Licensing and certification of CAM practitioners
Licensing and certification of Complementary and Alternative Medicine (CAM) practitioners involve regulatory processes that ensure practitioners meet specific educational and training standards to provide safe and effective care. In the United States, licensing is administered at the state level and typically requires practitioners to complete designated educational programs, pass relevant examinations, and maintain continuing education to keep their licenses valid. Certification, on the other hand, is often provided by professional organizations that validate a practitioner's expertise in a particular CAM specialty, usually involving a competency exam.
The requirements for both licensing and certification vary significantly across different CAM fields, such as chiropractic, acupuncture, homeopathy, naturopathy, osteopathy, midwifery, massage therapy, and hypnosis. For instance, chiropractors are licensed in all states, whereas the licensing for acupuncturists can differ, depending on whether they are physician acupuncturists or non-physician practitioners. Similarly, while most states require massage therapists to be licensed, others have distinct regulations for midwives and hypnotherapists. Overall, the landscape of CAM regulation reflects a diverse approach to ensuring practitioner qualifications, balancing safety, accessibility, and the evolving nature of healthcare practices.
Licensing and certification of CAM practitioners
DEFINITION:The regulation of complementary and alternative medicine practice through licensing and certification.
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 US 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 and twenty hours of acupuncture training, including one hundred and twenty hours of didactic training and one hundred hours of clinical training. Some states may require more hours. 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. However, in Arizona, California, Connecticut, District of Columbia, Idaho, Kansas, Maine, Minnesota, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington, naturopathic licenses include homeopathy.
Naturopaths. Twenty-six jurisdictions have licensure requirements for naturopaths in the United States. For licensure, naturopaths must complete four years of naturopathic medical college and pass the Naturopathic Physicians Licensing Examination. Several states also require that naturopaths be qualified to practice natural childbirth or acupuncture or to dispense natural substances. In Tennessee, Florida and South Carolina, practicing naturopathy is illegal. In California, Colorado, Idaho, New Mexico, Minnesota, Pennsylvania, and Wisconsin, licensure or registration is offered but not required as long as practitioners do not market themselves as a registered or licensed naturopath. The remaining states do not license naturopaths, and most do not permit them to practice.
Osteopaths. Osteopaths are licensed as medical doctors in all US 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 US Medical Licensing Exam or the Comprehensive Osteopathic Medical Licensing Exam.
Massage therapists. Massage therapists are licensed in forty-five US 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 obtain certification, which consists of both clinical and didactic hours.
Midwives. Midwives can be either nurse-midwives or non-nurse midwives. Most midwives in the US 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, and Washington require hypnotherapists be licensed. In Colorado, they can be licensed as psychotherapists or listed on an unlicensed psychotherapist database. Some of the remaining states have regulations regarding the practice of hypnosis. California, Florida, Illinois, New Jersey, Texas, and Utah do not have mandatory registration but do lay out specific regulations for the practice of hypnotism and guidelines for licensure exemption. The remaining states may require that the hypnotist have other medical credentials, while 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.
Bibliography
Arizona Department of Health Services. “Midwife Licensing Program: News and Updates.” www.azdhs.gov/als/midwife.
Chiroweb. “Licensure and Legal Scope of Practice.” www.chirowweb.com/archives/ahcpr/chapter5.htm.
"Homeopathy Practice and the Law: A Guide for Homeopathy Practitioners in the United States and Canada." North American Society of Homeopaths, 9 Dec. 2022, homeopathy.org/wp-content/uploads/2023/01/Homeopathy-Practice-and-the-Law-Dec-2022.pdf. Accessed 20 Sept. 2024.
“International Association of Hypnotherapists - Hypnosis Law.” Institute of Interpersonal Hypnotherapy, www.instituteofhypnotherapy.com/iaih-hypnosis-law/. Accessed 20 Sept. 2024.
“Massage Therapy State Licensing Requirements.” Associated Bodywork & Massage Professionals, www.abmp.com/practitioners/state-requirements. Accessed 20 Sept. 2024.
“Naturopathic Doctor Licensure - List of States and Provinces.” AANMC, aanmc.org/licensure/. Accessed 20 Sept. 2024.
Pokladnikova, Jitka, and Ivo Telec. "Provision of Complementary and Alternative Medicine: Compliance with the Health Professional Requirements." Health Policy, vol. 124, no. 3, Mar. 2020, pp. 311-316. doi.org/10.1016/j.healthpol.2020.01.009.
“Study Chiropractic.” Association of Chiropractic Colleges, www.chirocolleges.org/students/study-chiropractic/. Accessed 20 Sept. 2024.
Tierney, Gillian. Opportunities in Holistic Health Care Careers. Rev. ed., McGraw-Hill, 2007.