Overview
The education and training of practitioners of complementary and alternative medicine (CAM) are widely varied, as these practices encompass any type of therapy that is not considered conventional or scientifically proven. Many of these therapies, however, have a long history in other cultures. CAM education and training may involve rigorous courses of study similar to those for a medical degree or for postdoctoral training. However, some CAM education consists of only minimal training, such as a six-week course that leads to a certificate. Even within the same discipline, training and certification requirements may vary widely from state to state, because there is no national regulatory body to oversee the process.
The education and training of CAM practitioners are the focus here, so the discussion will cover only those areas of unconventional therapy with standard educational or training programs. Covered here are acupuncturists, chiropractors, homeopaths, massage therapists, naturopaths, and integrated medicine programs that combine conventional medicine with CAM practice.
Many other types of CAM practitioners, such as aromatherapists, crystal therapists, reflexologists, reiki practitioners, and native or indigenous healers, study for long periods with experienced experts in their field. However, no particular training programs, educational courses, recognized requirements, or state or national certifications are available in the United States for these practitioners.
Practitioners
Acupuncturist. Acupuncture is a standard accepted
practice in the Chinese medicine tradition; however, it is relatively new in the
United States and, as such, varies from state to state in education and
certification requirements and venues. About forty states have established
criteria for persons seeking to practice acupuncture. Nonmedical professionals, to
become licensed as an acupuncturist, must take a four-year course of study and a
board examination. Persons with a medical background, such as medical doctors,
dentists, nurses, and chiropractors, must often complete a rigorous course of
study too, including classroom study (a minimum of three hundred hours) and
clinical acupuncture practice, before becoming licensed.
Courses in acupuncture focus on anatomy, physiology, and other areas that are
typical for any type of medical practice. Courses also include detailed study of
the nervous and vascular systems so that a practitioner has a thorough
understanding of needle insertion and the body’s reaction to it. A practitioner of
acupuncture may also be trained in other aspects of Chinese traditional
medicine.
Two bodies certify and accredit acupuncture colleges and practitioners in the United States: the Accreditation Commission for Acupuncture and Oriental Medicine and the American Board of Medical Acupuncture. These organizations provide continuing education and examinations for practitioners and oversight for educational programs in the United States. They also provide standards for acupuncturists trained in other countries who wish to practice in the United States.
Chiropractor. This branch of CAM may be one of the most highly
regulated in the United States. The Council on Chiropractic Education (CCE) is an
accreditation body for chiropractic schools, and its accreditation criteria are
recognized by the U.S. Department of Education. CCE regulates all training
programs for chiropractors. The American Chiropractic Association, a
leading professional organization for chiropractors, provides continuing medical
education and other resources to practitioners.
A chiropractic training program must include a minimum of 4,200 hours of class time, laboratory work, and clinical experience and must include courses in orthopedics, neurology, and physiotherapy (all with a focus on clinical practice of manipulation and spinal alignment). Chiropractors may also pursue studies in a specialty, such as orthopedics, sports medicine, or rehabilitation.
After completion of a doctor of chiropractic (D.C.) program, student practitioners must pass a four-part examination from the National Board of Chiropractic Examiners and must pass a state examination to be licensed. In some areas, the state examination takes the place of the national examination.
Homeopath. The education and training of a homeopath can take
varied courses. Programs designed for medical doctors or others with medical
training tend to focus on homeopathy and its application,
assuming that those with a medical degree would already have a basic background in
medicine and medical practice. Other courses, geared to those who do not have a
medical background, focus more on medical education, such as anatomy and
physiology, but also train students in homeopathy practices and principles.
A few states in the United States offer training in homeopathy (Arizona, California, Colorado, Florida, Massachusetts, and Utah, and the District of Columbia). Admission requirements for courses of study vary widely; some require a medical doctor (M.D.) or similar degree, and others enroll students with little or no medical background. Because homeopathy itself is not regulated in the United States, anyone can use the word “homeopath” to describe themselves or their type of work. However, a person cannot identify himself or herself as a homeopathic doctor or imply to the public that he or she is practicing medicine if he or she does not hold a medical license.
