Heidi Weinhold is licensed as a physician in Arizona and Vermont, where she can diagnose diseases, prescribe drugs, order lab work, have hospital privileges and perform minor surgery.

	V.W.H. Campbell Jr., Post-Gazette Naturopathic doctor Heidi Weinhold of Peters. Click photo for larger image.

As a naturopathic doctor now living in Pennsylvania, she has none of those privileges and can't call herself a doctor.

Such is the situation facing members of the Pennsylvania Association of Naturopathic Physicians, who at best are building careers on the fringe of their profession, working as nutrition counselors, educators or in homeopathic or herbal medicine.

The group is trying to get naturopathic doctors licensed in Pennsylvania, a status provided in 13 states and the U.S. Virgin Islands. California was the latest to join this group Jan. 1, with another half-dozen states expected to consider legislation this year.

After failed attempts in the Legislature in 1999 and 2001, the Pennsylvania association is revamping its strategies to better educate lawmakers about what naturopathic doctors are and what they do. Proceeds from a state conference in Lancaster County that opens Thursday will help the group mount its latest efforts to get a new bill introduced next year.

"We can't practice as we're trained at this point,'' said Michael Reece, the association's president, who practices nutrition and homeopathic medicine in a Lancaster clinic.

Naturopathic doctors -- who carry an N.D. behind their name -- focus on the whole health of patients and emphasize the use of diet, exercise, nutritional supplements and herbal therapies to help prevent disease and to promote wellness. They attend accredited, four-year graduate level naturopathic medical schools to become primary-care practitioners, but have a more limited scope of practice than do medical doctors. They receive the same basic sciences as an M.D., but also study clinical nutrition, acupuncture, homeopathic and botanical medicine and psychology. They do not go through residency programs, but must pass rigorous national and state boards to practice.

"Our philosophy is to look more at the whole person, each person is an individual, and the other difference is we use holistic, natural medicine. A lot of herbs and vitamins for optimal health,'' Weinhold says. "It isn't merely replacing Prozac with St. John's wort. It's actually looking at what's causing depression.''

But after a reporter spoke with the president of the Pennsylvania Medical Society, it became clear the naturopathic association has a lot of educational work ahead.

"What does a naturopath do?'' asks Dr. Jitendra Desai, an Allegheny County urologist who got his medical training in India, where there is a strong tradition of integrated medicine.

Once the society has a better understanding of naturopathic doctors, he said the scope of authority proposed in a bill would have to be evaluated to see if the society would support it. "We'll have to look at the [medical school] curriculum, look at their abilities, look at their qualifications.''

But he added that if naturopathic doctors were seeking to do minor surgery "we'd have some problems with that.''

Dr. Alan Gaby, past president of the American Holistic Medical Association who practices in Baltimore, said because of their training and philosophy, naturopathic doctors are particularly effective in treating patients "who are falling through the cracks in modern medicine.''

Those include people with fatigue, chronic illnesses, depression and migraine headaches. "By using herbs and dietary modification, they can often get people out of the medical system.''

N.D.s can treat up to 90 percent of the conditions that a family doctor can treat. And in the wake of Pennsylvania's malpractice crisis, Gaby noted that the annual malpractice premium for naturopathic doctors is under $1,000. "What they do is inherently safe. They go into medicine to help people. [Licensure] would really help the malpractice crisis for one.''

Nationally, there are about 3,000 naturopathic doctors, and about 200 are expected to seek licensure this year in California. The Pennsylvania association has far less than that: just 18 members. However, that's double from five years ago.

"It's a Catch-22,'' says Reece. "Because we don't have a license here, that scares some people off. Some want to come here and set up practice.''

Licensure would legitimize the profession, discredit the folks who set up shop after they've received a mail-order diploma, and perhaps most important, make naturopathic doctors eligible for insurance reimbursement.

The authority granted to N.D.s varies by state.

Naturopathic doctors in Arizona and Washington state have full prescription-writing authority. California, however, requires physician oversight for them to write prescriptions for some drugs, although they can diagnose and treat disease, perform physical exams, draw blood and order lab tests.

The District of Columbia is about to approve licensing there. The proposal is supported by the district's board of medicine because it understands that naturopathic doctors have comparable training and must meet national standards, said Karen Howard, executive director of the American Association of Naturopathic Physicians, which is pushing to have the profession licensed in all 50 states.

In some states, however, the medical boards view the move as "infringement on their turf. There's a very steep learning curve about naturopathic doctors and what they do.''

Weinhold, 30, of Peters, who attended Southwest College of Naturopathic Medicine in Tempe, Ariz. -- one of five accredited naturopathic colleges in the United States -- returned to the Pittsburgh area in 2000 to care for her ailing father, who has Alzheimer's disease. She works out of The Enhancement Center in McMurray, offering nutritional and herbal medicine and other specialties.

"I'm frustrated that I can be licensed in Arizona and be called a doctor and return to my home state and can't call myself a doctor,'' she says. "I think it would really benefit everyone in Pennsylvania to have an integrative approach.''

Reece agrees. "This isn't a turf issue,'' he says. "We're not looking to take business away from medical doctors. We're a complement. We have distinct benefits we can offer people.''

You can read more about naturopathic doctors on the Web site of the American Association of Naturopathic Physicians, www.naturopathic.org.