Towards An Inclusive Legislative Model for the Homeopathic Profession
by Loretta Butehorn PhD, CCH; Begabati Lannahan RN, CCH; Todd Rowe MD, MC(H), CCH, DHt; Lucy Vaughters PA-C, CCH
Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.
-The Lorax, Dr. Seuss
Overview
The United States homeopathic community in recent years has been troubled with conflict about the best legislative models to adopt for the homeopathic profession. Many models have been proposed which range from freedom legislation to licensure models. The debate has often centered around an either/or philosophy rather than a both/and approach to this issue.
Unfortunately, this issue has divided the homeopathic community and led to much acrimonious debate. It also has prevented the homeopathic community from moving forward as an organized profession and stifled its growth.
The hope in writing this article is to suggest an inclusive model for the homeopathic profession that will bridge the various “camps” and lead to a possible solution to the debate. In this way, it is hoped that each homeopathic professional can find a place within the homeopathic community that they are comfortable with, while respecting the needs and training of other homeopathic practitioners.
Legislative Models for the Homeopathic Profession
Suggested below are five separate models for homeopathic practice. These levels are not hierarchical and are not exclusive. They can be practiced independently along side each other. Each of the various levels also has advantages and weaknesses.
1. Freedom Legislation - Minnesota, California, Rhode Island, Oklahoma; Arizona (modified form)
2. Homeopathic Medical Assistant Registration - Arizona; Nevada; Connecticut
3. Homeopathic Practitioner Licensure - Other Countries
4. Doctor of Homeopathy Licensure - Other Countries
5. Sub-specialization Homeopathic Licensure - Many States
Level One: Freedom Legislation
Health Freedom is a growing movement in the United States. It takes different forms depending on the State in which it is introduced. Freedom legislation permits unlicensed health care practitioners freedom to practice in the State in which they are practicing, gives freedom of access to patients of unlicensed health care practitioners and legitimizes alternative health care practice. Depending on the State in which this legislation is passed, practitioners are required to disclose their training and qualifications to their clients and not represent themselves as a doctor or physician. Typical modalities that are affected include acupressure; aromatherapy; Ayurveda; cranial sacral therapy; culturally traditional healing practices; detoxification practices and therapies; energetic healing; polarity therapy; folk practices; healing touch; herbology or herbalism; homeopathy; iridology; body work and massage therapy; meditation; mind-body healing practices; naturopathy; yoga teachers; and unlicensed traditional Oriental practices, such as Qi Gong energy healing.
Freedom legislation is currently present in Minnesota, California, Rhode Island and Oklahoma. It is also present in a modified form in Arizona. Freedom of practice is easier in countries where there exists common law (such as England and Canada). The United States does not operate under common law. In common law countries, the homeopathic practitioner can practice as a consultant but not form a treatment plan.
Pros: Safety and protection for the homeopathic practitioner in homeopathic
Practice: Makes Homeopathy More Available in a Legal Way to the Public
Cons: Does not help to build a unified homeopathic profession, nor is there any
regulatory oversight for the safety of patients; Legitimization of
homeopathic practice
Level Two: Homeopathic Medical Assistant Registration and Homeopathic Veterinary Medical Assistant Registration
Homeopathic Medical Assistant Registration is a model of practice where the homeopathic assistant works under the auspices of a licensed homeopathic physician. This individual can be a Medical Doctor, Osteopathic Doctor, Veterinary Doctor or Naturopathic Doctor. Typically homeopathic medical assistants are not licensed but registered by a State Licensing Board.
There are two states where homeopathic medical assistant registration currently exists: Arizona and Nevada. There are fourteen states where regulation of naturopathic medical assistants currently exist (Oregon, California, Idaho, Utah, Arizona, Montana, Kansas, Minnesota, Vermont, New Hampshire, Connecticut, Maine, Massachusetts, Washington DC). Homeopathic medicine is included within the scope of practice of naturopathic medicine. 47 of the 50 states have provisions for Veterinary Technicians.
