Differentiating Between ND, Integrative MD, DO, and DC Providers

Choosing the right doctor can be difficult, especially when it comes to integrative health and medicine.  The right doctor(s) will be able to meet your unique health needs and support you in achieving your goals.  In this FAQ document you will find information that will describe the similarities as well as differences between four distinct groups of doctors, all of whom are licensed professionals and committed to whole-person, complementary, and integrative health care.  These include:

  • Naturopathic doctors (ND or NMD)
  • Osteopathic Doctors (DO)
  • Integrative MDs and DOs
  • Chiropractic Doctors (DC)

This FAQ focuses primarily on licensed professionals who have graduated from a four-year, in-residence, graduate level medical school recognized by the U.S. Department of Education, have passed a standardized board examinations, and hold state issued medical licenses from their respective licensing body.   

Integrative Doctors

Note that all of these doctors are considered “integrative” in the sense that they may combine conventional medicine approaches with evidence-informed complementary medicine to provide patients with the most appropriate and effective treatments.  They share a philosophy of health that acknowledges the role diet, lifestyle, emotions, and environment have on individuals’ health, and focus on health promotion, disease prevention, and the natural and integrative treatment of illnesses. “Integrative medical practices” often employ a combination of MDs, NDs, DOs, DCs and/or other allied care providers, either under one roof or through referral or partnership. 

In this FAQ, we define integrative doctors as those who have earned a certification from the American Board of Integrative Medicine (ABOIM).  While any of the listed professionals may also refer to themselves as “functional”, we define functional doctors as those who have completed study with the Institute for Functional Medicine Certified Practitioner (IFMCP) program.

Approach to Patient Care


All four types of doctors share principles of patient care. They consider the whole person, address underlying causes of illness and encourage healthy lifestyle habits while addressing the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s well-being. Patient care varies depending on provider training, education, clinical experience and personal style. Two doctors with the same titles/credentials may have unique approaches to patient care, and many doctors have training or credentials in two or more areas.  All the doctors listed below may consult with and refer to a broad and diverse community of health professionals to best support their patients.

Naturopathic Doctors

NDs follow six core principles in clinical care, leading with the healing power of nature, which recognizes that with proper support, the body often has the capacity to recover from injury and illness. NDs focus on identifying and removing obstacles to recovery in order to facilitate the body’s health-restoring and maintenance processes. NDs often spend between one and two hours with patients in an initial appointment to uncover genetic, behavioral, environmental, and lifestyle factors impacting health. NDs view symptoms as the body’s attempt to communicate and correct imbalances. When it comes to illness, naturopathic doctors work to identify and treat the underlying root cause of symptoms which inform the development of personalized treatment plans and to educate, engage and empower patients on their health care path.

NDs employ the Therapeutic Order, which prioritizes natural, minimally invasive therapies first. As state licensure defines, naturopathic doctors can order diagnostic tests such as blood tests, X-rays, MRIs, and perform minor surgery and office procedures NDs can act as primary care providers or may choose to specialize. Specialty associations currently exist for Endocrinology, Environmental Medicine, Gastroenterology, Intravenous Therapies, Pediatrics, Primary Care Medicine, and Oncology. NDs are also trained to use pharmacological drugs when necessary and may do so as state licensure permits.

Osteopathic Doctors

DOs follow the principles that the human body is a unit, rather than a collection of systems, and that structure and function are interrelated. DOs recognize that the body’s systems are always communicating and believe that disease occurs when the systems are overloaded, and communication is hindered. They respect that the body has an innate healing ability, and osteopathic practices work to optimize structure and function to facilitate the body’s self-healing capacity.

All DOs are able to prescribe pharmaceuticals, and many practice similarly to MDs. DOs practice according to the latest science and technology in pharmaceuticals, surgery and integrative medicine. Uniquely, DOs have advanced training in osteopathic manual medicine (OMM), a hands-on technique used to help diagnose illness or injury and facilitate the body’s natural tendency for self-healing. Some DOs may go on to pursue additional training in any surgical or non-surgical specialty along with specialized fellowships. 

Medical Doctors / (Board Certified in Integrative Medicine)

Integrative doctors start as conventionally trained MDs or DOs, and, after becoming board-certified in a primary specialty (i.e. neurology, orthopedics, family medicine), may choose to pursue additional study to specialize in integrative medicine. Integrative medicine doctors draw on many therapeutic approaches and disciplines to help patients identify and treat the root causes of illness as well as symptoms. There is an emphasis on less-invasive and less-harmful interventions, when possible. These providers may also employ pharmaceuticals and other conventional treatments, such as surgery. 

