Naturopathy in Australia is reaching fever pitch. The public and profession alike are advocating for greater recognition of what is an effective and popular form of healthcare, despite ongoing marginalisation by mainstream medicine. But one can hardly have a conversation about the state of naturopathy these days without eventually slamming face first into the ‘registration’ wall. Many naturopaths believe that the answer to our eternal quest for legitimacy, or at least for greater respect of our profession in, hinges on the attainment of statutory registration for naturopaths under the Australian Health Professionals Regulatory Agency (AHPRA).
The topic of registration is a polarising one, creating a heated debate between the pro- and anti-registration camps. Many tout registration as being a panacea for all our naturopathic woes, however, there is a determined fraction within the profession who adamantly fight against it, suggesting that for many it is not the cure-all it appears to be.
What’s the big deal, anyway?
The benefits of registration for naturopaths are proposed to be many and varied, but perhaps one of the fundamental arguments made from a professional perspective centers around the protection it will gift us for our title ‘naturopath’. For many, the current free-for-all that exists around our title means it is wrought with trouble and chaos, with our name having being dragged through the mud more times than one cares to remember thanks to the lack of security associated with its use. The persistent and frustrating connotation of ‘naturopath = quack’ is in part fueled by the minority of irresponsible individuals who are attracted to naturopathy purely because they can practice without accreditation or regulation. In fact, an increasing number of formally trained and practicing naturopaths are now choosing to distance themselves from these associations by moving towards the use of titles other than ‘naturopath’.
Refer at your own risk
Another acclaimed benefit of registration is the integration it will afford us into the mainstream healthcare system. Ever since the profession began transforming education standards and increased the level of qualifications being offered in the 1980’s and 1990’s, there has been an upswell from within the profession for greater recognition for our contributions to the health of Australians. However, despite the shift of naturopathy towards an evidence-based practice model and an increasing number of degree level qualified practitioners in the field, relations between naturopathy and orthodox medicine have remained tense. Although there is a growing portion of Medicos who are open to complementary therapies for their patients, they ultimately have a forced hand when it comes to referrals, as they can be found liable under their own strict regulations and insurance restrictions if they refer to an unregistered practitioner who causes harm. As it stands, those doctors who do choose to refer to a naturopath are doing so at their own risk, as in their eyes and the eyes of their regulatory bodies and insurers, they receive no guarantee of their patient’s safety thanks to our unregistered status. For all of their shortcomings, even the Australian Medical Association supports registration for naturopaths.
Cleaning up the conflict of interest
A lesser-known benefit of statutory registration for naturopathy is the opportunity it offers our profession to once and for all cleanly separate the handling of our professional interests from public interests. Presently, our professional associations work tirelessly to juggle both public and professional issues, representing both a significant conflict of interest and a heavy burden for our them to be carrying. Instead of devoting their time and resources (aka our membership fees) solely towards representing our needs as practitioners, they must split efforts between fielding public complaints and advocating for our professional interests (including, ironically, trying to lobby for statutory registration).
Associations are frequently the subject of criticism from their members for their lack of action and advocacy, however few of these critics realise just how bogged down they are with administrative tasks related to accreditation of members and handling of public inquiries – tasks that would be relinquished to AHPRA if registration status was achieved.
Protection for everyone
Regulation under AHPRA would mean that the public would have access to an independent body representing their interests – moving towards greater safety for the public and greater autonomy for our associations. AHPRA is a regulatory body whose primary function is to protect members of the public from harm. Health professions that have been deemed to pose a significant risk of harm to the public are required to be registered. AHPRA achieves this through 15 National Boards, each of who regulate the 14 registered professions (plus an extra board for Aboriginal & Torres Strait Islander Health Practice). The national boards set the standards and policies that must be followed by registered practitioners and they provide an online register that the public can search to check if a practitioner is qualified and registered. This would leave our associations free to focus solely on defining our scope of practice and advocating for our profession in other policy and healthcare realms.
