Requirements for Practice
Licensure is a process in which the government reviews and verifies the credentials of a health care practitioner and then grants a license to practice within a given state. Certification is a credential issued by a professional organization that represents a complementary and alternative medicine (CAM) specialty. Persons seeking certification must pass a test of their knowledge of the specialty. Licensing is required to practice, but credentialing may not be.
In the United States, licensure for CAM practitioners is provided by the state in which the person seeks to practice. Licensure most often requires educational credentials and the passing of an examination that demonstrates the practitioner’s knowledge. All licensed CAM practitioners are required to complete a specified number of hours of continuing education annually to maintain their licenses. Licensure and certification requirements for CAM practitioners vary with the CAM field. The CAM practices discussed here are chiropractic, acupuncture, homeopathy, osteopathy, naturopathy, midwifery, massage therapy, and hypnosis.
Licensing
Chiropractors. Chiropractors are licensed by all fifty
U.S. states and the District of Columbia. To be licensed, a chiropractor must
complete four years of chiropractic education and then must
pass the National Board of Chiropractic Examiners examination or a state-prepared
examination.
Acupuncturists. Physician acupuncturists, as distinguished from
nonphysician acupuncturists, can practice in any state and are, according to the
American Academy of Medical Acupuncture, required to have medical training and two
hundred hours of acupuncture training. Nonphysician acupuncturists receive
different credentials depending on the type of acupuncture training program they
attended. A nonphysician acupuncturist can be a certified acupuncturist, a
licensed acupuncturist, a diplomate of acupuncture, or a master or doctor of
Oriental medicine.
Training in acupuncture takes from two to four years and often includes clinical internships. Licensing of nonphysician acupuncturists varies from state to state. Many states license certified acupuncturists, but a few states have no regulations regarding acupuncture. Some states permit only physician acupuncturists to practice.
Homeopaths. Arizona, Connecticut, and Nevada are the only states
that license homeopaths; homeopaths in these states are required to be medical
doctors. Rhode Island, California, and Minnesota permit homeopaths to practice
without a license under the new health freedom laws. Homeopaths are not permitted
to practice in the remaining states. General homeopathic
education lasts four years, but it is shorter for already licensed medical
doctors.
Naturopaths. The states of Alaska, Arizona, California,
Connecticut, Florida, Hawaii, Idaho, Kansas, Maine, Montana, and New Hampshire,
and the District of Columbia, license naturopaths. For licensure, the naturopath
must complete four years of naturopathic medical college and pass the Naturopathic
Physicians Licensing Examination. Several of these states also require that
naturopaths be qualified to practice natural childbirth or acupuncture or to
dispense natural substances. In Tennessee and South Carolina, practicing
naturopathy is illegal. The remaining states do not license
naturopaths and do not permit them to practice.
Osteopaths. Osteopaths are licensed as medical
doctors in all U.S. states. Medical licensure requires graduation from an
accredited medical or osteopathic school, an internship and residency, and,
possibly, a fellowship in a specialty. In addition, they must pass either the U.S.
Medical Licensing Exam or the Comprehensive Osteopathic Medical Licensing
Exam.
Massage therapists. Massage therapists are licensed in
thirty-seven U.S. states and the District of Columbia. The requirements for
licensure vary from state to state, but many states require that massage
therapists pass an examination and be certified.
Midwives. Midwives can be either nurse-midwives or non-nurse
midwives. Most midwives in the United States are nurse-midwives. Non-nurse
midwives are permitted to practice only in a few states (such as Arizona).
Non-nurse midwives can attend a midwifery school and then serve as an
apprentice to a licensed midwife. In Arizona, they must pass a state examination.
Nurse-midwives must have a bachelor’s degree in nursing and a master’s degree in
nursing with a concentration in midwifery. They must pass a nurse licensing
examination and an advanced-practice nursing examination, then must work as an
intern or apprentice for about two years in an emergency room, clinic, hospital,
or obstetrician’s office. To be licensed, nurse-midwives must pass the American
Midwifery Certification Board exam.
Hypnotists. The states of Colorado, Connecticut, Indiana, and
Washington require licensure for hypnotists. Each state has its own criteria for
licensing. Indiana has an educational requirement for licensing, but the other
three states do not. Some of the remaining states have regulations regarding the
practice of hypnosis; others require that the hypnotist have other
medical credentials; and others treat hypnotists as business persons and require
no credentialing.
Certification
No formal certification process exists for chiropractors. Nonphysician acupuncturists have to be certified to be licensed, but physician acupuncturists do not. To be certified, nonphysician acupuncturists must pass the National Certification Commission of Acupuncture and Oriental Medicine examination.
Medical doctors and osteopaths who become homeopaths can be certified by the American Board of Homeotherapeutics. They must be educated in homeopathy and must pass oral and written examinations. Nonphysician homeopaths can achieve certification by passing the examination of the Council for Homeopathic Certification. This credential is not required for state licensure.
Naturopaths do not have a certification process. Osteopaths can become board certified in their specialty, but it is not required for licensing. Massage therapists must be certified to practice. They can become certified by passing the Federation of State Massage Therapy Boards examination or by passing one of the National Certification Examination for Therapeutic Massage and Bodywork examinations.
A certification process exists for hypnotists, but it is not required for state licensure. The American Council of Hypnotist Examiners certifies hypnotists who pass its examination. Nurse-midwives must be certified to be licensed. Non-nurse midwives may become certified by the North American Registry of Midwives after completing their education.
Arizona Department of Health Services. “Midwife Licensing Program: News and Updates.” Available at http://www.azdhs.gov/als/midwife. A summary of Arizona law on the licensing of midwives.
Chiroweb. “Licensure and Legal Scope of Practice.” Available at http://www.chirowweb.com/archives/ahcpr/chapter5.htm. Discusses the state licensing of chiropractors in the United States.
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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