Demystifying the Doctors

A closer look at the training requirements and educational standards for those who use the title “doctor”

By Paul Henderson

From a designation earned through rigorous education lasting years, to credentials bought over the Internet like a pair of socks, the word “doctor” is being used and misused in modern healthcare. Heck, Vitality is in the business of health and we had a hard time sorting some of this out.

So you are seeing a “doctor,” what does that mean? According to section 33 of Ontario’s Regulated Health Practitioners Act of 1991 no one is allowed to use the title “doctor” or abbreviation except members of one of five organizations: the College of Chiropractors of Ontario; the College of Optometrists of Ontario; the College of Physicians and Surgeons of Ontario; the College of Psychologists of Ontario; or the Royal College of Dental Surgeons of Ontario.

Despite this, many professions do use the title “doctor” based on historical usage, or because it is commonly and/or legally used in other jurisdictions. For example, while not yet regulated in Ontario, Traditional Chinese Medicine is regulated in British Columbia by the College of Traditional Chinese Medicine Practitioners and Acupuncturists of B.C.

Medical Doctor (MD)

This is the allopathic doctor designation most commonly seen. An MD requires at least 2 to 4 years of undergraduate university, followed by 3 to 4 years of medical school, and then 2 to 7 years of residency after which time an exam has to be passed to practice medicine in Canada. Medical Doctors in this province are regulated by the College of Physicians and Surgeons of Ontario.

Doctor of Chiropractic (DC)

The DC designation requires at least a 3-year undergraduate degree in sciences, followed by 4 years of chiropractic college (most attend the Canadian Memorial Chiropractic College in Toronto), and then provincial and national licensing exams must be passed. Chiropractors in Ontario are regulated by the College of Chiropractors of Ontario (CCO) through the Chiropractic Act (1991), which is part of the Regulated Health Professions Act (RHPA) (1991).

Naturopathic Doctor (ND)

The ND designation requires at least 3 years of pre-medical undergraduate university, followed by 4-1/2 years intensive full-time at a naturopathic college (most attend the Canadian College of Naturopathic Medicine in Toronto), and then licensing exams must be passed. Naturopathic Doctors in Ontario are regulated under the Drugless Practitioners Act (1925) by The Board of Directors of Drugless Therapy – Naturopathy (BDDTN).

Naturopathic Doctors are a regulated profession, but they exist in a bit of a limbo to some extent. There are five professions regulated under the RHPA, but NDs are the only healthcare profession still regulated under the Drugless Practitioners Act of 1925. However, this should soon change and naturopathic doctors are hoping to be included in the RHPA, which will be open for review in the Fall of 2006. According to Margaret McHugh, the executive director of the Ontario Association of Naturopathic Doctors, the government has promised both NDs and Doctors of Traditional Chinese Medicine that they will be included in the revised RHPA next year.

The Unregulated

There are a number of healing modalities that are unregulated in Ontario, but that use the title “doctor” based on tradition and/or legal use in other jurisdictions. When a field is unregulated that means there are no set standards of education and competency of practice established, making it tough for consumers to know what is what. When in doubt, do some research and find out what school a practitioner attended, and how much credibility that school has.

Doctor of Traditional Chinese Medicine (Dr. TCM)

Traditional Chinese Medicine is currently not regulated in Ontario, but the TCM profession is working hard towards being included along with NDs in the RHPA. If that happens, a regulatory body would likely be created much like the College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia (www.ctma.bc.ca).We contacted Mary Xiumei Wu, founder and president of the Toronto School of Traditional Chinese Medicine (TSTCM), who is currently involved in gaining recognition and regulation of TCM in Ontario. According to Dr. Wu, in China TCM doctors receive a minimum of 5 years full-time undergraduate medical school training in both TCM and Western medicine including a one-year internship. Some also pursue a TCM Master’s (3 years post-graduate), and Ph.D (6 years post-graduate).

The Dr. TCM designation recognized in British Columbia requires a minimum of 2 years university education followed by a professional education totalling 3,250 hours in 6 academic years, including 1050 hours of clinical instruction.

Dr. Wu’s school TSTCM offers a Doctor of TCM diploma requiring a minimum of 2 years of university or equivalent as a pre-requisite. The program is then 4,220 hours, with 1,340 hours of clinical training. This can be done in 4 years with a full-time intensive schedule or 6 to 10 years on a part-time basis.