Chiropractic Doctors

Chiropractors practice a hands-on approach to health care and use patient examination to inform diagnosis and treatment. Chiropractors are able to recommend therapeutic and rehabilitative exercises, and many also use nutritional and lifestyle counseling. 

DCs employ laboratory testing, diagnostic imaging and other diagnostic interventions as indicated. Chiropractic doctors focus on disorders of the musculoskeletal and nervous systems and the effects of disorder in these areas on general health. Chiropractic doctors commonly work with patients who complain of neuromusculoskeletal issues and back, joint and limb pain or headaches.

Doctors across the spectrum may seek to study additional medical approaches and to develop further skill and capacity for patient care.   It’s important to note that all of the above licensed providers can study Integrative Medicine. Similarly, each can take coursework in Functional Medicine.  Naturopathic doctors may seek advanced training in naturopathic sub-specialties as part of post-graduate education.



All four types of practitioners graduate from a four-year, full-time, in-residence medical school accredited by the U.S. Department of Education. For all doctors, the first two years of medical school focus on biomedical science, clinical science, and diagnostics. 

Naturopathic Doctors

For naturopathic doctors, much of the ND curriculum in the third and fourth years is devoted to the study of non-pharmaceutical/non-surgical approaches to managing patient conditions in addition to learning evidence-based conventional therapeutic interventions. As part of the pharmacology curriculum, naturopathic doctors learn both medical and clinical pharmacology.  While pharmacology course work is similar to conventional medical schools, NDs receive additional training in botanical and supplement/drug interactions plus nutrient depletion caused by long term pharmaceutical use. NDs complete advanced training in clinical nutrition/food as medicine (155+ hours), botanical medicine/evidence-based herbal medicine (130+ hours), and behavioral medicine/counseling (150+ hours), physical medicine, homeopathy, minor surgery, and more. In order to become a licensed ND, graduates must pass the Naturopathic Physician Licensing Exam (NPLEX) administered by the North American Board of Naturopathic Examiners (NABNE).

Like MDs and DOs, a growing number of naturopathic doctors choose to specialize* or focus their practices. Specialty associations currently exist for endocrinologyenvironmental medicinegastroenterologypediatricsprimary carepsychiatry, and oncology and board certification is a component of some of those specialties.

*Use of the term specialist may vary by regulatory jurisdiction.

Osteopathic Doctors

Osteopathic medical school curriculums are very similar to those of conventional medical doctors (MDs).DO students complete approximately 200 hours of training in osteopathic manual medicine (OMM). As the American Osteopathic Association explains, DO students “receive extra training in the musculoskeletal system, which is the body’s interconnected system of nerves, muscles and bones.” DOs use this knowledge to perform osteopathic manipulative treatment (OMT). All DOs complete a three to seven year residency towards a chosen specialty. While MD and DO students enroll in the same residency programs and take the same state board exams, DO students also take the Comprehensive Medical Licensing Examination (COMLEX) while in medical school.  DOs practice in all 50 states.

Medical Doctors / (Board Certified in Integrative Medicine)

After completing a residency and becoming licensed in a primary specialty, some DOs and MDs go on to pursue training in a post-graduate sub-specialty. One- or two-year fellowships offer in-depth training in a particular area, and as of 2014, integrative medicine is one of these options. More than 18 integrative medicine fellowships exist that prepare doctors to sit for the American Board of Integrative Medicine (ABOIM) exam. Integrative medicine fellowships provide 1,000+ hours of coursework in integrative medicine. Some programs offer hands-on clinical training in botanical medicine, clinical nutrition, mind-body medicine, complementary and alternative medicine (i.e. Ayurveda, manual medicine, homeopathy), environmental health, and more. Board certification is available through the American Board of Physician Specialities (ABPS) via the American Board of Integrative Medicine (ABOIM) speciality board for MDs and DOs.

More than 60 medical schools offer an integrative medicine fellowship that prepares doctors to sit for the American Board of Integrative Medicine exam. 

