continuing to administer injections. This disruption is unfortunate and was brought to the attention of the government and the new ND regulatory body (The College of Naturopaths of Ontario), however, they failed to find a solution or allow a grace period. Your ND should be able to provide you with a short-term options to ensure continuity of care.
Bottom Line: NDs can safely prescribe certain restricted substances, and counsel you on the risks/benefits of your medications.
Your Benefit: Improved access to prescription substances.
Believe it or not, NDs have not been able to use the title “Doctor”, despite being Naturopathic Doctors and receiving diplomas stating “Doctor of Naturopathic Medicine” after 7+ years of education. Under the RHPA, NDs will finally be recognized. Most NDs didn’t get into the profession so everyone would call us “Doctor”, but it’s kind of cool that it now applies to us. (Most of my patients call me by my first name anyway!)
Bottom Line: NDs are (and have always been) Doctors
Your Benefit: You can choose to see a doctor that focuses on health, wellness, and disease prevention.
Being a part of the RHPA puts NDs on the same playing field as the rest of the health care professions. In the future, I would expect that you will see better insurance coverage through your health insurance. I would also expect that NDs will be able to handle motor vehicle claims, have more lab tests covered by OHIP, and prescribe certain primary care drugs (No, NDs don’t think drugs are bad).
Changing legislation takes a lot of time, a lot of effort, and a lot of lobbying. Here’s a huge Thank You to everyone involved in the process, and to all of the patients of Naturopathic Doctors who took the time to write to their MPPs during the last few months!
Tracey Teasdale, ND, CISSN