The division of tasks between regulating body and professional association is explored in great detail in the excellent article by Wardle, Steel, & McIntyre (2013) available here, which is essential reading for any naturopath interested in the registration debate.
But, Is it all it’s cracked up to be?
To the contrary of the above-boasted benefits, there are many within the profession who staunchly oppose statutory registration, claiming that it is not all it’s cracked up to be. The disadvantages proposed by these groups circle back to a few core themes – increased financial cost, restrictions on scope of practice, and disagreement that naturopathy has the ability to cause harm (the concerns of some opponents have been reviewed eloquently and in greater detail by Canaway, 2009).
Registration under AHPRA places a significantly higher financial burden on the individual practitioner, with registration fees varying between $500-$790, depending on the modality and registration division (these figures are based on existing registered modalities, as no current fee schedule is proposed for naturopathy). These costs would be in addition to preexisting costs individual practitioners are already paying for association membership and insurance, drastically increasing the price of entry for a naturopath into the professional practicing arena.
Scope of practice
Opponents of registration also express their grave concern that registration will lead to a restriction on our naturopathic scope of practice. As discussed above, the AHPRA model allocates responsibility of scope of practice to professional associations (see Wardle, Steel & McIntyre, 2013), but critics often cite the Traditional Chinese Medicine (TCM), acupuncture, or chiropractic modalities as examples of how registration can lead to oppression of scope of practice and negative outcomes for the profession. Published examples of these downfalls are difficult to find and this argument relies heavily on anecdotal evidence shared between practitioners behind closed doors. They also suggest that the National Boards of AHPRA are vulnerable to infiltration with bureaucrats who may have ulterior motives that are unreflective of the rest of the practicing profession.
Risk of harm
The ‘anti-reggers’ stand firmly behind their belief that naturopathic medicine is inherently safe and gentle, posing little to no harm to the public. They say this in spite of the countless examples of the potential risks associated with unregulated naturopathic medicine and formal recommendations for the need for registration for naturopaths (the infamous Lin report).
Others again, who are perhaps less idealistic and more accepting of the inherent risks associated with practicing naturopathy, believe that gaining registration status will never equate to complete guarantee of safety and will largely be ineffective at regulating rogue individuals who will carry on practicing what is essentially ‘naturopathy’ by simply hiding behind the guise of another unprotected title. They, therefore, agree that registration is not a worthwhile pursuit for the profession.
Contrary to what many contemporary naturopaths understand about the push for registration, efforts for attainment have been ongoing for many decades. The history of the movement is a lengthy story, worthy of an entire article of its own, but in short, dates as far back as 1927 – when the matter was discussed for the first time in parliament. The movement swelled again in the 1960’s and 1970’s but didn’t gain any meaningful traction until 1984, when naturopathy reached a near inclusion into the registered practitioner ranks off the back of the local success of naturopaths in the Northern Territory’s Health Practitioners & Allied Health Professions Act 1985. However, in 1992, naturopathy was removed from the act due to professional infighting – fighting which sadly continues to this very day.
The Northern Territory Act of 1985 included a minimum-level education requirement of a 4-year bachelor degree for naturopaths to be registered. At this time in Australia, there were many colleges whose programs did not meet this level and as such, the owners of these colleges coalesced based on their shared feelings of discrimination. Together, they adamantly blocked the movement of naturopaths towards registered status in what appeared to be an effort to protect their financial interests in the colleges. This coalition quickly evolved into the association we now know as the Australian Traditional Medicine Society (ATMS), an association that remained run by a board of college owners rather than an independent association run by practitioners or academics for many years (although when on record, ATMS officials report a different version of past events). To this day, ATMS remains staunchly anti-registration, their official position statement being “that government registration…is neither justifiable or achievable.” Instead, they support a co-regulation model for naturopathy, which is essentially the model that our profession is currently operating within – that being, a model that places all responsibility onto the professional associations, including defining our scope of practice, regulating code of conduct, and protecting public interests. As recently as 2014, ATMS have continued their opposition against efforts to raise the minimum education standards for our profession, seeking to maintain the lowest standards as possible and consequently hindering progress for registration.
