Emily Telfair, ND
I found my voice. And in the process, I found the voice we share as a profession. After I graduated from naturopathic medical school in 2005, I arrived in Baltimore, Maryland, without any family connections or much familiarity – simply with an intuitive feeling that I was supposed to be here. I harnessed the tools and knowledge I was given in school to start a practice, and my office became my new classroom as my patients became my new teachers. Nearly 8 years later, my role expanded from healer to advocate, no longer just wearing the hat of a practitioner, but simultaneously leading the charge, along with a committed group of colleagues, to transform healthcare in Maryland through the licensure of naturopathic doctors. I never felt so certain of my voice as I did during the experiences of meeting with legislators, testifying before health committees, and even negotiating with our opponents. The celebratory news is that the Maryland Association of Naturopathic Physicians (MDANP) was successful in passing our licensure legislation in March, 2014, making Maryland the 18th licensed state in the country. My reflection below is meant to capture elements of this journey that may inspire other political pioneers in our profession to hold strong to the torch that lights the way towards transformation and possibility.
A New Approach
For the past 3 ½ years, I have been immersed in what I now refer to as “the politics of healing,” or the system that dictates the choices and access an individual has to high quality, health-promoting, prevention-focused healthcare. Through my role as president of the MDANP during our determined pursuit of licensure in Maryland, I quickly learned that the controlling forces of healthcare in our state and in our nation are often steeped in ignorance, resistance to change, and turf protection. These qualities leave little room for actual healing to take place. The rising rates of obesity and diabetes alone (which have each more than doubled in Maryland in the last 20 years1) demonstrate the need for a new approach in both politics and healing.
Our Tools for Success
Now that I am several steps outside of this accomplishment that seemed at times insurmountable, I can see more clearly the tools that propelled the MDANP towards success:
Forming a Team: Within the MDANP we had a committed group of 6 naturopathic doctors who rallied together and shared their unique gifts and talents to support every angle of the legislative process from studying legislation in other licensed states, to organizing our Lobby Day and creating numerous presentations for key stakeholders and healthcare organizations. Our fearless and faithful lobbyist, Jim McComb, served as a wise mentor to our team. He steered us through the turbulence of the legislature and the resistance of our opponents with grace and honor.
Securing Strong Sponsors: The MDANP was fortunate to have the backing of strong and vocal sponsors in both the House (Delegates Nathaniel Oaks and Susan Krebs) and Senate (Senator Catherine Pugh). They championed our cause among their colleagues and truly took to heart the impact that this legislation could have on the health of our state.
Persistent Messaging: Since Maryland is a fairly small state, the MDANP had the advantage of a visible presence in Annapolis throughout the 90-day legislative session each year. As a team we finely tuned our messaging, which included responses to the opposition and clear facts about the public health advantages of licensing naturopathic doctors in Maryland.
Forming Relationships: The practice of naturopathic medicine is rooted in our relationship with Nature and connection to the human spirit. So naturally, our message appealed to numerous legislators and healthcare practitioners who understood the importance of reintroducing wellness and healing back into healthcare. “It just makes sense!” one of our advocates would declare. Over 3 years, the MDANP gained the trust of the majority of the health committee members and even the Maryland Secretary of Health, which was a significant turning point in moving the bill closer to passage.
A Change of Heart
The strongest arm of opposition against passage of licensure for naturopathic doctors in Maryland came from the Maryland State Medical Society, known as MedChi. As an organization, MedChi has powerful influence in Annapolis among legislators. There are approximately 25 licensable NDs in Maryland and over 28 000 licensed allopathic physicians2 (only 8000 of whom are members of MedChi), thus setting us up for a David and Goliath scenario. While MedChi promoted false messaging through Annapolis which questioned the scientific basis of our therapies, the quality of our training, and our potential risk to patient safety, the MDANP repeatedly countered these falsehoods with the simple Truth about our medicine and an unshakable foundation of Integrity. A new approach in politics and healing indeed!
Each day that I drove to Annapolis to fight the good fight, I passed by the historic MedChi building in Baltimore and said a prayer to change the minds and hearts of those physicians who based their judgment of the naturopathic profession on lack of knowledge and fear of the unknown. If we were up against the 800-pound gorilla (as MedChi was often referred to by legislators), then why not bring out the most therapeutic tools in our naturopathic arsenal – love, respect, and forgiveness? This does not mean that the MDANP gave in to MedChi; it means that we did not for a moment give up. Our medicine was more potent, less toxic, and deeper-acting than anything the opposition had to offer. The legislators and other healthcare groups also benefitted from our healing presence in Annapolis, as one by one we converted opponents to supporters.