Several programs offer homeopathic education, but no single certification is recognized throughout the United States. Each state has its own standards for licensing this type of care. Some homeopaths are licensed in a conventional type of medicine and may hold a degree as an M.D. or as a nurse practitioner. In Arizona, Connecticut, and Nevada, M.D.’s and D.O.’s (doctors of osteopathy) can be licensed as homeopathic physicians. Homeopathic assistants, who practice under the supervision of a homeopath, are licensed in Arizona and Nevada.
Organizations such as the Council for Homeopathic Certification and the American Board of Homeotherapeutics offer certifications to homeopaths who have completed certain requirements: for example, M.D.’s or D.O.’s who pass oral and written exams in homeopathy. Upon completing these exams, the successful candidate is awarded a diplomate of homeotherapeutics (D.Ht.). Even though the Department of Education does not recognize any one organization as a certifying body, homeopathic practitioners use the standards upheld by these organizations to maintain competency and to encourage self-regulation.
Massage therapist. Most U.S. states regulate the practice of
massage
therapy in some way with a type of governing board providing
certification or licensure. Usually, a massage therapist must complete some course
of training and pass a board examination to be licensed. However, the requirements
vary widely from state to state. Education provided in massage therapy schools
typically requires about five hundred hours of study and involves courses in
anatomy, physiology, motion and body mechanics, and clinical massage practice.
Licensure also may involve passing a nationally recognized test, such as the
National Certification Examination for Therapeutic Massage and Bodywork or the
Massage and Bodywork Licensing Examination.
Naturopath. There are two basic types of naturopath: traditional
and naturopathic physicians. Education and training for traditional naturopaths
vary from nondegree certificate programs to undergraduate degree programs. After
completion of a degree program, a traditional naturopath can certify with the
American Naturopathic Medical Certificate Board and become a naturopathic
consultant. Traditionally, these types of naturopaths do not practice medicine and
thus do not require a license.
A naturopathic physician must have a doctor of naturopathic medicine (N.D., or N.M.D. in Arizona) degree from an accredited school of naturopathic medicine. Only four schools in the United States (in Washington, Oregon, Arizona, and Connecticut) are accredited for this type of education. The N.D. involves four years of graduate-level study in a standard medical curriculum, with added courses in natural therapeutics. Practitioners must then pass a state board licensing examination. (In the state of Utah, naturopathic doctors must complete a residency before starting a practice.)
Practitioners often work as primary care clinicians, but some states do not recognize the D.M. degree, so practitioners in these areas cannot legally practice medicine. Generally, they may still practice traditional naturopathic medicine. Two states, South Carolina and Tennessee, specifically prohibit the practice of naturopathy in any form.
The Council of Naturopathic Medical Education is a governing body that provides
accreditation for education in naturopathy. The American Naturopathic
Certification Board provides testing and continuing education for this
profession.
Alternative Medicine. http://www.pitt.edu/~cbw/altm.html.
American Academy of Acupuncture. http://medicalacupuncture.org.
American Association of Naturopathic Physicians. http://naturopathic.org.
American Chiropractic Association. http://www.acatoday.org.
American Massage Therapy Association. http://www.amtamassage.org.
International Website for Professional Homeopathy. http://www.world-of-homeopathy.info.
National Center for Complementary and Alternative Medicine. “Selecting a Complementary and Alternative Medicine Practitioner.” Available at http://nccam.nih.gov/health/decisions/practitioner.htm. Discusses choosing and evaluating a practitioner and provides questions to ask a practitioner about his or her education.
Tierney, Gillian. Opportunities in Holistic Health Care Careers. Rev. ed. New York: McGraw-Hill, 2007. This book addresses the job outlook, educational requirements, regulation, and salaries for many CAM practitioners.
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