A UNITED VOICE
The Australian Register of Naturopaths and Herbalist (ARONAH) came into existence in 2013 in an effort to unite the front in our quest for registration. ARONAH was established “to provide minimum education standards for herbalists and naturopaths in Australia that mirrors the government requirements for the regulation of health practitioners.” Ultimately, the framework ARONAH have developed provide an easily transferable model of statutory registration should registration be achieved for naturopaths with AHPRA. As such, ARONAH have created a code of conduct that would be very similar to any standards and policies under AHPRA.
The Naturopath and Herbalist Association of Australia (NHAA), the Australian Naturopathic Practitioners Association (ANPA), and the Australian Natural Therapies Association (ANTA) consistently and publically voice their support for ARONAH and statutory registration for their members.
the way forward
Evidently, the topic is highly charged and there are no clear signs that a resolution is within reach. For many pro-reggers, the inertia towards registration feels punishing, a frustration that has recently cost them their inclusion in the private health rebate scheme. While for the anti-reggers, the striving for registration feels like a slight on their sense of tradition and a lifetime of work. With these stubborn internal divides, the struggle for registration can, at times, feel like a futile attempt to bridge a gap simply too large to overcome. Without a united front, there is little chance of having our voice heard in the main area – a sentiment echoed to us from within the very chambers of government itself. For now, the debate continues to blaze away, with plenty of ideologues at the ready to keep the fire fuelled from each side of the fence.
As far as we’re concerned, an open, reasonable discussion is the only way forward, and we hope that we’ve sparked one somewhere out there with these thoughts.
We would love to hear what you think about the debate – what side of the fence do you sit on? What ideas do you have for moving forward either way on this issue?
The Naturopathic Insider
ANTA. (2017). Statutory Registration. Retrieved from https://www.australiannaturaltherapistsassociation.com.au/Public/Resources/Statutory_Registration/Public/Resources/Statutory_Registration.aspx?hkey=8c990abf-14a0-4a1b-9665-ecb161912c00
ARONAH. (2016). ARONAH Code of Conduct. Australian Register of Naturopaths and Herbalists. Retrieved from http://www.aronah.org/wp-content/uploads/ARONAH-Code-Of-Conduct-final.pdf
ARONAH. (2018). Australian Register of Naturopaths and Herbalists » About ARONAH [ARONAH]. Retrieved from http://www.aronah.org/about-aronah/
ATMS. (2017). ATMS POSITION STATEMENT: Government Registration of Naturopaths, Herbalists, Nutritionists and Homeopaths. Australian Traditional Medicine Society.
Australian Health Practitioner Regulation Agency – Home. (2018). Retrieved from https://www.ahpra.gov.au/
Australian Naturopathic Practitioners Association. (2017). Regulation for naturopaths (continued). Retrieved from https://anpa.asn.au/regulation-for-naturopaths-continued/
Canaway, R. (2009). A Culture of Dissent: Australian Naturopaths’ Perspectives on Practitioner Regulation. Complementary Health Practice Review, 14(3), 136–152. https://doi.org/10.1177/1533210109360308
Complementary Medicine – 2012. (2012, August 28). Retrieved from https://ama.com.au/position-statement/complementary-medicine-2012
FX Medicine. (2018). Naturopathy: What is Co-Regulation? with Peter Berryman | FX Medicine. Retrieved from https://www.fxmedicine.com.au/blog-post/naturopathy-what-co-regulation-peter-berryman
NHAA. (n.d.). Regulation of Practitioners. Retrieved from https://www.nhaa.org.au/mediareleases/be-informed/regulation-of-practitioners
Wardle, J., Steel, A., & McIntyre, E. (2013). Independent registration for naturopaths and herbalists in Australia: the coming of age of an ancient profession in contemporary healthcare, 25(3), 1–7.