An ND degree is a Doctor of Naturopathic Medicine, a four-year graduate-level degree that trains practitioners to diagnose and treat patients using a combination of conventional diagnostic tools and natural therapies. It’s a professional doctorate, similar in structure to an MD or DO program, though with significant differences in clinical training hours, treatment philosophy, and scope of practice.
What the Degree Covers
ND programs take four years to complete and are structured much like conventional medical schools in their first two years, with coursework in anatomy, physiology, biochemistry, pathology, microbiology, and immunology. Where the programs diverge is in clinical training. ND students study botanical medicine, homeopathy, nutrition therapy, physical medicine, and psychology alongside conventional pharmacology and diagnostic imaging.
Applicants need a bachelor’s degree with undergraduate science prerequisites. All accredited programs require coursework in biology, general chemistry, and organic chemistry. Physics, biochemistry, math, and psychology may also be required depending on the school.
Accredited Programs in North America
Only a handful of schools offer accredited ND degrees. The Council on Naturopathic Medical Education (CNME) currently accredits programs at seven institutions:
- Bastyr University (campuses in Washington State and San Diego, California)
- Canadian College of Naturopathic Medicine (campuses in Toronto, Ontario and New Westminster, British Columbia)
- National University of Health Sciences (Lombard, Illinois)
- National University of Natural Medicine (Portland, Oregon)
- Sonoran University of Health Sciences (Tempe, Arizona)
- Universidad Ana G. Méndez (Gurabo, Puerto Rico)
Graduating from a CNME-accredited program is typically required to sit for licensing exams and practice legally in regulated states.
Licensing Exams
After completing the degree, graduates must pass the NPLEX (Naturopathic Physicians Licensing Examinations), which has two parts. Part I covers biomedical sciences: 200 questions on anatomy, physiology, biochemistry, genetics, microbiology, immunology, and pathology. Students usually take this exam during their program.
Part II is a clinical exam with roughly 400 questions organized into about 80 case clusters. It tests diagnostic skills (physical exam findings, lab interpretation, imaging), botanical medicine, homeopathy, nutrition, physical medicine, psychology, emergency medicine, and pharmacology. Passing both parts is required for licensure in regulated jurisdictions.
Where NDs Can Practice
Licensure for naturopathic doctors varies significantly by state. At least 23 states and Washington, D.C. currently regulate the profession. These include Arizona, California, Colorado, Connecticut, Hawaii, Oregon, Vermont, Washington, and others. In states without regulation, the legal standing of naturopathic practice is murky, and the title “naturopathic doctor” may not carry the same protections or requirements.
Scope of practice also varies. Fifteen states grant NDs some form of prescriptive authority, though most limit this to non-controlled medications, antibiotics, vitamins, minerals, and other natural therapeutic substances. Eight states (Arizona, California, New Hampshire, New Mexico, Oregon, Utah, Vermont, and Washington) allow NDs to prescribe limited controlled substances, sometimes with additional training or supervision requirements.
How ND Training Compares to MD Training
Both degrees require four years of graduate study and cover foundational medical sciences. The critical difference is clinical training. ND programs require a minimum of 1,200 hours of direct patient contact. MD programs, by contrast, include 12,000 to 16,000 hours of clinical training, at least ten times more. Much of that difference comes from the residency system: MDs complete three to seven years of supervised residency after medical school, while residency programs for NDs exist but are not universally required.
The treatment approach also differs. MD training emphasizes pharmaceutical interventions and surgery. ND training prioritizes natural and preventive therapies, though it includes pharmacology. NDs are not trained to perform major surgery, and their prescriptive authority is narrower than that of MDs in every state.
Career Outlook and Salary
Most naturopathic doctors work in private practice, either solo or in integrative health clinics alongside conventional providers. Some work in wellness centers, corporate health programs, or academic settings. According to a 2020 survey by the Association of Accredited Naturopathic Medical Colleges, full-time NDs earn between $80,000 and $150,000 per year on average. Income depends heavily on location, patient volume, years in practice, and any specialty services offered.
Building a private practice takes time, and many new graduates start with lower earnings that grow as they establish a patient base. NDs in states with broader scope of practice and stronger public awareness of naturopathic medicine tend to earn more.