A Framework for Credentialing Naturopathic Physicians in Academic Health Centers: Oregon Health and Science University

Dear Editor:

Today an increasing number of Americans utilize complementary and alternative (CAM) therapies. In fact, approximately 38% of adults use some form of CAM for health promotion and symptom management. ¹ As a result, the integration of conventional, allopathic, and CAM methods of care is becoming a part of the mainstream healthcare system in the United States. ² With the increase in CAM use has come a concern about how hospitals and integrative medical centers should credential CAM practitioners. A random survey of 39 academic health centers (AHCs), revealed that none had written policies concerning CAM credentialing practices. ³ This letter briefly reviews the issues in the credentialing and privileging at AHCs of naturopathic physicians (NDs) with degrees from accredited naturopathic medical schools ⁴ and reviews the written policy developed at Oregon Health and Science University (OHSU) that is currently used to credential and privilege NDs.

Credentialing is defined as “the process of obtaining, verifying, and assessing the qualifications of a healthcare practitioner to provide patient care services in or for a healthcare organization.” ⁵ Once a practitioner is credentialed, a healthcare organization takes further steps to assess the practitioner's clinical competence in a specific area of patient care. This process is known as privileging. Although licensed NDs who have graduated from an accredited naturopathic medical school have a uniform education and are required to pass national board exams, the current lack of standardized residency requirements, licensure in only 17 states, and varying scopes of practice between licensed states create challenges in credentialing and privileging at AHCs. ^4,6–7 In addition, credentialing may result in decreased individualization of services, increased patient volume, and decreased time spent with patients, which can lead to decreased satisfaction for both patients and NDs. ^5,8 Despite these challenges, the benefits of credentialing and privileging for patients and clinicians are many and include the facilitation of collaboration and patient communication between clinicians, coordination of care and risk management through electronic medical records, and the translation of naturopathic therapies into standardized diagnostic codes to streamline billing. ⁵

In November 2012, OHSU approved credentialing and privileging requirements for NDs (see Table 1). To maintain consistency with the rigorous standards applied to all credentialed healthcare professionals at the institution, the requirements include postdoctoral training (clinical or research) in an AHC to establish cultural competence and the completion of one year in a residency approved by the Council on Naturopathic Medical Education or two years of direct clinical practice in a hospital accredited by the Joint Commission or the Centers for Medicare and Medicaid Services to establish clinical competence. The scope of practice approved closely follows the ND scope of practice in Oregon. ⁹ The approval of these requirements and ND scope brings into existence a defined process that provides a path to credentialing and privileging NDs at OHSU, some of whom in Oregon and elsewhere, already meet these requirements.