Integrative medicine fellowships provide 1,000+ hours of coursework and hands-on clinical training in botanical medicine, clinical nutrition, mind-body medicine, complementary and alternative medicine (i.e. Ayurveda, manual medicine, homeopathy), environmental health, and more.  Board certification is available to MDs and DOs. 

Chiropractic Doctors

DCs attend four-year post graduate, full time chiropractic medical schools recognized by the U.S. Department of Education. Chiropractors study the same basic sciences as the other fields of medicine such as anatomy, and physiology as well as rehabilitation, nutrition and public health. In total, the curriculum requires at least 4,200 hours of classroom, laboratory and clinical experience. Chiropractic education is approved by the Council on Chiropractic Education recognized by the U.S. Department of Education. 

After graduation, chiropractic doctors must pass national standardized board exams before being eligible for licensure and must maintain their license by acquiring continuing education (CE) credits. Certification is overseen by the National Board of Chiropractic Examiners (NBCE).

Doctors across the spectrum may seek to study additional medical approaches and to develop further skills and capacity for patient care. It’s important to note that all the above licensed providers can study Integrative Medicine or Functional Medicine. 

Functional Medicine

Those practicing functional medicine can graduate from any of the four types of medical schools. After completing state licensure, doctors pursue functional medicine training in post-graduate study, through the Institute for Functional Medicine. Coursework consists of a week-long overview course and six two-to three-day modules (approximately 150 total hours) focusing on different systems of the body including: gastrointestinal, immune, hormone, and cardiometabolic.  IFMCP certification is awarded after successful completion of the coursework, a written case report, and passage of a written exam. Functional medicine providers pursue a detailed understanding of each patient’s genetic, biochemical, and lifestyle factors, often through lab testing. That information is leveraged to direct personalized treatment plans. How they approach both diagnosis and treatment varies largely depending on the practitioner’s foundational medical education and training (ND, DO, DC or MD). Note that the IFMCP (the official functional medicine certification) is also available to many health care professionals who are not doctors, such as registered nurses, dieticians, occupational therapists, physical therapists, and others. There is no board certification for functional medicine.

Choosing a Doctor

Health care is highly personal. Often, there is not a single practitioner that will meet all your health and medical needs. A team or combination of doctors with a range of expertise may help you achieve more of your health goals over a lifetime. To find a practitioner and to create a team where you can address both short and long-term concerns is often more important than any single credential.

To find a naturopathic doctor please visit the websites for the Institute for Natural Medicine or the American Association of Naturopathic Physicians.A service for consumers from the American Association of Naturopathic Physicians (AANP) and the Institute for Natural Medicine (INM). For their contributions to this piece, the AANP and the INM would like to acknowledge Tabatha Parker, NDRomie Mushtaq, MD, ABIHMRoger Mignosa, DO Mary Pardee, ND, IFMCP, and Thomas Kruzel, ND

INM's team is made up of naturopathic doctors and health journalists.

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Deb Hubers

Debra Hubers is a serial entrepreneur and has started seven businesses; ranging from an advanced genomics to an employer health care purchasing cooperative. Deb has over 35 years of experience in healthcare finance, education, technology, and pharmacogenomics.

Ms. Hubers has dedicated her career to measuring and improving healthcare outcomes. Her expertise is leveraging technology to deliver personalized, preventative medicine. Ms. Hubers co-founded La Vita Compounding Pharmacy in 2007. Collaborating with her business partner, physicians and strategic partners, Deb has grown La Vita to be one of the most respected and sought-after personalized medicine providers on the west coast. She is also Co-Founder of EpigeneticsRx, a leading provider of precise, personalized, prevention which positively impacts genetic expression.

Alex Keller, ND

Dr. Alex Keller, ND, AFMCP is a graduate of the University of Ottawa with an Honours Bachelor in Health Sciences and Psychology. Although originally intending to attend conventional medical school, following a three-month volunteer internship at a rural Kenyan hospital where he observed how doctors used local food to treat patients, he shifted his career goals and pursued a degree in naturopathic medicine at the Canadian College of Naturopathic Medicine in Toronto.

After one year of practicing with the esteemed Dr. Chris Pickrell, ND, RH in a community acupuncture setting, in 2015 he and his wife Dr. Jenn Keller, ND moved to rural Ottawa, Canada where they started an organic farm and retreat center. In the same year, Alex and his athletic therapist sister Jess Keller combined their practices to form Keller Active Health, an integrative physical therapy clinic.

