An ND is a naturopathic doctor, a healthcare provider who completes a four-year graduate-level medical program focused on treating illness through natural therapies, nutrition, and disease prevention. NDs are licensed to diagnose conditions and prescribe treatments in 26 U.S. jurisdictions, though their scope of practice varies significantly by state.
What Naturopathic Doctors Do
Naturopathic doctors function as primary care providers in states where they’re licensed. They conduct physical exams, order diagnostic tests, diagnose medical conditions, and create treatment plans. What sets them apart from conventional physicians is their emphasis on finding and addressing the root cause of illness rather than focusing primarily on symptom management, and their preference for natural or minimally invasive treatments as a first line of care.
Two core principles guide their clinical approach. The first, often called “the healing power of nature,” holds that the body has an inherent ability to heal itself, and that a provider’s job is to support that process. The second, “identify and treat the cause,” reflects the philosophy that illness doesn’t occur without an underlying reason, and that treating only symptoms without addressing what’s driving them leads to incomplete care. In practice, this means an ND might spend significant time on a patient’s diet, stress levels, sleep habits, and environmental exposures alongside any conventional testing.
Education and Training Requirements
Becoming a licensed ND requires a bachelor’s degree followed by a four-year, in-residence doctoral program at a school accredited by the Council on Naturopathic Medical Education (CNME), the only accrediting body recognized by the U.S. Department of Education for naturopathic programs. Students complete a minimum of 4,100 hours of classroom and clinical instruction, including at least 1,200 hours of supervised hands-on patient care.
The curriculum covers the same foundational sciences taught in conventional medical schools: anatomy (with cadaver dissection), physiology, biochemistry, microbiology, immunology, and pharmacology. On top of that, ND students study botanical medicine, clinical nutrition, homeopathy, physical medicine, and lifestyle counseling. There are currently seven accredited ND programs in the U.S. and Canada, at institutions including Bastyr University (Washington and California), National University of Natural Medicine (Oregon), Sonoran University of Health Sciences (Arizona), National University of Health Sciences (Illinois), Canadian College of Naturopathic Medicine (Ontario and British Columbia), and Universidad Ana G. Méndez (Puerto Rico).
After graduating, NDs must pass a two-part national board exam called the NPLEX. Part I covers biomedical sciences, and Part II tests core clinical knowledge. Depending on the state, additional elective exams in acupuncture, pharmacology, minor surgery, or injectable therapies may also be required for licensure.
How NDs Differ From MDs
NDs and MDs share a foundation in basic medical sciences, but the two paths diverge sharply in clinical training hours and treatment philosophy. The American Medical Association notes that physicians complete 12,000 to 16,000 hours of clinical training through medical school and residency, compared to the ND minimum of 1,200 hours of direct patient contact. MDs and DOs also complete residency programs lasting three to seven years after medical school, which NDs are not required to do.
The treatment toolbox is different as well. MDs typically reach for pharmaceutical drugs and surgical procedures as standard interventions. NDs tend to prioritize dietary changes, herbal medicine, supplements, physical therapies, and lifestyle modifications, turning to prescription medications when those approaches aren’t sufficient. In states like Washington, NDs can prescribe most non-controlled prescription drugs and certain controlled substances like testosterone, but their prescribing authority is narrower than what MDs hold.
Licensed ND vs. Traditional Naturopath
This distinction matters and causes real confusion. A licensed naturopathic doctor (ND or NMD) has completed an accredited four-year doctoral program, passed national board exams, and holds a state license to diagnose and treat patients. A traditional naturopath has not. Traditional naturopath programs are often online or correspondence-based, lack standardized curricula, and carry no accreditation recognized by the U.S. Department of Education.
In states that don’t regulate naturopathic practice, a traditional naturopath can choose to call themselves a “naturopathic doctor” with no legal consequence. If you’re looking for a provider with medical training, check that they graduated from a CNME-accredited school and hold an active license in your state. The titles are not interchangeable: a licensed ND is trained to diagnose and prescribe, while a traditional naturopath is not.
Where NDs Can Practice
Currently, 23 states plus the District of Columbia, Puerto Rico, and the U.S. Virgin Islands have licensing or registration laws for naturopathic doctors. These include Alaska, Arizona, California, Colorado, Connecticut, Hawaii, Idaho, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, New Mexico, North Dakota, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Washington, and Wisconsin.
What an ND is allowed to do varies widely between these jurisdictions. Some states grant broad primary care authority, including prescribing rights and the ability to perform minor surgical procedures. Others limit NDs to a narrower set of natural therapies. In states without licensing laws, NDs may practice in a more limited capacity or not at all, depending on how state law defines the practice of medicine.
Insurance Coverage
Coverage for naturopathic visits is inconsistent and has been shrinking in some areas. Some private insurance plans cover ND visits, particularly in states with licensing laws, but it depends entirely on your specific plan and provider network. Medicare does not cover naturopathic care under traditional Medicare. Some Medicare Advantage plans have offered limited naturopathic benefits in the past, but several carriers, including Regence, dropped this coverage starting in 2024.
If you’re considering seeing an ND, the most reliable step is to call your insurance company and ask specifically about naturopathic coverage before booking. Many NDs also offer direct-pay or sliding-scale options for patients without coverage. Your plan’s annual Summary of Benefits will also list whether naturopathic services are included.