When it came time to compromise towards the end of the legislative session, we had to weigh out what we could let go of in the bill in exchange for a scope of practice that still preserved the essence of our medicine. Sitting at the conference table with all of the stakeholders and key legislators, my colleagues and I were well aware that we were in the process of making history. One or 2 words deleted or added to the bill could change our chances of passing the bill or dramatically shape how an naturopathic doctor could practice in Maryland. Once we agreed to the inclusion of a “collaboration agreement,” which simply means that in order to be licensed, an ND will have to submit the name and license number of a medical doctor or osteopathic physician which whom he/she will occasionally collaborate, then MedChi released their opposition, thereby removing our only remaining obstacle to passing the bill.
The Outcome
Aside from achieving a scope of practice for naturopathic doctors in Maryland that includes the ability to diagnose and treat, order laboratory tests, perform physical examination, use physical medicine modalities and our other trusted naturopathic therapies, the additional accomplishments of our legislative journey will support the growth of our profession just as much as our newly defined scope of practice.
The MDANP developed a number of strong relationships with allopathic supporters from the University of Maryland, the Evergreen Health Co-op, and the Casey Health Institute, which may hold future promise for naturopathic doctors to work in integrative healthcare settings. The Maryland University of Integrative Health (formerly Tai Sophia) has plans to open a naturopathic medicine program in Maryland to complement their growing curriculum of advanced degrees in integrative medicine. The Maryland Board of Pharmacy is excited to partner with the MDANP from a public health perspective to promote safe use of nutraceuticals. And in the Maryland legislature, the issue of licensing naturopathic doctors brought increased unity to the House Health and Government Operations Committee, with both a Republican and Democrat from that committee acting as co-lead sponsors on the bill. When the bill came for a vote on the floors of the House and Senate, it passed unanimously on both sides.
The first licenses for NDs in Maryland will be issued in March, 2016, and for now the regulating body for naturopathic doctors will be the Maryland Board of Physicians, with a Naturopathic Advisory Council sitting under the Board.
My colleagues and I are well aware of our great fortune in passing this legislation in under 4 years while knowing how challenging this process has been for other states. I trust that a string of serendipitous forces (along with the spirits of Drs Mitchell, Lindlahr, and Lust, to whom I often asked for help) were working in our favor to move this legislation before an election year and while we had the earnest commitment of our lobbyist to see this through to completion. The MDANP engaged in our pursuit of licensure while navigating the “politics of healing,” but I would like to think that the legacy our profession will leave in Maryland is having brought some healing back to politics.
Our Healing Voice
Growing up, I had a tendency to lose my voice during times of great excitement. But even when I went hoarse after celebrating Maryland’s accomplishment at the AANP’s annual DC Federal Legislative Initiative (FLI) event this past April, I felt a deep assurance that my voice was not “lost” this time, but merely resting. And while I am resting, I trust that my colleagues are carrying that voice forward in Illinois, Florida, New York, Pennsylvania, Massachusetts, Rhode Island, and many other states pursuing this same goal of changing hearts and transforming the landscape of our nation’s healthcare system.
In response to one of the provisions in the new licensure law which states that NDs will be prohibited from using the term “physician,” the MDANP has recently been renamed the Maryland Naturopathic Doctors Association (MNDA). We welcome our colleagues to visit our new website: www.marylandnd.org. As of April, 2014, I have also passed the presidential torch on to Kristaps Paddock, ND, who will be leading Maryland NDs through the changes associated with implementation of the new legislation.
References:
F as in Fat: How Obesity Threatens America’s Future. The State of Obesity, Maryland. F as in Fat Web site. http://www.fasinfat.org/states/md/. Accessed June 12, 2014.
Young A, Chaudhry HJ, Thomas JV, Dugan M. A Census of Actively Licensed Physicians in the United States, 2012. Journal of Medical Regulation. 2013;99(2). Federation of State Medical Boards Web site. http://www.fsmb.org/pdf/census.pdf. Accessed June 12, 2014.