A sampling of the requirements from some of the other TCM schools in Toronto include:

• Ontario College of Traditional Chinese Medicine — Dr. of TCM full time program requires 4,952 hours over 4 years.

• The College of TCM & Pharmacology Canada — 3,500 hours over 4 to 5 years.

• The Canadian College of Holistic Health — 2850 hours over 3 years.

Homeopathic Doctors (HD)

Many homeopaths have the designation HD after their names. These designations are not awarded by schools, but rather by one of the two professional associations in the province: NUPATH or the Ontario Homeopathic Association (OHA). This topic is a controversial one within the homeopathic community, which we will not go into in too much depth here. But basically, there is controversy in the homeopathy community over the OHA’s application for regulation to the Health Professions Regulatory Advisory Council (HPRAC) — the independent body that advises the Ontario Ministry of Health and Long-Term Care on matters of health regulation. All stakeholders were asked to make submissions to the HPRAC, but many are concerned that the OHA’s submission appears to the government as speaking for all homeopaths, when in fact many take issue with the OHA position. (Visit www.hprac.org and click on the links to homeopathy for more on this ongoing question of regulation in Ontario.)

We contacted the Toronto School of Homeopathic Medicine (TSHM), the Homeopathic College of Canada (HCC),the Canadian College of Holistic Health (CCHH), the Ontario College of Homeopathic Medicine (OCHM), and the British Institute of Homeopathy (BIH), all of whom responded with their requirements to become a homeopathic doctor.

Raymond Edge is the director of the Toronto School of Homeopathic Medicine (TSHM), a board member of NUPATH, and he explained NUPATH’s requirements for the designation HD (RHom) — RHom stands for registered homeopath. To join NUPATH a practitioner either has to have attended one of their three accredited schools — TSHM, the British Institute of Homeopathy, or the Hahnemann College for Heilkunst — or there is an application process. Edge says the NUPATH requirements are: “At least 2 years of post-secondary education, preferably in the sciences, and then a 3-year homeopathic program encompassing:

• 375 hours of Principles, Philosophy, History, Pharmacopaeia

• 675 hours of Homeopathic materia medica

• 450 hours of Practice Methodology

• 1625 hours of clinical training

• 850 hours of Anatomy&Physiology and Pathology

• 80 hours of Practitioner Development

• 90 hours Patient health awareness, Practice management, ethics

• For at total of 4145 hours of training.”

Other Homeopathic colleges:

• Homeopathy College of Canada www.homeopathy.edu: President of HCC, Fernando Ania, ND, HD says, “We at the HCC do not confer the title 'doctor.' It is the Homeopathic Medical Council of Canada (HMCC – www.hmcc.ca) that may allow or disallow the registrant to use or not the title Homeopathic Doctor (HD). It may request a board examination.” And on their website it says, “Since August 1995 the homeopathic profession is formally involved in the process of developing a regulation allowing the use of the titles Homeopathic Doctor, Doctor of Homeopathy or Homeopath as a step in guaranteeing high standards of education and health care in homeopathy.”

Visit the HCC website for specific course requirements and for an interesting history of homeopathy in Canada.

• Canadian College of Holistic Health - www.cchh.org: President of CCHH, Dr. Sohrab Khoshbin, president of CCHH said, “In order to become a doctor of Homeopathy at our college you would need to complete three year part-time program of 1,200 hours, which includes: anatomy & physiology, pathology, biochemistry, botony, nutrition, homeopathic medicine and internship, among others.  Pre-requisites for admission in the program is a high school diploma with credits in chemistry and biology."

Khoshbin also responded with the requirements for two other doctorate programs offered at CCHH: "The doctor of Chinese Medicine is a three year part-time program which includes: anatomy & physiology, pathology, biochemistry, theory of Chinese medicine, herbology, acupuncture, clinical practice, Tuina massage, among others. Pre-requisites for admission is a high school diploma with credits in chemistry and biology. The doctor of Alternative Medicine is a three year part-time program which includes a curriculum encompassing nutritional science, naturopathic science, homeopathy, Chinese medicine and acupuncture, energency medicine, kinesiology, diagnosis and case studies, clincial practice, among others in ethics and jurisprudence. Pre-requisites for admission is a B.Sc. with a courses in biology and chemistry or biochemistry or organic chemistry."

