Practice Building

Joy Stevens, ND, JD, PE

Congratulations! You passed NPLEX. No, you are not board-certified.

NPLEX Exam

The Naturopathic Physician Licensing Examination (“NPLEX”) is a 2-part examination, the purpose of which is to ensure a licensure candidate (“candidate”) is minimally competent in his or her medical knowledge to safely practice naturopathic medicine.

Part I of the exam covers the basic sciences of anatomy, physiology, biochemistry, genetics, microbiology, immunology, and pathology. It is a 5-hour exam, consisting of 200 questions, that is completed in two 2 ½-hour sessions – 1 in the morning and 1 in the afternoon.

Part II is the case-based clinical science exam, covering all areas of diagnosis, materia medica of botanical medicine and homeopathy, nutrition, physical medicine, health psychology, research, and medical interventions including emergency medicine, medical procedures, public health, and pharmacology. This 10 ½-hour exam, which consists of approximately 80 cases with 400 integrated questions, is given in 3 sessions over the course of 3 days.

Part II also has three 1 ½-hour clinical elective exams required by some licensing jurisdictions. However, any candidate may choose to take some or all of these exams. Two are case-based (acupuncture and minor surgery, each having 15-20 clinical summaries, with multiple questions for each summary), and the third is a 75-question pharmacology exam.

Passing these NPLEX exams is 1 step towards licensure, but is not a guarantee of license receipt.

Licensing

Similar to NPLEX, licensing is a process that shows that a physician has achieved minimum competency to practice medicine.

Licensing qualifications are determined by each jurisdiction (ie, state or province). With 1 exception, mentioned below, all licensing jurisdictions recognize the NPLEX exams and require passage of both parts as the first step of their licensing process.

A jurisdiction may choose to offer its own version of NPLEX. In fact, this is currently happening in the province of Ontario, Canada. To become licensed in Ontario, applicants are required to take the Ontario Clinical Sciences exam rather than NPLEX Part II. Applicants are still required to take NPLEX Part I until November 15, 2020, after which they will be required to take the Ontario Biomedical Sciences exam. For maximum licensing flexibility, applicants who may want to practice outside of the province are advised to take both the Ontario exams and the NPLEX exams. 

A jurisdiction’s licensing application lays out the remainder of the requirements for licensure. Some jurisdictions require a jurisprudence exam that focuses on the legislation, regulations, and standards of practice for the jurisdiction. Some require practical clinical exams. All require some degree of background checks.

Board Certification

It is unfortunate that NPLEX exams are referred to as “boards” or “board exams,” as this has led many to mistakenly believe that passing NPLEX exams means they are board-certified. They are not.

Once licensed, a naturopathic physician may commit to undertake additional training in a particular area to become board-certified. Board certification shows that a physician has achieved expertise in a specialty area of medicine.

Currently, the following board certifications are offered. The list may not be all-inclusive:

• DHANP – Diplomate of the Homeopathic Academy of Naturopathic Physicians 
• FABNO – Fellow of the American Board of Naturopathic Oncology 
• FABNP – Fellow to the American Board of Naturopathic Pediatrics
• BCIA – Biofeedback Certification

It is important to note there is no national organization overseeing naturopathic board certifications as there are with osteopathic and allopathic boards. Anyone can create a course, develop a test, and offer “board certification” in a particular area, with no third-party oversight or established standards. This is not a statement on the quality of the current board certifications, only a comment on the process.

Terms Matter

Why is it important for naturopathic physicians to use the term “board-certified” correctly? Claiming to be board-certified when only having a license to practice naturopathic medicine is making a false claim. Making a false claim could subject the physician to liability. Imagine sitting in court and listening to your patient’s attorney make the following statement:

“Members of the jury, Dr ____ stated she was board-certified, and my patient, who as you know was grievously harmed, understood board certification to mean the physician had undergone additional training and had achieved expertise. My client relied upon this assertion to his detriment.” 

It is also unprofessional and an embarrassment to the physician as an individual, and to all naturopathic physicians as a profession, when this term is used incorrectly.

After Receiving Your License

Once you receive your license, become active in your state association.

As mentioned, each jurisdiction sets the parameters under which a physician can practice medicine. Because jurisdictions are free to legislate and enact whatever laws those currently holding elected office decide, laws are fluid and subject to change with each legislative session.

It is the state associations that watch and work to ensure that the scope of practice does not suddenly and unexpectedly change with the whims of the legislature. For example, in Montana during the 2019 legislative session, while considering an opioid reform bill to require additional physician reporting and utilization of the prescription drug registry, a completely unexpected amendment was made to remove ALL scheduled drugs from the naturopathic physician formulary. Fortunately, the Montana Association of Naturopathic Physicians’ lobbyist alerted the association, thus giving the association time to mount a strong opposition, with the ultimate outcome being the preservation of the formulary.

Imagine if a legislator proposed to abolish naturopathic medicine as a licensed profession in its entirety. It is possible, and if no one is watching, the outcome could be disastrous. When it comes to legislated rights, it is essential to remain vigilant and protect those rights so as not to lose them. This is best achieved by being active in and supporting your state association.

Again, congratulations on passing NPLEX. Best wishes on licensing. Just remember, avoid the term “board-certified” unless you have received additional training in an area for which board certification is offered.

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Joy Stevens, ND, JD, PE, is a licensed naturopathic physician at Everhope Clinic in Billings, MT. Dr Stevens began her career as a petroleum engineer. She later earned her Juris Doctorate, enabling her to combine her love for engineering with law. After years of ill health, she discovered she had chronic Lyme disease. As part of her healing journey, she earned a degree in naturopathic medicine, becoming the physician she had wished she had found during her own illness. Now, Dr Stevens has a love for naturopathic medicine which she combines with a personal passion to help others with Lyme.