Ever curious and passionate about the education of evidence-based natural medicine, in 2017, Dr. Keller joined a fledgling Ottawa-based health tech startup named Fullscript. He serves as its Medical Director and oversees the development of medical education content for practitioners across North America.

Prior to medicine, Alex worked in the renewable energy sector, where he developed a deep passion for sustainable agriculture and environmental stewardship. This connection between medicine and agriculture now drives Alex to focus much of his energy on bringing awareness to the quality and sourcing standards in the supplement and organic agriculture supply chains.

Today, he splits his professional time practicing as a clinician, working for Fullscript, and expanding the farming operation while chasing his kids with Jenn and occasionally running ultra-marathon trail races. He is also currently completing an Executive MBA through the Quantic School of Business & Technology with a focus on supply chain innovation.

Pamela Snider, ND

Pamela Snider, ND, is Executive and Senior Editor for the Foundations of Naturopathic Medicine Project, producing a first of its kind international textbook of Naturopathic medicine through a series of international retreats and symposia. A nationally recognized integrative health and policy leader, she is active in both national and regional integrative health initiatives. Dr. Snider serves on the Board of Directors, was founding Executive Director and co-founder of the Academic Consortium for Integrative Health (ACIH/ACCAHCa consortium of the councils of schools, accrediting agencies and certifying bodies of the licensed, traditional and emerging integrative health professions, and is currently Vice Chair and co-founder of the Integrative Health Policy Consortium (IHPC).  Dr. Snider served as a founding Board Member of the Academy of Integrative Health & Medicine from 2014-2016. Her public policy work includes completing a two year appointment to the DHHS Center For Medicaid and Medicare Services (CMS) Medicare Coverage Advisory Committee (MCAC); serving as a Steering Committee Member for  the HRSA funded American College of Preventive Medicine NCCIM Integrative Medicine in Preventive Medicine Residency program, co-directing in USPHS Region X the Building Bridges Between Provider Communities Group, an exploration of interdisciplinary collaboration and common ground between public health and CAM; serving for 22 years on Washington State’s Health Professional Loan Repayment and Scholarship Program Advisory Committee (HPLRSP); providing technical assistance to and developing key language for the enabling legislation for NIH Center for Complementary and Alternative Medicine (NCCIH/NCCAM); and staffing Joseph Pizzorno ND during his appointment as Commissioner on the White House Commission on CAM Policy.

From 1994-2003, Dr. Snider served as Associate Dean for Public and Professional Affairs and Naturopathic Medicine at Bastyr University, dividing her work between academic and public affairs activities, including chairing the Naturopathic Medicine Program Curriculum Review Committee.  Dr. Snider has been teaching, publishing and lecturing widely on Naturopathic philosophy, theory integrative health, public policy, and other topics for over 30 years. Currently, an Associate Professor at National University of Natural Medicine (NUNM) in Portland, OR, Dr. Snider also continues at Bastyr University in her 22nd year as a faculty member teaching naturopathic medicine history, clinical theory, and global context. Among her Naturopathic medicine professional roles she serves on the Institute for Natural Medicine’s Leadership Council.  In 1989, she co-led the naturopathic profession with Dr. Jared Zeff, in developing a unifying definition of naturopathic medicine and its principles of practice adopted unanimously by the American Association of Naturopathic Physicians (AANP) House of Delegates. She was a co-investigator in the 2004 NIH NCCAM research study, the North American Naturopathic Medical Research Agenda and CAM Advisor in NIHCCAM’s Financing Integrative Health Care (University of Washington).  Her areas of experience include healthcare education; naturopathic and interdisciplinary clinical theory, curriculum development; clinical practice; government and legislative affairs, public policy, interdisciplinary collaboration, and community organizing.  Dr. Snider has received the Ontario Naturopathic Physician of the Year Award, the Physician of the Year Award from the AANP, the President’s Outstanding Vision Award and Distinguished Alumnus Award at Bastyr University, AANP’s President’s Award, an honorary Doctorate of Naturopathic Philosophy from the Canadian College of Naturopathic Medicine (CCNM), the William A Mitchell Vis Award from the AANP and The Gathering – NMSA’s Beacon Award. She received her ND degree in 1982 from Bastyr University of Natural Health Sciences and is a licensed naturopathic physician in the State of Washington. She lives with her husband and children at their homestead in North Bend Washington, in the beautiful mountain to sea landscape and home of The Revival – Restore the Vis, an annual student-led community gathering.