Visit their website for the curriculum for each of the professional diploma programs.

•  Ontario College of Homeopathic Medicine – www.ochm.ca: Dean of OCHM, Luba Plotkina, explained that they allow the HD after, not the Dr. before. According to their website, the Ontario College of Homeopathic Medicine offers a unique opportunity to complete a 4-1⁄2-year programme in 3 years (comprised of 9 semesters, 3 semesters per year) in Homeopathic Medicine & Health Sciences. The curriculum consists of 4,080 hours of Homeopathy and science studies including 1,600 hours of clinical internship.

• British Institute of Homeopathy – www.bihcanada.ca: Director of BIH, Liz Henderson, is following the letter of the law for now, waiting for regulation before promoting her students to use the doctor title. As she puts it: “For now I am just interested in offering Classical Homeopathy that can be grounded in Hahnemann’s teachings.” Course outlines are available on website.

Check out this look at some facts about homeopathic regulation in Ontario presented by NUPATH: www.nupath.org/regulation.html.

Doctors of Natural Medicine (DNM)

Unregulated professions mean there are no sets of standards for patients to rely upon, but the Doctor of Natural Medicine is by far the most confusing of all. According to those in the regulated profession of naturopathic medicine (NDs), the DNM designation is intentionally misleading to the public. Often NDs are referred to as Doctors of Naturopathic Medicine, so the invention of DNM as a designation is too close for comfort for some NDs, including the OAND, who tell Vitality that they receive complaints daily about DNMs.

Unregulated professions mean there are no sets of standards for patients to rely upon, but the Doctor of Natural Medicine is by far the most confusing of all. According to those in the regulated profession of naturopathic medicine (NDs), the DNM designation is intentionally misleading to the public. Often NDs are referred to as Doctors of Naturopathic Medicine, so the invention of DNM as a designation is too close for comfort for some NDs, including the OAND, who tell Vitality that they receive complaints daily about DNMs.

The problem is that the DNM designation doesn’t tell you anything about the practitioner or where they went to school. A DNM could be a conventionally trained medical doctor (MD) with added training in natural health, or could be a healer trained at an on-line college, mentored by another DNM.

The DNM designation is intended as a sort of umbrella term that all other healthcare practitioners can apply for as long as they have at least 1,000 hours of “training and experience in at least two areas of natural medicine.” This means that a doctor of TCM, or a homeopathic doctor, because of their training could simply apply for the DNM designation with no further schooling. A medical doctor or chiropractor who had the 1,000 hours of natural medicine training could also apply for the DNM designation.

The DNM designation is given out in Canada by the Examining Board of Natural Medicine Practitioners (EBNMP).  Category III is for Western trained doctors who have the 1,000 hours of natural medicine training. Category II is for naturopaths, TCM doctors, homeopaths, and the like, who have past natural medicine training equal to 4,000 hours of study, or whose combined training and years of experience amounts to 4,000 hours. Category I is for those who graduate from a “program in natural medicine” amounting to 4,000 hours. The prerequisite is a bachelor of science degree (BSc). The 4,000 hours over 4 years has to be done at a school or by mentoring with someone registered as a “mentorship professor” from EBNMP.

The more we looked into the DNM designation, the more confusing it became. Unregulated professions such as homeopathy have detailed education and professional standards laid out, even though there is more than one association. On the other hand, a practitioner who is a DNM may have many years of solid education and decades of clinical experience and knowledge, or that DNM may have some weekend or on-line courses, some mentorship from another DNM, and no experience. A DNM could be an allopathic medical doctor who also studied botanical medicine and TCM. Or a DNM might be a medical intuitive or energy healer. The designation is that broad.

As naturopathic doctor and CAND board member Iva Lloyd puts it, “(The) Doctor of Natural Medicine (designation) doesn’t really tell you anything. There may be ideals of educational standards or ideals of practice, but when anyone can use a designation without an outside, independent regulatory body overseeing each applicant and ensuring standards it leaves room for a lot of confusion.”

This month (July) there is a meeting planned in Utah for natural medicine practitioners to help establish a standard test for the DNM designation. Until that is created, and until there is outside regulation, the DNM designation itself doesn’t tell patients much of anything at all.