What’s the difference between an MD and an ND?
I frequently get asked about the difference between MD and ND and the different types of medicine- integrative, holistic, and functional medicine. Let’s dive into this in the hope that I can provide some clarity.
The difference between a Medical Doctor (MD) and Naturopathic Doctor (ND) is significant. Both degrees require an undergraduate (Bachelors) degree as their foundation. The education structure diverges, sometimes drastically, upon commencement.
An ND will have four years of training, including basic science and specific rotations. The curriculum is less structured, and clinical rotations less rigorous in comparison to most MD programs. Once completing the four years of basic science and rotations, an ND will have earned their ND degree and can practice. A residency is not required for licensing, and not all states accept licensure of an ND.
Naturopathic medicine does not generally have a standard of care that dictates any given disease condition receives a commonly agreed upon treatment protocol. Treatments offered for individual patients with the same condition can vary widely from clinic to clinic. The naturopathic model of health is based on the interworking and relatedness of the body, typically through herbal treatments and supplements. In the past, such treatment has primarily been empirically based. However, there is increasing evidence to now support those treatments.
Also, of note, some jurisdictions do not regulate the naturopathic profession, and individuals without accredited training sometimes use the title of ND. This includes online degrees. Graduates from CNME recognized 4-year programs had completed the four-year naturopathic education.
Conventional MD training requires four years of basic sciences and clinical rotations, after which a Doctorate of Medicine is granted. To practice and be board certified, a medical residency, and extensive clinical time in a chosen specialty is required. Board certification must be renewed at regular intervals, and continuing medical education is required annually.
The MD curriculum is structured, transparent, and evidence-based. The focus is on organ-specific disease diagnosis and treatment, mainly using medications or surgery directed by evidence-based medicine and care standards. There is a reproducible and accepted standard of care established for any given diagnosis.
Medical residency provides high volumes of cases seen in the setting of evidence-based medicine and the rigor of science. Medical school and residency develop and require a high degree of critical thinking. Deviations from best practices typically require a resident to academically defend their medical-decision making in a forum of their peers and supervisors.
What about Holistic and Integrative medicine? Is there a difference? And where does functional medicine come into the picture?
This is a general term used to denote a whole-body approach. This term is used to describe a general orientation to health and not necessarily a specific kind of medicine. For example, you can have a holistic nutritionist.
Treatment is focused on considering that the mind, spirit, and body are interconnected to health. Conceptually, by evaluating and addressing the physical, emotional, and spiritual contributions to health, the whole body is brought into a state of coherence.
This can be confusing. In the past, integrative medicine was based on the western paradigm of health but expanded its perspective and tools, incorporating acupuncture, massage, and adjuncts other than medication. There may be an emphasis on nutrition and wellness, movement and meditation, or diet and supplements. Still, the medical component of integrative medicine is often within the standard paradigm- using drugs to counter symptoms while also incorporating ancillary therapies.
Functional medicine is a relatively new term in medicine. It incorporates the tenets of both holistic and integrated models of care, yet uses a different paradigm entirely than the above disciplines.
This paradigm uses a system based biology framework to understand the interconnectedness of the human body. It focuses on optimizing and supporting the body’s inherent ability to heal rather than waiting for disease and pharmacological management.
It dives deep into bio-individuality, genetics, biochemistry, hormonal imbalances, and the body’s response to toxins, chemicals, and stressors.
Current science is now showing us through evidence-based studies that several modifiable factors contribute to our health risks.
What about my Functional Medicine Practice?
My training to become an Internal Medicine Doctor has provided me with a broad education and exposure to high case volumes, refined diagnostic capabilities, and an understanding of the healthcare system unheard of outside of medical residency. Medical school has provided me with an incredibly valuable and rigorous education.
My years as an attending physician in the Harborview emergency room and as an internist added to my education’s breadth, shaped my medical perspective, and furthered my clinical competency. It also gave me valuable insights into an increasingly polarized healthcare system that pits providers against CFO’s.
My subsequent training in functional medicine has introduced new perspectives and approaches to treating the whole patient, not just a specific process. Modern medicine in the United States does an exceptional job treating emergency and acute medical cases but sometimes struggle with presentations outside of the box.
Functional medicine incorporates a “whole person” approach frequently neglected in modern medicine.
I strive to incorporate the best of both systems.
The challenge (and desire) of any doctor is to provide exceptional care tailored to the specific individual. Using the functional medicine paradigm in conjunction with my internal medicine background provides me with a more significant “toolbox” to understand and treat my patients.