Naturopathic doctors: Underutilized partners in public health and primary care

Naturopathic doctors (NDs) aren’t the first health-care providers that come to mind when thinking about vaccines, so it came as a surprise to several people at a Toronto Public Health COVID-19 mass vaccination clinic that an ND was administering vaccines.

Naturopathic medicine is a distinct system of traditional, complementary and integrative medicine (TCIM) recognized by the World Health Organization; it is often seen as an alternative health system in opposition to science-based practices, and as such many would not expect NDs to be involved in vaccinations.

However, numerous people attending the clinic expressed relief at being able to discuss their vaccine worries with an ND, someone they trusted to be skeptical of broad public health measures and knowledgeable of the medical establishment’s flaws. Seeing a provider who they felt understood their health values gave comfort to some of the more hesitant visitors. One particularly hesitant person had a long list of concerns based on information posted online and on social media. The ND listened, responded to the questions, reviewed the risks and benefits of vaccination, and proactively explained side effects. Grateful for the respectful conversation, the hesitant person left the clinic that day but returned a week later to ask for the ND on site to administer a COVID-19 vaccine.

NDs are a regulated health profession in six provinces/territories in Canada. Educational requirements for licensure eligibility include a Bachelor’s degree, graduation from a Council for Naturopathic Medicine Education (CNME) accredited program, and completion of entry-to-practice examinations. The four-year training covers physiology, pathology and diagnostic skills as well therapeutic use of herbs and other natural health products, lifestyle management and disciplines such as Traditional Chinese Medicine.

Naturopathic doctors emphasize nonpharmaceutical interventions, primarily diet and lifestyle modification for health promotion and prevention. Additionally, NDs use nutritional supplements, herbal medicine, mind-body therapies, manual therapies, acupuncture and prescription drugs. Whereas lifestyle education and motivational counselling are broad skills in the wheelhouse of many health-care workers, NDs are uniquely qualified to advise patients with respect to evidence-informed use of natural health products, including patient education regarding effectiveness, dosing, contraindications, adverse effects and drug-herb interactions. No other health-care worker has the specific training in natural health products that NDs do, so this puts them at an advantage in communicating with patients. Use of Traditional, Complementary and Integrative Medicine (TCIM) is high in Canada, with approximately 56 per cent using at least one TCIM therapy, according to a 2015 survey.

NDs have a deep knowledge of the wellness industry, more so than any other regulated health professional. As the wellness industry continues to boom and become more mainstream, it’s uniquely valuable to have a provider with this particular content-matter expertise in health care. NDs can counsel patients on how to separate misinformation and disinformation from the available evidence so that they can safely integrate TCIM into their overall health care.

Criticism of naturopathic medicine has largely stemmed from the perspective that it eschews the use of evidence-based practice. Indeed, individual NDs have been rightfully criticized for pseudoscientific practices. While concern about the need for increased uptake of evidence-based practice in naturopathic medicine is warranted, the perspective that naturopathic medicine is in opposition to evidence-based practice is not consistent with research. Studies demonstrate that NDs have increasingly embraced evidence-based attitudes, education and practice. Research also suggests that multi-modal naturopathic medicine may be effective at managing conditions commonly seen in primary care, including cardiovascular disease, chronic low back pain, depression, anxiety and diabetes. Certainly, MDs concerned about the harms of pseudoscience should be open to dialogue and partnership with NDs who follow evidence-based approaches rather than summarily dismissing the entire profession.

The role of NDs in helping patients to differentiate between nonsense and useful wellness industry information, as well as the time they can allocate toward patient education, is particularly helpful in counselling those who may be vaccine hesitant. During the height of the COVID-19 vaccination effort, NDs worked for local public health units in British Columbia and Ontario at mass vaccination clinics. At these clinics, NDs offered understanding and validation of hesitancy; provided relatability and credibility; and built vaccine confidence through understanding, education and shared values. Although NDs in B.C. are able to administer vaccines as part of their scope of practice, Ontario only temporarily amended the Regulated Health Professionals Act to enable NDs to specifically administer COVID-19 vaccines. With minor regulatory changes, NDs could not only make ongoing contributions to public health but could also become an important part of primary care.

Primary care providers are increasingly burdened by a capacity crisis related to worker shortages, an aging population, pandemic-specific challenges and increased prevalence of chronic disease and multimorbidity. Team-based, interdisciplinary approaches like those employed by family health teams, community health centres and Aboriginal health centres enable more effective and efficient care for patients with multiple health concerns, thereby reducing the workload on family doctors. Much like social workers, pharmacists, dietitians and physiotherapists do in these interprofessional settings, NDs could collaborate in primary care clinics to increase health-care access, support public health measures, prevent and address chronic diseases and reduce unnecessary visits.