Susan Haeger

Susan Haeger is Founder/Principal of Transformative Health Solutions Inc. She has applied her twenty plus years in executive leadership to help shape and drive adoption of progressive health policy for whole person healthcare. She was a section contributor to the 2021 INM/AANP published professional white paper, Naturopathic Physicians as Whole Health Specialists: The Future is Whole Person Health Care that provides supporting evidence for the profession’s significant and unique contributions to preventive, whole person care and models of integrative clinical practice.

Bruce Barlean

Bruce Barlean is an owner and founder of Barlean’s, a global dietary supplement manufacturer located in the Pacific Northwest in Ferndale, WA. Bruce has been actively involved in the Natural Products industry since 1989 and is passionate about making a difference in the world and positively impacting the lives of others.

Bruce believes that people can make a difference in the world through ordinary purchases. He is committed to improving the quality of life for every person on the planet by making the best products and by using the profits to support outreach programs. Bruce summarizes it simply, “We make good stuff to do good stuff”.

In the late 1980’s Bruce became passionate about how health could be dramatically improved with Flax Oil Supplementation. Bruce along with his entrepreneurial parents saw the potential to improve the lives of many people and in 1989 they began selling Flax Oil under the Barlean’s name. From 1989 – 2000 the business grew an average of 40% year over year. While most companies saw a decline in business in the 2001 recession, Barlean’s continued to grow and soon became America’s #1 selling flaxseed oil and continues to be to the present. The brand has since expanded to include additional oils, green food concentrates and other premium supplements. Bruce continues to drive innovation and over the years his products and company have won countless awards including: Eight consecutive Vity Awards for #1 EFA, Six consecutive Vity Awards for #1 Greens Food Supplement, Natural Choice Award for Best Specialty Supplement, Best Product of the Year, Best New Product, Gold Medal Taster’s Choice Award, Gold Medal American Masters of Taste Award, #1 Health Food Store Brand for Consumer Satisfaction by Consumer Lab, and Manufacturer of the Year.

In 2013 as the company was on the eve of celebrating the 25th year in business Bruce and his parents decided to take their desire to help people to a new level that they call Pathway to a Better Life – which is now seen in the Barlean’s logo. Bruce and his parents had always been generous in their giving and support of charities, but as part of the Pathway to a Better Life they decided to increased partnership with charitable organizations such as: Vitamin Angels, Compassion International, KidsTown International, Autism Hope Alliance, Engedi Refuge, Project 92, and others. And because so many people are unable to meet basic nutritional needs, Bruce created a comprehensive Omega-3 and multivitamin formula that he distributes free-of-charge to local food banks. In addition, Bruce decided the company would supply food banks with organic coconut oil to provide people with a health alternative to standard cooking oils.

Always generous with his time Bruce has served as a youth leader for his local church for several years and continues to mentor youth. He has been on several not for profit boards including; Whatcom County Pregnancy Center (2003-2006), Natural Products Association (dates?), and the Institute for Natural Medicine Leadership Council (presently).

The Barlean family have been avid supporters of Bastyr University since the 1990’s and in 2013 were given Bastyr’s most prestigious honor, the Mission Award, which recognizes their leadership over time in improving the health and well-being of the human community.

Bruce currently resides in Ferndale, WA with his wife Lisa and their two dogs: Heinz & Shadow. When he’s not helping others he can be found fishing (catch & release).

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Michelle Simon

Michelle Simon, PHD, ND

President & CEO

As president and CEO of INM, Dr. Simon brings her passion for working with organizations dedicated to improving the quality and delivery of healthcare. This desire stems from her years of practice as a licensed naturopathic physician. In addition to holding a Naturopathic Doctorate from Bastyr University she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill.

She has served on boards for the American Association of Naturopathic Physicians (AANP), the Naturopathic Physicians Research Institute (NPRI), and several advisory boards. Dr. Simon served nine years on the Washington State Health Technology Clinical Committee, as Ambassador to the Academy of Integrative Health and Medicine (AIHM) and was recognized as 2018 AANP Physician of the Year. Dr. Simon shares with her husband a passion for adventure travel, preferably by boat or motorcycle. She also enjoys teaching a women’s off-road motorcycling class.