Pros: Direct Medical Guidance and Medical Support for Homeopathic
Practitioners; Similar to Nursing and Physician Assistant Model; Helps
Issue of Internships and Mentorship
Cons: Restricted form of practice (Must practice under a physician although
degree of restrictiveness for PA and NP varies from state to state); Lack of
Autonomy
Level Three: Homeopathic Practitioner Licensure
Homeopathic Practitioner Licensure provides for the licensure of professional homeopaths. These individuals typically graduate from part-time programs and do not have the authority to medically diagnose or prescribe (they can homeopathically diagnose). The standards for licensure are dependent on the State in which this occurs. Generally licensure at this level would be dependent on an external standard such as certification through the Council for Homeopathic Certification.
This form of licensure does not currently exist in the United States. It does exist elsewhere in the world, such as Canada.
Pros: Helps to grow and legitimize a unified homeopathic profession; Shields
non-medically-licensed homeopaths from prosecution; Helps to protect
reasonable fees for service; Helps to protect the public perception of and
respect for homeopathy; Dispensing permits for homeopathic medicines;
Potential for insurance reimbursment
Cons: Difficult to agree on a common standard although usable standards exist
through the CHC; Difficulties in establishing scope of practice: Difficulties
in Defining Scope of Practice
Level Four: Doctor of Homeopathy Licensure
This form of licensure generally focuses on homeopathic physicians. These individuals have been to full-time homeopathic medical schools and have the authority to medically diagnose and prescribe. This form of licensure does not currently exist in the United States. It does exist elsewhere in the world, India and Great Britain being the best-known.
Pros: Helps to grow and legitimize a unified homeopathic profession; Shields
non-medically-licensed homeopaths from prosecution; Helps to protect
reasonable fees for service; Helps to protect the public perception of and
respect for homeopathy; Dispensing permits for homeopathic medicines;
Potential for insurance reimbursment
Cons: The homeopathic community in the U.S. lacks standards for this level.
Level Five: Sub-specialization Homeopathic Licensure
This level includes medical doctors, osteopathic doctors, naturopathic doctors, doctor’s of oriental medicine, chiropractic doctor’s, physician assistants and nurse practitioners. Practitioners at this level have the authority to medically diagnose and prescribe. For Medical Doctors and Osteopathic Doctors, homeopathic licensure exists in the States of Arizona, Connecticut and Nevada and can be included in the scope of practice with regulatory Board approval in certain other states. For PA’s, homeopathy can be included in the scope of practice so long as it is within the supervising MD’s legal scope, and is approved by the State Regulatory Board. For Naturopathic Physicians, homeopathic licensure exists in the States of Washington, Oregon, California, Idaho, Utah, Arizona, Montana, Kansas, Minnesota, Vermont, New Hampshire, Connecticut, Maine, Massachusetts and Washington DC, For acupuncturists, homeopathic medicine is included in scope of practice for Arkansas, New Mexico and Florida. For Chiropractic Physicians, homeopathic medicine is included within the scope of practice for the State of Florida.
Pros: Provides for homeopathic licensure of specialty groups, or else inclusion of
homeopathy within the scope of practice, of specialty groups
Cons: Does not build a unified homeopathic profession; potential loss of
homeopathic identity when subsumed under sub-specialization licensure;
Lack the infrastructure to adequately train practitioners at this level
Arizona Model
Arizona currently has in place Levels One (modified form), Two and Five. The homeopathic community is working to establish Levels Three and Four. The modified form of Level One will only go into effect as of 9/08. Arizona will be the first State where homeopathic licensure and a modified form of freedom legislation coexist, although this also exists in other countries around the world such as the UK, New Zealand and Canada.
Will the Levels Interfere With Each Other?
Concerns have been expressed within the homeopathic community that to pursue one legislative model, makes it more difficult to pursue another. In particular, concerns have been expressed that to pursue a licensure model (Level’s 3-5) would make it more difficult to pursue freedom legislation (Level 1) or vice versa. We do not believe this to be the case and believe that these levels can coexist. We do feel that it is difficult to pass more than two of these options legislatively at one time. Licensure make make it easier to pass freedom legislation if it pre-exists.
Advantage of an Inclusive Model
It is critical that any legislation that is drafted at any given level, honor and respect the other levels. For example, concerns have been expressed in the past of new naturopathic legislation that would make it more difficult for non-naturopathic physicians to practice homeopathic medicine.
It is our belief that only by creating an inclusive model will the various factions of homeopathic medicine begin to work together more cohesively. In doing so, it is our hope that this would help to strengthen and grow the homeopathic profession.