Despite standardized training and licensing exams, NDs remain unregulated in a few provinces and territories, which can lead to friction with other health-care providers due to inconsistencies in regulatory guidelines between jurisdictions. These factors can exacerbate ideas of an unbridgeable divide between MDs and NDs that only serves to harm patients.

Differences in provincial regulation of NDs and scope of practice are vast. In Ontario, NDs can requisition laboratory tests, prescribe some prescription drugs and perform Pap tests. In B.C., NDs can prescribe most primary care medications, administer vaccines, insert IUDs and order diagnostic ultrasound and X-rays. Unfortunately, few models currently exist and research is limited on the opportunities and challenges of integrating NDs into the health-care system more broadly and into team-based primary care specifically.

Qualitative research at Anishnawbe Health in Toronto suggests NDs can contribute to positive health outcomes, patient satisfaction and improved access to health care among Indigenous clients. With more than 2.2 million Ontarians who don’t have a family doctor, there is a strong case for leveraging the skills and scope of NDs in helping to address health and human resource shortages, particularly in northern and rural communities.

Innovative, solution-based thinking will be required to navigate working equitably within both public and private health-care systems and insurance models unless government funding is made available to hire NDs on salary. National licensing and scope equivalency across jurisdictions is important to ensure consistency of care and practice standards and guidelines. A pilot project to assess the viability of ND integration into team-based primary care models is necessary to determine appropriate staffing, as well as to evaluate patient outcomes and experiences.

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  • Dr. Ronald Coleman says:

    Everyone wants to be a doctor, but nobody wants to read no heavy ass books.

  • Joe says:

    Very refreshing to be reading this positivity from this MD. It was a long time coming and I for one am very glad there was a willingness to collaborate with the very well educated, well experienced ND.

    Hopefully it’s not too far in the future when there is broad realization that “primary care” includes an ND as importantly as it does an MD. This collaborative article gives us hope.


    • Janet Bowman says:

      I think there alot of unsung heroes in the health professions. Your article is the tip of an iceberg of expertise and knowledge. I know we have seen alot of foreign nationals come with doctorates degrees only to step down to less demanding requalifing health professions ie osteopathic and such outlying though no less contributing professionals.

  • rickk says:

    Medicine in Ontario is now broken and there is significant skepticism among ‘the patients’. The policies and mandates in the covid 19 era contributed to this (no mask, then mask sometimes, then mask all the time; lockdown, then lockdown some of the time ie. you can buy a bottle of vodka but granny getting her hair done is verboten; the CPSO silencing physicians for opinions on why are we jabbing everyone vs those with increased risk, CPSO rescinding licenses for opinions; the ‘medical community’ ignoring actuarial and insurance data on increased deaths that shot up 2021 and continuing today (there’s a signal there for sure).

  • Jonathan Marcus says:

    What do you call alternative medicine for which evidence has been found?…. medicine. The main argument presented here for looking outside the healthcare system is the breakdown of the system. Reorganizing and funding the system is the answer not this. The reason naturopaths are well accepted by the public is they are paid privately for the most part and therefore can spend time with patients. Doctors are paid (more or less) for volume and as fees have fallen with inflation and increased overhead costs, face time with patients has fallen. FIX THE SYSTEM.

    • Terry Ragbir says:

      You’re absolutely correct that alternative medicine is medicine. You’re also correct that the system is broken. It’s also true that the practice of conventional medicine is broken irrespective of “the system”. Medical doctors are complicit in not spending time with patients, they don’t care to. But they are easily replaceable by an app or by AI…would save a lot of money and the quality of care might improve or at least stay the same.

    • Ali says:

      Our current system is becoming increasingly privatized and when patients head to the doctor they are being billed more and more yet the service is still deteriorating, so imo throwing money at the problem won’t fix it we need a strategic approach that can leverage expertise efficiently. Overlap in scope is good because it can act as a buffer in times of health care strain and with our population increasing and aging this would seem an important consideration.

  • Jacquie Poitras says:

    I am surprised at the lack of balance in this article including vague statements about NDs training in “diagnostic skills”. As a family physician, many of my patients are confused and believe that NDs are equivalent to physicians in training (they are not) and can provide equally informed diagnostic expertise. While there are some naturopaths who aim to be evidence-based and quasi-family physicians, this further confuses patients. I have had patients obtain care from their ND for anemia – providing them with “natural”, lower dose iron supplements while missing any further exploration of the underlying cause of the anemia. Understanding what is within and outside our scope is essential for any health care provider. While I agree that naturopaths can provide dietary and lifestyle motivational counselling outside our OHIP system to patients with the ability to pay, to say they are “uniquely” expert in this area is a disservice to dietitians and family physicians. This article reads as an advertisement for naturopaths, not as a challenge to governments to properly fund primary care.

