Big news for Ontario Naturopathic Doctors!

Proclamation of the Naturopathy Act 2007

Questions and Answers signpostAs of July 1, 2015, Naturopathic Medicine in Ontario has moved under the Regulated Health Professions Act (RHPA), which governs all regulated health professions in the province of Ontario.  The new regulatory body for the profession is The College of Naturopaths of Ontario.

This is a long-awaited (in the works since before 2007!) and exciting announcement for Naturopathic Doctors.  Becoming part of the RHPA opens the door for better integration with other regulated health professionals and improved collaborative care for our patients.

5 fun facts about Naturopathic Doctors:

  1. Naturopathic medicine is a distinct system of primary care that addresses the root cause of illness or disease and promotes health and healing using natural therapies.
  2. Naturopathic Doctors are authorized in Ontario to perform 7 “controlled acts,” giving us the largest scope of practice of any “natural medicine” practitioner.  Only medical doctors (MDs), nurse practitioners, and dentists are authorized to perform more controlled acts (we’re #4!).
  3. The titles “Naturopath,” “Naturopathic Doctor,” and “ND” are officially protected titles in Ontario, meaning that only those who have completed required training (undergraduate degree plus 4 years of naturopathic medical school) and met the requirements for licensing (North America and Ontario exams) can use these titles.
  4. Naturopathic Doctors are the natural medicine experts, integrating standard medical diagnostics with a broad range of natural therapies.
  5. Naturopathic treatment modalities may include clinical nutrition, botanical medicine, homeopathy, physical medicine, Asian medicine (including acupuncture), and lifestyle counselling.

What has changed as of July 1, 2015?

For the most part, NDs have maintained the same scope of practice, with some key changes.  I’ve noted specific changes that will affect patients in my practice.

Laboratory Testing:

NDs now have direct access to order lab testing (previously access was via an MD liaison) which includes 194 lab tests on blood, stool, urine, saliva, hair, tissue/discharge and breath and perform 16 in-office tests.  There are a few tests that NDs can no longer order:

  • Endocervical swab for Chlamydia trachomatis and/or Neisseria gonorrhoea (this will likely change, see below)
  • Genetic testing, including single nucleotide polymorphisms (SNPs)
  • Secretor tests, however these can be purchased directly online here

NDs can no longer draw most blood samples (other than for in-office tests listed above) in-office, so patients will have to visit an Ontario lab facility for blood draws for most tests.  Blood samples for IgG food sensitivity testing can no longer be collected in-office but patients can be sent to an Ontario lab for a blood draw instead

As before, any tests performed via an ND are NOT covered by OHIP and must be paid out-of-pocket by the patient.

The Ministry of Health and the Ontario Association of Naturopathic Doctors are working together to set up ND access to the following public health tests that were not previously available to NDs (date to be determined):

  • CMV (IgM, IgG, DNA)
  • Epstein Barr Virus
  • Hepatitis A Total Antibody (Anti-HA V)
  • Hepatitis B Core Antibody
  • Hepatitis B Surface Antibody
  • Hepatitis B Surface Antigen
  • Hepatitis B DNA
  • Hepatitis C Anti-HCV
  • Hepatitis Viral Load
  • HIV
  • Lyme Serology Testing
  • Rubella Antibody
  • VDRL
  • Chlamydia
  • Gonorrhea

Prescription Rights:

NDs have gained the ability to prescribe some additional restricted drugs and substances, but must first successfully complete a comprehensive prescribing course and exam.

Until NDs complete this requirement, there are some restrictions on prescribing, including the following key items that were previously not restricted:

  • Vitamin A > 10,000IU per day
  • Vitamin B12 administered via intramuscular injection (may still be prescribed orally)
  • Vitamin D > 1000IU per day
  • Vitamin K1 > 0.120mg per day
  • Vitamin K2 > 0.120mg per day
  • Folic acid > 1mg per day
  • Pancreatin > 20,000USP units lipase activity per dosage unit
  • L-Tryptophan > 220mg per day

Dosages of the above nutraceuticals that fall below the listed limits may still be prescribed as usual.

The name is Whimster, Dr. Whimster:

Despite common usage for many years, Naturopathic Doctors could not use the “Doctor” title in front of our names.  That is, until now!  As of July 1, 2015, Naturopathic Doctors may use the restricted title of “Doctor” or “Dr.” in front of our names, provided we include “Naturopath,” Naturopathic Doctor,” or “ND” after our names.

Those of you who are accustomed to calling me Dr. Kate, Dr. Whimster can now “officially” do so, but if you are accustomed to calling me Kate, don’t worry, that’s fine too!

What does this mean for me (the patient)?

For the most part, it will be business as usual for my patients.  Some testing procedures will change slightly to meet the new testing guidelines and some treatment plans will require adjustment in light of the new prescribing guidelines.

I am working on carving out some study time to complete the prescribing course and exam by the end of 2015 at the latest.

At both my practice locations, we are working on adjusting to the changes above to ensure a smooth continuation of care for all patients and will keep individuals informed of any changes that will affect them specifically.

This is an exciting time for Naturopathic Medicine in Ontario!

These regulatory changes ensure continued patient safety, increase clarity regarding the scope of Naturopathic Doctors, and open up opportunities for intra-professional collaboration and support.
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