Many alternative health care practitioners, especially chiropractors and naturopaths, claim that they are as well trained as physicians. This is false. It’s a dishonest self-promotional message. At least one naturopath has made this argument herself, and many chiropractors have acknowledged the problem.
Physician academic training is far longer and — more importantly — most of their serious learning occurs during extensive on-the-job training (residency), where they are thrust into demanding clinical environments and supervised for years as they deal with a great variety of clinical situations and many extremely sick and hurt patients. That hands-on phase of their training is where all doctors will tell you that they became professionals.
There is nothing like that in any non-medical health care training.
FALSE. "Naturopathic doctors" are not medically trained. They learn pseudoscience. Stop lying. https://t.co/dTiT5IHSTQ— Britt Marie Hermes (@NaturoDiaries) July 4, 2017
Overview of medical education
Although there’s regional variation, physician education around the world is mostly divided into three parts, and takes about 11 to 16 years — longer for medical specialization.
- Prerequisites for medical school — a suitable undergraduate university degree with suitable science curriculum, and good grades. This usually takes 4 to 5 years.
- Medical school proper — another four years of medical basics.
- Residency — on-the-job training, which lasts at least a couple years and may well go on for many more for medical specialities.
Up to the point of the residency, it’s roughly the same number number hours — 4-5 years to get through an undergrad degree, another 4-5 to get through medical, naturopathic, or chiropractic training. Of course, there are huge differences in the quality of that training. But the duration is the same.
At the end of step two, the difference becomes great. Chiropractors and naturopaths have limited and/or optional internship and residency options and requirements compared to doctors. Relatively speaking, they simply graduate and begin their careers. I’ve witnessed that transition up close (a good friend consulted with me extensively as she got her naturopathic practice rolling). But physicians are only just finally getting to the interesting part of their training.
Nothing quite like a real medical education experience to put the lie to alternative fantasies.
~ Jason Silvernail, DPT
The residency difference
Residency is where medical training really pulls ahead as a bigger investment of time and money and far higher quality. (And it doesn’t even end there!)
The term resident is a bit of a mystery to outsiders, but it’s charmingly straightforward: it refers to the fact that apprentice doctors are practically living where they are doing their training “in house,” at the hospital. They are residents! Residents collectively are the “house staff” of a hospital.
Medical residency is a true apprenticeship process — working as a junior, supervised physician for years. It’s infamously gruelling.
Naturopathic and chiropractic training often does involve some on-the-job training, but it is brief and limited compared to medical residency.
What does an MD-DC think of this?
I know a chiropractor who is also a physician. Who could possibly have a better perspective on this topic? Here’s that chiropractor’s reaction to this article (and my source needs to remain anonymous for now):
This is one of the sources of most frustration I have speaking with DCs and DPTs who don’t “get” that it’s the constantly scrutinized clinical environment of residency where the most learning occurs.
The real problem is in their heart of hearts they don’t know if they could even get into medical school, or through it. I can’t count how many have said, “I’ve thought about going back too” when they have no clue how competitive it is now, how challenging the MCAT actually is, and that at the end of the day they can’t admit there is a major difference in the education and training. Chiros have heard so many times how our core science was the same, etc. Every chance I have these days I tell chiros and others who ask that IT IS NOT the same. It’s not even close. The level of detail needed as a medical student makes prior exposure to the subject matter virtually moot.
I also understand why so few DCs who have gone back to school ever “do” much for the profession once they do. That’s been a consistent observation. The reality is that they are being kind by not opening their mouths.
Continuing education requirements for physicians are demanding. Chiropractors and naturopaths have their own continuing education requirements, but — again — they are much less rigorous. There is essentially zero oversight over what constitutes adequate continuing education.
Less formally, many physicians continue to work closely with other physicians and health care professionals — constantly exposed to different ideas and challenges — while the great majority chiropractors and naturopaths are essentially independent freelancers.
About Paul Ingraham
I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter.
- “Naturopaths not 'real' doctors, despite video claims they are ‘medically trained’: critics,” Sharon Kirkey, National Post, July 6, 2017
- The Chiropractic Controversies — An introduction to chiropractic controversies like aggressive billing, treating kids, and neck manipulation risks
- Pseudo-Quackery in the Treatment of Pain — The large, dangerous grey zone between evidence-based care and overt quackery in musculoskeletal and pain medicine