    • Jonathan Marcus says:

      This ^^^

    • Hanna says:

      I disagree with you. MDs and nurses have to let go of their self righteous belief that everyone has to uphold this hierarchical medical system and worship them as the only source of medical knowledge. A lot of the information spread around by MDs and Nurses about naturopaths are completely false and rooted in self righteousness. Patients benefit from working with NDs. NDs have also caused much less harm to patients than MDs and nurses. Time to let go of your ego and embrace patient centred care.

      • Paul Conte says:

        “NDs have also caused much less harm to patients than MDs and nurses”
        And you KNOW this how?

    • Terry Ragbir says:

      You’re right, it does read like an advertisement for NDs. And you’re right to be worried, but the threat is not from NDs, it’s from AI. Any doctor who follows an algorithmic (EBM) script is easily replaced and well could be soon enough.

    • Joe says:

      Your comment is nonsense and one that is likely based on the experience of a very few, rather than the majority of ND cases.

      Your fear is most common in any MD that is still resisting the need for good NDs.

      Fear from knowing that the more someone sees an ND, follows their well educated, evidence and knowledge based treatment, means a healthier, longer lasting life and in many cases, less need for the MD.

      Harmony is the answer. MDs that realize that close collaboration with an ND always results in better care for their patients will be the ones to excel in healthcare and not just be the symptom treating pill pushers that most have become.

  • Paul Conte says:

    How are ND’s “a cost-effective solution”?

  • T. Adams says:

    The article grasps the benefits of NDs who are being utilized in health care for the betterment of the public. We should insist on regulations for NDs. We rely on Medical Universities & Medical Centers to regulate them. Health systems are in dire need of practitioners and NDs are a cost effective solution to help unload some of the burden. Unfortunately there are social media accounts with large followings that refuse to follow the science & research data on ND effectiveness based on the unethical NDs. We don’t discredit MDs based on the large % of them who’ve made medical errors and prescribe medications because of pharmaceutical kickbacks. So why so much resistance to NDs?

  • Neil Shirtcliffe says:

    What is this doing here? Naturopaths have revealed their true nature as total cranks during the pandemic. A witchdoctor would be a better choice.

    • Jane Duval says:

      Agree. I find it shocking that such utter nonsense is tolerated, given the very real harms caused to gullible patients who postpone science-based treatment.

      • Nicole says:

        There is a proverbial seat at the table for all kinds of healthcare professionals: DOs, MDs, NPs, and NDs. They are all trained in rigorous post-graduation educational programs and while they may be trained differently, they are all needed. I prefer natural medicine; you may prefer a more traditional approach to medicine.

        All doctors make mistakes. For example: “Recent studies of medical errors have estimated errors may account for as many as 251,000 deaths annually in the United States (U.S)., making medical errors the third leading cause of death.” The research goes on to state, “…less than 10 percent of medical errors are reported” (Anderson JG, Abrahamson K. Your Health Care May Kill You: Medical Errors. Stud Health Technol Inform. 2017;234:13-17. PMID: 28186008; https://pubmed.ncbi.nlm.nih.gov/28186008/). That’s a lot of physician error that goes unnoticed and unreported.

        Compare that to this spreadsheet on disciplinary actions against NDs: https://docs.google.com/spreadsheets/d/1FSQxx1ienhHGpCbWPOqrSWQMxYLGTxnpCiSkNy4Rd9s/edit#gid=0 (FNMRA.org).

        If you read about something in the media, it doesn’t mean that it’s representative of what the facts are.

    • Terry says:

      Well, sometimes a witch doctor might be what’s needed. Have you tried one? Perhaps when conv. medicine fails you might look elsewhere. Hopefully you find a legit one and don’t get taken advantage of by a fake witchdoctor.

    • Joe says:

      Time to do a bit of research.


Cyndi Gilbert


Dr. Cyndi Gilbert is a naturopathic doctor in Toronto, faculty at the Canadian College of Naturopathic Medicine, and the Associate Editor of CANDJ, the peer-reviewed journal of the Canadian Association of Naturopathic Doctors. She currently serves as the Board Chair of the Ontario Association of Naturopathic Doctors. She is also a writer and researcher on cultural humility, health equity and inclusive language.


Michelle Cohen


Dr. Michelle Cohen is a family physician in Brighton, Ont. She is also a writer and researcher on gender equity, health policy and health communication.

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