What is the difference between an MD and ND?
MD = Medical Doctor vs. ND = Naturopathic Doctor
Before med school…
When applying to medical school, both candidates require a four-year Bachelor’s degree with pre-med prerequisite courses. Both have a higher chance of getting accepted with a higher GPA and more exposure to the clinical world from job-shadowing or volunteering. They must acquire strong recommendation letters from professors and undergo an intensive interview process. The only difference here is that MD candidates must take the MCAT (Medical College Admission Test) before applying. [Random fact: Dr. Sola had taken both the MCAT and the DAT (Dental Admission Test) and had taught MCAT Biology for 135 pre-med students at The Princeton Review in Baton Rouge, New Orleans, and Seattle.]
During the first 2 years of med school…
After getting accepted into medical school, both 1st-year MD and ND students get the once-in-a-lifetime experience of real human (cadaver) dissection, which is considered the “rite of passage” for every medical student. Both MD and ND students spend a great deal of time learning the basic sciences (i.e. anatomy, biochemistry, physiology, genetics, cell biology, histology, microbiology, etc.) and clinical diagnostics and application (i.e. pathology, infectious diseases, immunology, pharmacology, etc.). ND students must take additional courses in botanical medicine, nutrition, physical medicine, hydrotherapy, counseling, homeopathy, and phlebotomy for IV therapy. Both MD and ND students learn the basics of interviewing and examining a patient. Meanwhile, 1st- and 2nd-year ND students have clinic observation on various clinic shifts.
After 2nd year of med school…
Both MD and ND students take medical boards: USMLE Step 1 and NPLEX I, respectively.
During the last 2 years of med school…
MD students do rotations at hospitals and clinics affiliated with their school. They learn to apply current mainstream standard of care and assist residents in a particular specialty such as surgery, pediatrics, psychiatry, or internal medicine. Depending on the hospital’s strength and focus, some rotations may last longer compared to other medical schools. For example, at some schools, surgery rotation can last three months instead of three weeks. During this time, they are interacting with patients and performing basic medical procedures, along with any tasks the resident doesn’t want to do. In their fourth year, they take USMLE Step 2.
ND students must pass the Clinic Entry Exam, which is another “rite of passage” to enter the clinic setting as a Student Clinician. They continue to balance classes, clinic shifts, and preceptorships. Classes are focused on extensive knowledge on current standard of care, grand rounds to discuss clinical cases, medical ethics, jurisprudence, business, public health, minor surgery, emergency medicine, as well as integrative, alternative, and complimentary treatment modalities. Clinic shifts are divided into different specialties: naturopathic medicine, physical medicine (includes manipulation, orthopedic testing, hydrotherapy), environmental medicine, oncology, biofeedback, counseling, homeopathy, cardiovascular, diabetes, immune wellness, ADD/ADHD, dermatology (i.e. skin lesion removal, wound repair, etc.), Lyme disease, etc. Various integrative clinics that are affiliated with the naturopathic medical school provide different clinic shifts so that the student clinicians can get exposure to a diverse patient population (i.e. low-income, non-English speaking patients, geriatrics, etc.)
Third-year ND students (aka “secondaries”) get partnered with a different fourth-year or fifth-year ND students (“primaries”) for every different clinic shifts. Both work as a team in a primary care setting, where they directly interact with a patient, take the case, perform relevant physical examination, and come up with a differential diagnosis and treatment plan that is under the direct supervision of an attending or resident doctor. Primaries are in charge of charting SOAP notes and performing medical procedures (i.e. annual physical, pap smears, prostate exams, ordering labs, diagnosing a pathology under a microscope, writing prescriptions, etc.). Every chart note must be approved and signed off by their attending or resident doctor for that clinic shift.
While all ND students must attain certain amount of hours in ND and phys med shifts in order to graduate, they also begin to take more specialized clinic shifts to focus on a certain modality or type of condition(s). For example, an ND student clinician may choose a clinic shift that focuses on pharmacology for diabetic management vs. a clinic shift that focuses on minor surgery and IV therapy. ND shifts mainly focus on applying the philosophy and knowledge of naturopathic medicine with supplements, herbal medicine, advanced nutrition principles, and lifestyle changes while maintaining mainstream standard of care. ND students learn to read other doctors’ chart notes and work with every type of provider (i.e. MDs, DOs, etc.) to create the best care team the patient would need in order to succeed.
In order to graduate, the ND student must:
Pass the Clinic Exit Exam
Complete nearly 350 competencies that are supervised and approved by an attending or resident doctor
Attain an average of 600 patient contacts
Complete a minimum of 1,200 clinical hours
Complete a minimum of 132 preceptorship hours
After graduating from med school…
MDs take USMLE Step 3 after intern year (one year of post-medical school training) during their residency. Depending on the specialty, residency can range anywhere from an additional 3-7 years of education. MDs can choose to further their education in their specialty with an optional fellowship after residency.
NDs take NPLEX II before an optional naturopathic residency. Due to the limited resources for naturopathic residencies, residency is not required for licensure to practice naturopathic medicine (except in the state of Utah). Some NDs may choose to pursue 1-3 years of residency while others embark on starting their own practice or joining another pre-existing integrative practice. Thus, preceptorships are required to help develop further training in a specialty and develop a mentorship with a health care professional in their practice.